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     U,R»RY OF MEDICINE
 
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THE
FAMILY   MEDICAL  GUIDE:

     A COMPLETE POPULAR DICTIONARY
                     OF
MEDICINE  AND   HYGIENE.
                 COMPRISING
ALL POSSIBLE SELF-AIDS IN THE TREATMENT OF DISEASES, ACCIDENTS, EMERGEN-
  CIES, ETC., WITH ARTICLES ON GENERAL PHYSIOLOGY; ON DIET AND FOOD;
   ON THE DIFFERENT DRUGS, PLANTS, AND MEDICAL PREPARATIONS USED
     IN GENERAL PRACTICE: DEFINITIONS OF TECHNICAL TERMS USED
      IN MEDICINE; RECIPES FOR THE PREPARATION OF EVERY-
        THING USEFUL  IN THE DOMESTIC TREATMENT OF
               DISEASE, ETC., ETC., ETC.
                EDITED BY
EDWIN LANKESTER, M.D.,  F.R.S., Etc., Eta,
ASSISTED BY DISTINGUISHED MEMBERS OF THE ROYAL COLLEGES OF PHYSICIANS
          AND SURGEONS, LONDON.
        American  dJbition,
CAREFULLY REVISED, WITH ADDITIONS AND AMENDMENTS,
        BY COMPETENT-  AUTHORITIES.

         NEW YORK:
E. R. PELTON AND COMPANY,
      ' No. 25 Bond Street.
            1881. 
   weA
-   l 3$I
   Copyright by
E. R. PELTON & CO.,
      1SS0.
 
\
PREFACE.
       The rapid progress of medical science has rendered antiquated much of that
     which the public, as distinguished from professional medical men,  have been
     taught by previous books on Domestic  Medicine.   And it is  to  be further
     noted,  that  no work whatever which deals  with the preservation of  health
     —that is to say, Hygiene—is now available for the use of intelligent but non-
)£■.   professional  men.   With  a  view to the  production of a work  which should
*    remedy these deficiencies, the various subjects here treated have  been referred
 •3Q01.                            .              ...
■>ai v\ to tne niost  competent authorities—men specially skilled in the departments of
 T-m medical science of which they treat.   By this means the most recent acquisitions
  ,^s in medicine and surgery have been made available for popular use—it being the
  -   aim of the writers, while avoiding all technical phraseology, to expound their
     subjects  in such a fashion as  to be intelligible  to  all, and at the  same time
     to secure the most rigorous scientific accuracy.
       By this means, further, a knowledge of that all-important matter,  the main-
     tenance of personal and public health, may be generally communicated ; for as
     day by day the mode in which diseases are spread becomes clearer,  so day by
     day the plans for arresting their diffusion become better understood  and more
     readily applicable.   It has, for example, been tolerably clearly made out that
     overcrowding,  bad ventilation,  and improper nourishment are  the main, if  not
     the sole, causes of Typhus Fever ; that  bad drainage and the mingling of sew-
     age with water are the origin of Typhoid Fever, and the chief means  of spread-
     ing Cholera ; that by the vigorous carrying out of vaccination and re-vaccina-
     tion Small-pox may be stamped out ; and so on.   These matters,  of vital
     importance to the public, which have, if not concealed, certainly not  been made
     plain to them hitherto,  are here fully discussed.
       The Family Medical  Guide will be found to contain special  references
     to those  accidents which  may daily befall any  of us, where immediate help
     makes all the difference between life and death, but where no skilled  medical
     aid is at hand.   On  such occasions an intelligent man  or woman,  using  the
     information here furnished, may be of immense service.  So also there are times
     in family  life when a knowledge of the signs or symptoms of disease  may warn
     an anxious parent  in time to  save the life of a beloved child, whereas, did no
     such knowledge exist, the malady might be allowed to drift onward till past all 
4
PREFACE.
remedy.   Instances might easily be multiplied—let us be contented with refer-
ring to a ruptured blood-vessel and the inset of croup.
   Briefly, then, to diffuse a knowledge of medical matters in a manner intelligi-
ble to all, but in matter strictly accurate, is the aim of this book.
   It only remains to add, that in preparing the present  American  edition, the
entire work has been subjected to a most careful, minute, and laborious revision,
the language being rendered clearer and more simple, and the directions more
specific and precise.   Besides this, articles which were applicable only to English
local conditions have been  stricken out and others (entirely new) substituted
for  them ;  some  important articles which seemed  inadequate  have  been
expanded ; and American statistics and  regulations have been substituted in
those numerous cases where statistics and regulations form a part of the exposi-
tion.   Nevertheless, it  should be added, that with innumerable changes in
matters of detail, the original plan and purpose of the Medical  Guide, and its
characteristic and universally-conceded  excellences, have been scrupulously
preserved.
   Among these excellences  are  its great scope and comprehensiveness.   It
contains many times more articles than any other book of household medicine,
and while special attention is given to those common diseases which frequently
occur,  the other and rarer " ills  that flesh is heir  to"  are also  treated of  in a
complete and authoritative manner.
   Another feature of great value, on which much pains have  been bestowed, is
the articles on the  Medicines, Drugs, Plants, and Preparations  used in medical
practice, each of which has  a separate article.   This is of great value, because
there are many occasions when one knows that a certain  medicine is good for
a  certain disease or state of the  system, yet  does  not  know how or in what
doses to administer it, or what effects it ought to  produce.  The information
given on all these points is very clear and precise.
   Still another  feature, which will probably prove more  frequently  helpful than
any other, is the particular attention given to those sudden emergencies or accidents
which  are liable to occur  at any time and  which require immediate action.
These are treated  of  in  such  articles as  Accidents,  Bruises,  Bleeding,
Burns and  Scalds, Bites and Stings, Choking, Drowning, Dislocations,
Fractures,  Frozen  Limbs,  Gunshot  Wounds,  Railway   Accidents,
Poisoning,  Snake-bites, Sunstroke,  and Sprains.
   Special attention is also  invited to  a class of articles  which need only be
named in order to  show their character and value ; such as those on Food,
Diet,  Digestion, and Indigestion ; on Air and  Ventilation ; on Water
Alcohol, Wines, etc.; on Insanity ; on Nursing and Fevers ;  on Climate
Health Resorts, and Mineral  Waters ; on Bathing and Gymnastics •
on Eye, Vision, and Ophthalmia ; on Ear and Deafness ;  on  the Heart
the Liver, the  Kidneys, the Brain, the Stomach, the Muscles,  the Nerves
the Blood, and other subjects in human physiology.  Some of these articles
 in length and importance, are equivalent to special treatises. 
PREFACE.
5
  A last and most important consideration is that, as most of the articles were
written by London physicians of recognized ability and the highest reputation,
the  methods of  treating diseases recommended in this  book comprise the very latest
discoveries and improvements in the science and practice of medicine.  In this respect
it is probably  twenty years  ahead of the  average medical  practice  in  this
country, outside the few  largest cities ; and many, perhaps  most,  physicians
would  learn  much from it regarding  the uses of  medicines and the improved
modes of treating disease. 
NOTE  BY  DR.  LANKESTER.
  I should not have undertaken the editorship of this work had I not been
fully assured that the professional gentlemen who have written the chief part of
the articles were fully  competent  to  the task.   They  all  possess the highest
qualifications, and some of them are attached to public institutions, so that their
individual opinions may be regarded as of importance.
  Being especially anxious that the public should be instructed more or less on
the subject of the laws of health,  I have not hesitated to connect my name with
this book, for I am deeply convinced that it is for the benefit of the public that
they should be instructed  in  the  laws of  life.  In  as far as the prevention of
disease could be dealt with in this book, it has been done.
  On the whole, I believe the book will be found more up to the science of the
time than any previous attempt made to popularize the practice of medicine and
surgery.  Should reference to this dictionary lead persons to read some of  the
scientific treatises on physiology, or to interest themselves in introducing into
schools the  study of this  the  most important branch of human  knowledge, it
would be the  highest reward  and the greatest gratification I could obtain in
having connected my name with it.
                    EDWIN LANKESTER,  M.D.,  F.R.S., etc., etc.
HINTS  TO  THE  READER.
  i. The arrangement of the articles is strictly alphabetical, as in a dictionary or
cyclopcedia.   The great advantages  of this system will be made apparent by even a
very slight trial.
  2. Diseases are usually treated under their medical names, but the popular name
of each is inserted in its proper alphabetical place,  and numerous cross-references
enable anything wanted to be readily found.
  3. In consulting an article, bear  in mind that the other articles referred to in it
from time to time, or at the end, will  often contain  important information  not
found in the article itself.
  4.  When a technical or unusual  medical term is used,  an explanation of it
will always be found under the word  in its proper alphabetical place.
  5. In consulting the article on any  disease, it is well, after reading what is said
about the disease itself, to read also  what is said about the  medicine that may be
recommended.   All of the  commonly used drugs and  medicines are treated of in
their proper alphabetical places.
  6. The reader is  earnestly  recommended to glance  through the book, page by
page.   Only in this way can one learn what  it really contains ; and many useful
things will be found which would never be specially looked for. 
FAMILY   MEDICAL   GUIDE.
K3F* Hie arrangement cf topics in this booJc is strictly alphabetical, as
       in a dictionary or cyclopaedia.
iW Be sure to read "Hints to the Header" on preceding page.
  ABDOMEN is the  name  given  to that
large cavity situated in the lower part of the
trunk, and bounded above by the chest (from
which it is separated by a muscle called the
diaphragm),  and  below by the pelvis.  All
around are various muscles and membranes,
and outside  of  all the  skin ;  these  various
layers are called the abdominal walls.   The
cavity is lined by a smooth membrane, the
peritoneum,  which enables   the
viscera to move freely upon  one another
The contents  arc  numerous and important,
and consist—i. Of those organs which are
essential for the absorption of the food which
is  swallowed by the  mouth ;  namely, the
stomach, intestinal canal, liver, and pancreas.
2.  Of the kidneys needful for the removal of
different materials from the blood which flow
          by the gastric juice,  and all the albuminoid
          substances, as meat, the gluten of bread, etc.,
          are here dissolved and prepared for absorp-
          tion.   The liver and  pancreas pour their se-
          cretions into the upper part of the small in-
          testines,  and mix  with  the  food  about  six
          inches after it has passed the stomach ; they
          act upon the fatty or oily part of the food,
          and enable it to be afterward readily absorb-
different i  cd.  The whole of the intestinal canal, which
        1  is about 25 feet long, is  freely supplied with
vessels which absorb the soluble parts of the
food and supply the blood with new material,
which is essential for  the human economy.
The  walls  are  partly made of involuntary
muscular fibres, which are arranged in a cir-
cular  and  longitudinal  manner  round the
bowel ; when these fibres contract,  the food
away in the urine.   3. Of  various  blood- I is propelled along the whole length of the in-
vessels which  convey blood to  and from a 1 testines by degrees.  The Kidneys are the
part ; and of the spleen which seems to play
.1 part in the proper formation of the blood.
The position of the viscera may be more read-
ily understood by mapping out the front sur-
face of  the  abdomen.  Take two  pieces of
tape and lay each vertically in the same line
as the nipples ;  lay two more  transversely
across the abdomen, the one at the level of
the  lower ribs where they can be felt  to ter-
minate,  and the other lower down over the
prominent crests of  the hip-bones.  The re-
gion is now divided into nine compartments,
thus—
 Right Side.
Hypochondriac.
Lumbar.
Inguinal.
 Centre.
Epigastric.
Umbilical.
Hypogastric.
 Left Side.
Hypochondriac.
Lumbar.
Inguinal.
The Liver occupies  the right hypochondriac
and the epigastric regions, and in some cases
may be so enlarged  as to  reach into the lum-
bar and umbilical regions.  The stomach is
found  chiefly in the epigastric region, but its
extent varies with the amount of  distension
of the organ.  The Spleen lies in the left hy-
pochondriac region.  The Kidneys lie one
on  either side of the spine,  far back in the
lumbar region's.  The large and small intes-
tines are coiled  up in the remainder of the
cavity and move freely upon each other. The
food after entering the stomach passes down
the small intestines and then  down the large
bowel into the rectum, whence it is discharg-
ed.   In the  stomach the food is acted upon
organs by which the urine is excreted from
the body ; besides  water there are various
salts and organic matter which are constantly
being removed from the blood, and which, if
retained, may cause injurious consequences.
The abdomen varies much  in  size ; in very
fat people it may attain very large dimensions
from the accumulation of fat in the abdom-
inal  walls and around  the viscera.   The
bowels may be  full of flatus or gas, and so
cause  an increase  in size.   Any tumors in
the abdomen (such as ovarian, hepatic, or
those formed in the liver),  and  pregnancy,
vastly alter both its shape and size.  Cysts or
cavities  containing  fluid,  have  a similar
effect, and then the prominence of any partic-
ular part  depends  upon the  situation of the
new growth.  The abdominal cavity is some-
limes filled with fluid,  and then the patient is
said to be suffering  from  ascites.  In the
ordinary process of breathing the diaphragm
descends and increases the  capacity of the
chest;  when from any cause this is interfered
with, shortness of breath is the result; so any
tumors or accumulations of fluid, fat, or gas,
tend to produce embarrassed .breathing by
preventing free action  of the diaphragm.  In
some women who have borne many children,
the abdominal walls become flabby and weak,
and remain  distended ; in  such, numerous
transverse lines over  the lower part of the
abdomen show the previous distension.
  ABLUTION, a washing away, internal or
external.  See Bathing. 
8
ABNORMAL
ABSCESS
  ABNORMAL, a  term used by  medical
men  to  denote anything irregular,  out of
order, or not in accordance with health.
  ABORTION means the premature expul-
sion of  the foetus from the womb.  Some-
times  the  word  miscarriage, or  premature
labor,  is applied to such an  accident, especi-
ally during the later months of pregnancy.
The causes  which lead to abortion are num-
berless, but in the main they may be grouped
into causes affecting  the life of the foetus
either  directly or indirectly.   The condition
of the  mother has a powerful influence,  cer-
tain states of constitution  having a great  ten-
dency to cause expulsion of the immature
foetus.  When this constitutional susceptibil-
ity exists,  and  especially when  there  has
been a habit of aborting, very  slight causes
will bring it on.  In such individuals, draw-
ing  a tooth, running up and down stairs,
severe coughing, or any violent emotion,  will
suffice to bring on movements of the womb.
Hence it is of the utmost importance to avoid
any of these exciting causes.   Some of these
causes operate by separating the attachments
of the  foetus from the mother ; but others, as
scarlet-fever,  smallpox,  typhus, etc., which
commonly cause abortion,  first  of  all  kill
the  foetus, and then  lead to its  expulsion.
The death of the fcetus is  followed by the ex-
pulsion,  but by no means  always at the same
period.  Bleeding, too, into the womb, com-
monly leads to abortion.  One of the most
certain causes of abortion  is syphilis, whether
affecting the mother or child, but especially
if both are under its influence.
  Symptoms.—The signs which announce
the onset of abortion are not  always very
noticeable.  They are generally languor, un-
easiness, and some pain in the  back.  After
the pains becjin they resemble those of ordi-
nary labor. There is some slight discharge of
glairy matter often  tinged with blood,  and
pains beginning in the back and loins extend
round into the abdomen  and downward  into
the thighs.  These recur at intervals until the
fcetus is  expelled.  In patients who have ac-
quired the habit of aborting,  the fcetus often
comes away with  hardly  any inconvenience.
Sometimes there is much bleeding with abor-
tion.  This is technically known as " flood-
ing."
  Treatment.—The great thing to  know in
dealing with abortion is up to what period it
can be stopped, and after what period it  is to
be  fostered.   Roughly it may  be. said,  that
bleeding is  the sign  that expulsion lias be-
come inevitable ; if there  are slight pains and
glairy discharge only, we  may hope to arrest
it ; but if the pains begin to come on at regu-
lar intervals, and  there be bleeding,  we  can
hardly hope to avert  the  mischief.   To  stop
or prevent an abortion, the first thing is abso-
lute rest.  The body should only be lightly
covered, and all excitement of every kind
avoided.  The patient should have  cooling
drinks, and cold should be applied to the ab-
domen.  With these  precautions a dose ci
opium will sometimes  arrest the contractions
of the womb.  Thirty drops of laudanum arc
required for this  purpose, or small  doses ol
tincture of Indian hemp, 12 or 15 drops for a
dose, in cold water, to be given every 2 or 3
hours.- Should these measures fail, the fcetus
must be allowed to come away, due  precau-
tion  being taken against loss of blood. Plug-
ging, as  it is  called, is the best precaution,
but here the case passes  into  a stage where
skilled attendance is requisite if obtainable.
  ABORTION,  CRIMINAL.—By this is
meant unlawful attempts, successful or unsuc-
cessful, to procure  the  premature expulsion
of the fcetus.   Such attempts are by no means
unfrequent, with  a view to avoid shame  and
disgrace, or even to avoid inconvenience, but
it should be distinctly understood that not only
is  the  act felony, but should  death occur to
the  unfortunate woman  the  crime  rises to
murder in the eye  of  the law.  Moreover, it
is  to be  understood  that abortion is  at all
times attended with risk to life, and that abor-
tion  unlawfully induced is more dangerous
than that arising from natural causes.   In all
cases it may te said that the risk to the mother
equals the risk to the child, and  though such
a consideration would not always weigh wilh
the unhappy woman who  desires to be rid of
the proof of her guilt, it will with an accom-
plice.   The plans commonly  had recourse to
for procuring the expulsion of the fcetus are
of two kinds.  One  is by giving medicines
which acts on the womb, either directly or in-
directly  ; these  often give rise to inflamma-
tion of  the interior of the abdomen, and so
death.   Another plan, still  more dangerous
in uninstructed  hands, is to obtain the death
of the foetus  by means  of instruments, and
subsequently  wait  for its expulsion.  As al-
ready said, this often  leads  to  the  death of
the mother before it does to that of the child.
   ABRASION, a rubbing eff of the epidermis
of the skin leading  to  the  exposure of the
true skin below.   In treating abrasions from
any  cause, all dirt or  poisonjous matter should
be carefully washed away with lint and tepid
water.   The  wound  may then be dressed in
any  simple way with lint  dipped  in  tepid
water and covered with oil-silk, or a simple
dressing of lint and cerate.
   ABSCESS  is a term  commonly rpplied
to a painful  and  inflamed  swelling  which
after a certain course, in most instances  very
rapid and acute, in others slow and indolent,
terminates in the  discharge of a yellowish
creamy  fluid  called   pus  or matter.   This
affection varies  very  much in its extent and
severity, and  in the seat of the swelling.  A
gumboil, a whitlow, and the large and painful
collection of pus frequently formed in the fe-
male breast during suckling, are all instances 
ABSCESS
ABSORBENTS-            9
of abscess.   Though commonly recognized
as an  affection of the surface of the body,
abscess may attack some important  internal
organ, as the brain, the liver, or a kidney.
Indeed, there is no structure or organ which
enjoys immunity from the possible deposit of
pus and  formation of abscess.  In consider-
ing the symptoms of  the affection it is neces-
sary to distinguish those swellings which are
much  inflamed, very painful  and rapid in
their course, from those which grow slowly
and  gently, and with little if any redness of
the skin.  The symptoms by which we  may
know the first variety of swelling or an acute
inflammatory abscess  are these :  A very hot
Jind  painful  swelling  covered by  stretched
skin of a bright red hue, most intense at the
centre.  As the swelling increases in size the
pain becomes very severe, and has  a  charac-
teristic throbbing or pulsating character.  In
the further  course of  the affection, the skin
and soft parts  around the inflamed swelling
become puffy and  retain for a short time the
impression  of  the finger.   As the centre of
the abscess  becomes more  painful and in-
flamed it loses its hardness and gradually
ripens  or breaks  down into pus.  The skin
at this part becomes  thinner, more  promi-
nent, and loses its  bright red color, presenting
the well-known sign of  pointing,  a light yel-
low  or bluish  spot.   The whole swelling is
now soft, and by  making gentle pressure al-
ternately with the fingers  of each  hand, a
sensation may be generally felt of a  small
wave of fluid moved from side to side.   The
abscess finally  bursts and discharges the con-
tained pus through one or more small aper-
tures  formsd  in  the  thinnest  portion of
skin.  The  discharge at first is profuse, and
consists of  a thick  yellowish fluid ;   as the
cavity of the abscess  contracts and closes it
becomes clear and thin.  During the  process
of healing  the outer layers  of skin about the
seat of the abscess peel off.   The progress of
an abscess   toward  ripening and the dis-
charge of pus is usually accompanied  by con-
stitutional symptoms proportional in severity
 to the size of the swelling and the amountof
inflammation.  .These  symptoms are : shiv-
ering,  general uneasiness, feverishness, head-
ache, and wandering pains  in the back  and
joints.   Acute abscess  is generally the result
of debility or a bad state of the blood, and is
often met with after fever and during suck-
ling (see Brkast).   In persons who  have
subsisted for some time on bad or insufficient
food, any slight injury, as  a bruise  or  cut,
may result in inflammation and the formation
of pus.  Inflammatory diseases of bones and
glands in  scrofulous   subjects are  frequent
causes of abscess.  In the  second variety of
abscess  the symptoms are  much less severe.
The swelling increases in  size very slowly,
and with little  pain or tenderness.  The skin
remains for a long time free from inflamma-
tion or  puffiness, until the pus has  collected
in such quantity as to cause its distension and
attenuation.  There  is then a slight blush of
redness and the matter or pus is discharged
through a small opening, as  in the acute ab-
scess.  This variety is  known by the  name
of chronic or cold abscess.
  Treatment.—In the early stage of a pain-
ful  inflamed swelling on the surface of the
limbs or the trunk an attempt may be made
to prevent the formation of pus by applying
cold lotions and  leeches,  and  keeping the
affected part at perfect  rest.   If the patient,
however, has had  much  shivering and com-
plains of throbbing pain about the  swelling,
one should at once carry out such measures
as may further the ripening  and pointing of
the  abscess.  Nothing favors the rapid for-
mation of healthy pus so much as nourishing
and easily digestible food, as  soups, beef-tea,
eggs,  etc.   Ale and small quantities of wine,
or some spirit, may be given.   The severe
and throbbing pain of the abscess will be re-
lieved by the frequently repeated application
of hot poultices made of  linseed  meal, bread,
or bran.  A prolonged  stay  in a close room
is to be avoided, as fresh pure  air  is almost
as essential for speedy recovery as good diet.
When the skin  in  the centre of the abscess
has become thin and changed in color, and
there is a distinct feeling of fluid beneath, an
incision may be made with a lancet at this
part for the purpose of letting out pus.   The
fluid should be allowed  to flow away spon-
taneously, as forcing  it out by  pressure not
only causes much  pain, but increases the in-
flammation.   After the  abscess has  been
opened or has burst spontaneously the appli-
cation of the poultices should still be continu-
ed for some days.  When  the discharge has
become thin and  scanty the  poultice may be
replaced by water-dressing ; that is, by pieces
of lint dipped in  cold water and  covered  by
some waterproof material, as  oil-silk or gutta-
percha tissue.
  ABSINTHE is a strong liqueur  much
used  in some parts of  Europe, especially
France.   It  is flavored  with  wormwood,
which itself is a bitter tonic, but the liqueur
used too freely gives rise to symptoms some
what resembling those of chronic alcoholism
(see Alcoholism),  but  differing in  certain
minor respects.  The word  Absinthism has
been introduced to designate this state.  See
Wormwood.
  ABSORBENTS are medicines which soak
up, or in any manner neutralize acid or nox-
ious matter in the stomach and bowels. (See
Antacids  and Chalk..)  Another kind of
Absorbents are a set of minute vessels which
are distributed over the whole body, and have
the power of soaking up the food from the
stomach and  intestines, and also  the  effete
materials in all parts of the body, and carry-
ing them into the blood. 
10
ABSORPTION
ACCIDENTS
  ABSORPTION  is a  physiological term
applied to that  process by which the chyle is
taken up  from the food  in the intestines as
well as the removal of the effete  materials of
the tissues of the body by  the vessels called
absorbents, or lymphatics.  The fluid in these
vessels is called lymph, and  that  in the lac-
teals chyle.  The two  great factors  of  the
blood  are  lymph  and chyle.  See  Chyle,
Lymphatics.
  ABSTINENCE.—This term is commonly
applied to complete or partial deprivation of
food by one's own  voluntary act.   As such,
it may be productive of  good, or  it may be
productive of harm.  Certain articles of food
and drink invariably disagree with certain in-
dividuals, and abstinence from these is only
an act of wisdom on the part of the person so
affected.   On  the  other  hand, abstinence is
quite capable of doing great harm.   A defi-
cient supply of duly nutritious food inevitably
leads to disease ; no matter what is the reason
for the  deficiency.  Voluntary  abstinence
from food enjoined  by certain churches dur-
ing certain periods  often does great harm if
injudiciously carried out.   In any doubtful
case it should  only be  done under  proper
medical authority.
  ACACIA.—The  gum  Acacia which ordi-
narily occurs in rounded  masses called tears,
is  procured  from  various species  of  the
Acacia tribe growing in the desert  parts of
Africa.  There it is sometimes used as food.
In this country the gums  commonly employ-
ed for  domestic, commercial, and  other pur-
poses are called gum Acacia, but in reality
are the product of  many other trees, cherry
gum being largely used.   In medicine, gum
Acacia is chiefly used to suspend heavy pow-
ders when given in  liquid, bismuth for exam-
ple ; and, when swallowed slowly, to allay
cough.  The gum, in solution, is sometimes
given after a corrosive or irritant poison has
been swallowed, to protect the coats of the
stomach.
  ACCIDENTS.—Of all  the  evils which
flesh is heir to, there is nothing in which the
benefit of present help in time of  need is so
welcome as in " an accident."  Be it ever so
slight  or ever so severe, from a small bruise
or  sprain to an  alarming  hemorrhage or
railway  " smash,"  the  assistance,  or  aid,
rendered  by some   one  whose  presence of
mind and common-sense  are equal to the
occasion,  is invaluable.  We  intend  in  this
article to  point out, in  the various forms
which  an accident  may take,  What to do.
In the first place, if possible, before entering
into any detail—Send some one for the near-
est physician.  The accidents which most
commonly  happen  are  bruises,  sprains,
burns, scalds, cuts, punctures, foreign  bod-
ies,  such as  splinters,  fish-bones,  needles,
shot,  etc., in the various structures of the
body,  or in its several  passages, such as the
nose, cars, throat, eyes, etc. ; broken bones,
bones put out of place, or dislocated, serious
injuries to large blood-vessels,  suffocation
from  drowning  or  hanging, suspended ani-
mation, poisoned wounds, bites  from rabid
animals or snakes.  We shall, therefore, pro-
ceed to offer  some ready methods of dealing
with each of these, and bearing in mind that
a little knowledge is a dangerous thing, par-
ticularly in Surgery, be as untechnical, plain,
and straightforward in our directions as pos-
sible.
  The following articles should  be  in every
home : Old linen, which may be  formed into
lint (charpie)  by  being scraped with a blunt
knife on one  side ;  laths of various lengths ;
roller bandages, which  may be made from
old sheeting,  and torn about 2.\  or  3 inches
wide ; some cotton wool ; a few broad tapes;
some old wide handkerchiefs or  neckties ;  a
pair of  good scissors, and a pair of  forceps
or pliers ; adhesive  or  diachylon  plaster.
The simplest materials  can be turned to ac-
count.  Thus, old  newspapers,  rolled  up,
make excellent splints ;  bandboxes,  with the
bottom knocked out,  are  capital  makeshifts,
if the bedclothing is required to be kept off a
broken  or wounded  limb.   The nap of  an
old hat plucked  off  and plugged into a cut is
often of great service.  A very small amount
of mechanical skill may be turned to the most
valuable account, such as the use  of a pocket-
knife saw, for the manufacture of exttmpore
splints,  which should be  well padded with
cotton wool,  old linen, handkerchiefs,  tow,
or any handy material, and applied comfort-
ably, but  firmly, on both sides of a  broken
bone which has been previously reduced—that
is, its ends put in apposition.  (See SrLiNTS.)
Bandages  and slings can He made  out  of
old sheeting, towels,  or  handkerchiefs,  and,
to facilitate application, should be rolled up.
(See Bandages.)
  Bleeding.—Hemorrhage, or bleeding (see
Hemorrhage),  is  of two  kinds,  namely,
arterial or venous : in the former the blood
is scarlet,  and spurts out of the wound in
jets ; in the latter it is dark purple, and rather
oozes than gushes  out.   In the  more trivial
cuts, the edges of the wound merely require
to be brought together with strips of adhesive
plaster, not too close  together, and  if the bleed-
ing be obstinate, a pad of lint should be firm-
ly bound  over the seat of wound by a roller-
bandage.   (N.B.—Adhesive  plaster should
always be taken off  when  it gets black.)   A
piece of  lint  steeped in some styptic, or pcr-
chloride  of iron, is of  great service.  If  a
main artery be wounded, pressure should be
made immediately with the thumb or fingers,
between the wound  and the heart, bearing  in
mind that  the arteries carry blood to the ex-
tremities ; or a tourniquet, as it is termed, be
extemporized, by tying a knot in a handker-
chief, and tying the  handkerchief round the 
ACCIDENTS
11
 limb, so  that  the  knot presses  immediately
 above the wound ; a piece of stick  thrust be-
 tween  the  handkerchief and the limb, and a
 twist or two given it, will  arrest the hemor-
 rhage most effectually.   In the case of some
 large  vein  being wounded, a  stout pad of
 lint, or linen, graduated, i.e., somewhat coni-
 cal in form, should be thrust into the. wound,
 with the  apex of the pad downward, and re-
 tained by means of a well-applied roller-band-
 age.   The  great  vessels  most  commonly
 wounded, because most exposed, are :  the
 great artery of the thigh (femoral),  the course
 of which may be indicated thus—divide the
 fold of the groin,  and in an imaginary line
 draw from  its centre to the middle of the in-
 side of the knee, the vessel will be felt beat-
 ing : the  two  small  arteries  at  the wrist
 (radial and ulnar).   The course of the great
 artery  of the  arm (brachial) may be  thus in-
 dicated :  a line drawn on the inner side of the
 swell of the great muscle (biceps), commenc-
 ing on the other side of the armpit, and end-
 ing about the middle  and rather to the inner
 side  of the bend  of  the elbow.   The great
 vessels of the  neck (carotid artery  and jugu-
 lar vein) are sometimes cut in attempts at
 suicide, or stabbing, and are very difficult for
 any one but a surgeon to attempt to treat, and
 very rapid in the result, although great service
 may be done by immediate pressure with the
 thumb  in the wound.  (See Cur Throat.)
   Bruises.—If an injury be inflicted on the
 skin  by some  instrument   which  does  not
 break it, a  bruise or contusion is the result.
 Bruises vary in degrees of severity, the most
 simple  being a discoloration of the  skin ac-
 companied  by some amount of swelling and
 pain, the black or blue color being owing to
 some  of the  small superficial  blood-vessels
 which are distributed to the skin having been
 burst by the blow, and the contained  blood
 effused.   The  discoloration,  however,  does
 not usually come  on until some  little time
 after the receipt of the injury.  In the more
 severe forms, large vessels  may be ruptured
 and the blood  escape into the surrounding
 textures, or the various structures of a limb,
 for example, may bz entirely crushed, giving
 rise to conditions  which will be more con-
 veniently treated under other headings.  (See
 Aneurism,  Amputation.)   Treatment.—Or-
 dinary bruises  may be treated by the applica-
 tion of lint steeped in cold water and laid
 upon the part ;  if more severe,  by the use of
 some stimulating liniment,  such as the com-
 mon ammonia liniment, or camphor liniment
 rubbed  gently into  the injured part whenlhe
 pain  is subsiding ; brandy, spirits of  wine,
 vinegar, or a solution of alum or tannin, fre-
quently do good.   These remedies, with/<rr-
 fect rest of  the  seat of injury, and a due at-
tention  to the state of the bowels, and a mod-
erate diet, will be found sufficient.   If, after
the" receipt  of  a severe bruise, the swollen
 part appears to throb violently, the case is in
 all probability of a serious nature, and .pro-
 fessional aid should be at once sought.
   Sprains.—When,  through any  sudden or
 violent wrench,  a  joint, or  tendons, or th*
 structures connecting the several parts of the
 body,  become  strained, pain, swelling,  and
 ecchymosis (bruise) occur ;  and if this happen
 to any of the larger joints, such as the knee
 or  elbow, the result  may  be most serious  ;
 especially if the individual  to whom the acci-
 dent happens has been intemperate in drink
 and is of weak  health.  Treatment.—Perfect
 rest, and the  parts  maintained at rest by
 splints  and  bandages  (see   Bandages), if
 necessary ;  warm fomentations, the bowelj
 to  be  kept open, and the living  moderate.
 Should the sprain be very severe, and  if there
 be great heat, swelling, and throbbing, leeches'
 should be applied to  the affected  part, cold-
 water douching,  and  some stimulating lini-
 ment, such as camphor or opodeldoc.
  Burns and Scalds.—For the more com-
 plete  account and  method of treatment of
 these accidents, refer to Burns.   The great
 thing to be attended to in these cases  is that
 great care is to be taken  not to tear away the
 clothing from the burned or scalded surface—
 supposing, of course, that the seat of the in-
 jury is in any part  so covered—as by so
 doing the cuticle  or scarf skin is stripped  off,
 and a large, raw, ulcerating surface is the re-
 sult, and the process of healing greatly com-
 plicated. (See Burns.)
  Bites or Stings.—In the case of stings of
 bees or wasps, as some faintness or depres-
 sion results, stimulants  should  be at once
 administered, such as brandy and water, or
 sal-volatile ;  and the seat of injury should be
 carefully searched for the sting, which is gen-
 erally  left  in,  while  the wound  should be
 treated  with  sal-volatile, vinegar,  or  eau de
 Cologne.  Supposing the throat be stung in
 drinking, there is, of course, great  danger of
 suffocation, and leeches may be  applied out-
 side the throat, and a gargle of hot salt-and-
 water used immediately, and medical attend-
 ance sought at once.  In snake bites,  power-
 ful  stimulants, such as hot  brandy  and water
 and ammonia,  should be  given freely.  In
 the case of poisoned  wounds of the fingers,
 etc., the  cut  or puncture should be immedi-
 ately sucked, and  bathed in  warm water ; and
 no  hesitation whatever should be  shown  in
 this proceeding, as the danger of the  poison
lies in  the  fact of its being absorbed by the
skin, and not in its being introduced into  the
system by the stomach.  The bleeding should
be freely encouraged.  Cauterizing  the wound
may be employed ; but it is doubtful if much'
good results from this proceeding, unless it
be  done thoroughly and on  the instant, by
some  such agent as nitric acid,  caustic, pot-
ash, carbolic acid,  or even a red-hot iron,
 (See Snakes, Bites of.) 
12           ACETIC  ACID
ACONITIN
   ACETIC ACID may be prepared in vari-
 ous ways, but that commonly used is obtain-
 ed from the distillation of wood in appropri-
 ate retorts, whence it is also called pyroligne-
 ous  acid.   It is used  in  medicine in two
 forms—the  strong, or glacial, and the dilute.
 The glacial acetic acid, so called from  being
 normally solid or in the condition of  ice, is
 chiefly used for external applications, the
 most frequent being  for the destruction  of
 warts.
   ACHOLIA signifies absence of  bile, and
 this  occurs in acute   atrophy  of the  liver,
 and  in some  other diseases of that  organ.
 (See Jaundice.)
   ACIDITY  OP THE  STOMACH is  a
 frequent symptom of indigestion, and  arises
 from the food taken being converted  by de-
 composition  into an  organic acid  of  some
 kind.  The treatment  consists  in  avoiding
 those articles of diet which produce acidity,
 as sugar,  butter, and  starch, and in  taking
 medicines which will correct acidity.   One
 of the best of these is bicarbonate of potash,
 which may be taken with some  tonic, as tinc-
 ture  of orange-peel, in doses  of 10  or  15
 grains three or four times a day.  (See An-
 tacid, Gastrodynia,  Indigestion.)
   ACNE is a term given to  the small  raised
 spots so  often  met with in youth, on the
 back and over the shoulders and on the chin.
 It is most common about the age of puberty,
 and sometimes covers the face so much as to
 cause great  disfiguration.  It is met with in
 both sexes.  The surface of  the  skin  is not
 really level, but there are numerous little pits
 or pores which open on the surface, and end
 in small pouches called  sebaceous follicles  ;
 now, when the channels get blocked up, the
contents  of these follicles increase, and as
 there is no outlet a little pimple is produced,
with a small black depressed centre, marking
the seat of obstruction  ; sometimes the spots
are red from  the vessels around becoming
congested, and if there is much  irritation a
little matter may be  found.  It is very easy
to squeeze out the contents by pressing the
pimple between the fingers, or it may be done
by using  a watch-key in  a similar way.  In
some cases  they are very troublesome, and
 resist  ordinary treatment.   Cold  bathing
every morning, and  frequent friction of the
skin  with  rough towels so  as to excite  a
healthy action, are  very useful proceedings.
 Active exercise should be taken, and  a diet
 not containing too much animal food or stim-
ulants.  A  mixture of sulphur and alcohol
 rubbed together, so as  \o form a smooth
 paste, is an excellent application for acne ; it
 may be rubbed over the skin every night and
washed  off  in  the  morning.   A  popular
remedy is to take every morning a teaspoon-
ful of fresh yeast or balm in a glass of beer,
and it certainly does seem to do good in some
cases.  When the spots occur on the chin or
upper lip, and  are very numerous, it is best
not to shave, as much irritation may be caus-
ed by that process.   It is a disease generally
which may last a long  time, as fresh spots
often appear as the old ones are healing.
  ACONITE.—The common plant, Aconi-
turn Xapellus, or  Monk's-hood, is one of the
most deadly poisons known.  Every portion
of the plant is poisonous, but the root espe-
cially so.  In medicine, preparations both of
the green part and of the root are employed
—the former furnishing an extract, the latter
a weaker and a stronger tincture, the stronger
intended for outward application  only,  and
called a liniment.  The tincture is  the only
preparation  which should be used,  and then
with the greatest caution.  When taken into
the  mouth it causes a curious tingling sen-
sation,  by and by  followed  by numbness.
When swallowed, a similar  sensation is pro-
duced in the hands and feet; but its most im-
portant  action is on the  heart, the number of
whose beats is reduced by it, and the force of
the pulse considerably lessened.  The num-
ber of respirations per minute is also dimin-
ished.   Should the use of the drug be carried
too far, great muscular weakness is the re-
sult ; extreme faintness is produced, and in
fatal cases the  poisoned individuals seem to
die by stoppage of  the  heart's action.  It is
chiefly used  for two purposes : as a means of
relieving pain—that is, as an anodyne ; and as
a means of keeping down inflammation—that
is, as an antiphlogistic.   The  latter practice
has  been seized  upon  by homoeopathies as
their own,  the chief  remedy  they use  in
inflammation  being aconite.  For  relieving
pain, the remedy may be applied  locally or
given internally.  It is  chiefly used in neu-
ralgia and that special form  of the same mal-
ady known  as sciatica.  When given inter-
nally, the dose should not exceed five minims
or drops of the tincture,  and  this should only
be repeated  after an  interval of four or five
hours and with great caution.  When used
externally, the best plan is to rub  the tinc-
ture, mixed with a little soap liniment to facil-
itate the process, into  the  painful  spot  by
means of a piece  of  warm flannel or  soft
glove.   Care must be taken  to see that there
is no crack  or injury of the surface,  which
would render its application in  this manner
most dangerous.   It has also been  used in-
ternally in acute rheumatism, in gout, and in
certain forms of heart-disease.
  ACONITIN is the alkaloid, as it is called
of aconite, that is to say, its active principle,
which happens to possess an alkaline reac-
tion and otherwise to behave like an alkali.
It is ordinarily obtained  from the root, not of
the Aconi turn Napellus,  but  from that of the
Aconitum ferox, a native of India, and  for-
merly much  used as a poison there.   Aconi-
tin  is one of  the  most powerful poisons
known,  and  should not be  handled save by 
ACRID
AERATION
13
 competent persons.   Its properties are those
 of aconite in an exaggerated degree.
  ACRID, a term applied to any substance
 which produces irritation, more especially of
 the stomach.  Thus, poisons that produce in-
 flammation, pain, and heat in the stomach
 are called acrid.
  ACTEA is the root of Actcea racemosa, a
 native of North America ;  it is commonly
 called black snake-root, and a decoction of it
 has  been much used  here  in domestic prac-
 tice  for coughs.   It has been strongly recom-
 mended in rheumatism.
  ACUPRESSURE signifies a method  of
 arresting  hemorrhage   from   an  artery,
 wounded either by accident or in the slips of
 an  operation, by  passing  a needle under it,
 and  thus pressing it against  adjacent struc
 ture—just, in fact, as the stalk of a flower is
 compressed against the coat when fastened
 in with  a pin.  It is preferred  in many in-
 stances  by  surgeons to the ligature.   (See
 Arteries, Wounds of.)
  ACUPUNCTURE is a method of lessen-
 ing  pain, such  as neuralgia, by  thrusting
 needles, some two or three inches long, into
 the painful part.   It has been suggested that
 the relief caused by the proceeding is owing
 to the  fluid  contained in the nerve-sheaths
 being thus allowed to escape.  It is a  favorite
 proceeding with the Chinese.
  ACUTE HYDROCEPHALUS,  a form
 of inflammation of  the membranes of  the
 brain, or meningitis, common between two
 and  five years of age, but occurring occasion-
 ally  in the adult, and nearly always  proving
 fatal.  (See Meningitis.)
  ADDISON'S  DISEASE is  the   name
 given to a somewhat obscure malady,  first de-
 scribed by  Dr.  Thomas  Addison, of Guy's
 Hospital, London.  It is  almost invariably
 associated with disease of certain structures
 in the body, the functions of which  are un-
 known,  but  which,  being situated  immedi-
 ately  above  either  kidney, are called  the
 suprarenal  capsules.    Moreover, the  dis-
 ease is almost invariably of the  kind called
 tubercular, and  is frequently associated with
 similar disease elsewhere.  The most  marked
 feature of the disease is a gradual bronzing
 of the skin, which goes on until the patient is
 of the deepest  mulatto  tint, or  even  quite
 black in  some parts of the body.  This the
 patient probably only remarks when his at-
 tention is called to it; but in all probability he
 complains first  of all of great debility and
 feebleness, his appetite becomes impaired, and
 very likely his stomach becomes irritable and
he habitually vomits his food.  Such patients
commonly persist  in standing postures of de-
 bility, the head and shoulders hang forward,
 and there is about them a very peculiar, list-
less expression.   There is, as a rule, no com-
plaint beyond that of weakness, though some-
times vomiting  and  difficulties in breathing
are present.   Unfortunately, as far as we
know, the well-pronounced  disease about
which there  can be  no  mistake  is  fatal.
Nothing seems  to do  any good.  Strength-
ening remedies of all kinds have been tried,
and life has been prolonged as much as five
years, but finally with termination in death.
Ordinarily the disease  lasts a much shorter
time—on an average 18 months.  This ten-
dency to a fatal termination, however, renders
it of the greatest importance that we should
bear in mind that there are other circumstan-
ces which give rise to skin-bronzing, especi-
ally in females.   During pregnancy the skin
of females becomes  very much  darker  than
usual, especially on the breast and abdomen,
and even in some an increased  darkness  of
complexion is noticeable during menstrua-
tion.   This form of bronzing  passes away
with its cause.
  ADHESION  is a term used to  express
the union  or ready healing of the divid-
ed portions of soft  structures after  wounds
and ruptures.  In healthy subjects and under
favorable hygienic conditions, the edges of a
wound in the  soft parts, and the extremities
of a ruptured tendon, will, if they have been
kept in contact, become in a short time bound
together either by the process of healing by
direct  or immediate union, or, what is more
frequently the case,  by  the formation of an
intermediate   cicatrice   or scar.   Adhesion
generally results  from  the pouring  out into
the wound of a clear tenacious fluid called
fibrine or  coagulable lymph, which  becomes
organized and subsequently  converted into
scar  structure.   The process of union  be-
tween divided soft  parts, by means of the
early  formation of a scar from this coagulable
lymph, is called healing by primary adhesion.
When the  edges  of  an old   and gaping
wound,  the surface of which is raw and dis-
charges pus, can be brought together so as to
unite, the process of adhesion in  this instance
is called healing  by secondary adhesion.   This
variety of healing is sometimes  observed in
neglected   wounds,  extending  through  the
thickness of the lips, and in the union of two
or more fingers after bad burns.
  ADIPOSE, a medical  term for the fatty
tissue which is more or less prevalent through-
out the body ; when it  occurs  in  isolated
nodules under the skin, fatty tumors  are said
to have formed.  When there is a large ac-
cumulation of adipose tissue beneath the skin
all over the body, the individual becomes stout
and unwieldy.  This condition seems natural
to some people, but in others it is induced by
excessive drinking and sedentary work.  (See
Bantingism, and Weight and  Height.)
  AERATED BREAD. (See Bread.)
  AERATION is the  term applied to the
process  by which the   air taken in  during
breathing  is  absorbed  by the   blood in the
lungs.  (See Respiration.) 
14
AFFUSION
AIR
  AFFUSION, to which the term  cold  is
commonly  prefixed, is a mode of treatment
sometimes had recourse to in narcotic poison-
ing.   It is also a powerful means of reducing
bodily heat, if  that be too high, and was  at
one time employed in  fever for that purpose.
For this purpose baths of regulated tempera-
ture have now in great measure superseded
affusion. The patient is seated or placed  in
a position where the water will do no harm,
and four or five buckets of cold water poured
over his head and chest from a height of two
feet or more.  The  colder the water  and the
greater the  height,  the  greater the  effect  of
the remedy.  After this the  patient  is care-
fully dried and placed  in bed.
  AFTER-BIRTH.  (See Placenta.)
  AFTER-PAINS is  the term  applied  to
those pains which follow on the expulsion  of
the child and its appendages in a labor other-
wise quite natural.  Sometimes they are very
severe.   They are more common in women
who have previously borne children.  They
begin shortly  after delivery, and may con-
tinue,  if  unchecked,  for  four-and-twenty
hours.  They  are commonly due to efforts
on the part of the uterus to get rid of clotted
blood which may have  collected in its interior.
If so,  these blood-clots should be removed
and the  pains will commonly  cease.  They
may also be due to distension of the  bladder
or bowel. These should therefore be seen to.
After all causes are removed a sedative may
be given, such as a small dose of opium,  or
warmth applied to the abdomen.
  AGUE, a disease characterized by parox-
ysms of fever occurring  at intervals, brought
on by a malarious poison.  Each  attack has
a cold, a hot, and a sweating stage, and  is
followed by a period of complete cessation of
fever.  (See Intermittent Fever.)
  AIR.—The air is a gaseous envelope which
surrounds the earth, and which is  commonly
called  the atmosphere.   It is  composed  of
nearly four parts of nitrogen and one part of
oxygen ; the oxygen  is the  most important
constituent, as it is essential to the support of
animal and vegetable life, and  hence  was
called  by the  older chemists  vital  air ; the
nitrogen serves chiefly to dilute the  oxygen,
and prevents oxidating processes taking place
too rapidly.  The  atmosphere  is  a  mere
mechanical mixture of these two gases,and not
a chemical compound  like water, in which the
constituent parts, hydrogen and oxygen, are
much more intimately united.  The air  is
kept of an uniform density in consequence of
a principle known to chemists as the diffusion
of gases, by virtue of  which  there is a thor-
ough intermixture of the two elements. This is
due to the absence of  cohesion among the
particles of which gases and vapors  consist.
When mercury and water are shaken up to-
gether they soon separate on  standing, and
the denser fluid sinks  to the  bottom of the
vessel ;  but however much gases may differ
from each other in density, they will soon mix
thoroughly if free communication is  allowed
between them.  Oxygen has  a specific grav-
ity of 1.1056, and nitrogen of .972, air being
taken as the unit ;  but by means of diffusion
the heavier gas does not accumulate near the
surface of the earth, but is uniformly distrib-
uted through the air. Chemical actions, too, on
the face  of the earth  are constantly taking
place, and  oxygen  is being  removed  from,
while carbonic acid and other gases are add-
ed to, the atmosphere ; these do not sink to the
lower level of the  air,  although heavier than
either oxygen or  nitrogen, but  rapidly mix
and become equally diffused.  And this  is a
very important  process,  as   without  it life
could not well be maintained  in  the  vicinity
of manufactories or in  large towns, owing to
the rapid accumulation of impurities,   Car-
bonic acid and  water are  the most common
impurities in  common air ;  the former  is de-
rived from  the process  of respiration in ani-
mals and vegetables, from the combustion of
coal and gas, and from other chemical process-
es.   It may  be recognized by placing some
lime-water in a saucer  in  a room where sev-
eral people have been sitting ; a pellicle will
soon form over the surface, owing to the car-
bonic acid having combined with the lime and
formed-chalk..  Carbonic acid is very preju-
dicial to life, and therefore close rooms should
be avoided, and a  proper  supply of  pure air
should be constantly  passing  through the
room ; ventilation is easily procured by open-
ing the door or  window occasionally ;  the
fire,  also, by creating a draught up the chim-
ney, causes a current of air to enter the  room.
The amount of water varies with the state of
the atmosphere.  If a glass of cold water be
brought  into a warm room the outside soon
becomes bedewed  with moisture, owing to
the cold glass condensing  the aqueous vapor
of the air  into visible drops.  Th-e dew on
the grass in the early morning is a common
example  of the presence of moisture ; when
the sun rises the earth  becomes  warmer and
the dew escapes  into the  air  as invisible
vapor.  Evapuration from rivers, lakes, and
seas is the source of the moisture.  Ammonia
exists in  small quantities, about one part in
a million of air ; it is mainly from this source
that  vegetables obtain  the  nitrogen  which
they require to form their  seeds and fruit, for
they do not seem  able to  assimilate the free
nitrogen  of the atrrtosphere.   Ozone is pres-
ent in  fresh air, but not in the close air of
towns, as it  is decomposed  by  the organic
matter.   It is supposed to be formed by the
discharge of electricity, and  to  be  an active
kind of oxygen.  In large towns carburetted
hydrogen,  sulphuretted  hydrogen, and  sul-
phurous  acid may exist  in  minute traces
Many substances which occur in small quan-
tities, such as dust  or the minutely divided 
AIR-PASSAGES
ALBUMINURIA          15
particles of inorganic bodies, may be looked
upon as accidental impurities.  More impor-
tant  than  these are volatile organic impuri-
ties, which  probably in  a great measure in-
fluence the healthiness of a locality.  The low
fevers and agues met with in marshy districts
are caused by the presence of  some organic
impurity, and any one walking along a  river-
bank of an evening when the water is low must
have recognized at various times a  very dis-
agreeable odor.   Any one who passes from
the  fresh air into a  crowded room becomes
aware of the existence of organic impurities.
The  poor, who herd  together in small, close
rooms, seem to prefer the warmth to ventila-
tion, although in doing so they act in a way
very injurious  to health.   Many fevers are
conveyed by means of the air from one  local-
ity to another ; in this way scarlet-fever or
measles may spread ; this, too, will account
for the rapid  extension of cholera  from one
country to another.   Air may be inodorous
and yet not  healthy, for there may be no
smell, although particles emanating from  a
fever  patient may be  floating in it ; it may
be odorous and yet healthy, as  in the  vicin-
ity of gas-works, tan  yards, and tallow-melt-
ing ; these  smells, though disagreeable, are
not injurious to most people.  In some  local-
ities,  as  in the vicinity of copper or iron
works, the air becomes loaded  with the  im-
pure gases emanating from the  furnaces ; in
some  parts  this is so  injurious as to pre-
vent trees or plants growing for some  miles
around.
   Since air is essential for the continuance of
life, it is most important to breathe it as pure
as  possible.   Every  room  should be  well
ventilated, as otherwise carbonic acid is apt
to accumulate and produce a feeling of drow-
siness and languor  with  headache.  When
this gas accumulates  to more than four parts
in ten thuusand of air it is injurious  to health.
Organic bodies in a state of putrescence should
be destroyed  or buried so as to prevent any
noxious particles  spreading  into  the atmos-
phere.  Excreta should  be removed, and the
cause of any bad smells arising from water-
closets or cesspools should at once be seen to.
By breathing pure air  and by removing every-
thing which  tends to contaminate it, a great
deal may be done to prevent the onset of dis-
ease.  (See Fevers. Ventilation.)
  AIR-PASSAGES  form  the channel by
which the air can enter the  lungs ; different
names have been given to each part of the
tube.  At the back part of  the mouth, and
just in front of the oesophagus, or gullet, is a
chamber called the larynx ; this cavity com-
municates above with the mouth and  nose,
and can be closed by a valvular lid called the
epiglottis ;  below, it  is continuous  with  the
trocher, or  windpipe, a capacious, circular
tube, lying in front of the  neck ; at the level
of the top of the sternum  or  breastbone this
tube divides into two branches, called bron-
chi, one of which goes to either lung ; these
again, on arriving at the lungs, break up and
subdivide into a number of very fine branches,
and  at last end in dilated extremities with
very fine walls, which are called the air-cells.
In the  ordinary state, the epiglottis is open,
and  air can go  in and out the larynx with
ease, and enter or pass away  through  the
mouth and nose, for both these cavaities com-
municate  freely  with each other behingV-but
when the act of  swallowing  takes  pTace the
epiglottis falls over the upper opening of the
larynx and prevents any food  going that way.
Anything which prevents the entrance of air
into  the lungs by obstructing the air-passages,
as a  coin or marble in the windpipe, spasm ol
the epiglottis, inflammation within the larynx
or a growth in  that tube, or pressure from
without as in cases of hanging and strangula-
tion, will  cause great distress in proportion
to the amount of the obstruction, and, if very
great, will cause death by apneea.
  ALBINO is a name to an individual whose
hair, skin, eyes,  etc., are deprived ot all color-
ing matter ; in other respects they may have
perfect  health.  They are generally  short
sighted, and the pupils of the  eye have  a pink
color ;  the hair is thin and  of a silvery-white
color.  Nothing,  of  course, can  be  done for
this singular condition.
  ALBUMEN  is  a chemical  compound
found in the tissues of  both  plants and ani-
mals.  The best example of it in the animal
kingdom  is the white of the egg.  It is also
found in all animal blood and the nerves and
brain.   It is found  in the juices  of  many
kinds of  vegetable  food,  as  in  cabbages,
asparagus, and  potatoes.   It is in all these
instances in solution in water.  It is  easily
discovered by the facility with which it coagu-
lates by heat.  It is thus that  the white of the
egg becomes solid by boiling.   Blood and the
nervous organs of animals are also coagulated
and  thickened by exposure to heat.   It be-
longs to that class of alimentary substances
which are called proteinaceous. nitrogenous,
or flesh-forming.  As a part  of our food, it
supplies the waste of  the nerves and muscles
of the body.   It sometimes appears  in the
urine and constitutes the disease called albu-
minuria.   (See Albuminuria, Bright's Dis-
EASE.)
  ALBUMINURIA, or  the  presence  of
albumen in  the urine, is a symptom met with
in many  cases of  disease  of  the urinary
organs.  It is known by boiling the urine in
a glass tube over a spirit-lamp, when a white,
flocculent precipitate is thrown down, and this
deposit is not  dissolved  on  adding a little
nitric acid.  In all cases of Bright's Disease
this  substance is present in  greater or  less
quantity in the urine ; in many cases of heart-
disease, when associated with dropsy of other
parts ; in many  febrile disorders,  as typhus 
1G
ALCOHOL
ALCOHOLISM
 and typhoid fevers, diphtheria,  etc. ; in all
 cases where blood is also present in the urine
 (see Hematuria), and whenever there is pus
 in the urine, as when a stone is present in the
 bladder or when there is inflammation of the
 lining membrane of that organ.  Albuminuria
 itself requires no special treatment ; it is only
 an important symptom of grave mischief else-
 where, and so the treatment that should be
 adopted must have reference to the particular
 disease which is the cause of the albuminuria.
 (See Bright's Disease.)
   ALCOHOL is the active principle of wines,
 spirits, beers, and other fermented beverages.
 It is formed during the process  of fermenta-
 tion from fruit  sugar.  When fruit sugar  is
 exposed  to the action of a  ferment it loses
 carbonic acid gas, and is converted into alco-
 hol.   This substance has a special power of
 acting upon the nervous system ; it is on this
 account  that  it has been  taken largely by
 mankind in fermented beverages.  Alcohol
 acts upon the nervous system, producing  first
 a pleasant stimulation, then great excitement,
 and  finally a state in which  the  person who
 takes it  is more or less unconscious.   This
 state is called drunkenness.   Habitually taken
 in small quantities it produces great disturb-
 ance of the nervous system  (Alcoholism).
 When taken in large quantities it causes com-
 plete derangement of the  brain and nervous
 system, which often terminates fatally, and al-
 ways leaves it more or less permanently de-
 ranged (see Delirium Tremens).  The ner-
 vous is not the only system  affected by the
 constant  abuse  of alcoholic drinks.   The
 mucous membrane of the stomach becomes
 inflamed, and  indigestion is produced.  The
 liver is subject to a peculiar  disease from its
 action  (see  Cirrhosis).  The blood is  de-
 ranged, and the nourishment of the various
 organs is interfered with.  A series of changes
 take place in the heart, the liver, and the kid-
 neys, which are known by the name of Fatty
 Degeneration (Degeneration, Fatty). Such
 an agent should be carefully watched on ac-
 count of its very general use.   The inquiry is
 often  made as to  how much alcohol can be
 taken in a day with impunity.  It is quite
 safe to say that  children and  young healthy
 adults  can have perfect health without taking
 it at all.  Where small quantities are required
 it may be stated that from one to two ounces
 of  pure alcohol is all that can be safely  taken
 from day to day.
  The question is often discussed as to whether
alcohol is in any way consumed in the system
 or thrown off the body in  the same state in
 which it was taken. Whilst there is abundant:
evidence  that  alcohol when  taken  in  large
 quantities is thrown off by the various, excre-
 tory organs, the latest researches show that  a
considerable quantity of alcohol taken  is de-
composed and thrown off the system in other
forms.   In some forms of disease alcohol is
the only substance acting as a  nutrient that
can be absorbed into the blood, and in these
cases it acts as  a  stimulant to the heart and
brain, and also supplies aliment to the body.
In the low forms of fevers and other exhaust-
ive diseases  of the  body it is the sheet-anchor
of the physician, and life is imperilled where
its  agency is disregarded.  Alcohol is used
in medicine of various degrees ol strength ;
chiefly for dissolving out  the active ingredi-
ents of various remedies.  Such solutions are
called tinctures.. Its properties are, as is well
known, stimulant ; as  such it is used in the
form of wine and spirits.
  We subjoin a table of the quantities of alco-
hol contained  in various  common forms of
beverages:

Quantity of JVatsr, Alcohol, S/i^ar, and Acid con-
  tained in one Imperial Pint of various Fermented
  Beverages.
Name of Beverage.	Water.	Alcohol.	Su^ar.	Acid.
Pale Ale....... Mild Ale.......	Ozs. l7'/2 18% 18 '9 16 nv2 16 18 >7'/3 i?H i8# '7 9/2 5 12 16 1014	Ozs. I-'-f I 4 4 2 2}<f '•4 UK 3 4 Ii 8 4 9 a	Ozs. Cms. 0 240 0 280 2 136 0 100 1 2 0 3^0 0 So 0 0 0 0 0 0 0 0 1 133 0 400 0 £0 0 0 0 0 i 0 0 0	Grains. 40 38 54
Port............				
Brown Sherry.. Claret..........				90 170 161
Hock...........				160 127 140 90 100
				
Gin (best),				100 100 100 100
  ALCOHOLISM, the result of a long con-
tinued abuse of intoxicating liquors, causes
a  serious change in  the  blood, and  then
of the various tissues of the body. The liver
may become fatty orcirrhosed, the heart weak
and  flabby, and unable to perform its func-
tions so well as before ; the kidneys are liable
to waste, the lungs to become  emphysema-
tous, and  the  patient short of breath.  The
brain also shares in the general mischief, and
many of the nerve-ceils waste through being
badly nourished ; the  mind in  consequence
becomes  affected ;  there is loss of memory,
giddiness  at times, disagreeable dreams, and
restlessness  at night, occasionally flashes of
light appear before  the eyes, and the  patient
wakes up in the morning with no appetite for
breakfast, and a feeling of sickness.  His
nervous system, too,  is  weakened ;  any ex-
citement 01 trouble affects  him ; in advanced
cases the tongue and hand tremble, and weep-
ing comes on with a very slight cause. If the
heart be affected, he  may be  troubled with 
ALE
AMAUROSIS
1*
 fainting, which  at  length  may prove fat d.
 Many  of these cases may go on for years
 without seeming to hive their health impaired
 by the quantity of spirit they take, but sooner
 or later it tells upon them, and any acute ill-
 ness will quickly carry them off ; such a course
 of life induces premature old age.  Very little
 can be  done for the habitual drunkard, who
 may cease for a short time from  drinking
 while he may  be suffering  from some ailment
 caused by his  habits  of life ; a sedative may
 be given at  bed-rim;; to  enable him  to sleep
 better,  and for the  dyspepsia or  indigestion
 which accompanies  this  disease  some bitter
 tonic, as gentian or quassia, may be given
 with nitric or  hydrochloric acid two or three
 times a day ;  small  doses  of strychnine and
 arsenious acid have  been  taken  with advan-
 tage, but these are very poisonous remedies,
 and.must only be taken under medical advice.
   ALE.  (See Beer.)
   ALIMENT.   (See Food, Diet.)
   ALKALIES  are  the  oxides   of  certain
 metals  aid  their salts.  Ammonia, which is
 not the  base of a metal, acts as the alkalies,
 and is called the volatile alkali. (See Potass,
 Soda, Ammonia, Lime, Magnesia, Lithia.)
   ALKALOID, a term applied to those veg-
 etable  principles which  act chemically like
 alkalies, such as quinine,  morphine, strych-
 nine, etc.
   ALLOPATHY is a term  applied  to  the
 practice of medicine as carried on by the great
 mass of medical practitioners.  It is opposed
 to the term  Homoeopathy, in which diseases
 are supposed to be cured by remedies which
 produce the  same effect on the system as the
 disease : hence the  axiom,  similia simitibus
 curantur.  On  the  other hand, Allopathy is
 supposed to  cure by  remedies which produce
 effects different  from those they are given to
 cure ; and a contrary axiom is assumed, con-
 traria contrariis  curantur.
   ALLSPICE is the fruit of a tree belong-
 ing to the same family as  the clove.  It con-
 tains an agreeable volatile  oil, which is used
 for  giving flavor to  bread-sauce  and other
 articles of food.   (See Pimento.)
   ALMONDS  are the seeds of a species of
 Amygdalus, and  are of two kinds, sweet and
 bitter.   The sweet  almonds  are  brought to
 table, and in countries where they grow form
 an important  article  of diet.   They contain
 starch,  oil, and albumen.   The  oil is often
 expressed and  used  as salad oil.   The bitter
 almond contains, in addition  to the fixed oil,
 a  peculiar oil  known by  the name of oil of
 bitter almonds.  The almond itself and this
 volatile  oil are used  in cookerv for the pur-
 pose of giving flavor to custards,  cakes, pud-
 dings, etc.  It is also used in perfumery. The
smell of  the oil is imitated by an  artificial
compound, nitro-benzol, obtained  from  coal-
tar, and  it is  often sold in the shops for oil of
bitter almonds.  In  the shops two kinds of
 ! oil of bitter almonds are sold, the pure and
  impure.  The impure  contains hydrocyanic
  acid, and is very poisonous, while the  pure
  contains no poisonous principle.  The taking
  impure oil  of  bitter  almonds by  mistake  or
  design is a  frequent cause of death.
    ALOES  is  the  thickened  juice of various
  species of  plants,  called aloes,  giowing  in
  many parts of the world.   That used in med-
  icine  is chiefly brought from  Africa and the
  West  Indies.   Few remedies are more uselul
  than aloes,  and it enters  into many prepara-
  tions used in medicine.   Its most prominent
  properties  are purgative.  When  given  as
  such it had  better not be given in large doses  ;
  half of an ordinary pill, that is, two or three
  grains, taken regularly for a time, being gen-
  erally  quite enough to  insure  regular action
  of the bowels.   It seems to act as a tonic as
  well as  a  purgative.   In larger doses  it is
  said to produce piles, and should not be em-
  ployed where these exist, neither should large
  doses  be given during pregnancy.
   ALTERATIVES is  a  term  applied  to
  medicines  which are supposed to  alter the
  condition of the blood and tissues without
  exciting any sensible  action of the excretory
  organs.  Thus, small doses of the mercurial
  preparations are regarded as alteratives.
   ALUM is  a compound  crystalline  body
  having as its essentials alumina and sulphuric
  acid with potass or ammonia.  It is an astrin-
 gent substance, and  hence is  used  to lessen
  discharges of many kinds.  It is also used an
  a gargle in  sore throat.  When heated it melts
  and becomes powdery ; this, which is called
|  burnt  alum, is often used  for  ulcers when
  they become flabby.  Along with  decoction
  of oak bark, in the strength of 2 or 3 grains  to
  the oilnce of decoction, it constitutes one  of
  the safest local  applications for ordinary dis-
  charges.
|   AMAUROSIS is used to express imperfect
I  vision  or total blindness due to  some un-
 healthy changes in the back  of the eye, in the
| optic nerve or nerve of sight, or in the brain.
  It also includes various  nervous affections of
  the eye in which there is no apparent change
  of  structure to  account  for  the  failure of
 vision.   Since the introduction of  the oph-
 thalmoscope,  an instrument  by  means of
  which  the interior of the eye-ball can be illu-
 minated  and examined, a great number of
 well-marked affections of the visual apparatus
 have been ranged under this heading.   The
 chief causes ol  amaurosis are the following :
 Diseases of the  brain,  as apoplexy, inflam-
 mation,  tumors, abscess  ; affections of the
 nerve  of sight ; tumors growing  within the
 eye socket and  disease of the.soft parts sur-
 rounding the eyeball  ; inflammation of  the
 retina  and choroid,  two  membranes of the
 eye ;  certain chinges in  these membranes
 associated with Bright's disease of  the  kid-
 neys,  with syphilis, and with diabetes.   It :s 
18
AMAUROSIS
AMBULANCES
  believed by some authorities that excess in
  tobacco smoking is a not inlrequent cause of
  blindness.    Amaurosis occasionally  results
  from debility and during convalescence from
  fever, diarrlicea,  and proluse  hemorrhage,
  and may occur  in  pregnant and  hysterical
  women, and in children  affected with intes-
  tinal worms.  The most common and  impor-
  tant cause of impaired vision, however, is de-
  bility and  congestion of  the interior of  the
  eyes due to the prolonged use of these  organs
  under certain conditions.   Use  of the eyes,
  however long  continued, can  do very little
  harm so long as  the light is not very intense
  and the regarded objects are diversified in
  form, size, and color,  but when minute  ob-
  jects are closely watched for a long time undei
  a bright light, especially when one eye only
  is used, as in microscopical  examinations,
  injury of the retina or visual membrane is
  likely to result.   Long-continued exercise of
  the  eyes in very hot and  badly-ventilated
  rooms with  glaring lights is another frequent
  cause of amaurosis. Watchmakers, draughts-
  men, compositors,  and  needlewomen  are
  peculiarly exposed by their  occupations to
 amaurosis.  The sudden  exposure to bright
 ■light of a person who has previously remained
 for a long time in dusk or total darkness may
 give rise to impairment of vision, a fact which
 should be remembered in the treatment of
 convalescents from long  and severe illness.
 There are many different forms of amaurosis.
 It  may  affect one or both eyes.  In  some
 cases it consists in total blindness, in  others,
 in  slight weakness of vision.   It may be per-
 manent, temporary, or intermittent.   Some-
 times it  comes on suddenly, but in most in-
 stances  slowly, and at first almost impercep-
 tibly.  It may be attended  with severe local
 and general  symptoms, as intense pain  in  the
 eyeball,  headache, vomiting, giddiness, con-
 vulsions, and palsy ; or, on the other hand,
 it  may  cause no uneasiness  to  the patient
 except what  arises from the iailure of a most
 important sense.  The following are the chief
 symptoms of the affection,  especially of the
 Slow form, that results  from long-continued
 abuse of vision : Difficulty in reading print or
 writing,  the letters being doubled, or halved,
 or distorted,  obscured, or discolored ; the ap-
 pearance of small  black  specks, like particles
 of soot, floating before the eye ; the appear-
 ance of larger fixed specks ; a dense mist be-
 fore  the eye, varying  in color at  different
 times ; flashes of  bright yellow or blue light
 appearing when the eyelids are closed  ; dis-
 tortion of objects, especially of  flame ;  an
 iridescent and rainbow-like halo around  flame
 and strongly illuminated objects  ; in  some
 rases intolerance  of light,  in others a desire
 for light ; the pupil  is generally large and
 dilated and  the iris immovable, but this  is
 not a constant symptom ; pain and a sense of
fulness in the eyeball ; with these  symptoms
 is associated a gradual failure of vision, until
 Lie power of appreciating the shape and color
 of external objects is quite lost.
    Treatment.—In the treatment of amauro-
 sis one  must seek for the probable cause of
 the disease.  In the  common  instances of
 impairment of vision coming on in debilitat-
 ed subjects  who have been engaged in occu-
 pations necessitating a long-continued  exam-
 ination  of minute  and  brightly-illuminated
 objects  cr hard study during the night, much
 good  may  be done  by a  discontinuance of
 such pursuits, by strengthening the system.
 Quinine and steel drops may be taken with
 advantage, but more  beneficial than any me-
 dicinal  agent will be found good living, fresh
 air, and a change of scene and occupation.
 The bowels  should  be  freely  relieved and
 kept open  by blue  pills,  Epsom salts, or a
 frequently-repeated   black  draught.    Wine
 and beer ought to be taken.  A bright light
 must  be avoided, and the patient,  when tak-
 ing exercise in  the   open air,  should  wear
 spectacles with glasses of a light  blue tint.
 This treatment,- it must be remembered, is
 applicable only  to amaurosis brought about
 by such avoidable circumstances as want of
 fresh air and good diet and an incautious use
 of the eyes.   In other forms of  the affection,
 a proper use of remedial means is to be based
 upon  a recognition  of its true  cause,  which
 may exist either in a general affection of the
 body or in disease of some distant organ.
   AMBER is a hard, semi-transparent sub-
 stance of a yellow color.  It has  the character
 of a resin, and is supposed to be of  vegetable
 origin.  An  oil  is  obtained from  it  called
 Oleum succini, which  is extensively used  as an
 embrocation  in rheumatism and whooping-
 cough.
   AMBLYOPIA.   (See Vision.  Douple.)
   AMBULANCES.—Numerous conveyan-
 ces have been designed, and are in use, for
 the carriage  of the  disabled, and as it would
 be almost impossible to  refer to them  all in
 detail, some  few practical suggestions, which
 would refer  equally  to  civil as to  military
 practice, on the proper position  of  wounded
 men during  the act  of transportation,  with
 some remarks on their removal by bearers
 when no conveyances are  at hand,  will  be of
 value.    Ambulance  conveyances,  however
 borne, are constructed for carrying patients,
 either lying at full length or sitting.   The re-
 cumbent position  is  undoubtedly the best in
 the case of  severe wounds, and in cases of
 shock or faintness from hemorrhage, as it is
the position  in which  the  several parts of the
body are subjected to the least amount of con-
cussion  The sitting posture is,  as a general
rule, only adapted for  those whose injuries aie
of  a comparatively slight nature.   The semi-
recumbent position is where the  trunk of the
S"1 1-StKraLSed; and suPP°rted  at  a certain
 angle with  the lower  part of the body and 
AMENORRHEA                              AMMONIA             19
lower extrem'ties ; the knees are also raised,
and the thighs bent and supported at an angle
with the legs. This position is very desirable
in wounds of the chest, owing to the feeling of
oppression in breathing, preventing the re-
cumbent position  and the jolting of the sit-
ting.   If no conveyance be at  hand, the as-
sistance of bearers must be resorted to, and
it will be convenient to mention som^ method
cf affording help when only one attendant or
bearer  is at hand.  If the wound be in the
head, neck, or upper  part  of the trunk, the
patient should partly support himself, with a
stick in one hand (or musket), while his other
hand and arm lean upon the upper part ot the
back and distant  shoulder  of  the attendant
who walks  by his  side.  At the same  time
the attendant should place his near arm across
the neck of the wounded man, reaching round
and partly encircling his body with the fore-
arm and  hand, so as to support the trunk.
If more than one attendant is available, a
regular litter is  at  hand.  The  first method
they may  adopt   is  that  of   carrying  the
patient by  the two bearers joining hands
beneath the  thighs, while their  arms which
are not thus  occupied  are passed round
his loins.  A second  and better method of
joining two  hands  for  the  semi recumbent
support of  a patient is  as  follows : The ad-
vanced right and left hands of the two bear-
ers are closely locked together, and the wrists
brought into contact; at the same time their
other hands are made to  rest upon an 1, in a
certain degree,  grasp  each other's shoulders
on the same sides  respectively.   One of the
best methods is that of  a  four-handed seat
with crossed arms, known commonly as the
"sedan chairs,"  and to effect it readily the
following directions are useful :  The bearers,
A. and B.,  stand  thus :  A. on  the left  side,
B. on  the  right.   A  grasps with his right
hand the left arm of B.; B. grasps  with his
left hand his own  right arm.  B. then grasps
with his right hand  the left arm of A. ; A.
with his left hand his own right arm.
  AMENORRHCEA means an absence of
the usual flow  which  generally occurs  at
regular periods in women from  the time of
puberty until middle life.  Menstruation usu-
ally begins  between  the age of twelve and
fourteen'; in some cases it is very much later,
in a few it never appears at all, and in many
the " periods" are very  irregular.  Amenor-
rhcea may result either from retention or sup-
pression of  the flow of  blood  ; in  the first
case it  depends upon some  malformation of
the organs of generation, and a simple surgi-
cal operation is necessary for its cure ;  it may
be suspected in a young girl who has all the
usual  symptoms and  discomfort  attending
that  period, but from whom there is no ex-
ternal flow.   Suppression of the flow is iar
more  common ; it  occurs naturally in  every
case of pregnancy  ; it  is often  brought about
 by exposure to  cold, by sitting  on the damp
 grass, or by  getting wet in the feet ; it en-
 sues in the  course of  many exhausting dis-
 eases, as consumption, kidney disease,  can-
 cer, etc. ; it is  met with for a time after the
 patient  has passed through a severe illness,
 as fyphusor typhoid lever, and finally it may
 result from disease of  the uterus and  ova-
 ries.  In many cases of anaemia, amenorrhcea
 is generally found to exist:  in fact, a condi-
 tion which brings  about one will generally
 cause the other, so  that  patients  suffering
 from  this complaint are  usually extremely
 pale ; the lips and  inside of the  eyelids lose
 their usual color ; the patient is  very liable to
 headache,  palpitation of the heart, faintness,
 and lassitude.  When the cause is due to preg-
 nancy, of course nothing need be done, as the
 symptom  is  quite  natural ;  in  other cases
 tonics are  of the greatest service, and  espe-
 cially  those preparations which  contain  iron.
 Moderate  exercise in the open  air, without
 tiring the patient too much, is  necessary ; a
 generous and wholesome diet, avoidance of
 late hours and close  rooms, early rising and
 ffesh, bracing air, with cold bathing, will  do
 much good ; but some of these remedies can-
 not be adopted when the patient is suffering
 from other diseases which really are the cause
 of  the  amenorrhcea.   Stimulants   are not
 needed, but a glass of beer or a glass or two
 of light wine, may  be taken at dinner.  The
 bowels should be kept open by aperients, and
 a warm bath should be  given at  bed-time just
 before the time when the " period" should
 recur.   These remedies  are most  valuable
 when the amenorrhoea is  dependent upon
 anaemia, on overwork,  exposure to cold, etc.;
 but in cases of consumption, cancer, uterine,
 ovarian, and kidney diseases, etc., there  is  no
 occasion to  treat  the  amenorrhoea, but  at-
 tention must be directed to the  more impor-
 tant malady.
   AMMONIA  is used, botii by itself and
 combined with other chem'cal  agents, for a
 variety of  purposes.   It   is nowadays got
 from gas-house refuse, but used to be obtained
 by burning hartshorn, whence it got the  same
 name.   I'.s application  as  burnt feuhers  is
 familiar to many ;  to more it is  known in the
 form  of smelling salts.  Pure ammonia,  or,
 as it is called by chemists,  caustic ammonia,
 is rarely used.   When ammonia is given  in-
 ternally for its stimulant virtues, its carbonate
 is used—sal volatile, or smelling salts.  It is
 used as aromatic spirit of ammonia in doses
 of from a few drops on  sugar to  a teaspoonful
 or more (m. v. to 3J.) to relieve flatulence, to
 remove the feeling of sinking, and  to get  rid
 of acidity and heartburn.   It is also useful in
 some forms of headache.   It frequently does
 much good  in  the chronic bronchitis of old
 people, when their winter cough is compli-
 cated  with copious tenacious expectoration.
1 Ordinary  smelling salts may be used as an 
20          AMMONIACUM
ANESTHETICS
emetic in  certain forms of poisoning ; about
a teaspoonful should be given dissolved in
lukewarm water.   Liquid  ammonia has been
of late used with much success as a remedy
for snake-bite.   It has been given internally
in considerable quantity along with brandy or
whiskey.  In Australia it has been repeatedly
injected into veins  for snake-bite,  and the
treatment has proved there quite successful,
but has failed in India.   The  old  remedy,
hartshorn and oil {freshly prepared), will be
found very  useful lor the stings of bees and
wasps, the bites  of mosquitoes,  gnats,  and
such like.
  Acetate of Ammonia has  been a  good
deal  used in practice as Kquor of acetate of
ammonia,   commonly   called  Mindererus*
Spirit.  Its  dose is  from ten drops to a tea-
spoonful (m. x. to 3j.), and it has commonly
been given to relieve feverishness, as in ordi-
nary  fevers, colds, etc.   In such like forms
of disease it is supposed to cool the skin by
promoting perspiration, whence it is called a
diaphoretic. It may be given along with sweet
spirits of nitre and a few drops (2 or 3) of anti-
mony wine, when the skin is hot and dry and
the pulse quick.
  Hydrochlorate of Ammonia, also known
as Chloride of Ammoniacum, more commonly
as Sal Ammoniac, is a remedy of exceeding
great value in certain forms of  headache.  It
is not easy  to say which form it is exactly
suited for, but it often succeeds with headache
and  tic-douloureux when everything else has
failed.  Twenty or.  thirty  grains  should be
taken for a dose.  It is rather nauseous, and
may be given in beer.   It is also useful in
certain  female complaints, especially  when
the periods have been irregular or have prem-
aturely ceased.
  AMMONIACUM is what is called a gum
resin—that  is to say, it  is both gummy and
resinous in character.  It  comes  from the
north-east of India.  A plaster of it, combined
with mercury, has been a good deal used for
getting rid of old swellings.  It  is of most use
in the chronic bronchitis  of old age, and is
given in doses of from five to twenty grains.
  AMNESIA,  or loss of  memory, is met
with in some cases of apoplexy.  It varies in
amount.  At times  the patient will lose all
memory of recent  events, while  there is a
clear recollection of the past ;  at other  times
the converse may exist, while generally there
is more or less forgetfulness of everything.
  AN/EM LA is a condition in  which there
is an impoverished state of the blood, and
where the patient is very pale and in a state
of general debility.  Anemia may exist alone
or in conjunction with other exhausting dis-
eases, as consumption or cancer.  In the first
variety the patients are generally young worn-
en who are employed in close workshops and
confined places from morning to  night ; or
they  are  women who have lived  badly, and
 having had  several children,  are suffering
 from over-lactation. In such people the whole
 surface of the skin is paler than  usual, and the
 lips and lining membrane of the eyelids  in-
 stead of being rosy, are of a pale pink color.
 There is also a leeling of general debility and
 an inability  for much exertion.  Palpitation
 of the heart, headache, pain in the back and in
 the left side, are commonly met with.  This
 disease arises  chiefly from  want of pure air
 and light, and  from living badly.   The treat-
 ment consists, therefore, of moderate exercise
 every day in the fresh air, and working  or
 living in rooms with plenty of light and means
 for  ventilating the apartment  whenever  the
 air becomes impure.  The diet  should be light
 and nourishing ; a moderate amount of ani-
 mal food should be  taken, but anything which
 is heavy or which  causes indigestion should
 be avoided.  Stimulants should  not be resorted
 to, but a glass of beer with a meal may be
 beneficial.   A  cold bath in the morning is
 often of great  service, and for  those who  can
 afford it, change of air and scene is very use-
 ful ; such persons may take horseback exer
 cise, and they  should  go to the sea-side  or
 some place where the  air is bracing and re-
 freshing.  Tonic medicines are  of great value,
 and for this purpose preparations containing
 iron are most beneficial ;  a  patient may thus
 return to the  bloom  of health in a very few
 weeks.  When women are at  the  same time
 suffering from over-lactation it may be advis-
 able to wean the child.   Anaemia is often as-
 sociated  with  a temporary cessation of  the
 menstrual function, but  this is usually restored
 with the improvement of the  geneial health.
 The habits of town-life predispose to this dis-
 ease in a great measure,  and in all  cases
 country  air is most beneficial.   In young
 girls light lacing is  olten most  injurious, as it
 prevents due expansion of the  chest and pie-
 vents the  free entrance of air  into the lungs,
 a process which  is most important for the
 various changes which are constantly  going
 on  in  the blood.   Persons Who are anaemic
 are very often nervous and  hysterical, and all
 sources of mental worry or  anxiety should be
 avoided as  far as  possible.  It is a disease
 which  too  often arises  from  neglect of the
 common principles of  health  and from  the
 artificial life of modern  society ; but it is  one
 which, unless treated early,  may lay the seeds
 of future and more serious diseases.
   ANESTHETICS  are  remedial  agents
 which take away  the  sensibility from a  part
 or the whole of the system.  Those substan-
 ces which, when  externally applied  to  any
 particular organ, take away its power of sen-
 sation are  called  local anaesthetics,  whilst
 those which are taken internally and   act
 through the blood are called general anaesthet-
j ics.  The same substances are generally  cap-
I able of acting in both ways.  Thus chloroform
 and ether, both of which are  general  anaes- 
ANASARCA
ANEURISM             21
thetics when  applied  locally, especially  by
means of a spray, are capable of  producing
on a particular part an entire want of sensa-
tion.  The agents which produce this impres-
sion on the uervous system are very numer-
ous.  The properties of these  substances may
be consulted in the articles Aconite, Bella-
donna, Chloroform, Ether, Opium.
  ANASARCA is a state in  which there is a
general s veiling of the body and extremities,
caused  by an  effusion of the  serum of the
blood into the loose cellular tissue  under the
skin.  Tne skin  in such cases is generally
very pale,  and when the finger is pressed
upon it, a little pit or depression is  formed as
the effused fluid is by the'pressure squeezed
away.   It is generally associated with kidney
disease, and often occurs after scarlet-fever,
when that organ is also affected. It is gener-
ally noticed first in the face ani  genitals,
where  the skin is looser  than  elsewhere, and
the patient's face has  then a  puffy look.   In
more chronic cases, when the kidneys  are
much diseased, the whole surface of the body
may become puffy and  swollen ; the lips es-
pecially  are liable to suffer, and  they  are
wo'se  after they  have been  in a dependent
position, as the fluid gravitates to  the lowest
parts, and thus it often happens that the face
is most  swollen in a  morning.  When  only
one limb is thus affected, it is said tobeceiem-
atous,  but when  the whole surface is purfy,
the patient is  siid  to have anasarca.  Both
conditions,  however,  arise  from  the  same
causes.  In anaemic girls, where the blood is
much impoverished, and thinner than usual,
oedema of the feet not  infrequently occurs,
but this variety may be  cured by treatment.
Swelling of the legs and other parts of the
b >dy may thus arise from various states in
which  the  blood  is altered in quality, and
these cases are in a great measure  amenable
to treatment.   Other  cases,  however,  arise,
where the blood is altered in quantity, such
as those where there is some  mechanical ob-
struction  to its flow.  When the  return  of
blood to the heart is prevented by obstruction
of the veins, the parts behind the obstruction
become so full of blood that the serum exudes
from the distended vessels, and soaks the tis-
sues around.  The swelling of the arm and
hind, which sometimes  is caused  by falling
asleep in a chair  while the arm is hung over
the back,  is  due  to  the  prevention  of the
proper return of the blood current ; in like
manner, a tight bandage will  produce similar
effects  ;  but these are easily  remedied.  _ A
more serious class of cases are those in which
the obstruction is seated in the heart or lungs,
and arises from disease of those organs.  It
is  not  uncommon  in persons who  have bad
winter  cough and shortness of  breath for some
time to find a swelling of the legs ;  this arises
from the obstruction to the  flow  of blood
through  the lungs.   The  treatment of  such
cases will  depend upon  the  nature of the
cause, and for this puroose a  cartful inquiry
into all the symptoms of the case is required.
Relief may usually be obtained by preventing
the affected part from remaining in  too de
pendent a position ; thus the legs may be con-
siderably reduced in size by placing them in a
horizontal position.  Pricking  the extremities
with a needle so as to allow the  effused fluid
to escape is often of  great advantage ; but
here great care must be taken, and the parts
should be wrapped in flann Is wrung out in
hot water,  and gradual oozing may  be  per-
mitted for some days.  This plan is more suc-
cessful in cases resulting from kidney disease
than in those in which the hea^t is affected.
  ANCHYLOSIS is a term used in surgery,
signifying a fusion or welding together, either
partially or  totally, of the end  of bones at the
joints, as a  result of  injury or disease.   It is
commonly divided into three varieties : false,
that is, where the bag containing  the joint oil
becomes thickened and thus impedes motion.
Ligamentous, where  two opposed   articular
surfaces  become unnaturally  united.  Bony,
when the  last-named form of  anchylosis be-
comes ossified or converted into bone tissue.
With regard to treatment, the only form in
which a non-professional man can be of assist-
ance  is in the first-named, when,  after tne
inflammation  following  a severe wrench or
sprain, where   stiffness threatens,  passive
motion, i.e., for the  bending or extension of
the joint, is performed  by another  person,
assisted by shampooing, warm baths, rubbing
or  emollient applications.   The second or
third stages come under the surgeon's care.
  ANEURISM is a  pulsating  tumor  com-
municating, either directly or indirectly, with
the calibre of an artery (see Artery).  If its
sac is composed of  the arterial coats, it is
called a  true  aneurism  ; if formed  by  sur-
rounding  tissues,  owing to a wound being
made in the vessel, it is termed false.  Tru«
aneurism is  the result of disease of the arterial
coats, and its mode of formation varies either
by these  coats  evenly dilating into a pouch,
in the walls of which atheroma (see Athe-
roma) is apparent, or by the gi'dng way of
the internal and middle coats owing  to disin-
tegration, the  external«one forming  the wall
of the cyst,  or by rupture of the internal and
middle coats during  some violent muscular
effort, in which the arterial tunics are stretch-
ed beyond what they are able to bear.   The
contents of the sac are blood, fluid or coagu-
lated, and layers of fibrin.  There are several
kinds  of  true  aneurisms ;  thus,  surgeons
speak of the tubular, i.e., when the sac is uni-
formly dilated ; the sacculated, when the sac is
unequally dilated ;  the  dissecting, when the
blood gets  between the  coats of the artery.
Tumors  situated over an artery may  have
a pulsation communicated to them by the
underlying  vessels, and simulate aneurism  ; 
22
ANGELICA
ANKLES
 but such a tumor can be  generally told from
 an aneurism, lrom  the fact that  by pressure
 the latter can be emptied, and refills immedi-
 ately the pressure is removed ;  and on listen-
 ing to it closely with a stethoscope (see Steth-
 oscope), a  peculiar thrill, or  rush, can be
 heard, caused by the blood passing through it.
   Treatment.—The chief means adopted for
 the cure of aneurism are the ligature, pressure,
 and  flexion.   That  by ligature  consists in
 passing  a  stout hempen thread round  the
 artery, between the aneurism and the heart,
 so cutting off the current of blood through the
 main trunk,  the circulation being  gradually
 re-established  by  what is  termed  collateral
 means ;  that is to say, the work of  the main
 vessel is thrown upon  its smaller  branches,
 and by their dilatation the blood finds its way
 into  the limb beyond  the point of ligature.
 Pressure may  be exerted upon  an aneurism
 either by mechanical means, such as tourni-
 quets, or by the fingers—digital compression.
 The treatment by  flexion consists  in flexing
 or bending the limb, such as the leg upon the
 thigh, or the forearm  upon the  arm, where
 the aneurism is situated, as it frequently is in
 that  portion of an artery  immediately oppo-
 site  to  the  point  of flexure of the limb in
 which it lies, such as in the ham (popliteal
 aneurism), or bend of elbow.   In the case of
 false  aneurism,  resulting  from rupture or
 puncture of an artery, pressure should be im-
 mediately applied between the  heart and the
 supposed point of escape of blood, until sur-
 gical  aid arrives.   There  are  several  other
 methods of treatment, which, however, need
 not be discussed here.
   Internal Aneurism.—Though  in  a work
 like  this it is necessary to refer to internal
 aneurism for the sake of  completeness, not
 much need  be said with regard to it.  The
 forms of aneurism, as above defined, which
 most frequently occur internally,  are aneu-
 risms of the great vessel of the body, the aorta,
 or of its branches,  or  aneurisms  occurring
 within the head.  Cerebral aneurisms—aortic
 aneurisms—may be situate either in the cavity
 of the chest  or in  the  abdomen.  In either
 situation a certain number of them admit of
 surgical  operation,  which is sometimes  suc-
 cessful ;  while  some of them  yield to reme-
 dial treatment, especially if accompanied by
 absolute rest  in bed.  In all cases where such
 a thing is suspected, the earliest opportunity
 should be taken of consulting a skilled prac-
 titioner on the subject
  ANGELICA root is produced by the plant
 known  as  Gaudea  Angelica,   the  Angelica
 Arcliangelica  of the botanist.   It contains a
 pleasant  volatile oil, and is used as a stimulant
 and carminative in  medicine.  The stem of
 the same plant is  preserved in  sugar,  and
 used as a sweetmeat.
  ANGINA   PECTORIS or BREAST
PANG is fortunately  not a disease of fre-
quent occurrence.  It comes on in paroxysms,
in which there is a struggling for breath, in-
tense pains about the region of the heart, and
a terrible sense of  impending death.  The
anguish is extreme while it lasts, but it passes
off and leaves the patient apparently tolerably
well till the next attack.  The face is pale, the
body covered with sweat, and the  sufferer per-
fectly sensible.   The  attack  does  not last
long, ordinarily only a minute or  two, though
sometimes longer. It always recurs, but at no
fixed interval ;  it may be  absent weeks or
months,  but  the  intervals  tend  to become
shorter  the  longer the disease lasts.   They
come at anytime—night or day—whether the
patient be walking about or lying down.  As
to the cause of these  attacks, that is obscure ;
generally there  is some malady of the heait
itself.  It may be  fatty, or its own particular
vessels  may  be diseased and the circulation
through them obstructed, or both may exist.
These  are the diseased conditions most fre-
quently found.  After one seizure, as already
pointed out, another is  to be dreaded as likely,
and accordingly, during the interval,  every-
thing ought  to  be done that will conduce to
the patient's health.   During  the paroxysm
stimulants like  brandy, aromatic spirit of
ammonia,  ether,  and  spirit  of   chloroform
ought to be given. Recently a drug, nitrate of
amyl, has been found  to control the attack,
but  this  is too  dangerous for common use
without medical advice.
  ANGOSTURA BARK  is obtained from
South America.  It is not much used in med-
icine, but its name has been given to a  kind
of " bitters" a good deal   employed.  It  is
tonic in its properties, and is also said to he
of  some  use in  ague and similar  tropic-d
fevers.   A simple infusion of the bark might
be used  with  advantage in  domestic practice
for loss of appetite and weak digestion.
  ANGULAR CURVATURE is a disease
of the  spine often met with in scrofulous or
rickety children, and resulting from the erect
posture being assumed when the spinal col-
umn is  too  weak to bear  the  weight ol the
head and upper part of the body.  The spine
is curved so that the  convexity  looks  back-
ward ;  the ribs often bulge out more on one
side than on the other ;  and the chest is much
encroached upon, so  that  there is less room
than usual for the lungs to expand.   It is a
sign generally of serious  constitutional im-
port, but its nature and  treatment  will le
treated of in the article on  Rickets.
  ANIMAL HEAT.  (See Heat, Animal )
  ANISEED furnishes a  volatile  oil  with
stimulant properties.   A drop or  two may be
given on sugar to allay windy spasms.
  ANKLES  (WEAK) is  an affection  de-
pending  upon weakness of  the  flexing and
extending muscles of  the  ankle-joint, or on
a rickety condition of the bones  of the ler-.
To remedy this condition, high-heeled boots 
ANODYNES                                   ANUS               23
 should be worn, with  the  inner edge of the
 heel thicker than the outer or a stout webbing
 bandage  should  be applied carried round the
 ankle from the inner side  of the foot (see
 Bandages).   Cold water douching, and some
 astringent lotions, such as  arnica lotion, are
 sometimes of  value.
   ANODYNES.  (See Narcotics.)
   ANTACIDS  are  any  kind of medicine
 which counteract the formation of acids in the
 system.   The alkalies and alkaline earths are
 the best antacids.  The carbonate and bicar-
 bonate of these substances are better than the j
 pure alkalies and earths, which act as caustics,
 and unless largely diluted, injure  the coats !
 of the stomach.   The best  forms of  antacid I
 medicines are the bicarbonates of soda and
 potash, and the carbonates of lime and mag-
 nesia.  (See Chalk.)
   ANTHELMINTICS are medicines which
 are given to expel worms from the  intestinal J
 canal ; they are  generally given in conjunc-
 tion with a purgative,  so  as to favor their
 action and to get rid  more effectually of the
 parasite.  The anthelmintics in most common
 use are only three or four in number,   i. The
 extract of male-fern, which is given in cases
 of tapeworm,  and which should be taken on I
 an empty stomach after   fasting.  2. San- I
 tonin, a crystalline white neutral  principle,
 turning yellow on exposure to the light ; it
 should be given when a round  worm or lum-
 bricus is present in the intestines ; five grains
 of this substance with an  equal quantity of
 compound jalap  powder will prove effectual
 in a child from six to ten years of age.   3.
 Kousso is part of a plant growing in  Abys-
 sinia ; it may  be given  for tape-worm, but it
 is not  in  common use.  4.  Kamela  is an
 orange-red powder which purges freely, and is
 used in India for tape-worms ; it is a powerful
 anthelmintic, but  is seldom administered in
 this  country.  In addition to the above  an-
 thelmintics, there are many  purgatives, as
 rhubarb  or jalap, which  will  bring  away
 worms, but they have no  special  character
 beyond their purgative action.   Injections or
 enemata of salt and water,  or solution of the
 perchloride of iron and infusion of quassia,
 are very  useful  in the  treatment of  thread-
 worms in children.  (See Entozoa and Par-
 asites.)
   ANTHRAX is the technical name for car-
 buncle.  (See  Carbuncle.)
  ANTIDOTE is the  name  given  to  any
 remedy which, whether used externally or in-
 ternally, is capable of counteracting the effect
 of a poisonous agent.  (See Poisoning ;  also
 see each particular poison.)
  ANTIMONY is most commonly employed !
 in combination with cream of tartar, when it
 is called tartarated antimony, or more com-
 monly, tartar emetic.   It is a powerful med-
icine, and must be cautiously used.  In small
doses not exceeding half a grain, it promotes
perspiration, in larger doses producing nau-
sea, and in still larger doses vomiting ; for
the latter purpose two or three grains suffice.
It is best given as antimony wine, from 10 to
30  drops,  to  produce perspiration ;  a  tea-
spoo.nful or more to produce sickness.   As a
remedy it used to  be much employed in in-
ternal  inflammation,  especially those of the
lungs,  on account of  its power of controlling
the circulation, but is now seldom resorted
to.   So, also,  it was  used in croup,  and by
many  is still  so employed.   It. is useful in
promoting expectoration in the earlier stages
of bronchitis, when the chest is sore and the
cough dry.  It is very  useful in feverish colds,
promoting  perspiration  and relieving the
aching pains then often experienced.  It had
better  be  combined  with  a  few  grains of
Dover's Powder.  The  dose is from 3 to  5
grains.   Antimony  has  occasionally  been
used as a slow or secret poison.  The symp-
toms it  produces are sickness, tendency to
vomit,  complete loss of appetite, and extreme
debility.   Its detection is easy.
  ANTIPHLOGISTICS are remedies which
are supposed to oppose inflammation  in any
part of the body, and act as antagonist's to
any excitement or stimulation going on in the
body from disease.   Bleeding is one of the
most powerful antiphlogistic  remedies.  The
salts of antimony and mercury are also anti-
phlogistic remedies.
  ANTISCORBUTICS are  medicines and
articles of  diet that counteract the effects of
sea-scurvy, or any tendency to that  disease.
The most efficient antiscorbutics are uncooked
vegetables,  and lemon-, lime-, and  orange-
juice.  (See Scurvy.)
  ANTISEPTICS are agents that counter-
act the effect of putrescency  in the living or
dead organism, as carbolic  acid, charcoal,
common salt,  vinegar.  (See Deodorants,
Disinfectants.)
  ANTISPASMODICS are those medicines
which overcome pain, cramp, or spasm in the
human  body,  as ether, opium, assafoetida,
and brandy.
  ANUS (ARTIFICIAL) is an  unnatural
opening  in some part of the walls of  the ab-
domen, communicaiing  either directly or in-
directly with an orifice in the intestinal canal.
Through this opening, when it is  placed in
the lower portion of the gut, the whole of the
excrement  is passed,  and a mixture of excre-
mentitious  matter and partially digested food,
when it  is  placed higher up and  near the
stomach.   The most  frequent causes of the
affection are penetrating wounds of the ab o
men, neglected strangulation, and mortifica-
tion of a rupture, and the ulceration set up by
the presence of a foreign body in the intes-
tine ;  but  an  artificial anus is  sometimes
formed intentionally  by the surgeon  in cases
of obstruction  of the bowels, or to relieve the
severe  pains caused by the  flow of excrement 
24
AORTA
APERIENTS
 over a cancerous growth in the rectum.   In
 some  instances, instead of a large  opening
 into  the  intestine,  there  exist  one, two, or \
 more  minute orifices through  which  but  a
 small  quantity  of excrement, and  that  in a
 liquid state, is passed.   To this latter condi-
 tion the name of fcecal fistula  is given by  sur-
 geons. Artificial anus  is a  most annoying
 affection, and, when placed near the stomach,
 terminates sooner or later in  death, owing to
 the  debility caused  by  the discharge of  par-
 tially digested food.  In consequence of  the
 Irequent  and  involuntary flow  of excrement
 from the  orifice, the patient complains of un- j
 cleanliness, and suffers from  pain and  irrita-
 tion in the skin  about  the  opening.  Severe
 colic is also  a  frequent  affection in cases of
 this kind.  Occasionally  there  is a prolapse
 or  protrusion of a  considerable portion of
 bowel through the artificial opening, a very
 painful condition, and necessitating immedi-
 ate relief  and return of  the  displaced  tube.
 The palliative treatment of artificial anus con-
 sists in frequently repeated cleansing of the
 skin around the opening  and  the application
 of lead lotion, zinc ointment, or a  lotion of
 zinc and tannin.  For the purpose of hinder-
 ing  the constant discharge of  excrement, a
 plug of metal or wood  must be worn.   In
 some instances  a metal case  has been  worn
 for the purpose of catching  the discharge.
 These appliances vary much in form  and con-
 struction.
  AORTA is the name given to the  large
 vessel  which arises  from  the  left ventricle of
 the heart, and thence conveys the  arterial
 blood  by  numerous  branches  to the various
 parts of the body.   It is an elastic tube  about
 three  inches  in circumference  at first,  but
 afterward  becomes considerably narrower.
 In the first part of its course it is nearly ver-'
 tical for about two inches and  just behind  the
 sternum ;  it then forms an arch, and,  curv-
 ing from right to left, and  from before back-
 ward, it descends by the side of the vertebral
column, through the diaphragm into the  ab-
 dominal cavity, and there divides into two
 terminal branches called the  iliac  arteries.
 From  the upper portion  of  the arch  arise
 three great trunks, the  innominate,  left car
otid, and left subclavian ;  these  vessels  send
 the blood  to the head and neck and upper  ex-
 tremities.   From each side of  the descending
aorta are  sent off numerous branches which
supply the lungs, and the thoracic and abdom-
 inal walls, while from the anterior aspect in
trie lower part of its course vessels are given
off which  convey the blood to the  stomach,
liver, kidney,  pancreas,  spleen, and intes-
tines.  This vessel is often liable to  disease.
 As people advance in age or when their blood
becomes impoverished by disease, the walls of
 this artery are liable to decay  through receiv-
 ing insufficient nourishment.and degeneration
of the coats takes place in consequence.  As a
 result of this the vessel  becomes more  rigid,
 and there  is  difficulty in  the conveyance of
 the blood to the various organs ; sometimes
 an uniform dilatation of the aorta occurs, at
 others a bulging ol the wall takes place at one
 spot, and gives rise to  an aneurism, a state
 attended with great danger.   People who are
 subject to gout, or who indulge in drink, or
 those who have kidney  disease,  are  liable to
 have degeneration of  the coats of the vessel ;
 it is rarely met with in children, and  is alto-
 gether a chronic condition arising from a viti-
 ated  state of the blood, and often produced
 by neglect of the ordinary principles of health.
 Great exertion, such as  is  brought on by row-
 ing or by athletic sports, tend to cause dilata-
 tion of  this vessel, and it  is said to occur
 among  soldiers as a  result  of  wearing too
 tight stocks, which impede the passage of the
 blood to the head and neck.  It seems like-
 ly that amongst  men  who  train severely,
 harm is done  by suddenly  returning to a lib-
 eral  diet after living for weeks in rigid disci-
 pline.  Malformation of this vessel sometimes
 occurs in foetal life ; it is in  rare  cases given
 off from the right ventricle instead of the left;
 for such cases  no treatment can be  of any
 avail, and death generally takes place in early
 life.
  APERIENTS are medicines which act on
 the  bowels and enable  them to  expel  their
 contents.    They  are  also called purgative
 medicines.  They  act for the most  part in
 making the muscular coat of the bowel con-
 tract more vigorously than usual, and some set
 up an irritation of the lining membrane ; some
 simply empty the  bowel, others drain away a
 certain quantity of fluid from the blood.  Ape-
 rients are  divided into  different classes ac-
 cording to  their nature and action, l. There
 are the simple aperients,  as senna, castor-oil,
 and  rhubarb ;  prunes,  figs, tamarinds, and
 sulphur also belong to  this  class ; they simply
 empty the bowel, do not cause much griping
 pain, and are useful in many cases of disorder-
 ed stomach ; when administered, some warm
 stomachic,  as ginger  or peppermint, is  gen-
 erally  given with the dose.   2. The saline
 aperients, as Epsom salts or sulphate  of mag-
 nesia, Rochelle salt, citrate of magnesia, sul-
 phate of potash, etc.  These  may be taken in
an effervescing form,  and are  useful  when
 there is any fever present with the constipa-
 tion.  3. Drastic  aperients, like  colocynth
 and jalap, cause much purging and drain the
 blood of fluid  also ; they act as direct irritants
 to the intestinal canal.   4.  Hydragogue aperi-
ents, as elaterium, scammony, and gamboge,
cause very  watery evacuations, and hence are
used in cases  of dropsy arising  either from
disease  of  the heart or kidneys,  so as to di-
minish the  quantity of fluid  which is effused
 into   the  different  tissues.   5.  Cholagogue
 aperients, or those which are supposed to ac-
 more especially on the liver,  as mercury, tart 
APHASIA                                  APHTHAE              2a
 axacum, and podophyllin.  6.  Emmenagogue
 aperients, or those which act more especially
 on the womb, as aloes, etc.  The reader must
 refer to each drug for any further description
 of its action.
   APHASIA, or loss of the faculty of speak-
 ing, occurs in certain cases  of  hemiplegia of
 the right arm and leg ;  this must  be  distin-
 guished from aphonia or loss of voice : in the
 former the faculty is lost,  in  the  latter  the
 mechanism is interfered with.   The persons
 so affected will  probably understand what is
 going on around, but are  unable  to ask for
 anything, and if they speak at all, will limit
 themselves to the use of monosyllables. Even
 if asked to spell their own name they will fail
 to do so, and in  reply to any  question  they
 generally reiterate the same expression.  The
 handwriting  is affected, too, in most cases,
 and although they know what particular letter
 to write, they are unable to put it in writing.
 Often in the course of a few weeks or montns
 recovery slowly  takes place, and  every day
 they will learn a few fresh words until  they
 acquire a tolerably large vocabulary. Nothing
 can be done  specially for this singular symp-
 tom, except  daily educating the patient, be-
 ginning with simple words and  short phrases.
   APHONIA implies  loss  of voice.   It is
 very frequent  in  cases of common cold,  or
 catarrh,  and  then the  patient can  hardly
 speak above a whisper, and there is frequently
 more or less pain or feeling of soreness in the
 throat and chest.  The  best thing to do is
 to  wrap some warm, dry flannel  round the
 throat, and inhale steam by the mouth. This
 may easily be done by pouring boiling water
 into a jug and then draw in air by the mouth
 while  the face is held over the vessel ; still
 better, the individual may use an inhaler made
 for  the purpose and of  various kinds ; such
 can easily be obtained at a druggist's.  It is
 necessary,  as far as possible, to avoid going
 out at night,  or even during the day when the
 air is cold and  raw, or  when  there is much
 fog.  This variety is very curable, although
 it  is much more common in some people  than
 in others,  and more so  in women than  in
 men.  Another kind is  met with in some
 cases of hysteria, and chiefly in highly nervous
 young women.  It occurs quite  suddenly, and
 even v/hile  conversing  as usual,  and often
 without any marked cause.  Generally, how-
 ever, there is some emotional cause  which has
 brought on the complaint,  as  fright, mental
 worry, loss of a relation,  or trouble in pecu-
 niary affairs.  When it happens for the first
 time it is apt to alarm the patient, but there
 is  really no  danger  in  it.   Frequently  the
 voice returns as quickly as it went, and to the
great surprise and delight of the patient  and
her friends, but the complaint  is very liable
to come back again.   There is  no actual dis-
ease, but the muscles which are brought into
action in the mechanism of speech  are  not
affected by  the  will, and  hence will not act.
As  a rule, the voice will return in a month, if
the throat  be galvanized, even  though the
patient has not spoken above a whisper for a
year ; sometimes the voice will return imme-
diately after the first application of the gal-
vanic current  ; in a  very few  cases the dis-
ease is more obstinate and may last for a long
time. Change of air and horse exercise, easy
circumstances, and the removal, if  possible,
of the exciting cause,  will often effect a  cure.
Sudden  shocks have  been known  to  bring
back the voice at once.   In the  last stage of
consumption,  aphonia is often met  with, and
here, too, there is a roughening or ulceration
of the vocal cords which are mainly concerned
in the production of  speech.   In other  cases
there may be warty growths on the vocal  cords
which intertere  with speech.  These may be
seen by means of the laryngoscope,  an instru-
ment provided with a mirror, by means of
which the insideof the upper art of the air-pas-
sages may  readily be seen ; and  indeed this
instrument  is very useful in making out the
cause in all the varieties of  aphonia.   The
treatment for these growths consists in  their
removal.  Foreign bodies in  the larynx or
upper part  of the air-passages,  as coins or
marbles, etc.. are obvious causes of loss of
voice ; they should be removed without delay.
  AFHTHiE (or Thrush) are  small round
ulcers  covered  with  whitish   patches  of  a
sloughy  appearance   which  occur in  the
mouths  of children and not unfrequently ex-
tend downward into  the stomach.   They
constitute the disease called thrush in infants.
In  adults  they  rarely occur  except in the
worst stages of certain fevers or allied con-
ditions,  where the bodily powers are at the
lowest possible ebb.   In children they  often
begin as small white blebs or blisters on the
tongue and insides of the cheeks. These burst,
and the  little ulcers remain behind.  Some-
times a number of these  grow together, and
form a single mass covered with the whitish
or yellowish leathery-looking substance.   Be-
neath the membrane the sores are red and
angry looking.  They occasion great discom-
fort to the  poor infant, and frequently inter-
fere with its powers of taking food.   Not un-
frequently  the condition  follows or accom-
panies measles.   In dealing with such a con-
dition the first thing  is to keep up the child's
strength by careful feeding.  Raw meat well
pulped may be  given if necessary.   As the
bowels are generally disordered they should
be  attended to,  a little  gray powder being
perhaps the best  opening medicine. This may
be required, even supposing the child has di-
arrhoea.  Lime-water is  a valuable  internal
remedy,  and  should  be  given always  with
milk.  For  the  lips and  mouth borax  and
honey or glycerine, well smeared on, is  per-
haps the best application.  Or a wash consist-
ing of 60 grains of sulphate  of soda to the 
26
APNCEA
APOPLEXY
 ounce of water may be  freely applied by a
 feather or brush.
   APNOZ3A is the name given to the mode
 of death which results from not allowing the
 entranceof air into the lungs.  Death does  not
 take place directly, but may occupy three or
 four minutes ; a simple experiment may be
 made upon a dog  : thus, if a string is passed
 round the trachea and suddenly tightened so
 as to  prevent  any air  ent  ring, the animal
 will struggle  very severely, and  will die in
 from four to five minutes.   In cases of suffo-
 cation, where the head or a pillow is placed
 over the nostrils, death is produced in a sim-
 ilar way ; and also  in  those  cases where a
 cord is drawn round the neck, as in the pro-
 cess of strangulation.  When hanging  takes
 place death may  be produced by fracture of
 the spine, or by apoplexy ; yet sometimes it is
 produced by apncea when the drop is not very
 great, and then death is not so quick as where
 injury to the spinal  cord  is  met with.  In
 drowning, also, death is produced by apncea ;
 for a time the person may be enabled to keep
 on the surface and inhale air, but as exhaus-
 tion comes on he sinks, and the water above
 him effectually prevents the entrance of air,
 and death must ensue very shortly.  It will
 be seen, therefore, that death can hardly take
 place in less than four minutes, even when
 the strangulation  is  very complete,  and of
 course it takes much  longer in the majority
 of cases.  Every means should  therefore be
 taken to  restore the respiration as soon as
 possible, so long as the body is warm, and by
 continuing to do  so  for a long time  many
 cases  have  been successfully  restored  to
 health, although quite insensible and appar-
 ently  dead.   Any  person   found hanging
 should be at once  cut down, and all pressure
 removed from the neck ;  the  patient should
 be placed in the open air, and  artificial res-
 piration should be performed at  once.  Simi-
 lar treatment  ought to be adopted in cases
 of strangulation, suffocation,  or drowning.
 (See Drowning and Hanging.)
  APOPLEXY is a state in which a person
 falls down suddenly and lies without sense or
 motion, while the breathing  is often labored
 and noisy, and the pulse beats often with un-
 natural force.  To  this condition the name of
 coma  has been applied.   A person thus  at-
 tacked is  unable  to think or to feel, or to
 make any voluntary movement, but the func-
 tions  of  the   respiratory and   circulatory
 organs still continue, although their action is
 more  or  less  interfered with.  The attack
 does not always come on in the same way.
 In some cases the person falls down in a deep
 sleep, with a flushed face and labored breath-
 ing, and convulsions may ensue, or rigidity
and contraction of the muscles of the arm or
leg.  In other cases the coma  is not the ear-
liest symptom ; there may at first be sharp
and sudden  pain in the head, then faintness
 and pallid skin and vomiting ; after a 1 jpse of
 time, which may vary from a few minutes to
 several hours, the patient becomes heavy and
 stupid, and sinks into a state of coma.  And
 these cases are nearly always latal, and more
 dangerous than  those which commence sud-
 denly.   There is yet a  third set of cases, in
 which  the apoplectic  state  is  not so  well
 marked,  and in  which the patient  may be-
 come paralyzed without  actually losing con-
 sciousness.  There  is sudden  loss of power
 on one side  of the  body, and to this kind of
 paralysis the  name hemiplegia is  applie 1
 (see Hemiplegia) ; the patient may be sensi-
 ble, and able to answer questions and give an
 account of the attack, but  very frequently
 speech is affected, and there has been some
 transient giddiness.   These cases  are less
 formidable than  the others above-mentioned.
 Sometimes the patient soon gets  well, and
 the  paralysis passes away completely ; or he
 may recover to a certain point and be able to
 walk about, but only partially regain the
 power of moving his leg  and drag it after him
 in walking ;  or the leg may improve and his
 arm remain weak.  Occasionally no improve-
 ment takes place,  and the person  becomes
 bedridden and perhaps unable to walk, while
 he is still  more or less sensible, and after a
 lapse of some weeks or months, he finally dies
 of exhaustion. In the first method, then, there
 is coma  with paralysis ; in  the second, pa-
 ralysis  followed  by coma ; and in the third
 paralysis without coma.  When a person falls
 down in a fit of apoplexy he is  quite uncon-
 scious of anybody or anything  around him ;
 if pinched or pricked with a pin he will not
 feel it ; if spoken to loudly  he  will not take
 any notice ; if a limb be raised by a bystander
 it will  fall  helplessly  down   again.   The
 breathing may be heavy and noisy, or irregu-
 lar, and when he takes  a  breath  it is attended
 by a snoring noise, and  his cheeks  puff out
 when he empties his chest on expiration.  The
 face is sometimes flushed or of a dusky ap-
 pearance ; the eyes are generally closed, and
 the pupils  smaller than natural.   Often, too,
 one  side of the face is palsied and the mouth
 is awry,  because it is  drawn  over to the
 healthy side  , when this  occurs, the  patient
 cannot  masticate his food  well, because  it
 lodges  between the gum and  cheek of the
 affected  side ; wtien he  tries to whistle the
 paralyzed cheeks  puff out in a helpless man-
 ner ; occasionally, also, he is unable to close
 the eye on the  palsied side, and care should
 be taken to keep it covered, as otherwise the
 wind or dust, or some foreign  matter, may
get into it and cause considerable irritation.
Sometimes convulsions  occur,  or one limb
may be rigid.  The bowels are often slug-
gish, and a motion is passed  in the bed un-
consciously ;  the  urine, too, will  flow or drib-
ble away without  the patient  being  aware of
it.  This state does not, as a rule, last long, 
APOPLEXY                              ARACHNITIS           27
and dtath may take place in a few hours ;  in
other cases the coma may still continue, and
the patient may linger on  for several days,
and even for a month ;  but generally, if death
does not  take place in  twenty-four  hours,
there is considerable hope of  recovery.  The
deep sleep by degrees passes off, the  patient
becomes partially sensible  of persons or ob-
jects around him, and is able to swallow some
nourishing liquid ;  but although conscious-
ness may thus  return, the  memory  is often
much affected, and the patient is low-spirited,
and ready to weep on any occasion, or he may
remain more or  less imbecile for the rest of
his life.  When  the coma has passed away,
the hemiplegia,  or palsy of one  side of the
body,  may  yet  remain  for  some weeks  or
months ;  in some cases complete  recovery
may take  place ;  others are bedridden for
life,  while many obtain  a partial use of the
palsied arm or leg.  As a rule, the face is the
first  to recover,  then the leg, and lastly the
arm.   The speech  is  sometimes thick  for
some weeks, but it  generally improves at  an
early period; and there are certain cases  in
which  although  the patient  knows clearly
what is said, yet he cannot answer properly,
and keeps to one or two monosyllables on  all
occasions, and so makes absurd replies ; in
such cases the ordinary process of writing can-
not be performed.   Apoplexy attacks people
of all ages : but it is far  more common after
fifty  years of age ; it is  met with in both
sexes ; it  is found  not only in  full-blooded
people with  a red face, short thick neck, and
stout frame, but also in thin and spare people.
Some  persons are  more or less liable than
others in  consequence of some hereditary
taint of  constitution.  A  patient generally
has some warnings before a fit comes on :
headache, sickness, and giddiness coming on
in advanced life are threatening symptoms ;
or there may be double vision or squint, or
numbness of a limb, and the familiar sensa-
tion  of pins  and needles  ; in other cases loss
of memory and a mistaken use of words are
signs of the coming attack.  Anything which
makes the heart beat  faster or fills  the head
with blood may excite an attack ; much bodily
exercise, as  galloping on horseback  or  hast-
ening to catch a train, or running upstairs ;
any violent mental shock or fright, or any kind
of excitement—may bring on a fit in those who
are liable to the disease, and therefore should
be avoided.  Straining at stool and any stoop-
ing position should be guarded against.  And
it is important to remember  the  danger that
may  arise from neglecting these  precautions,
as an attack may with due care be warded off.
  Treatment.—When a person is in  a fit, his
neckcloth or any  tight  part of the dress
should be loosened : he  should be kept in a
horizontal position  and  placed on  a bed  or
couch, with his head  slightly  raised.   A
piece of linen, dipped in vinegar and water,
may be laid across the forehead, and hot bot-
tles should be applied to the feet if they are
cold.   Perfect quiet  should  be kept, and
the blinds may be drawn down, so as not  to
let too much light into  the room, and only
one or two people should be allowed by the
bedside.
  APPENDIX   VERMIFORMIS  is  a
small  portion of  the  crccum  (see Intes-
tines) which  hangs down  in a worm-like
shape in  the centre of the abdomen.  It  is
remarkable for no known use  being assign-
able to it.  At the same time, it is often a
source of  disease and  death.   In  the pas-
sage of the food through the intestines  it of-
ten happens  that  a cherry-stone,  lemon  or
orange seed, or other such hard substance,
drops  into the cavity of the  appendix and
produces inflammation, ulceration, and often
death. This catastrophe may be suspected
when intense pain occurs  in the abdomen
over the  seat of the caecum.
  APPETITE, as  used  in  medical   lan-
guage, means  a  healthy  desire  for  food.
Loss of  appetite, technically called anorex-
ia, is one of the most common symptoms of
disease, as the return of appetite  is one  of
the most certain  signs  of  returning health.
This  returning  appetite is  one  of  those
things which require somewhat careful man-
agement.  It is sometimes not a bad rule  to
make a patient hungry  and keep  him hun-
gry ; certainly anything like overtasking the
stomach  or its powers is to be carefully avoid-
ed.  At  first, as  the powers of the stomach
have been greatly weakened, small quanti-
ties of food, carefully  prepared,  ought  to be
given and  repeated frequently if necessary.
Disordered appetite is frequently a symptom
in females  of hysteria ; it may also  occur  in
early pregnancy.
  APPLE is the fruit of a species of Pyrus,
and one  of the most popular of  fruits.   Ap-
ples contain malic acid, which gives  them
their  acid  flavor, and a varying quantity  of
sugar, pectin, cellulose, and  salts.  Practi-
cally, they are divided into eating and  cook-
ing apples, the latter having more cellulose
and acid, and less sugar.   When eaten it  is
advisable to  take  off the peel and  remove
the core, as those parts  are less digestible.
In  cooking, the  peel should be  removed
and  sugar added.   If roasted,  the  peel
should be allowed to remain on.   Apples,
like other vegetable products, contain saline
matters  which act beneficially  on the sys-
tem.  One or two apples  a day, according
to their size, may be  taken advantageously
as an anti-scorbutic.
  AQUA  FORTIS is  an old Latin name,
meaning strong water,  for nitric acid.  (See
Nitric Acid.)
  ARACHNITIS  is a  name  sometimes
given  to inflammation of  the membranes of
the brain.   (See Meningitis.) 
28          ARCUS  SENILIS
ARSENIC
  ARCUS SENILIS  is a term applied to '
the narrow opaque zone which may be ob-
served  near  the  margin  of  the  cornea of
many aged persons.  It usually affects both
eyes, and varies in tint, according to its per-
iod of duration, from a pale gray to a dense
chalky white.  It does not  extend to the
circumference  of the cornea, but  leaves a j
narrow ring of  clear  corneal tissue  between i
its  sharply  defined  outer  margin  and the
commencement of the  white  external  tunic
of the eyeball,  the sclerotic.  It commences j
as an indistinct semi-opaque crescent seated
near the upper or lower margin of the cornea,
which crescent  gradually extends around the
whole circumference of this  portion  of the
eye  and  increases  in width and  opacity.
This appearance is due to fatty changes in
the circumferential parts of the cornea, and
is, according to man)' authorities, an indica-
tion of fatty degeneration of the  heart and
other internal organs of the body.   This so-
called arcus senilis, though most  frequently
met with in old subjects, often makes its ap-
pearance on  persons of thirty or forty, es-
pecially  in  those  who in consequence of
physical or mental exhaustion, or from he-
reditary predisposition, become prematurely
aged.
  ARDENT SPIRITS.  (See  Alcohol.)
  ARISTOLOCHIA.  a genus  of plants,
so called from  its being thought a remedy
promoting recovery after child birth.  There
is a species called the Virginian snake root,
having the doubtful reputation of being a
remedy against the bites of serpents.  It  is
used  in  medicine, and is  a  stimulant and
tonic, and given in cases of debility and ague.
  ARM, BROKEN.  (See Fractures.)
  ARNICA, the root of the Arnica  montana,
as a remedy, is  mostly used in homoeopathic
practice.   Its  tincture is  most  commonly
used as an outward  application in  sprains
and bruises, and for these it is excellent.
  AROMATICS are  drugs which have a
pleasant  smell,  agreeable   flavor,  and
slightly stimulating properties.  Most of the
essential oils belong  to these groups of sub-
stances.
  ARRACK is a kind  of distilled spirit,
much used in the East, and is obtained from
fermented rice, betel nuts,  and  the  sap and
fruit of palms.  It is prepared with  less care
than European  distilled spirits.and  contains
pure oil  and other  substances, which pro-
duce headache  and other disturbances cf the
nervous system.
  ARROWROOT is the name  given to an
alimentary substance  obtained  from the
tubers and roots of various plants.   Genuine
arrowroot is, however, obtained  from the
root stock  of various  species  of  A/aranla.
Arrowroot is a  white powder, consisting en-
tirely  of  the  granules  of  starch.   It is
sold in shops  under  the  names  of  West
Indian,  East  Indian, and  Bermuda  arrow-
roots.   From whatever part of the  world
they come,  they have the  same properties.
They letch  different  prices,  according  to
their  whiteness, absence  of  flavor,  and
other properties.  Like all mylaceous food,
anowroot becomes  thickened by boiling  in
water, and  can  be made  the recipient  of
other substances,  as  wine,  brandy,  sugar,
spices, etc.  It is on this account extensive-
ly used  in the sick-room.   It should, how-
ever,  be recollected that it has no higher die-
tetical value than other forms of starch.  (See
Corn Flour,  Sago, Tapioca.)
  ARSENIC is the common term  for what
is more strictly called arsenious  acid,  or
white arsenic.  It is both a dangerous  poi-
son and a powerful remedy.  The  quantity
given should therefore be exceedingly small,
never exceeding the twelfth  part of a grain.
It is best given in the solution known  as
Liquor Arsenicalis  or Fowler's Solution,  of
which three, four,or five drops maybe given
in water immediately after a meal.  Notwith-
standing  the  disastrous   consequences  of
large doses,  given in the  small  ones de-
scribed  it is very valuable in  certain com-
plaints.   Even  in  tropical fevers of  the
same class in  which quinine  has been given
and failed, arsenic will  sometimes  succeed.
While,  on  account of its cheapness  and
small bulk, arsenic may in certain cases take
the place  of quinine, it may almost always
be superadded to the latter with advantage,
or better  still, be continued when  the  qui-
nine  has  been  left  oft".   There are some
kinds of headache,  especially one  called
brow-ague, which seems to be allied to  true
ague: in these arsenic  does good, as it al-
so  does  in  others  more distinctly neu-
ralgic   in  character.   It   has  also  been
given for  some  forms of  nervous disorder.
Of all remedies arsenic seems to be  that
which is of most use in skin diseases, es-
pecially those  of a scaly  or scurfy  kind ;
where much purulent matter is  produced it
seldom  does  much good.  Its effects are
sometimes marvellous.  Small doses should
be given very  regularly  in the way indicated
above, and  if any  smarting  of the eyes
comes on, it should  be discontinued for a
time, and again resumed in smaller quantity.
In cancerous  affections arsenic has  some-
times been  used locally for its destructive
effects, but this is dangerous, and lives have
been  lost by the practice.   In poisoning  by
arsenic  the contents of the stomach should
be promptly evacuated, and as an  antidote
the hydrate peroxide of iron  given.   The
antidote is  made  by taking a  druggist's
stock-bottle of tincture  of muriate of iron.
adding to  it the contents of the Liquor Am-
monias bottle, and pouring off the fluid  at
the  top.   The precipitate  at the bottom  is
the antidote. 
ARTERIES
ASPHYXIA
29
   ARTERIES are elastic tubes conveying
 blood from the heart, to which, after  having
 nourished  the various Structures to which it
 is distributed by means of the capillaries, or
 ultimate branches, it is carried  back by the
 veins.  For the general reader it is sufficient
 to state that an artery consists of three coats
 or coverings :  (i) An outer one, composed
 of elastic fibrous tissue ; (2) A middle, com-
 posed of muscular  fibre in a great meas-
 ure ;  and (3) An internal composed  of  epi-
 thelium, of which there are several subdivi-
 sions, which we need not specify here.  The
 elasticity of the coats of an artery serve to
 assist in  the   propulsion  of   the  blood
 throughout the  system.  The arterial  sys-
 tem   is divided  into two  main  parts.  one
 springing from the left ventricle of the heart,
 and carrying the blood  by means of the aorta,
 the great artery of the body, and  its branch-
 es to  the head, trunk, and limbs ; and a sec-
 ondary system (pulmonary) upon which  the
 former depends, namely, that arising from
 the   right   ventricle of  the  heart, which
 throws the spent blood, already sent back to
 the heart by the veins, to  the lungs to  be
 converted  (arterialized) into fit  and  proper
 blood for distribution  by the  first-named
 system.  (See Heart.)
  ARTHRITIS properly  signifies  any in-
 flammation of a joint, but in surgery the term
 is most frequently associated with rheuma-
 tism : thus we  hear of  Chronic rheumatic ar-
 thritis, a disease characterized by an  altera-
 tion of all the structures composing a joint.
 It afflicts rheumatic  and gouty patients, and
 its symptoms are, a racking, gnawing, wear-
 ing pain in  any joint, generally dependent
 on weather, accompanied by a grating feeling
 when the joint  is used, and an audible evi-
 dence of  friction of   the  opposed surface
 of the articulation.   Opiate  embrocations,
 warm  douches, Turkish baths, seem to  be
 good  local means of alleviation.
  ARTIFICIAL MINERAL WATERS.
 (See  Mineral  Waters, Artificial.)
  ARTIFICIAL RESPIRATION is used
 in cases  of drowning, or after an overdose
 of chloroform has been given, or whenever
 death  by apncea has ensued, and {here is a
 chance of saving the patient.  For  the vari-
 ous methods to be adopted,  see  Drown-
 ing.
  ASCARIDES  are   commonly  called
 thread-worms.   They look to the naked  eye
 like short bits  of white thread ; they are of
 two kinds, male and female, the latter being
 about half an inch in length, and  longer and
 larger than the  former.   They live chiefly in
 the lower part of the bowel, and may accumu-
 late there in vast numbers ; sometimes they
crawl  out or pass out when the  bowels  are
 relieved.   Great itching is  caused  in  the
surrounding  parts when they are  present.
When recently expelled they are  seen  to
 move about like little maggots.  This worm
 is chiefly found in the stage  of infancy and
 childhood,and only rarely attacks the adult.
 The symptoms by which it may be known to
 be present are, picking of the nostrils, foeiid
 breath, distension of the stomach, and irrita-
 tion about the anus  and genitals as well  as
 the actual passage of the worms.   In female
 children a discharge from the genitals is not
 uncommon in consequence of the  irritation
 caused by the worms.  The precise cause
 is not  clear; it is  found among the chil-
 dren of the poor and those of dirty habits,
 and  is  said to be caused by eating black-
 berries, apples, etc., and it seems most com-
 mon also in those who are fond of sugar  or
 sweet articles of diet.  It  is certain that the
 ova producing the worms  are taken  in with
 the food.   It is not difficult to get rid of this
 parasite ; an occasional purge, with an  in-
 jection every morning up the bowel of a so-
 lution  of common salt, and careful attention
 to  the diet,  which   should  be plain  and
 wholesome, will usually suffice.
  ASCITES signifies dropsy of the abdo-
 men.  In such cases  there is an accumula-
 tion  of fluid in the cavity of the abdomen ;
 this is sometimes so great as to cause extreme
 distension, and  then the patient  can only
 breathe with difficulty.    Its most common
 causes are diseases of the  liver, heart, or kid-
 neys ; in cases arising from mischief in the
 two  latter organs, dropsy  of other parts, and
 especially of the legs, is liable to ensue, but
 not so  when the liver is affected.   Cirrhosis
 of the liver arising from drink causes an ob-
 struction to the passage of the blood, and  so
 the abdominal cavity  becomes full of fluid ;
 the patient is then of a sallow or yellow color,
 loses flesh, and also his appetite.  The abdo-
 men is round and swollen, and Llue lines may
 be seen running over the surface  in conse-
 quence of the fulness of the  veins.  It  is a
 disease which is gradual in its course,  and
 may last some months or years.  Hot fomen-
 tations may be applied over the surface  of
 the abdomen to relieve any pain which may
 exist, and sometimes tapping the swelling
 and letting out the fluid  is very beneficial.
 Chronic inflammation of the  peritoneum  ( r
 scrofulous disease of the mesenteric glands
 in children is a  frequent cause of  ascites,
 and here the general health must be attended
 to, for  the local  disease  depends in those
 cases on the constitutional taint.  Cancer of
 the liver  or  other abdominal organ may
 cause ascites  in the  course of its progress,
 but in such cases no remedies are of much
 avail except in so far as they relieve the pa-
 tient from suffering.
  ASIATIC  CHOLERA.  (See Cholera.)
  ASPHYXIA  is  the name given to the
mode of death which occurs in drowning,
suffocation,  strangulation,  and   in  some
cases of hanging.   The  term  apncea, is how- 
30           ASSAFCETIDA
ASTRINGENTS
ever, a  more  correct  designation.   (See
Apng:a.)
  ASSAFCETDDA is a foul-smelling gum
resin, brought  from the East, where it  is
more appreciated than with us.  It is, per-
haps, best given in the form of a pill, but in
any shape it renders the recipient disagree-
able.   It is  much used in the  treatment of
hysteria, and  is  supposed  by many  to  be
highly beneficial.  Combined with  aloes,  it
is useful in certain  forms  of flatulent colic,
especiallv in hvsterical women.
  ASSES' MILK.  (See Milk.)
  ASTHENIA, a medical  expression  used
to indicate a want of power or strength in
the system.
  ASTHMA is a peculiar  but  familiar dis-
ease of the breathing organs which is char-
acterized* by a  painful gasping for breath,
coming  on  suddenly, and passing  away
%vithout  necessarily leaving injury to the
lung behind it.  We  may speak of at  least
three varieties of the disease :  ist. The first
spoken  of, which is also called Spasmodic
Asthma ;  2d.  Asthma occurring as a sign
of other disease, i.e.. Symptomatic Asthma ;
and  3d.  Certain  peculiar  varieties of the
disease, of which hay-fever is the most im-
portant.  Spasmodic  Asthma is  so called
because it is supposed to  be due to spasm
or violent  contraction  of  the air tubes,
whereby air  is prevented from reaching the
interior of the lung.  Most frequently the
disease comes on without any warning, and
commonly occurs an hour or two after mid-
night, the patient  being  suddenly  roused
from his sleep by  an attack.  '1 here is  a
feeling first of all of  constriction,  which
grows till there  is a fearful  struggle for
breath.  The patient most frequently has re-
course to the open window, and there hold-
ing firm with his hands, so as to enable him
to use the powerful muscles of  the  upper
arm for breathing, he  may remain for hours
gasping for breath.  Over the chest various
kinds of unusual sounds are heard, the skin
becomes  cold,  and  the  temperature falls
sometimes  many  degrees.  Subsequently
this  gives  way to  sweating from  fatigue.
By and by relief comes, the patient begins
to cough, expels some  pellets of mucus,
and  before  long falls  asleep.  Next day,
most probably,  the sides ache all over from
the fatigue undergone.   During  the  inter-
vals of attack  the patient may be tolerably
well, but as a rule is not strong, and practi-
cally may be said to  be a  valetudinarian—
one  constantly looking  after his  health.
The   disease   is often  most  capricious,
attacking  the  individual in apparently the
most  healthy  situations, and  leaving him
alone  in  smoky,  apparently  unhealthy
quarters.  Not unfrequently asthma is hered-
itary, and commonly  sets in about middle
life.   The immediate  cause in  bringing on
the fit is very variable, but of all causes the
most certain  and most frequent is eating
a heavy meal late in the day.  Suppers, es-
pecially of an indigestible kind, are  promi-
nent causes of an attack.   Asthma seldom
directly destroys life, however  bad  the pa-
tient may seem in the fit.  Many who are
subjects of asthma live a good long life, the
reason probably being that  they are forced
to  take care  of themselves.   Generally,
however,  the  disease  induces  other  con-
ditions, especially of heart and  lung, which
indirectly prove  fatal.  Symptomatic asth-
ma, as far as the paroxysm  is concerned, re-
sembles the other form, only being connected
with disease of  the  lung or heart, its  con-
ditions are not the same, and the fits are not
subject to the  same laws.   The conditions of
lung most commonly associated with asth-
matic attacks, are  chronic  bronchitis  and
emphysema.   Sometimes  the  order is re-
versed, and the  asthma gives rise to these.
The third variety of asthma is that which is
induced  by certain  peculiar  causes,  hay-
lever (which see) being among them.
  Treatment.—Treatment  can do much and
yet little for asthma.   The  grand rule to be
observed  is to  avoid everything likely to
set up the attack, particularly unwholesome
articles  of food.   Abstinence   from  food
must not be carried  too  far, as we some-
times have seen  it done, and  so  the onset of
other diseases favored.   If the attack has
been brought on by an injudicious meal, by
all means let the stomach be emptied.  But
in the paroxysm other remedies are to be
thought  of.   Foremost among these  we
should place a pipe of tobacco or stramoni-
um, a few whiffs of which will frequently act
like a charm.   Stramonium  inhaled is  also
a powerful remedy.   For  many  chloroform
or ether is best, but requires careful manage-
ment, while in others a draught of hot brandy
and water, or  strong coffee, is best.   In  the
interval  the health of the patient should be
carefully attended to,  iodide of potassium
and arsenic being among the most approved
remedies to be then  given.
   ASTIGMATISM is a term signifying ir-
regular refraction ; that is  to  say, that light,
as it passes through the transparent portions
of the eye to the retina, is acted upon differ-
ently by sections of these portions, thus pro-
ducing  a blurring of  the  object; or, while
one  portion of  the .viewed  object appears
distinct,  the one next  to it seems smudgy.
It is dependent  upon  several causes, such
as some original defect in  the eye, the re-
sults of wounds of the  eyeball,  or displace-
ment of the lens.  Spectacles recommended
by some competent oculist are the means of
relief.  (See Eye.)
  ASTRINGENTS are drugs which act by
causing  a shrinking  or puckering  of  the
tissue  to which they are applied if strong 
ATAXY
BALDNESS
" 1
ol
enough ;  they coagulate albumen, and check
the flow  of blood from a■ part.  Some act
locally, and may  be  applied  to a wounded
surface ;  others are absorbed into the blood,
and check hemorrhage from a distant  part.
Tannic and gallic acids are found in  gall-
nuts, and are most powerful astringents; iron,
zinc,  some  salts  of  lead,  and more espe-
cially the  acetate  or  sugar of lead, are
v ry efficacious ;  catechu,  logwood, chalk,
and  kino  are  also  astringents.    Matico
may be applied locally to awound to check
bleeding.  Turpentine is a very useful as-
tringent in some cases, and more  especially
when there is hemorrhage  from the lungs,
when it  can be  inhaled   with  steam.  In
cases of  diarrhoea, chalk, opium, and  cate-
chu or sugar of lead can be given, while  if
there is hemorrhage from the womb or kid-
ney, iron  and mixtures containing tannin or
gallic acid are necessary.   Iron and  tannin
or gallic  acid must not be given together, as
they form a disagreeable and nauseous inky
compound.   The reader must refer to the
different  drugs  mentioned for an account of
them.
  ATAXY, a peculiar affection of the spinal
cord, in which the patient loses control over
the movements  of his limbs.  (See Progres-
sive Locomotor  Ataxy.)
  ATHEROMA, a degeneration  which is
very liable  to occur in old age, as a natural
result of  senile decay ; it occurs in earlier
life in those who have led fast and intem-
perate lives, and is one of the many changes
which result in  bringing the  sufferer to an
early death.  (See Degeneration.)
  ATMOSPHERE.   (See Air.)
  ATROPHY  or  WASTING  is a  term
used  generally and  specifically.  Thus,  if
the arms  and legs waste in  any disease, they
  BAKERS' ITCH is  a form of  skin  dis-
ease produced on the  hands of bakers by
the irritation  of the yeast used  in making
bread.   (See Psoriasis.)
  BALDNESS.—Although  this  term  im-
plies complete removal of the hairs either
over the whole scalp or over portions of it,
it is proposed  to describe  under  this head
the causes and nature of the different varie-
ties of  thinning and atrophy, as  well as of
loss of the hair  Baldness, or alopecia as it
is technically called, may be  partial or gen-
eral, temporary or  permanent.   It  is best
known in the form of senile  baldness :  that
disappearance of the hair from the crown of
the scalp which is one of the changes indi-
cating general structural decay and advanc-
ing age.-  In some individuals the head be-
comes   bald during  middle life, and  in
others it is well covered by hairs  even at a
are said  to be  atrophied, or  their muscles
are said  to be  atrophied.  The  same often
happens  in a  paralyzed  part.   There are,
however, certain specific  forms of disease to
which the term atrophy  applies.   Such are
acute yellow   atrophy   of  the   liver (see
Liver),  progressive  muscular atrophy (see
Progressive.)
  ATROPIA, the active  principle of  Bella-
donna.  (See Belladonna.)
  AURA is the name given to certain pecu-
liar sensations which sometimes  give  warn-
ing of the immediate onset of an attack of
epilepsy.  These  feelings are of very vari-
ous kinds.  Perhaps the  most common are a
feeling of a stream of water or air—cold or hot
—gradually creeping up  from an extremity
toward  the  head.  This  feeling  reaches  a
certain point, and then the patient becomes
unconscious.  It  directly ushers in  the at-
tack.  The period during which  this lasts is
short, generally exceedingly so ;  but  its im-
portance rests  on this, that occasionally, if
it can  be stopped,  the  fits  do  not  occur.
For this purpose machines  are  sometimes
worn which, being  touched,  suddenly and
powerfully grasp the arm or leg,  certainly in
some cases working the desired result.
  AURICLE is the name given to  two of
the cavities  of the heart  from their  resem-
blance to an ear.  (See Heart.)
  AUSCULTATION is the art of  ascer-
taining the condition of the internal  organs
of the body, especially the lungs, by the aid
of the ear.  (See Percussion, Stethoscope.)
  AXILLA is the anatomical name  for the
arm-pit.
  AZOTE is a name for  nitrogen gas.  Sub-
stances,  such  as certain foods,  are  called
azotized,  on account of their  containing
nitrogen.  (See Food.)
very old age.   These  differences  depend
upon two influences:  that of general health
and  strength  of  constitution, and  that  of
hereditary" peculiarities.   In  this  form  of
baldness, whether due to  senile or prema-
ture  decav, the hairs  first become gray and
then white ;  they no  longer present their
usual appearance, but are short, split, and
very dry and  crisp.  The scalp at the same
time becomes thin and tense.   At  last the
white  hairs  are  shed,  and no  others  are
formed :  complete baldness is  then  pro-
duced, and the thin scalp becomes smooth
and shining.   These changes always begin
on and are  very often  limited to  the vertex
of the head ;  they are due to senile shrink-
ing of the tissues of the scalp  and oblitera-
tion  of the  hair follicles—those small  de-
pressions in  the  skin in which  hair origi-
nates.  Of temporary baldness there are sev-
B. 
32             BALDNESS
BANDAGES
eral  varieties.   The  most  common  form, I
perhaps, is that general  thinning which is
caused  by exhausting diseases,  as for in-
stance,  fevers, by  bodily  decay,  and  by
great mental emotion.   Sometimes exten- j
sive  thinning, or even total loss of hair, may !
be seen in children.and young adults, appar-
ently strong and in good health, and without
any affection of the scalp to account for  this |
serious condition.   It has been  suggested
that  this early loss  of hair  may  be due to
failure of nervous power, or to cessation of
the natural reproducing function of the hair-
bulbs  and hair-forming  apparatus.   Tem-
porary baldness is also very frequently pro-
duced  by parasitic   diseases of  the  scalp, j
such  as favus and  the  different forms of
tinea.   According to the nature of the  dis-
ease  it is  gereral or partial :  in favus the
whole scalp is  affected, and in tinea  decal-
vans  there is complete baldness only over
small  patches.    Thinning of the hair  is a
symptom  of venereal disease ; in cases of
specific sore-throat,  associated with a pim-
ply or scaly eruption on the limbs and chest,
the  hair  is very loose, and comes out in
large  quantities  when  it  is  combed  or
brushed ;  in some instances the  patient be-
comes quite bald.  This affection, however,
is usually  temporary, and  the hair  grows
again after the course of  the general disease
has been averted by suitable remedies.  The
congenital and senile varieties of baldness
do not yield either to local or general treat-
ment.   In the former  class of  cases,  one
must wait patiently until the formative or-
gans of the hair are well developed, and in
the latter class the loss of hair is to  be re-
garded as  an inevitable  result  of advancing
age.  The application of stimulating washes
only irritates the skin, and may do much mis-
chief.   In  temporary  baldness,  occurring
during convalescence from  fever  or other
exhausting maladies, the hair usually grows
again as the patient becomes restored  to the
previous  condition  of health and  strength.
In cases  where the hair becomes  thin and
loose in consequence of debility or want of
tone, local stimulant is the best  treatment;
in slight forms of the affection,  cold water
should be poured over the head every morn- j
ing,  and the scalp then  well rubbed  with  a
rough towel ; at night, a wash made up of
equal  parts of  glycerine and  sal volatile
should be rubbed into the scalp at the roots
of the  hairs.   In more  advanced  forms of
baldness  from  debility,  tincture of  iodine
may be painted over the most denuded  por-
tions of the scalp two or three times  in the
course of the week.   Shaving  the scalp  also
does good in bad  cases.   The  best  treat-
ment for the excessive thinning  of the hair
which sometimes occurs in girls  who  are |
growing quickly consists in  the cold douche,
friction with a rough towel, and the local ap-
plication of glycerine and  sal  volatile  or
glycerine and lime-water.  The hair when it
begins to grow again is soft  and downy, but
in course of time resumes its natural appear-
ance.   While it is  in  this state care should
be taken not to apply any oil or pomatum to
the  scalp.   In  baldness from constitutional
debility or  disorder attention  should be
paid to the important organs of the body.
The stomach  is  very  often  at  fault,  and
sometimes  the nervous  system  is  affected.
In cases of this kind  the baldness  must be
attacked  indirectly  with   anti-dyspeptic
remedies and nervous tonics.
  BALM OF GILEAD is the name given
to a juice which exudes from the  branches
and leaves  of various  species  of Balsam-
odendron.   It eventually  becomes  solid.
Its  properties, like those of other  so-called
balms  and balsams, have been  much exag-
gerated.
  BALSAM OF  COPAIBA.   (See Copai-
ba.)
  BALSAM, FRIAR'S.   (See Benzoin.)
  BALSAM  OF  PERU is a thick, treacly
looking substance  with a peculiar odor
called  "balsamic."   It  was at  one  time
much used in the treatment  of wounds ; now
it is  sometimes applied  to bed sores, but
seldom.  Occasionally it is  given in chronic
bronchitis of the aged.  It is rarely used.
  BALSAM  OF  TOLU.  (See Tolu Bal-
sam.)
  BANDAGES  consist of strips of linen,
calico, or flannel, of various breadth  and of
any length.  The  best material  is  stout un-
bleached calico ; but a strip of sheeting, or
strips of an old petticoat or dress, are very ser-
viceable.   They should  be  rolled up firmly
for use, as they are applied by  unrolling
them over the part to be bandaged.  There
are many forms  of bandages  in use  among
surgeons  which  have   received  various
names, either from their shape  or  inventor;
but it will be  found  that as they all depend
for their efficacy upon the dictates of "com-
mon-sense,"  the  more  complicated  forms
may be omitted.   There are, howevtr, some
few plain  rules for  guidance in  the appli-
cation even of the simplest bandage which
can be  used ; as the manner in which  it is
bound round  the limb makes all  the differ-
ence to the comfort  of the  patient.  It will
be  found most convenient to hold  the roller
on the inner side of the limb (if  it be a  limb)
to  be bandaged, so  that in the  case of the
right side being operated on, the bandage is
held  in the operator's  right hand, and vice
versd;  and for quickness in application the
portion which is  still unwound  should be
underneath that which is being wound round
the limb—in  fact, the bandage  should form
a sort of  continuous figure of 8.  On first
starting off, rather more than the circumfer-
ence  of the limb  should be  unwound and 
BANT1NGISM
BATHING (SEA)
33
 cast around the part, and the hand not em-
 ployed  in  holding the bandages made to
 tuck the free end under the first complete
 turn.   If this slight manoeuvre be  dexter-
 ously done, the bandage will never slip, un-
 less purposely unwound.   It is then lightly
 but firmly wound round the limb  by a series
 of turns as far as required.   Now it is evi-
 dent that in the case of a well-shaped,  mus-
 cular limb, this winding cannot be made
 evenly, as it will not lie flatly ; the simple
 device of "reversing" is then employed :  it
 consists of  taking a " turn" in its applica-
 tion, and bending it upon itself by changing
 the surface of the roller which  is applied to
 the skin by making an acute  angle or re-
 verse at each turn, and giving  it a sharp
 " twitch" at each.   In bandaging  the arm or
 leg, it is best to  commence with a few turns
 round the hand  or  foot first, whether  it be
 for the retention  of  splints or  dressings.
 Bandages should always be applied with an
 equable pressure throughout, and  not too
 tightly.   Any  person  possessed   of  the
 slightest  ingenuity or  neatness  of  hand
 would, after a few hints from  a  good hos-
 pital nurse, or an intelligent surgeon, learn
 the essentials of bandaging  in  a  very  short
 time.   Bandages, such as the above, maybe
 rendered hard and strong by smearing  their
 successive turns  with gum,  plaster of Paris,
 glue, paste, or white of egg, which speedily
 sets, serving the double  purpose of bandage
 and splints.   (See Slings, Splints.)
   BANTINGISM is  a term applied  to  a
 system of diet by which it is  proposed  to
 make fat people thin, and which succeeded
 in the case  of a Mr. Banting, who wrote  a
 pamphlet on the subject. The great  princi-
 ple recognized in the system is  the with-
 drawal from the diet of those articles of food,
 such as bread, potatoes,  sugar, fat, and but-
 ter, which are known, when taken  in excess,
 to  produce  obesity.  There is no  doubt,
 when the accumulation of fat  in  the body
 interferes   with   exercise   and  produces
 shortness of breath and palpitations,  that
 means should be  taken  to  reduce  the fat-
 making articles of diet.  At  the same time
 this may be done too violently, and persons
 have been  thus  greatly  injured.   If stout
 persons  wish to reduce themselves,  they
 should  diminish  the   quantity of  bread,
 sugar, fat, and butter in  their diet, but not
 suddenly leave off anything to which  they
 have  been  habituated through a  long  life.
 (See Weight and Height.)
  BARBADOES LEG. (See  Elephanti-
 asis.)
  BARBADOES TAR is  a species of
 naphtha, found naturally in the island of Bar-
 badoes in great abundance.  It is a thick
 bituminous  substance, like  molasses, hav-
ing a pungent odor  resembling tar.   It is
only used in this  country as  a  horse medi-
 cine, but in the West Indies has a reputa-
 tion in bronchial and pulmonary diseases.
   BARBERRY, the common name of the
 Berberis vulgaris.  The  fruits are of a  red
 color, and  contain a sweetish acid juice,
 which  is reckoned  febrifuge.   An active
 principle is also obtained from  this plant,
 called  Berberia.
   BARK.  (See Cinchona.)
   BARLEY is a well-known grain, valua-
 ble as an article of diet, both as an addition
 to soups and broths, and, when  ground in
 the form of meal, as a nutritious food.  The
 medicinal drink known  as barley-water is
 made fiom  the  pearl or  Scotch  barley, and
 if carefully made is a pleasant and soothing
 drink in diseases of  the throat and chest.
   BARRENNESS.  (See Sterility.)
   BARYTA is  a mineral product,  a prep-
 aration of which is used in  medicine under
 the name of solution  of the muriate of bary-
 ta, or chloride of barium.  It is prescribed
 in scrofulous affections, glandular enlarge-
 ments,  and  cutaneous diseases, and care
 must be taken in its administration,  as it is
 very  powerful.
   BASILICON is known as  Royal Oint-
 ment, and is an  old-fashioned remedy for ul-
 cers,  wounds, and abrasions.   It is of three
 kinds :  the  black, made with pitch ;   the
 green, in which  the flowers of melilot form a
 part  and  the yellow, made  cf wax, rosin,
 and lard, and is the only one now in use.
   BATHING (SEA) is a remedy potent for
 good or evil.  There are few constitutions
 so delicate that they will  not bear sea-bath-
 ing if the process of preparation is carefully
 gone  through, but  that is all-important.  It
 is true,  no preparation is needed for a strong
 man, but then he does not so much need the
 benefit to be acquired from the  baths.  To a
 delicate female sea bathing is often like the
 renewal of life, but it must be carefully gone
 about.  If the patient has been accustomed
 to a  cold  bath  in the  morning,  the only
 change required  first of all is the substitu-
 tion of salt water for  fresh; if she has not,
 she must use the sea-water tepid first cf all,
 gradually accustoming herself to the water
 the temperature  of the sea.   Next, a sunny
 day having been selected,  she may try, when
 the sun has been well out, a bath from the
 beach, but only remaining in the water long
 enough  to be  completely  wetted from head
 to foot, then well rubbed  dry,  and a gentle
 walk along the shore.  This should  not be
 attempted within less than three hours after
 breakfast, but by degrees the  time may be
 lessened, breakfast being made less and less
 of a meal till it consists merely of a cup
 of milk, which   it  is  better  to take  in
all cases before  proceeding to  bathe.  By
and by the morning hours maybe used for
bathing, these are the  best; the bath  should
 not last more than ten minutes, and a smart. 
31
BATHS
BED-SORES
 ish walk should follow.  Never bathe with a
full stomach or when feeling cold before enter-
 ing the water.   It is not advisable to bathe
 more than once  a day at the sea-side, except
 a morning bath at home be taken and  subsc-
 quentlvone in the sea in the forenoon.
  BATHS,  whether regarded  as  means  of
 preserving or recovering health, are of very
 great importance.  The  baths employed by
 a very considerable number of our country-
 men  daily for the purposes of cleanliness
 and  the  preservation of  health  are cold
 baths—that  is D say, their average tempera-
 ture  is under Co°.   If  intended  more  for
 cleanliness, water of a higher  temperature,
 from  Go" to  iooc, is  employed.   They differ
 too in respect of mode of use, for whereas
 the cold  bath is administered  variously, as
 shower,  plunge, shallow,  or sponge  baths,
 the warm bath is almost entirely  restricted
to  what is  called the shallow  bath.   The
 douche is perhaps the  most powerful mode
 of administering the cold bath, but is com-
 monly used as an appendage to the so-called
 Turkish or Roman bath.  This form of bath
 consists merely of heated  air,  and  though
 habitually used  by many healthy persons,
 belongs rather to the category of baths used
as remedial  measures, than to those in daily
 use.  As remedial  measures, hot-air baths
are sometimes very useful, especially  per-
haps  in  cases  of  sub-acute  rheumatism,
colds, and the like.  They are, however, to
 housed with caution, as to many individuals
they  are dangerous, producing unpleasant
sensations in the head.   This  is especially
■the case if high temperatures arc in use.  As
a rule, it may be said  that  1400 F. is quite
high enough for all us'eful purposes, and the
time  of  remaining  in the  bath should  be
.regulated rather by the  effect produced  in
 bringing out perspiration than by other con-
siderations.   As a rule such baths  terminate
cither with a cold plunge or a douche, which
•to many is the pleasantcst part of the whole.
J/edicaled baths are in  use  in this  country;
 some prepared  so as to  resemble mineral
waters abroad, others constituted on a differ-
ent principle, and used mainly in  the treat-
ment of skin disease.  One variety, viz., al-
 kaline baths, have been  found  of  great use
in chronic or sub-acute rheumatism.  Iodine
 baths have  been  used for the  same  com-
plaint, and for advanced  syphilis.   Sulphur
 baths have been used  in lead-poisoning,  as
well as in  itch.   The most important  of
(these baths, if indeed it deserves the name of
bath at all, is  the so-called  mercurial  vapor
b uh.   This  is of undoubted value as  a rem-
edy in syphilis.    About 30 grains of calo-
 mel  is  placed  in  a kind  of  saucer sur-
 rounded by hot water, the whole kept heated
 by a spirit-lamp,   The patient sits on a cane-
 bottomed chair.   The apparatus  is placed
 below,  and  the  whole  covered with  a
blanket,  so as  to  completely envelop  pa-
tient  and all.  In  about 20  minutes both
water and  calomel will  have disappeared,
after which the patient is put to bed.  This
valuable  plan of treatment should never be
had recourse to without advice.   The mus-
tard foot-bath is a favorite remedy among fe-
males, who ascribe to it considerable pow-
ers of bringing on the menstrual flow.  (See
Hydropathy and Sitz Bath.)
  BAY is the name given to the Laurus  no-
bilis.  It  is the true laurel of the ancients,
the sweet bayof the English.   The berries of
the bay are aromatic, and are used as spices
in food.  They are also employed in medi-
cine, and act as carminatives and stimulants.
The leaves also contain an aromatic  oil, and
smell very pleasantly, and arc used in  the
same way as the berries.
  BAY CHERRY,  or  Bay Laurel, is  the
name given to the common Prunus  Lauro-
cerasus.   This shrub  goes by the name of
the Laurel in our gardens.   Its leaves and
fruit contain oil  of bitter almonds and  hy-
drocyanic acid.   They are used in the same
manner  as oil  of bitter almonds.  (Sec
Almonds.)
  BAY-SALT is a name given to a form of
common  salt, chloride of sodium, which is
prepared from sea-water by evaporation in
the sun.   It is chiefly manufactured  in  the
Mediterranean,  and has nothing to recom-
mend it beyond common salt, except that it
contains  some of the  other saline constitu-
ents of sea-water.
  BED-SORES are large unhealthy ulcers
formed  over  the hips,  buttocks,  and  the
lower parts of the back of  bedridden per-
sons.  They are due to long-continued pres-
sure on  these parts, to a vitiated state of
blood, and to general debility, and are met
with in the subjects of fever, paralysis, bro-
ken back, and in very old people who have
been in bed for  a long  time.  In cases of
palsy of  the  lower half of the body, bed-
sores are very large  and deep, and spread
w.th rapidity.   In these cases ulceration is
favored by loss  of sensibility and  power of
motion, and  by  the  contact  of fasces and
urine which arc passed  without the knowl-
edge of the patient.  A bed-sore commences
as a dusky-red patch on  the skin, which  be-
comes excoriated.  After the separation of
the cuticle the  surrounding solt  parts  be-
come  swollen, and the inflamed integument
is converted into a gray or  black  slough,
from the  under surface of which  there is a
discharge of thin matter.   This sloughing
process extends both superficially and deep-
ly until a large  cavity is formed, which in
some  instances  exposes bone.   In old or
very debilitated subjects death is frequently
the result  of  this  affection.   Except in
cases of  palsy and  broken back, the exist-
ence of a bed-sore bears witness to  the in- 
BEEF-TEA
BELLADONNA           35
competence or carelessness of the nurse.
In cases of long-continued  illness and con-
finement 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 attention to  cleanliness.
Draw  sheets  should  be  placed over the
lower half of the  bed, and be frequently re-
newed, and the buttocks and back ought to
be washed  twice  in  the  day with a weak
lead lotion or spirits of wine, and after-
ward  carefully dried.   When a red patch
makes its appearance on  the skin, collodion
should be applied and the inflamed part  pro-
tected from further pressure by means  of a
circular air cushion perforated in the centre.
When the skin is broken, resin ointment will
be found a good dressing.  The treatment
of large sloughing sores consists in the use
of  poultices  sprinkled   with  charcoal  or
chloride  of  lime, and  in  supporting  the
strength of the patient by good  diet and  al-
coholic stimulants.  In the first stage of bed-
sore when the skin is simply reddened, the
contact for ten minutes of a bladder  con-
taining ice, followed by the application of a
linseed-meal  poultice,  will often prevent
further mischief.
  BEEF-TEA.—This valuable preparation
is of such constant use in  sickness, that  it
may almost rank  as a  medicine, and  it is
very important that  all those who have the
care of invalids or delicate persons should
fully understand its value and composition.
The great object  of  the cook should be  to
extract every particle of nutriment from the
beef she uses ; and in order to secure really
goo4 nutritious beef-tea,  there must  be  no
stint in the quantity of  material  used.  A
pound of gravy beef will  not make above a
pint of really strong beef-tea ; but there are
many  degrees of  strength  required,  ac-
cording to the purpose  for which  it is  con-
sumed.  Where it is necessary to feed a pa-
tient with spoonfuls of beef-tea, and to get as
much nourishment taken as possible to as-
sist recovery,  an excellent and delicious ex-
tract or essence of meat  can be made  by
cutting up about a pound of gravy beef and
placing it in ajar, with alternate slices  of a
nice large turnip and a little salt.  Add  no
water, but cover  the  jar  tightly and let  it
stew in the  oven for six  or  eight  hours.
When taken out a most fragrant and nutri-
tious cupful of extract of beef will be there,
which will contain all the life-giving constit-
uents of the  meat.   Very different  is  the
action of such beef-tea as  this on the system
from that of the extract of meat sold as  Lie-
big's extract, which, though excellent as an
addition  to other food, and most valuable
as a digestive, will never support life or fail-
ing  strength  alone.  (See  Meat, Extract
of.)
  BEER is  a form  of  alcoholic beverage
made from the fermentation of roasted ger-
minating  grain.  When  a seed  begins to
germinate its starch is converted into sugar.
By roasting the process of germination is ar-
rested, and the  dried grain, under the name
of malt, is used for making beer.  Beers arc
not,  however,  alone  fermented malt.   In
this country and now nearly all over Europe
the flower of the hop is added before the fer-
mentation  is commenced, and a bitter taste
and tonic quality is given to beer which is not
possessed  by wines or spirits.   Hence me-
dicinally beers act as stimulants and tonics.
Beer is sold according to the way it is made,
under various names.  Thus we have  ales,
porter, and stout.  Ales  are  mild,  strong,
and bitter.  Mild ales contain from half an
ounce to an ounce of alcohol  in the  pint.
Those which contain  the least amount of
alcohol are most to be recommended as or-
dinary articles of diet.  Strong ales contain
from one ounce to an ounce and a half of
alcohol in  the  pint,  and  ought only to be
used when the  stimulant  effects of alcohol
are required.   Bitter, pale,  or India ales
contain from one to two ounces of  alcohol,
and  have  a  larger quantity  of hops  than
either mild or strong ales.   In  some cases of
disease where tonics arc necessary to enable
the stomach to digest its food, theyare to be
greatly commended.   Porter  and  stout are
brewed  to suit a  prejudice.   They  are
brewed with over-roasted or blackened malts,
and thus get a  dark  color.  London porter
contains from three quarters  of an ounce to
an ounce of alcohol in the  pint, while stout
contains an  ounce and a half.  They are
supposed to be more  nutritious  than  ales,
but as the blackened malt of which they are
made contains no nutritious property, this is
evidently a mistake.  (See Table in Alco-
hol.)  All these beers are bottled for  sale.
The only  difference bottling  makes  is  that
the carbonic acid gas liberated  during fer-
mentation is kept in the  bottle and passes
out mixed with the beer.  In some cases
this carbonic acid has apparently the power
of assisting digestion, and as a matter of ex-
perience is preferred  to  draught beer.  In
some states of  the  system beer is a  most
objectionable article of  diet.  The  unfer-
mented saccharine matter undergoes changes
in the stomach  which communicate certain
properties to the blood, favorable to the gen-
eration of such  diseases as rheumatism and
gout.   When these diseases  are not  pro-
duced there is  a general  condition of the
system brought about in  which  attacks of
serious disease are  rendered much  more
liable to a fatal termination than they other-
wise would be.
  BEESWAX.  (See Wax.)
  BELCHING.  (See Eructation.)
  BELLADONNA,  technically  known as
Atropa Belladonna, is a native  of Great Brit- 
3G
BELLY
BIRDS AS  FOOD
ain, but is easily cultivated  here.  All parts
of the plant are active, but those chiefly used
are  the leaves and  the  root.   From  the
leaves are prepared a tincture, and an  ex-
tract from the root, the alkaloid atropia, and
a liniment.  The effects of belladonna  are
very striking, especially in allaying pain and
arresting  muscular spasm.  In  large  doses
it is poisonous, and its attractive berries  not
unfrequently prove fatal to children.  When
taken internally the drug produces a dryness
of the throat, and sometimes an eruption on
the skin.   These have been said to resemble
scarlet fever, and. hence  this substance has
been used by homoeopaths in the treatment of
scarlet fever, and it has been tried, but vain-
ly, as a  preventive  of that disease.   One of
its most notable effects is  dilatation  of  the
pupil, so that the iris or colored part of the
eye almost disappears, and sight is impaired.
This occurs whether the medicine is given
internally or applied externally, and is  taken
advantage of by oculists in dealing with eye-
diseases.   In  many spasmodic or convulsive
diseases belladonna is of use.  Thus, it has
been used1 in asthma, in whooping-cough,
in epilepsy and neuralgia.   In inflammation
of the eye, when there is danger of the pupil
becoming closed permanently, belladonna is
of the greatest  possible  use  by removing
the edges  of the iris as far as possible from
each other.  It is also of use in the inconti-
nence of urine in children.  Briefly, it may
be said that wherever there is  much local
pain, especially with stiffness depending on
muscles,  belladonna does  good.  Here it
may be  applied  locally, either as  a plaster
made from the extract, or as a liniment con-
taining a good deal of a strong tincture.  In
palpitation of the  heart  depending on dis-
ease of that organ, a plaster worn constantly
over the  part gives very great relief.  In
chronic   rheumatism  the  liniment  well
rubbed in is of great value.  The tincture of
belladonna should not  be given in  greater
doses than 10 drops, nor the extract in more
than half a grain.   The liniment is  not in-
tended for internal use.  The extract is often
given in purgative pills to prevent griping.
  Atropia is the alkaloid or active principle
of belladonna ; combined with sulphuric acid
it is  used by oculists to dilate  the  pupil of
the eye.   Atropia  should not  be given  in-
ternally, but may be applied under the skin.
  BELLY.  (See Abdomen.)
  BELLY-ACHE. (See Colic.)
  BENZOIN or GUM BENJAMIN is a
resinous exudation from a plant growing in
the Eastern Archipelago.  Combined with
aloes, storax,  and balsam of Tolu dissolved
in  spirit, it used to have a great reputation
as a vulnerary or application to cut surfaces.
This compound  was known as Friar's Bal-
sam.  It is rarely given internally.
  BERBERRY.  (See Barberry.)
   BERRIES, poisonous.   Children  often
 cat poisonous berries, and show symptoms
 of illness, before it can be found out exactly
 what they have eaten.  When such a suspi-
 cion  exists, the safest way is at once to ad-
 minister an emetic of the easiest and quick-
 est kind.  Mustard and water is  nearly al-
 ways obtainable, or salt and water ; and tick-
 ling the inside of the throat with a feather till
 vomiting comes on, repeating the operation
 till all substances seem to be expelled ; then
 give vinegar and water or milk to the patient
 to neutralize the effect of the poison in the
 stomach.
   BETEL is used  in the East Indies as a
 masticatory.   It  is the  fruit  of a species of
 palm called Areca Catechu.   This fruit con-
 tains tannic acid, and it is on account of the
 astringent properties of this substance that it
 is used.  When chewed the nut is cut up and
 placed in a leaf of the Piper Betel and mixed
 with  a small quantity of lime.  Cloves, cin-
 namon, and other spices are sometimes add-
 ed.
   BILE or GALL, the name of the  secre-
 tion  formed by the liver, which is emptied
 into the  gall-bladder, from whence it flows
 into the intestines, where it mingles with the
 food.  It is of a green  color, and  intensely
 bitter taste, hence  the term "bitter as gall "
 (see Liver).   When the action of the bowels
 and stomach are  reversed, and vomiting oc-
 curs, the bile comes into  the  mouth, and
 is readily recognized by its bitter taste.  It is
 not, however,all bitter tastes in the mouth that
 arise from bile.  This arises more often from
 butyric acid (see Butter).  The gall of ani-
 mals, more especially that of the ox, is  used
 in  medicine as a tonic, and in cases of de-
 ficient biliary secretion.  It  has been em-
 ployed as an application to bruises and sores,
 but its utility  in these cases is very question-
 able,  and  it  is therefore not to be recom-
 mended.  (See Ox-Gai.l.)
  BILIOUS  HEADACHE.   (See  Head-
 ache.)
  BILIOUS  FEVER.   (See Remittent
 Fever.)
  BIRDS AS FOOD.—Next to the flesh of
 mammalia, that of birds is most consumed
 as food by man.  Several species  are  do-
 mesticated in this country, and used as food,
 whilst a large  number of wild birds are con-
 sumed.   Upwards of 170 species have been
 recorded as eaten by man in various parts
of the world.   The flesh of birds  has  not
 been  so  carefully analyzed  as that of the
mammalia.  It contains, generally,  more of
the principle  creatin, and this is especially
the case with wild birds.   Young birds con-
tain albumen and gelatine, whilst older bird 1
contain fibrine.  Ttie flesh of birds containi
but little fat; this is  more  especially the
case in wild birds.   Domestic fowls are fat-
tened, more  especially in the  form of the 
BIRTH                                   BLISTER
capon.   The goose and duck become fat by
abundant feeding  in  domestication.   The
flesh  of birds  presents a greater variety of
flavor than that of any other class of animals.
These flavors are dependent on the presence
in the flesh of compounds which are not well
understood.  As a rule  the  flesh  of  car-
nivorous birds have a stronger flavor  than
those which  are herbivorous  or graminivo-
rous.
   BIRTH-   (See Labor.)
   BIRTH-MARK.  (Sec Naevus.)
   BISMUTH  is  used in medicine in two
forms, the sub-nitrate and carbonate.   The
former is the  more  commonly  emplo3'ed.
It is exceedingly useful in certain kinds  of
irritation of  the  stomach, especially when
food gives rise to pains, but should be given
in good large doses of 20 or 30 grains.   As
it is  quite insoluble  it  must be given  in
something which will suspend it; gruel will
do.   Gum Arabic is commonly used for the
purpose. A liquid form of the remedy has
been  prepared by a chemist named Schacht,
whence it is known as Schacht's Solution of
Bismuth.  It is a good and useful prepara-
tion.   Some  people prefer the carbonate  to
the nitrate ; its effects are similar.
   BISTOURY.—A surgical instrument,  usu-
ally carried in the pocket-case.  It is a long,
narrow-bladed knife, and may be straight or
curved.
   BITES.  (See Insects and Snakes.)
   BITTER  ALMONDS.  (See Almonds.)
   BITTER-SWEET.  (See Dulcamara.)
   BLACK DRAUGHT is a popular name
given to an infusion of  senna, with Epsom
salts or sulphate of magnesia.   (See Senna.)
   BLACK DROP is a solution of opiurfl  in
verjuice, the  juice of the  crab apple.   It is
sold in the shops as a patent medicine.  One
drop is equal to  three of laudanum.  It  is
supposed to disturb the system  less  than
other  liquid  preparations  of opium.   (See
Opium.)
   BLACK SNAKE ROOT.   (See Actea.)
   BLACK VOMIT is a  term  applied to the
dark-colored  fluid that is thrown up in many
fevers.   It consists  mainly of decomposed
blood.  It is often seen in yellow fever, and
is considered  one of the most  disastrous
symptoms of that disease.  (See Fever.)
  BLACK WASH is made  by adding cal-
omel to lime-water, and is used as an exter-
nal application for venereal and other sores.
   BLADDER.—This  organ is situated  in
the pelvis, in  front of the rectum in the male,
and of the womb in the female.  It is a hol-
low cavity,  made  up chiefly  of  muscular
fibres which enable it to contract, and lined
within by a smooth  coat of epithelium.  It
has three openings ; two small ones on its
posterior aspect, where are the ureters, these
being the small tubes which convey the urine
from the kidney on each side  into the blad-
der ; in front there is also the opening into
the urethra, or  canal which alLows the pas-
sage of the urine out of the body.   The
bladder, like other organs, is  liable to dis-
ease ; it may be inflamed and  cause intense
pain  (see  Cystitis).  It  may become di-
lated from being  too  full  of  urine, or its
walls may become  paralyzed, as in some
cases of disease of the ^pine (see Para-
plegia).  A calculus, or stone, may become
deposited or form in this cavity, requiring
for its removal  the operation of lithotomy or
lithotrity.   Or  the  prostate, a gland which
is situated  at the neck  of the  bladder, may
become enlarged, as in old people ;  or  a
tumor, either cancerous or simple in its na-
ture, may be developed.
  BLEBS, or BULLffi, are large vesicles,
like little blisters, which form on the surface
of the skin in  some diseases,  and very fre-
quently in  the  later  stages of erysipelas of
the face.
  BLEEDING is a procedure  not often
adopted now,  except  in cases of heart  or
lung disease, where  there is great obstruc-
tion to  the  circulation.  Formerly, nearly
every one was bled as a matter of course in
the spring  and in the  autumn of the year.
(See Accidents,  Hemorrhage, and Vene-
section.)
  BLINDNESS.  (See Amaurosis, Color
Blindness, and Eye).
  BLISTER.—Any substance which,  ap-
plied to the skin, raises the outer cuticle or
scarf-skin,  and  fills the space  between that
and the true skin with water or serum is
called a blister.  There are many substances
used  for raising blisters.   The most com-
monly applied  blister is made  from Spanish
fly, or cantharides ; besides which, mustard,
croton oil,  nitric acid, and many other sub-
stances, are  sometimes used.   Blisters are
considered by many physicians to be most
valuable, as they are most powerful remedies.
They frequently produce a  desirable deple-
tion of  the system, and do away with the
necessity for bleeding.  The ordinary blister-
ing plaster, is composed of lard, suet, rosin,
wax, and Spanish flies, a piece of which mix-
ture is spread on adhesive plaster, cut to the
proper shape and size.   All blisters  should
have a margin of at least half an inch.  The
plaster  must be  spread with the  thumb,
smoothly and evenly, and not  less than the
thickness of the thumb-nail  in depth.  The
time a blister takes to rise depends, first, on
the part where  it  is placed, and, secondly,
on the temperament of the patient; the period
is, however, usually between eight and eigh-
teen hours. It is best to apply a blister before
going to bed, as the patient then generally
sleeps through the early stage of the process.
As soon as the blister  has been formed the
plaster should  be gently taken off,  and the
bag of fluid carefully nicked  with  a sharp 
38
BLOOD
BLOOD
pair of scissors at the lower part, so as to I
insure the  escape of all the  serum, which
should be carefully prevented  from running
on to the  skin.  Care must be taken  not to
remove any of the outer skin. A warm bread
poultice,  inclosed  in a  piece  of muslin,
should then be applied, and kept on  for an
hour.  When this is removed, the  blistered
surface should be dusted with violet powder,
and covered from the air, a little fresh powder
being added from time to time. This method
of dressinga blister generally causes it to heal
in a  few hours, and  prevents the cracking,
smarting and stiffness that often follows the
application of ointment, or washing the part.
Blisters are always  liable to affect the kid-
neys, and, in  some  constitutions,  produce
very painful results.  To prevent this, the
patient should drink freely of barley water,
with about a scruple of powdered  nitre in
each quart, during the time the blister is on,
and  for a while after its  removal.  A mus-
tard  blister is seldom  used, unless very
severe counter-irritation is required,  and is
a severe and painful remedy.  Tartar emetic,
rubbed into the skin, is another counter-ir-
ritant,  and  produces a  crop  of  vesicles,
which fill with  serum, like the chicken-pox.
  BLOOD is that fluid which is formed from
the food of animals, out of which  all the
organs  of  the  body are  developed. The
blood of men, when  drawn and looked at
with the naked eye,  is a red liquid.   When
allowed to stand a few minutes it coagulates,
and is  separated into two parts : a solid part,
called clol,and 3. liquid part in which the clot
floats, and which is called  serum.  If a drop
of blood is  placed under a microscope be-
fore  it coagulates, it is found to consist of
two parts—a liquid  called liquor sanguinis,
and a number of small flattened globules or
cells, which are called blood-globules.  The
latter are of two kinds, red and white. The
white  globules  are  rounder,  rougher,  and
larger than  the red  ones.  They differ  fur-
ther in containing a more solid central part
or kernel, and do not form more than  one in
a hundred of the blood-globules altogether,
though the  lymph  is full of them.  These
kernels or nuclei  are supposed to escape
and become red globules.  The red globules
are  very minute,  and when measured are
found to be  -3-5,11,-111 of an inch in diameter—
that  is, 3500 of these minute  bodies could
be placed side by side on a single  linear
inch ; these red globules are depressed both
above and below, and in man and those ani-
mals which suckle  their  young, have  no
kernel , but in birds, reptiles and fishes they
have one.  The red globules are composed of
a red substance, called haemoglobin, which
can  be,separated  into  an albumen  called
globulin, and a coloring matter, which gives
the thin red color, and  is called haematin.
The  size and  shape  of the blood-globules
I vary in different animals.  In sheep, oxen,
 and deer, they are smaller than in man, and
 are much larger in reptiles ; they are oval in
 birds and fishes.  A  knowledge of the forms
 of the blood-globules has sometimes led to
 the detection of crime,  by  revealing  the
 exact nature of  blood-stains found  upon
 clothes after the commission of crime.  The
 liquor sanguinis consists of water, albumen
 and saline matters.  When blood coagulates,
 an albuminous body, which has been called
 blood-fibrin,  is formed,  and separates, en-
 tangling the blood-globules, and  constitutes
 the clot.   The  serum which is left holds in
 solution  most  of the  albumen   and  saline
 matters.   The  serum also contains various
 other matter, such as coloring and odorifer-
 ous principles, with  dissolved fatty matters.
 It also contains oxygen and nitrogen gases,
 carbonic acid, and a little ammonia.  Thus
 constituted,  it is  carried by  means  of the
 heart and arteries to all parts of the body.
 On coming  in  contact with the delicate
 structures of the body it supplies them with
 new materials, by which they perform their
 various functions, and carries away those
 particles which have done their  duty in the
 work of life.  In its course through the body
 it is carried to various glands, which sepa-
 rate from it those compounds which are to be
 thrown off from the body.  In the liver  it
 gets rid of certain products which form the
 bile, and which appear to be again taken up
 into the  blood in the bowels.  In the kid-
 neys it gets rid of a substance called urea,
 which, like the albumens, is  formed of all
 four of the organic elements, and represents
 these substances  in a  changed  and effete
 form, by which they are thrown out from the
 body.  (See Heart).
    Blood might be said, with some degree of
 truth, to be the  most important  constituent
 of the body.  It is the means whereby every
 structure which is worn out for the time
 being is  renewed, and the means whereby
 its debris is washed  away.  It is clear, there-
 fore, that  any  serious  impairment  of  its
 properties in either of these respects, must
 speedily lead  to  alterations of the greatest
 importance throughout the system.  But,
 besides such  apparent changes,  there are
 supposed to be  others whereby the  whole
 system becomes  altered in such a fashion
 through  the agency of the blood, that  no
 part can be  said to be in a condition  of
 health.  Such   diseases  have been  called
 general diseases or blood diseases.   But  as
 it is by  no means clear that in these the
 blood is affected more than any other part,
 we shall, in dealing with morbid states of the
 blood, confine ourselves to those  conditions
 where that fluid is tangibly altered in some
 respect.  Now, blood consists of two parts,
 a solid and a fluid ; the former consisting of
 what are called blood-corpuscles, red  and 
BLOOD
BONE
39
 white,  which float in the fluid  part of the
 blood.   Either of these may exist in a mor-
 bid state, and so we shall try to consider the
 diseased   conditions  of  each  separately.
 When the blood is poor in quality—that is to
 say, when its red corpuscles are deficient—
 whatever  other  change  may  have  taken
 place,  the  patient is said  to  suffer  from
 Ansemia (which see).   These corpuscles may
 also  be imperfectly colored ; at all  events
 the patient is pale, the  gums  white, and
 sometimes  there  is a greenish-white  tinge
 all over the body. This last condition exists
 in  what is called chlorosis.   There is,  how-
 ever, another  condition, perhaps  allied to
 these,  in which  not  only are the red cor-
 puscles imperfectly   constituted,  but the
 white ones  greatly exceed  their usual pro-
 portion.  This  condition  is described  as
 those of white-celled blood, Leucaemia or
 Leucocythaomia.  In  it the spleen is gener-
 ally greatly enlarged,  and other  organs may
 be so also.  There is  a condition where the
 blood is infected from a suppurating wound,
 in  which  pus  is supposed  to be  found,
 though this has been by no means found.
 This  condition is characterized by the forma-
 mation of abscesses in all parts of the body,
 especially the internal organs.   It  is  com-
 mon  in war after injuries to bone.   It goes
 by the  name of pyaemia, i.e., pus in  blood.
 In  all of these conditions, the solids of the
 blood are concerned ;  in those which follow
 it is the fluid part which  is  at fault.   First
 among these, a very  rare  form  of disease,
 one where the fluid seems to contain an ex-
 cess of fat in  it.   To  this tlu name of piar-
 haemia  or lipaemia has been  given.   More
 common is that condition which gives rise
 to Diabetes, where there is an excess of sugar
 in the blood.  The source  of this sugar, is
 immaterial, though it is commonly supposed
 to  be the liver ; but  as excess of sugar in
 urine is called glycosuria,  so excess of the
 same substance in blood is called glycremia
 or  glycohaemia.  Wherever sugar is found
 in  the  body,  it  is  thence  removed  by the
 blood,  and  if in  excess is  removed by the
 urine.  Now this  is the constant rule with
 another substance, the removal  of which is
 essential  to  life.  This  substance is  urea,
 and the condition characterized by excess of
 urea in the  blood is  called  uraemia.   This
 condition supervenes in diseases of the kid-
 ney, which interfere with their function, and
 is the common  mode  in which  these prove
 fatal (see Ur/f.mia).   There are yet other
 morbid states  of  the  blood, in which the
 fluid  portion  is altered.   One of these is
 characterized by a general yellow tint of the
 body.   Bile is circulating with  the  blood,
 and the body turns yellow in consequence.
This is  jaundice, or, if the bile has not been
formed, and its unformed materials are cir-
culating, there will be no jaundice ;  this is
acholia or suppression of bile.  There are
three other conditions in which the blood  is
altered, but in a way as yet unknown to us.
In all of them there is an unusual tendency
for the  blood  to break out of its vessels,
though  in  other respects they are widely
different.  There is in some individuals an
uncontrollable  tendency to bleeding, from
their  birth  upwards ; this is spoken  of as
a hemorrhagic  diathesis  or  hemophilia.
Again, there are two conditions acquired by
insufficient food and exposure, the causes of
which we know, though the changes in the
blood are unknown.   These are sea scurvy
and  land scurvy, or purpura (see Scurvy).
In  certain  epidemic  diseases,  the* blood
undergoes a change which favors bleedings
under the skin, from the  gums, etc.  Such
maladies are then said to  assume a hemor-
rhagic type.
  BLUE DISEASE. See Cyanosis.
  BLUE OINTMENT, the popular  name
of the  mercurial ointment of the  Pharmaco-
poeia.  It is made with fresh lard and pure
quicksilver.  (See Mercury.)
  BLUE PILL, the popular  name  of the
mercurial pill  of  the  Pharmacopoeia. (See
Mercury.)  It  is  made  with conserve  of
roses and pure quicksilver.
  BLUE STONE.  (See Copper.)
  BOIL.   It  is  hardly necessary to define
what a boil is to unprofessional readers.  As
they  frequently depend  upon  the  state  of
health, constitutional treatment is necessary.
Locally,  if soft, red, and painful, a hot lin-
seed-meal or bread poultice should be applied,
and changed when cold (see  Poultice), and
a clean  cut  made well- into  it with a  sharp
penknife or lancet.   If indolent (or slow  in
coming to a head), a mixture of equal parts of
glycerine, extract of opium, and belladonna,
with about twenty times its bulk of resin oint-
ment, is a most excellent application, or iodine
paint in obstinately indolent cases.  The con-
stitutional treatment consists in the adminis-
tration of tonics, such as iron, quinine, and
ammonia ; the  bowels should be  kept open,
but not purged.
  BONE is the hard parts of the vertebrate
animals which  form  their  skeleton.  Bones
are divided into two sorts, according to their
composition, and are called cartilaginous and
osseous.   The  former are  characterized  by
the absence of phosphate of  lime, while the
latter consist of from 40 to 60 per cent of that
material.  In the living human body the bones
contain a considerable quantity  of water ;
when dried, they are found to consist of about
one third  of organic matter  and  two thirds
earthy matter.   The organic  matter consists
of fat and gelatine.  The  teeth are composed
of the same materials  as  the  bones, but they
contain less organic and more mineral matter.
The  enamel of teeth contains only two per
cent of animal matter.  In  some animals,  as 
40
BONE
BRAIN
the so-called  cartilaginous fishes, comprising
sharks, rays,  and many of the larger fishes,
there is  little or no mineral matter in the
bones at all.   In  some  parts of the human
skeleton, as  the cartilages  of the  ribs  and
joints,  there  is very little  mineral matter.
Although the bones are very hard, like all
other tissues  of the body  they are developed
from cells.   Originally the bony skeleton in
the young of  the higher animals is composed
almost entirely of cartilage.   Gradually bony
matter is deposited  in the cartilage, and the
osseous takes  the place of  cartilaginous tis-
sue. It is some years after birth that the car-
tilaginous skeleton of the infant becomes fully
converted into bone.  Bony matter is, how-
ever, formed  after birth independent of  carti-
lage, as is seen in the union of bones after a
fracture,  or in the formation of new bones in
cases of necrosis.  (See Necrosis.)  When a
very thin slice of bone is examined  under the
microscope, it is found to consist of fibrous,
hard material, in which are a series of radiat-
ing bodies—black spots with lines running in
all  directions—looking like  minute insects.
These are really little cavities, and  are called
" bone-lacuiKC ;" they are the active agents in
the growth  of  the  bone, and maintain the
bones in their integrity.  These cavities radi-
ate around certain centres or tubes,  which are
called the Haversian canals, and which serve
as passages  for the  minute blood-vessels and
capillaries which nourish and cause the bone
to live.   The cartilages present much simpler
cells than  those of  bone, and between them
are deposited much  larger quantities of inter-
cellular matter than in bone.  The cartilages
also possess  fewer   blood-vessels  than the
bones.  The  teeth resemble bone in their ulti-
mate structure.  On  the outside  of all teeth is
the enamel, which contains very little animal
matter, and  a great  deal of mineral matter.
The outside of the fangs of the teeth are cov-
ered with bony matter, while the mass of the
tooth is made of a  substance called dentine,
which  stands between  the  bony matter and
enamel in the quality of hardness, and is full
of very little  tubes,  which meet  in the middle
of the pulp.  It is this substance which is so
largely developed in  the tusks of the elephant,
and produces ivory.  The  bones of animals
are sometimes  recommended as articles  of
diet.  Boiled with their  meat on they yield
gelatine and  fat, and portions  of  the  phos-
phate of  lime are supposed to  be  yielded in
the solution.   They  should  never  be thrown
away, but used for making soup.   Bone dust
is used for making jellies, and is a better way
of introducing phosphate of lime into the sys-
tem.   Ivory  dust is  obtained from  the refuse
of the ivory-turner's lathe and saw, and con-
tains more  phosphate of lime than bone dust.
In  rickets  and softening of  the bones and
scrofula these things may be used as articles
of diet with advantage.  The marrow of bones
 is principally fat, and, after boiling the bones,
 it may be taken by invalids where a fatty diet
 is required.   Bones when damp are liable to
 decompose, and when used for cooking  pur-
 poses should be  employed  fresh  and  well
 crushed  before they are cooked.
   BONE-FELON.  (See Whitlow.)
   BORAX, known to chemists as biborate of
 soda, is  chiefly used as a domestic remedy for
 children whose  mouths are sore with thrush.
 It is mixed with honey, and smeared all  over
 the inside of the mouth.
   BOUGIE is a long and smooth cylindrical
 instrument used in the treatment of stricture
 of the urethra, rectum, or any other canal lead-
 ing to the interior of the body.  There is great
 variety in the size and composition of bougies,
 some consisting merely of threads of spun
 glass, or of horsehair, others forming thick
 cylinders made of gulta-peTcha, of caoutchouc,
 or of linen  hardened by wax  or gum-copal.
 Instruments  similar in form and purpose are
 also made of metal, but to these the name of
 sounds is usually  given.   The treatment by
 bougies consists in passing the  instrument
 through a stricture, and allowing it to remain
 for a time, in  order to produce by pressure
 gradual relaxation of  the contracted portion
i of  the canal.  The parts of the body into
 which a bougie is introduced  in disease are
 the urethra, the gullet, the rectum, the entrance
 to  the  womb,  and the  Eustachian tube or
 canal leading from the back of the throat to
 the internal ear.   When a rapid dilatation of
 the  contracted  passage is required, recourse
 is had  to bougies formed  of  some material
 which will  readily expand when  moistened.
 Instruments of this kind  are  usually com-
 posed of catgut,  of  pieces of  compressed
 sponge, or of the stem of the sea-tangle (Lai/i-
 inaria digitata).
    BOWELS.   (See  Abdomen,  Enteritis,
 and Melaena.)
    BRAIN.—The brain is a complicated struc-
 ture formed of nerve-tissue, and constituting
 a most important part of  the nervous system
 of man.  It is enclosed in a bony cavity called
 the skull, and is thereby protected in a great
 measure  from  external  injury ; it has also
 three special membranes covering it : the dura
 mater, a fibrous  texture lining the skull ; the
 arachnoid, a fine delicate membrane lining the
 dura mater, and covering also the brain ; and
 finally, the pi a mater, a tissue rich in vessels,
 which here become ol  very minute size, and,
 running into the   brain, supply  that  organ
 with blood.   The  brain may be looked  upon
 as a prolongation of  the  spinal cord, which,
 when it enters the cranial cavity, spreads out
 in a fan-like manner and forms those  large
 masses  of nerve substance  known as the cer-
 ebrum and cerebellum.  The brain is formed
 in  two nearly, if  not   quite, symmetrical
 halves, which are partially joined  together,
i so that a close communication exists between 
BRAIN
BRAN
41
 each division.  Each  part is composed of a
 vast  number of white fibres, which  form a
 great proportion of the bulk, while externally
 there is a shell of gray matter where the nerve-
 cells are met with, and where the active func-
 tions of the brain in great measure are devel-
 oped.   This shell, or superficial layer of gray
 matter, is  about TYy to 1 of  an inch in thick-
 ness, and  is in man and the higher animals
 very much convoluted, so as to increase the
 superficial area ; the convex surface  of the
 brain is marked with a number of sulci, or
 grooves, into which the vessels of the pia ma-
 ter dip and supply the  nerve-cells  with nutri-
 ment.  The  white  fibres merely convey im-
 pressions,  while in  the gray matter reside the
 functions of  the mind.  A  fair, but  not ac-
 curate, analogy  may be  made by  comparing
 the gray matter to an electric battery, and the
 white fibres to the telegraphic wires :  the one
 generates  force,  the other  only conducts it ;
 yet both are  liable to  deceive ;  there may be
 changes in the gray matter, as in cases of in-
 sanity, or the fibres maybe broken and paral- i
 ysis ensue.   Those functions  of  the brain
 which are called the  intellect,  emotion, and
 will, and  which  together make up the mind,
 have their seat in the outer gray shell, which j
 is made up of layers  of delicate nerve-cells,
 freely supplied  with blood ;  but each nerve-
 cell communicates with other nerve-cells, and i
 with  distant  parts  by means of  fibres, and
 these fibres  pass down  through  the  spinal
 cord  and ramify all over the body under the
 name of nerves.   For instance, we desire to
 move a  hand ;  through the  influence of the
 will,  or volition, an  impression  is  sent by
 means of these fibres  from  the surface of the
 brain down to the right  muscle  or muscles of
 the arm which  have to  perform  the  move-
 ment ;  the direction  of the current here is
 from the centre to the periphery or circumfer-
 ence.  Again, when a finger is pricked, the
 sensation is  really  felt in the brain and con-
 veyed there by another set of fibres ; it is not
 until the brain receives the message, not  until
 it knows  what has  taken place, that we feel
 the sensation called pain.   The direction of
 the current is here from the periphery to the j
 centre : the first set of  fibres are called motor j
 or  excito-motor  fibres,  and the second set j
 sensory or excito-sensory fibres.  Thus there J
 is a complete circle  formed by the brain and
 nerve-fibres, and by this means most of our
 movements  are  performed,  our sensations
 felt, and our knowledge of the external world
 acquired.   Besides  this large circuit there are
 smaller  ones, and some of  these  do not in-
 clude the surface of the  brain, and therefore
 their movements are  made  unconsciously ;
 such  movements are termed  reflex  move-
 ments, and the will  has no power over them.
 Besides this active gray matter and the white
fibres in the brain, there are numerous local
centres in each half, termed  nuclei ; they also
are formed of  nerve-cells, and  from  them
proceed various  nerves which have special
duties to perform.  These nuclei are  seated
in the  lower part of the brain, and near its
middle line, and the  fibres from  them form
nerves which, emerging from the base of the
brain, pass through various holes in the skull,
called  foramina, and  then they supply the
parts  for  which  they  are  destined.   These
nerves are twelve  in  number on each side,
and they have very different functions ; some
are for ordinary motion, as the third, fourth,
and sixth pairs, etc. ; some for common or or-
dinary sensation, as the fifth pair ; some for
special senses, as the first pair for smelling, the
second for sight, the eighth for hearing, and
part of the ninth for taste.  The brain is not a
solid body, but hollowed within into various
cavities, called ventricles, which are lined by
a fine epithelial membrane, and contain a little
serous fluid.   The  lateral  ventricles are the
largest, and are found one  in  each  hemi-
sphere ; the third ventricle lies  below them,
while the fourth is smaller and  more  pos-
terior : it is here that many important nerves
arise, and any  injury to this spot will cause
rapidly fatal  results ;  the fifth  ventricle  is
very small and unimportant.  The internal
carotid and the vertebral arteries on each side
are the chief vessels which give the  brain its
blood ; on entering the skull, they divide and
form very free communication with each other
at the  base ; then, more minutely dividing,
they ramify all over the  surface of the brain
and enter its  substances ;  the blood returns
by passages hollowed out in the  dura mater,
called sinuses.   The various diseases  of the
brain   are described  under  the names by
which.they are commonly  known, and refer-
ence must therefore be made to those articles
for information ; the following is a list of the
subjects  to  be referred to : Inflammation of
the membranes,  or Meningitis;  Apoplexy;
Hemorrhage, Cerebral ;  Cerebral  Softening,
Malformation of the  Brain, Hydrocephalus,
Paralysis, Hemiplegia, Palsy,  Fits, Epilepsy,
and Coma,
  BRAIN FEVER.  (See Meningitis).
  BRAN.—When wheat is ground in the mill
it is separated into two portions, the flour and
the bran.  The flour is the inner portion of the
grain, while the bran is the outside.  A grain
of wheat is really a fruit, and the bran is the
outside epicarp.  It is separated on account
of its coloring the flour and making it look
coarser.   It is, however, frequently retained
and mixed with the  flour made  into  bread.
Such bread is called whole meal or brown bread.
Although  the bran  is so  often  rejected  it
nevertheless contains constituents which ren-
der it  a  useful article  of diet ;   indeed  it
contains more flesh-forming matter and min-
eral matter containing phosphate of lime than
the flour  does.   Where  persons  can  digest
brown  bread it is undoubtedly more economi- 
 43              BRANDY

 cal than white bread.  Bran, however, in its
 coarse  condition acts upon the  bowels,  and
 while it forms  a very excellent diet where the
 bowels are  confined, it is on that account to
 be avoided where  the  bowels act too freely.
 When  the bran is reduced to a flour with the
 rest of  the wheat, the bran is not so likely to
 act upon the bowels.
   BRANDY,  a form of distilled  spirits.  It
 is usually distilled  from some form of wine,
 and peach kernels are added to it while being
 distilled,  which  gives  it  its characteristic
 flavor.   Brandy usually contains more alco-
 hol  than other distilled spirits, and  on  this
 account is more frequently used as a stimulant
 in disease.   There is nothing in brandy to
 make its action in any way peculiar.  The
 very small  quantity of  oil of bitter almonds
 or hydrocyanic acid afforded  by the peach
 kernels could not in any way affect its action.
 (See Alcohol).
   BREAD.—All food is called by this name
 which  is  made from the  flour of grains or
 seeds and made into a dough and baked.   At
 the  present day the most  common  form of
 bread is  that made from the flour of wheat.
 Other flours are used, as those of rye, barley,
 maize and millet, but the flour of these grains
 is unsusceptible of  fermentation, thus  this
 kind of bread is heavier than that whch is fer-
 mented. By the process of fermentation bread
 is made vesicular, hence we divide bread into
 vesiculated  and unvesiculated,  or  into  un-
 leavened and leavened bread.  All flour made
 into loaves, cakes, biscuits, etc., is unleavened
 bread,  whilst the flour which  has the dough
 mixed with yeast, in order to start fermenta-
 tion, is called leavened  bread.  There is
 another way  of producing vesiculation in
 bread, and that is  by what is called aeration,
 and bread thus made is called  aerated bread.
 This bread  is  prepared  by adding carbonate
 of soda to the  flour and an acid, and as the
 acid expels  the carbonic acid gas from the
 soda the  bread becomes aerated.  Another
 way  is by  injecting carbonic acid into  the
 dough,  which on being expelled vesiculates
 the bread without interfering with its compo-
 sition.  Bread  contains the same substances
 as the flour from  which it is made.  In the
 process, however, of preparation, a quantity
 of water mixes with the bread, which reduces
 the quantity of alimentary matter it contains.
 The principal constituents of bread are starch
 and gluten,  which exist in the proportions of
 about four to one.    This is  the proportion in
 which the system requires the two classes of
 food  (see Food) which are represented by
 starch and gluten.    It is on this account that
 bread is regarded as a typical food.   Unleav-
 ened  bread is  less  digestible than leavened
bread, and hence in none of its forms is used
 so extensively.   Bread leavened with  yeast is
sometimes found to disagree with weak stom-
achs, and in  these cases the aerated bread is to
           BRIGHT'S DISL.A5L.

be preferred.  The addition of butter to bread
appears to increase its digestible property, and
adds to the alimentary properties represented
by the starch.
  BREAST.—At  the age  of puberty the
breasts both of boys and girls are subject to
swelling and tenderness,  which is perfectly
natural,  and  subsides  of  itself after a short
period of inconvenience.  Sore  Nipples.—
These painful cracks, or excoriations, are best
treated by painting them over with collodion,
and the nipple should be protected from the
child's mouth or from  the woman's clothing
by means of a metallic or caoutchouc shield
(not vulcanized) sold by  druggists for that
purpose.  Washing the nipples several times
daily  with a solution of alum  is of great ser-
vice  (see Nipples).   The breast is peculiarly
subject to tumors, the characters and diag-
nostic features of which may be found in any
work on  scientific  surgery.   There is, how-
ever,  one form of disease,  of  which it seems
important to say a  few words, and  that is
cancer (see Cancer).  It  first commences as
a swelling, attracting notice  by its presence,
is hard, with a tendency to increase in breadth
rather than  prominence, seems adherent to
the structures above it instead of rolling from
under them ; causes  the nipple after a while
to contract  or pucker in,  and  when  pain
comes on it  is  characterized by a severe,
shooting pain.  After a while  the neighboring
structures become  involved, and  the  skin
ulcerates, and  the cancer spreads, the glands
in the armpit become hardened or indurated,
and the health and strength rapidly decrease.
The question of removal or of palliation must
be referred to a surgeon.  The most frequent
disease of the  female breast which the public
are acquainted with, perhaps, is abscess.  Now,
this abscess  may arise from  several causes :
lactation, blows, cold, neglect in suckling,
sore nipples, etc., and is attended  with swell-
ings,  great pain, tenderness, fever,  and shiver-
ing.  The breast should be fomented or poul-
ticed,  " slung" with a handkerchief or band-
age,  and the  bowels kept open  by a  mild
purgative ; as  soon  as the matter " points,"
i.e., comes to the surface, an incision into the
abscess should be made with a sharp lancet,
taking care that the incision be vertical and
not across, as,  in the latter case,  the matter
will " pocket," or burrow, and fresh abscess-
es form.  Poultices should be  applied, and
tonics of iron, quinine, bark  and  ammonia,
port wine, etc., given.
  BREAST-BONE, a common name for the
sternum, a bone which runs  do.wn the front
of" the chest, and to which the  cartilages of
the ribs are attached.
  BREAST-PANG.   (See  Angina Pec-
toris.)
  BREATH, Shortness of. (See Dyspnoea.)
  BRIGHT'S  DISEASE is a name applied
to several affections of  the kidney which arc 
           BRIGHT'S  DISEASE

 dependent upon an altered condition of the
 blood, and generally associated with dropsy
 and with albumen in the urine.  Nephritis is
 the scientific term applicable to this affection ;
 the disease may be either acute or chronic, so
 that acute nephritis is synonymous with acute
 Bright's disease, and  chronic  nephritis with
 chronic  Bright's disease.   I. Acute Bright's
 disease may occur from a cold, from a  blow,
 from taking substances, like  turpentine or
 cantharis, which irritate the kidney ; but more
 usually it follows some acute febrile  disturb-
 ance, and  more expecially  it is associated
 with scarlet fever.  About the second  or third
 week  after the  commencement  of  scarlet
 fever, the patient may find his urine of a
 dark, porter color,  and rather diminished in
 quantity ;  at the same time  he will  feel lassi-
 tude, probably  slight  pain  across  the  loins,
 and there may be puffiness of the eyelids and
 loose parts of the skin ; if kept in bed, the
 urine in a few days becomes paler, but still
 looks  very cloudy and deposits a  copious
 sediment on standing ; when boiled, afloccu-
 lent precipitate is thrown down,  because the
 albumen which  is present becomes coagu-
 lated.   At times convulsions occur, because
 the blood gets altered in consequence of  the
 kidney disease, and these may be very numer-
 ous and end  fatally ; at the  same time less
 water is passed.  At other times the glands
 of the neck become large, swollen  and pain-
 ful, and, if they soften  and burst, they add
 seriously to  the danger of the  case.  As a
 rule, acute Bright's disease has a tendency to
 recover in  two or three  weeks ;  by degrees,
 the urine resumes its normal color, more is
 passed, and finally the albumen disappears ;
 the  dropsy also subsides,  and  the  patient
 merely feels weak and looks pale.
  Treatment.—Since the kidneys cannot do
 their work, the skin, lungs,  and bowels have
 to take  an increased  activity  ; hot baths do
 good by causing sweating, and  giving free
 action to the  excretory  power of  the skin  ;
 they may be given  at  bed-time and repeated
 every night ;  the water should be about  95°
 Fahr. to 98" Fahr., and the patient may remain
 in it from  five to ten minutes, then  quickly
 dried and put  to bed  at once.  Purgatives
 should be given so as to freely purge the pati-
 ent, and for this purpose compound jalap or
 compound scammony powder  are excellent.
 Rest in bed in  a  warm room  is most impor-
 tant, nor ought the patient to think of  leaving
 his room until all the dropsy and acute symp-
 toms have subsided.   The appetite is gener-
 ally very fair, and light, nourishing food may
 be taken, as bread and milk, beef.-tea, broth,
 a little mutton, rice pudding, arrowroot, and
gruel.    During  convalescence,  great  care
must be  exercised in not sending the patient
out too  soon, especially  when the weather is j
cold, nor should cold bathing be too soon re- J
sorted to ;  flannel should be  worn next the !
           BRIGHT'S  DISEASE        43

 skin, moderate exercise may be taken, and a
 nourishing diet ;  no stimulants are required in
 this disease, but  after  recovery a  pint of
 beer or two glasses of sherry or claret may be
 taken everyday with benefit ;  tonics contain-
 ing iron and quinine  will relieve the debility
 and the anaemia.
  2. Chronic Bright's disease occurs in three
 forms :  (a) a large  fatty kidney ; (b) a large
 waxy kidney ; (c) a small contracted kidney.
 (a)  The fatty kidney occurs in scrofulous or
 consumptive people and in those who drink
 sometimes ;  the course of the disease is very
 long, and may last for years ; it comes  on
 gradually, and the first thing the patient may
 notice is that he  passes less water and that
 his legs swell ;  this swelling is caused  bv
 dropsy of the lower extremities, and is worse
 at night; than in the morning ; the skin is pale,
 and pits readily  on pressure  (see  CEdema).
 The urine  is small  in quantity, often darker
 than usual, throws down albumen on boiling,
 and there  is more  or  less  deposit  when it
 stands.   In many cases much relief may  be
 obtained if the case is treated in time, but the
 dropsy then may  come back and  spread  up-
 wards so that the abdomen becomes distended
 with fluid  (see Ascites).   The  breathing is
 then impaired, and the more so if any hydro-
 thorax is present, as the lungs are encroached
 upon and there is  less space for breathing.
 The heart has more work to do, and becomes
 hypertrophied and  thicker  and larger than
 usual ;  there is often  nausea  or  vomiting,
 headache, and now and then bleeding from
 the nose.   The face becomes pale or sallow,
 and the  skin all over  the  body may become
 cedematous.  There is  no fever  nor  pain ;
 the appetite is often very fair, and  the chief
 distress  arises from the dropsy which is met
 with in the various tissues.
  Treatment. — The  treatment consists  of
 rest in bed, hot-air or hot-water baths to en-
courage the action of the skin, and purgatives
 which shall cause watery motions ; for this
 purpose jalap, scammony and cream of tartar
 are to be recommended.   If  the dropsy  in
 the legs be very  great, these limbs  may be
 pricked  with a needle or a lancet, in  several
 places, so as to let the  fluid  out ; the legs
 should then be wrapped in  hot flannel, and
a  mackintosh  placed  on  the  bed  under-
 neath ; in  this way many  quarts  of fluid
 may escape  in a few days and  give great
relief  to  the patient ;  he  will  feel  much
easier, and will pass more water and breathe
freely now  and  then ;  however, inflamma-
tion of the legs will come on after the punc-
ture.  Although relief may thus be given for
a time, the patient will  ultimately die worn
out by  the constant drain of albumen from
the blood, or suppression of urine may come
on and cause convulsions, coma, and death.
  (b) The waxy kidney is so called because its
appearance has some resemblance to wax ; it 
44        BRIGHT'S  DISEASE

is associated with a different set of symptoms, j
It occurs in those who have suffered from dis- |
eased  bone, scrofulous  abscssses, or  from
syphilis, or who have been exhausted by wast
ing diseases.  Nearly always the  loin  and
spleen share in the general mischief, and be-
come much larger than usual.  Such patients
have  very little, if any,  dropsy during the
whole of the illness,  but they pass a  large
quantity of pale-colored urine,  which contains
plenty of  albumen, but  deposits hardly any
sediment.   The  course of this disease is also
very  chronic, and may  go on for years ;  it
occurs in children as well as in adults ;  as in
the last case, there is no fever, nor is the ap-
petite  impaired  particularly.   Death  will
eventually take place under similar conditions
to those mentioned  under the fatty kidney.
Purgatives are less called for here, as there  is
seldom dropsy ;  a nourishing light diet should
be  given,  and  tonics containing  iron  and
quinine ; warm  clothing  must be worn, and
moderate  exercise may  be taken when the
weather is fine and mild.
  (c) The small, contracted kidney  occurs
chiefly in gouty people and in those who drink
much.  The disease comes on  very insidious-
ly,  and attains  considerable progress before
it is often found out ; dropsy is rarely pres-
ent, but much less  water is passed than in the
last case, although there  is often more than
usual ; it is pale in color, deposits very little
sediment, and contains only a little albumen ;
the urine should always be carefully tested in
gouty people to see if they have any kidney
disease.   Debility, headache, a sallow expres-
sion, occasionally nausea and  bleeding at the
nose, are symptoms met with in this form of
disease.  With it is often associated disease
of other organs, as the  cause  which sets up
mischief  in the  kidneys  will  also  cause
changes  in  other  tissues ; the vessels  often
have fat  or saline matter deposited in their
walls, and are then said to become atheroma-
tous and calcareous ;  the tissues supplied by
these vessels are  therefore  badly nourished,
and suffer in consequence ; the lungs become
emphysematous, and  the patient short of
breath ; the brain also is frequently involved,
and hemorrhage into its  substances or white
softening  may  result, and cause  apoplexy |
(see  Apoplexy).  There will then  be  pre- j
monitory  or warning symptoms,  of  giddi- j
ness, headache, and loss of memory, followed
by a stroke or fit, and hence those who suffer j
from this disease are always in a serious con-
dition.  The heart may become diseased, and i
inflammation of  the pericardium or  endocar- I
dium may ensue and add  to the  danger  (s«e !
Pericarditis and  Heart).   Death  may,
therefore, take place by one of these compli-
cations, carrying the patient off, or  the urine
may become suppressed and  cause convul-
sions, followed by coma and death.
  Treatment.—The treatment is  similar to
              BRONCHITIS

that mentioned in the last  variety.  In all
cases of Bright's disease the eyes are apt to
become affected from changes taking  place
in the retina, which cause  dimness of vision
and even  blindness.   The origin of Bright^
disease  is always in the blood, and that fluid
in  turn becomes still further altered by be-
coming contaminated with  materials which
ought to  be passed  off by the kidneys, but
which are retained in the system ; the blood
also becomes poor in quality by being daily
drained of albumen—one of its most impor-
tant constituents.  Pallor,  debility, loss of
flesh, and defect in the general nutrition arise
from this  cause.
  BRIMSTONE.   (See Sulphur.)
  BROMIDE  OF   POTASSIUM.   (See
Potass.)
  BROKEN BONES.  (See Fractures.)
  BROMINE,  an   elementary   substance
found in sea water, in company with chlorine
and iodine.  It is found in combination  with
sodium, and is used extensively in medicine.
  BRONCHI, the name given  to the air-
passages  which pass from the windpipe, and
are distributed to the  whole of the lungs (see
Lungs).   The air-passages are subject to in-
flammation and an  increase of  the  mucus,
constituting a very common form of disease.
(See Bronchitis.)
  BRONCHITIS is an  inflammatory  dis-
ease of the lining membrane  of the bronchial
tubes.   This disease may have an acute and
a chronic  form.  i. Acute Bronchitis.—This
complaint is a very common  one, and is very
liable to attack persons in the winter and at
times when the east or the northeast winds
are prevalent.  It commences with the symp-
toms of  a common  cold ;  there  is first a
feeling of chilliness and  aching pains in the
limbs ;  the patient  is  thirsty and feverish,
with languor and  headache, loss of appetite
and restlessness.  There is an uneasy feeling
of  soreness behind  the sternum or breast-
bone, and this is increased on taking a deep
inspiration or in going out into the cold air.
At  first  there is a dry, hacking cough,  and
very little phlegm is  brought up ;  in two or
three days the cough becomes looser, and the
expectoration is more abundant ; the latter
is  frothy, viscid, and shortly becomes  of a
greenish-yellow  color ; this is attended with
relief to the patient,  and the  feeling of sore-
ness and constriction  in the  chest  then  goes
away.   Wheezing  sounds are heard in the
air-passages, and may be felt when the hand
is  placed  on  the chest or  back ;  these  will
partly disappear after the phlegm  has  been
coughed up, and then recur  again  to  be
coughed  away in return.   The sounds are
due to the air passing over the viscid mucus,
which more or less fills the  bronchial tubes.
With proper care and rest this disease can be
checked and recovery soon take place.
  Treatment.—As soon as the patient  feels 
BRONCHITIS
BRONCHITIS
45
  ill he shoull  go to bed, and keep there until \
  he is well again ; in this way an  attack may j
  be checked in a few hours ; the air should be j
  warm, and for this  purpose a fire  may  be j
  lighted and the temperature kept up between !
  6o°  Fahr. and  63°Fahr.  There  should also j
  be a certain amount of moisture in the air, i
  and  to effect this a ketlle  of  boiling water j
  may  be  placed on the fire,  and the  steam j
  allowed to pass into the apartment ; this may
  be done two or  three  times  a day, and for
  about ten or fifteen minutes at a  time.  A
  warm bath before going to bed is also a most
  useful remedy,  but the patient should be well i
  dried and put to  bed directly afterwards,  so j
  as to encourage free  perspiration.  Some are j
  in the habit  of  taking  a Turkish  bath when J
  they have an attack coming on ; the  only in-
  convenience in  this  procedure  is the return
  home through the cold air afterwards. Which- j
  ever plan be adopted, the great object in the
  treatment is to  promote the action of the skin,
  and  cause a moderate  amount of sweating.
  A warm glass of whiskey and water, or port-
  wine negus,  may be taken at bed-time, and j
  this with much  comfort  to the patient ; there |
  is, however,  no  occasion to give any large
  amount of stimulants  for this  complaint  ; J
  many domestic  remedies are as useful as any j
 medicine.  A little prepared barley boiled  in j
  half a pint of milk, to which is added a wine- j
 glassful of whiskey, some grated nutmeg with j
 sugar, and lemon-juice, according  to  taste,
 will  be found  a  very  agreeable potion  at j
 night-time.  The patient will  not care to eat !
 any solid food  at first ; breadand-mllk, rice
 pudding,  or one made of arrow-root, tapioca, j
 or ground rice,  may be given; broth or beef- i
 tea or chicken-broth ;  jellies  may  also be j
 taken ; as a rule, hot, bland  fluids are most
 enjoyed.   A  hot  linseed-meal poultice  may
 be placed on the chest, and renewed  when it
 becomes cold (see Poultice).  The patient
 should wear  a  flannel  shirt next the skin,
 as it will absorb the perspiration as well as a
 linen  shirt, and has  the advantage over the
 latter of  not  causing that damp  and chilly
 feeling which  the  linen produces if  the  bed-
 clothes are removed  by chance and the wet
 shirt  is cooled.  Cotton wool laid on the chest
 is often as good  as  a poultice,  and never
 forms a damp, heavy mass, which the latter
 does, if not properly made. Hot local appli-
 cations assisted  by warm and moist air, and
 a few domestic remedies, will generally suffice
 to cure an attack of acute bronchitis ; if, how-
 ever,  the disease  be neglected in its  early
 stage, and the patient be exposed to draughts
and cold  air, serious symptoms may arise.
Such  symptoms would  be indicated  by the
lips becoming of a purplish color, while the
cheeks would be pale  and livid ; the  expres-
sion becomes more and  more anxious, while
the entrance of air  into the chest is more diffi-
cult, and the patient makes painful efforts to
 breathe.   Delirium may come on, and rapid
 sinking ; in these cases the patient dies from
 apncea, and the bronchial tubes are choked
 up with the viscid secretion which he had not
 strength to expectorate.  It is here, when the
 obstruction to the flow of  blood through the
 lungs is so great, that bleeding  may at times
 be advisable, and  afford great  relief.  Cup-
 ping-glasses may be applied to the chest with
 much benefit,  while stimulant expectorants,
 as ammonia and  ether,  may be given inter-
 nally.  Although   the cough may be  very
 troublesome, and  the  patient may complain
 much of want of rest, yet it is often very dan-
 gerous to give opium or any preparation of
 that drug, as it will add to the congestion and
 may  hasten a fatal termination.
   Acute Bronchitis in  Children is of much
 graver importance  than  in  the  adult, and a
 great deal of the mortality in childhood arises
 from this disease.   In children  the mischief
 is very apt to spread down the bronchial tubes
 even  to the smallest branches,  while in  the
 adult the  main branches are, as a rule,  the
 seat of the disorder ; and it is in proportion to
 this downward extension  that  the relative
 danger lies ; for the more the smaller tubes
 are affected, the less can the blood become
 properly aerated, and death may take place
 from  suffocation.  This  disease begins with
 the symptoms of an ordinary cold,  and  for
 some days perhaps nothing  more serious ap-
 pears ;  but by degrees there  is  more fever
 and  restlessness ; the heat of the skin,  as
 shown  by the thermometer, is  much  above
 the average, the  pulse rapid, the breathing
 quick and wheezing ; the cough is  more fre-
 quent and painful, and then the veins of the
 forehead and  neck stand out, and the face is
 flushed.  The child feels  as if the chest were
 stuffed, and wheezing sounds may be felt on
 both sides when the hand is placed over the
 back or front of the chest.   At bed-time the
 fever  and  cough are generally worse, and the
 child  is more restless ; then it will often sleep
 for several hours and awake with a fresh ac-
 cumulation of mucus and  phlegm in the chest,
 which causes  it to make vigorous  efforts to
 expel by coughing ; vomiting may come on,
 and this may give relief by freeing the tubes
 of mucus and allowing of easier respiration.
 The tongue is  moist throughout, the appetite
 bad, while tljere is  more or less thirst.   If
 the little patient become worse, the  face may
 be pale while lips are rather livid ;  the  nos-
 trils  dilate with  each inspiration, and  the
 breathing is more hurried and difficult.  Con-
 vulsions often  precede a fatal  termination ;
generally  death takes  place without much
suffering, as the child passes gradually into a
sleepy and unconscious state.
  Treatment.—The treatment should begin as
soon as possible, as  any delay is  dangerous.
The child  should be placed at once in bed,
wrapped in a flannel blanket or shirt, and the 
4G            BRONCHITIS
BRONCHITIS
temperature of the room kept between  6o°
Kahr. and 65° Fahr.  A  warm bath may be
given at  the  outset, so as to encourage  the
action of the skin, and the child should then
be quickly dried before  a  fire and  placed in
bed.  Cotton wool  should be  laid on  the
chest, or  a large piece  of spongiopiline wrung
out of hot water ; a hot linseed-meal poultice
may also be similarly  used.   These applica-
tions may be renewed  when  they become
cool, and the same process may be  repeated
for twenty-four or thirty-six hours ; occasion-
ally  a little mustard may be mixed with the
linseed-meal.  The bowels may be opened by
a dose of castor oil, and much relief may be
experienced in doing so, as, in children, when
inflammation of the  lungs occurs, there is
often diarrhoea or disturbance in the  intestinal
canal.  An emetic of  ipecacuanha wine may
be given  if there is much wheezing  and stuf-
fing  of the chest, and this will often relieve
much discomfort.   Expectorant medicines
should be given, so as to enable the patient to
expel the mucus which  is being poured out
into the bronchial tubes.   At the  same time,
the  strength must be carefully  supported ;
milk should  be given freely, and,  if neces-
sary, a  few doses  of  brandy  may be put in
also. Beef-tea or veal-broth may  be given
alternately ; solid food is not to be given, nor
will  the  child care  for it, as long as there is
much fever ;  the diet should then be liquid,
while it is also light and nourishing.  When
all  the severe  symptoms have subsided the
patient may return gradually to its usual diet,
and  the exhibition of some steel wine, or other
tonic, will expedite the recovery.  Yet for some
time care should be taken that the child is not
exposed  to  cold, or to  any influence which
might bring on a recurrence of the attack.
  2. Chronic Bronchitis.—This is a very com-
mon disease, and is very prevalent during the
winter months, causing a great deal of mor-
tality.   It may occur  at any age, but is most
usually met with in middle-aged  or old peo-
ple,  and  in those who suffer from emphy-
sema.  Cough, shortness of breath, and  ex-
pectoration are the three most constant symp-
toms of  chronic bronchitis ; the patient is
pretty free all the summer and during warm
weather, but as the winter comes on he takes
cold very readily, and the above symptoms
come on and prove more or less troublesome
all the winter ; they will disappear again in
the  summer, only  to recur when  the cold
weather  returns.  Each attack is, in fact, an
acute bronchitis, and  the symptoms  are the
same as those  which  have  been detailed
above.  Those who are liable to a cough every
winter generally become sooner or  later em-
physematous.  They  are unable  to undergo
any great exertion because they are so short
of breath ; the chest does not expand so much
as usual, and they often require support when
the  breathing is more  difficult than usual ;
 they cannot  lie down at night, but  prefer a
 reclining posture  in  bed ; the lips  are  livid
 and  congested,  and  the eyes  bright  and
 watery.   Palpitation of the heart is common,
 and a'feeling of fullness at the bottom of the
 sternum.  The   circulation  of  the blood
 through the lungs being obstructed,  the large
 veins  become  distended, and dropsy of the
 legs is very common in  those who have suf-
 fered long with this complaint. The  sleep is
 often disturbed at night  from attacks of  diffi-
 culty of breathing, and this is much aggravat-
 ed on a foggy night.   The appetite is injured,
 and any  indigestible food makes the patient
 worse, by causing distention of  the stomach,
 and thereby encroaching on the thoracic space
 by pushing up the diaphragm.
   Treatment. — The    best  treatment  for
 chronic bronchitis in a variable climate like
 ours,  is change of air and passing the winter
 in the south, or in some place where the  vari-
 ations of temperature are slight,  and where
 there  is  an  absence of  fogs and east wind.
 To the  majority of people this is, of course,
 impossible, and the treatment must be directed
 to avoiding as  much as possible any  exposure
 to cold, or to any of  the exciting causes  of
 this disease.  To those who are  engaged in
 out-door occupations, and exposed  to all the
 inclemency of the weather,  but little can  be
 done  except to alleviate  any distressing symp-
 toms  that may arise ; thick  boots should  be
 worn, so as  to prevent  damps and cold feet,
 for the circulation in such people  is  sluggish,
 and they cannot take active exercise to  keep
 themselves warm.  Flannel should always be
 worn next the skin, and warm baths may be
 occasionally taken, so  as to keep  the  func-
 tions  of the skin in  good order.  The diet
 should be nourishing, but easily  digestible  ;
 meat may be taken at least  once a-day, and
 a  pint  or two of beer, but  starchy  food, as
 potatoes, bread,  etc., should only be taken in
 moderate quantities.  Such  people should go
 out after sunset  as seldom as  possible, and
 they should  not talk in the open air  on a cold
 dav, but breathe through the nose,  as in this
 way  the air is somewhat warmed  before it
 passes down the bronchial tubes ;  a respirator
 is often of great  service.  For those who are
 not obliged to work, much benefit will  be
 found by only going out on  fine  and  mild
I days,  and by avoidance of night  air.  Some
 people are obliged to keep the house nearly
 all the  winter, otherwise they  get  an acute
 attack of bronchitis which may prove serious.
 A mild winter is a great boon to those who
i suffer from this disease.  By using these pre-
j cautionary measures an  attack may be warded
 off ;  but when such an attack does come on,
 the patient should at once place himself under
 treatment and go to bed ; the treatment then
I will be the same as that mentioned above  for
| acute bronchitis.  (See Asthma and Emmiy-
1 sema.) 
BRONCHOCELE
BUBO
4:
   BRONCHOCELE.  (See   Derbyshire
 Neck.)
   BRONZED  SKIN is a  peculiar discolor-
 ation occurring in Addison's  disease ; very
 little is known  as  yet about its nature, and
 there does not seem to  be any means  of
 remedying the  color.  (Sec Addison's Dis-
 ease.)
   BROOM, the common name of the  Spar-
 tium scoparius.   The tops  or ends of  the
 branches  are  employed  in  medicine.   They
 are emetic and purgative, and in small doses
 they act as diuretics.  Hence an  inlusion of
 broom-tops is used as a remedy for dropsy.
 A juice of broom-top is prepared and sold.
   BROW AGUE is a iorm of headache  in
 which the pain recurs regularly  at a fixed
 hour.   It has not necessarily anything to do
 with malaria,  such  as  induces  true ague, but
 headache in an  indivdual  who  has been ex-
 posed to such influences, is apt to assume an
 intermittent type.   (See  Headache and In-
 termittent Fever.)
   BRUISE, or  ecchymosis, is a painful and
 livid swelling at or near the  surface of the
 body, which is caused by external violence,
 f s a fall or a blow inflicted by some blunt ob-
 ject. It is met with in most cases of  contu-
 sion, and j.1so with  fractures and dislocations,
 and is caused by the rupture of  blood-vessels
 and the pouring out into  the  subcutaneous
 soft-tissues of blood or blood-stained  fluid.
 Bruises vary very much in extent, color, size,
 and situation.   In  the slightest form there is
 a small and superficial patch of a light or dark
 red color, and attended with very little swell-
 ing.  In the most severe cases a soft swelling
 is formed as large  as a  child's head,  or the
 whole of  a limb is  swollen  and of a black or
 daik blue color.  In some cases the bruise is
 formed  among the  muscles and at some dis-
 tance from the skin, and at others it involves
 only the surface of  the limb over a greater or
 less extent.  The rapidity with which a bruise
 is formed also varies according to  the situa-
 tion of  the injured part.   Where the skin is
 in close proximity  to subjacent bone, and is
 bound down  by unyielding tissue, the blood
 is effused slowly, but in a blow upon the eye-
 lids or upon the  breast a large  livid swelling
 is rapidly formed.   It has  been stated that a
 bruise when slowly formed presents a deep
 blue, and when rapidly formed a red or livid
 red  color. In fractures of the bones of the
 leg  and fore-arm  there  is  often  extensive
 bruising which is associated with  the forma-
 tion of large blebs or bulbs  on  the  surface of
 the skin,  which are  distended by  b»ack or
 purple fluid.   In contusions of the scalp in
 children  a large collection of  blood is often
formed under  the skin ; this is usually soft at
the centre and very hard at its margin, and
feels very much like a depression in the skull.
A large bruise when fully developed is of a
purple color,  mottled with yellow and green-
ish yellow patches.   As the blood becomes
absorbed  and  the bruise fades the purple
gives way to changing shades of brownish-
red,  green, and light yellow.  These changes
commence at the margins of the bruise.  The
rapidity with which the disappearance takes
place varies  according to  the age and gen-
eral  condition of the patient; the process is
slower in old than in young  persons, and in
strong healthy men than in persons who are
feeble  and ill-nourished. The effused blood,
even in  very extensive  bruises  is usually
wholly  removed  by  absorption, but it now
and  then occurs  that  a  collection of fluid
blood  caused by an  injury to  an unhealthy
individual, instead of becoming absorbed, sets
up inflammation  in  the surrounding tissues
and  forms an abscess which bursts and dis-
charges unhealthy ill-smelling matter or pus
mixed  with soft clots of blood.
   Treatment.—In the treatment of  recent
bruise  the first object is to check further effu-
sion  of blood. This may be best done by ap-
plying  cold, and by elevating, if possible, the
injured part above the level of the body in
order to retard the circulation ;  layers of lint
dipped in cold water and frequently renewed,
or a  bladder containing ice, are the best cool-
ing applications.  If the bruised parts be very
tense and painful  some leeches  may be ap-
plied near the margins of the dark blue  patch.
After  the acute  stage cf  pain  and heat has
passed off, and the indications remain of any
fresh effusion of blood, the treatment should
be directed so as  to  favor absorption  of the
fluids and to  remove the swelling ; for this
purpose the most useful agents are the tinc-
ture  of arnica,  a lotion  composed of two
ounces of spirits of wine to twelve ounces of
water,  or  a solution of  sulphurous  acid.
The  large transparent blebs which iorm over
very extensively bruised surfaces  should be
pricked with a sharp needle and then covered
with cotton  wool, which  will  absorb  the
dark-colored fluid which is thus  allowed to
trickle  away.   Bruises, however  large, soft
and  permanent they  may be,  ought never to
be opened,-since when once the clotted blood
which they contain is  exposed  to the  exter-
nal  air, decomposition takes place  and re-
sults in inflammation and the formation of
large abscesses. • (See Accidents.)
   BRYONY.—There are two  plants  called
by this name, and both of them used occasion
ally  in  medicine.   One is the Bryonia dioica,
and belongs to the order Cucurbitacecc.   It is
called red bryony on accunt of the color of
its berries.  The black bryony is the Tamus
communis, and belongs to the same order as
the sarsaparilla.   It has no active properties.
  BUBD  is an inflammation of a lymphatic
gland,  usually situated in the groin, and
having  as  a cause some venereal affection.
Abscesses  in the  groin,  however,  may  be
caused by some  injury to the leg  or foot, 
48              BUCHU

and may be the result of ulcers of the legs, or
they may come on after hard walking, riding,
or over-exercise.   The  treatment  is that of
acute abscess.  (See Abscess.)
  BUCHU is the leaf of a plant growing in
South Africa.  It is not much used now, but
Sir Benjamin Brodie had a great belief in its
efficacy in  irritation  or inflammation  of the
bladder connected with disease  of the kid-
neys.  It is best used as infusion, and should
be employed in good large doses, almost as a
drink.
  BULL2E, a name given to the  blisters or
vesicles which appear on the surface  of the
bodv in some forms of skin  diseases.
  BUNION  consists  in  a  subcutaneous
swelling seated on the inner side of the ball
of the great toe.  In  its early stage  it is a
thin-walled sac,  filled  with clear  fluid, and
then causes very little uneasiness,  but  subse-
quently, in consequence of constant pressure
and  friction,  becomes  hard  and tender.
Sometimes, particularly after active exercise,
the swelling becomes  very painful  and in-
flamed, and forms an abscess.  The develop
mentof a bunion is caused, in most instances,
by a distortion of the great  toe, and is much
accelerated by the use of  tight boots, and by
much walking.   When the bunion  is young,
and exists  as an  indolent movable swelling,
with a thin wall and fluid contents, firm pres-
sure with the fingers, or a sharp tap  with a
heavy object may cause it to burst, and bring
about a cure.  In those cases where the swell-
ing has existed for some time,  and become
hard and painful, very little can be done ex-
cept to wear boots  made large and roomy
over the toes, and with the sole thicker at the
outer than  at the inner edge, so that the foot
in walking may be  thrown  more  upon  the
outer part.  When the bunion becomes very
tender,  and the  skin covering it red and in-
flamed, the  treatment should be  immediate,
and consist in rest, and the application of one
or two leeches and warm fomentations.
  BURGUNDY (See Wines )
  BURNS AND SCALDS.—By  the term
burns is meant in surgery the result of the ap-
plication of excessive heat to the surface of the
body, by means of some heated solid body, or
as flame.   A  scald  implies the contact of
some hot or boiling fluid with the body.  As
these two  kinds of injury present  the same
appearances, are attended by similar constitu-
tional symptoms, and require the same treat-
ment, they will be described  together  in this
article.   Burns and scalds are very serious
accidents.  Even in their slightest forms they
are very painful, and when severe are attended
by bodily prostration  and congestion  in the
internal organs.   When  a considerable por-
tion of the integument of a limb has been de-
stroyed, the patient during the whole course
of a long-continued  treatment is threatened
by various fatal maladies, as visceral inflam-
          BURNS AND SCALDS

mation, perforation of the intestine, lock-jaw.
and  pysemia.   Even  after the wound  has
closed there is generally danger of distortion
and hideous disfigurement  from the contrac-
tion of the resulting scar.   The simplest  and
most  convenient classification  of burns  and
scalds with regard to their  results on the  sur-
face of the body is that  which arranges these
injuries in the three following  classes : That
in which the injury causes inflammation and
nothing more ;  that in which inflammation is
followed by destruction  and sloughing ; and,
finally, that in which sudden charring or com-
plete destruction  is produced in that part to
which  heat  is applied.   It should be  stated
that in all extensive burns the two former re-
sults,  and in very severe burns, all these re-
sults,  may be observed  on the same patient
Around a patch  of charred tissue there  will
be a zone of hopelessly  injured but yet living
and sensitive  skin, and around this again a
zone of inflammation, the  bright  ied tint of
which passes gradually  into the pale color of
healthy skin.  Simple  and transient inflam-
mation is generally the  result of a scald.   In
mild injuries of this kind  the  skin is merely
reddened.  This is by far the most trivial re-
sult of the application of heat, so long  as the
surface injured is not very  extensive.   A
scald  of this kind produced on the chest or
abdomen  of an  infant,  by boiling water, or
over the whole surface of the body of an adult
in consequence of submersion in a vat of hot
fluid may, however, prove rapidly fatal.   The
next variety of  local injury is vesication or
blistering ;  this is a very common result,
and  takes  place after  both  scalds   and
burns.   The reddened  skin is covered by
blisters or  blebs, varying in size, and con-
taining a clear yellowish  fluid.   This con-
dition  is well-marked in severe scalds of the
hand  and fore-arm ; immense bladder-like
swellings  suddenly appear about the back
of  the wrist, and  sometimes the epider-
mis  of the  fingers and the whole  hand  is
separated in the shape of a glove from the
parts  beneath.   Healthy and well-nourished
subjects soon recover from the effects of burns
which  do not pass beyond the stages of in-
flammation and vesication, but for some hours
after the infliction of the injury, suffer much
more  acute  local pain than those whose skin
has been  deeply destroyed by the action of
heat.   In the  second class of burns the  skin
is more or less disorganized.   At the seat of
the injury may be seen  soft  and elevated
patches of a dark-gray color, each surrounded
by reddened skin and blisters. These patches
in the course of time separate  from  the  sur-
face of the body, leaving  large sores, from
which there is a free discharge of pus or mat-
ter.   In some cases  the whole thickness of
the skin, in others, but its upper layer, is  thus
disorganized  and  thrown  off.  In cases of
sudden complete destruction of the surface of 
BURNS AND SCALDS
BURNS AND SCALDS       49
 the body  the  burnt skin is hard, dry, and
 tough, like parchment.  It is quite insensible,
 although pressure upon  it may act upon the
 nerves of deep-seated parts and so cause pain.
 The color of the destroyed patch varies ; it is
 sometimes yellowish-brown, at  others  deep
 black.  The thickness  of the burnt part varies
 according to the  intensity of the injury and
 the duration of the application of heat to the
 surface of the  body.   The integument only
 may be involved, or skin, muscle, and all the
 soft parts  composing a  limb  may be  thor-
 oughly charred.
   The chief dangers of burns  and scalds lie
 in the severe  general disturbance  to which
 they frequently give rise, especially in young
 children.  In the  first forty-eight hours the
 shock  may be  fatal, or  the patient  may be
 speedily carried off in consequence of conges-
 tion of the brain, lungs, or abdominal organs.
 Immediately after a severe  burn, the surface
 of the body is cold, the pulse weak or almost
 imperceptible, the lips blue, and the eyes fixed
 and glazed.  When with  these symptoms are
 associated delirium and convulsions, and the
 patient complains of no pain, death is gener-
 ally close at hand.   The  intensity of  this
 state of shock is proportionate, not so  much
 to the depth of the burn,  as  to its  superficial
 extent, and the age of the patient.  Complete
 destruction of  the hand or foot of a strong
 and healthy adult  will be attended with less
 prostration and collapse than a simple scald
 reaching over the front of the chest and ab-
 domen of  an infant.   From the  third to the
 fifteenth or sixteenth  day the chief sources
 of danger  are fever, diarrhoea, inflammation
 of the  stomach  and  intestines, lungs, and
 brain.   During  this period death sometimes
 occurs  from a giving way of a certain point
 of the  coats of the duodenum, or that part of
 the small  intestine <nto  which the stomach
 opens,  From the commencement of the third
 week until the  period when the wounds are
 completely closed, the patient is  exposed to
 the risks of pyaemia, tetanus, and hectic fever.
 If the burn has been extensive there is  gen-
 erally a profuse and exhausting discharge of
 very foetid matter from these wounds.
   Treatment.—In the treatment of severe
 burns the first and most important point is to
 endeavor to bring the patient out of the state
 of  shock.  When the  extremities  are  cold,
 and the intense pain of the injury is express-
 ed only by a feeble cry,  the body should be
 wrapped in warmed  blankets, and brandy
 and hot water  be  administered,  care being
 taken that no more brandy be given after the
 patient  has commenced  to  revive.  In  the
 next two weeks in complicated cases the diet
 must be light, and  saline draughts and  fre-
quent purgatives should be prescribed.  When
the patches of  burnt and disorganized  skin
have been thrown off, and large ulcers arc left,
from which there  is a copious discharge of
 matter, it is necessary to support the health
 of the  patient by good diet, a  free supply of
 wine  or  spirits,  and  by medicinal  tonics.
 The local treatment of burns and scalds which
 do not proceed beyond superficial inflamma-
 tion or blistering of the  surface  of the skin,
 consists in the  application of such  agents as
 may serve the threefold  purpose of reducing
 inflammation, relieving pain, and preserving
 the injured part from the air.   The following
 are some of the very many methods that  are
 used in ordinary surgical practice :  to dredge
 the burnt part with flour or starch, so as to
 form a thick crust or paste ; to apply  a thick
 layer of soft cotton  wool and to fix this by a
[ loose  bandage ; to  lay on strips of  lint  cr
 cotton rags steeped in a mixture of  equal
 parts of linseed oil and lime-water ; to use as
 a varnish a mixture of collodion and castor
 oil, two parts of the former to one of the  lat-
 ter' ; sweet  oil,  white  paint,  vinegar  and
 whitening are all useful applications.  Cot-
 ton wool  or flour may be   recommended
 as  the  most suitable  agent  in all  cases
 in which  the skin  has  not  been  injured
 to any great depth.  The  dressing,  when
 once applied must not be disturbed for sev-
 eral days, so that the surface of the skin may
 be protected from cold  and irritation until  the
 inflammation has ceased.  Fresh cotton wool
 is to be applied over the former  dressing  of
 this material, and fresh flour laid on until  the
 old and  new  layers form together a  thick
 crust.   After the dressing has  been detached
 from the burnt surface by the discharge from
 the ruptured blisters, and the smell from the
 wound is very offensive, the whole should be
 carefully removed  after  soaking  in  warm
 water.   The best application for the raw sur-
 face thus exposed is the ordinary chalk  oint-
 ment or lead  lotion.  When there is much
 blistering  and the  blebs  are  very large, a
 small prick should be made  into each before
 the dressing is applied, in order to allow the
 contained  fluid to  drain  away slowly.  In
 treating very superficial but  widely extended
 scalds  on  the chest or abdomen of infants,
 great caution must be taken not to apply cold
 water or cooling lotions of any kind ; the best
 agent in cases of this  kind  is  warm  cotton
 wool.   In the treatment of more severe burns
 which produce sloughing and destruction of
 skin, stimulating  applications  are the  rule.
 Of these the most approved are  spirits of tur-
 pentine, spirits of  wine, a mixture of lime-
 water and linseed oil, a liniment composed of
 one ounce of resin ointment and half an once
 of turpentine, an ointment of carbolic  acid, a
 mixture of carbolic acid and boiled linseed oil
 —one part to ten.   The  dressing should  be
 covered over with layers of cotton wool  or
 well-carded  oakum  which  can be  removed
 daily.   After the separation of the burnt por-
 tions of skin the  raw and ruddy wound may
 be dressed with lotions  consisting of a weak 
fiO       BURNS AND SCALDS
BURS7E
 solution of sulphate of zinc or of copper.
 This part of the treatment  of burns demands
 the greatest care and judgment on the part of
 the physician.  On  the one hand he has to
 guard  against general exhaustion and other
 results of a profuse discharge of matter, and
 on the other, against the too rapid formation
 of a sore which may be thick and contractile,
 and  a cause of great subsequent distortion.
 The deformities so frequently observed after
 burns in front of the neck  in the bend of the
 elbow, and in the hand are produced in the
 following way :  An extension wound left after
 the separation of destroyed skin is allowed
 to scar over rapidly, while  the movable parts
 on its neighborhood are, for the  sake of ease,
 retained by the patient too closely  to each
 other.   Thus  in  a burn in front of the neck
 the head is raised  on a pillow above the level
 .of the body, and  the chin depressed toward
 the chest.   In burns of the upper extremity
 the arm is bent and the fingers  closed upon
 the palm.   The dense scar formed over the
 wound naturally tends to keep the bent parts
 in their acquired position, and by the contrac-
 tile properties of  its tissue, subsequently in-
 creases the distortion  and deformity.   It  is
 necessary, therefore, in treating burns, to
 keep the edges of the wound apart and to let
 .the surface heal slowly.   Of course with ex-
 tensive wounds nothing can prevent the for-
 mation  of a contractile scar, which will drag
 upon the skin of neighboring parts ,  but much
 .■nay be done to prevent deformity by careful
 dressing and  by keeping  the injured part of
 the body in a good position.
   In concluding this article a few hints may
 oe given as to the best means of immediate
 action in burns and severe scalds.   In most
 instances where the clothes have caught fire
 the burnt person loses presence of mind, and
 rushes  out of the  room  with a draught by
 which  the  flame is fanned  and its ravages in-
 creased. By standers, or those summoned by
 the loud cries of  the patient, should at once
 do all in their power to prevent action of this
 kind.   If the  burning clothes cannot at once
 be torn away, the  person should be  laid upon
the ground and covered by a rug, a piece of
■carpet or  a  table-cover,  and  turned  over
 quickly from  side to side.,   In order to pre-
 vent any draught, the doors and  windows
■ought  at  once to be closed; water, when
■close  at hand, should, of  course, be thrown
-ever the  flame.   On removing  the  clothes
 from  a badly burnt person, great care must
be taken not to  tear away at the same time
 any portion of skin or to  rupture  any blis-
ters.  The body-ciothing over the seat of in-
 jury ought io be cut  in  small pieces, each of
 which is to be raised gently ; if any part of
 this should adhere to the burnt surface, it had
 better be left until the arrival of the physician.
 The stockings when  tight  should  be well
 soaked with oil before removal.  In scalds of
 the upper or  lower extremities the injured
 parts should be  immersed in tepid water be-
 fore the clothes are taken off.
   BURS2E are closed bags  of thin  mem-
 brane, containing an oily fluid ;  they exist in
 great  numbers near the surface of the body,
 and are placed between bone and skin, and
 between bone and muscle  or tendon, so as
 to favor the free and ready movement of the
 latter structures.  The tendons moving the
 fingers and toes also pass through large bursal
 sacs seated  in front of the  wrist and at the
 sides  of the ankle.  The most important of
 the superficial bursa?, or those seated between
 skin and bone, are, one in front of the knee-
 cap or patella ; one at  the back of the elbow  ;
 one over the bony projection  at the outer
 part of  the hip.   In addition  to these struc-
 tures,  which exist as  constant  and normal
 parts of the human body, there may be other
 bursae which are accidental  in character, and
 formed  in  abnormal  situations,  in  conse-
 quence  of the application of unwonted pres
 sure and friction.  These  accidental bursa;
 are developed in  club feet,  and over the
| prominence  formed  by  curvature of  the
 spine.   Bursa:' in their healthy condition con-
 tain but just the amount of fluid necessary for
j lubricating purposes, and  are  scarcely  to be
 recognized  during life.  In consequence of
 continued  pressure, however,  or  of injury,
 these  membranous sacs become distended
 from  increased  collection of fluid, and form
 prominent swellings, which,  with further pres-
 sure or injury,  become very painful and in-
 flamed.   Any  superficial   bursae  may be
 thus affected,  but  the  most  common and the
 best known instances are  the  bunion, the
 housemaid's knee, and the student's elbow,
 in  which the bursa? at the  inner side of the
 great toe, that over the knee-cap and that at
 the back of the elbow are respectively en-
 larged.   Another  frequent  situation of  dis-
 tended  bursae is the back of the  wrist, where
 it is met with as a smooth, painless, and very
 movable swelling, to  which surgeons  apply
 the name of ganglion.   When bursae are sub-
 jected  to  constant or frequently repeated
 pressure,  they often inflame, and gradually
 become harder in consequence of an increase
 in the thickness of their walls,  at the expense
 of the contained fluid.   They  are  sometimes
 converted into abscesses, and then constitute
 a  source of great  danger, as  the  neighbor-
 ing joint may become affected, or the bones
 exposed and diseased.   Much good may be
 done  by treatment  in the  early  stage of  an
 enlarged bursa ; rest of the affected member,
 and a removal of irritating  and  compressing
 agents,  must be  insisted upon  if there be any
 pain or  uneasiness in the swelling.  When the
 parts  are quiescent,  some means may be
 taken for removing the disease ;  firm  pres-
 sure with the hands, or  a sharp  tap with a
1 large volume or some heavy  object, will cause 
BUTTER
CALCULUS
51
rupture of the distended bag, and  effusion of
the contained fluid ;  this, however, is a rough
and  very painful piOceeding.    When  the
walls of the bursa have  become  much  thick-
ened, nothing short  of a surgical operation
for the removal  of the  swelling can give re-
lief.   In cases  of inflammation,  and  where
the formation of an abscess is  threatened,
leeches, warm fomentations or poultices, and
rest in the recumbent position, are  essential
means of treatment.
  BUTTER is  a common name given to a
variety of  fatty  substances used as   food,
whether obtained from the vegetable or  ani-
mal kingdoms.   Thus a fat  extracted from a
plant in Africa is called Shea Butter.   The
solid oil obtained from nutmegs is called but-
ter of nutmegs.  The term is, however, more
generally  employed  to  designate the fatty
matter found in  the milk of  animals.   The
most common source of butter is the milk of
the cow.  The quantity of  butter contained
in different kinds of milk varies.   Thus there
is 3 per cent in human  milk,  i-£  per cent  in
ass's milk,  arid  3^ per cent  in cow's milk.
Butter is sold in  the  markets as  fresh  butter
and salt butter.  The latter  has a certain
quantity of salt added  to  prevent its becom-
ing  rancid.   Butter by keeping is very liable
to become rancid, a very disagreeable acid
being formed in it called  butyric acid.   But-
ter often undergoes this decomposition after
it has  been  eaten, and the bitter taste often
felt in.  the throat and  attributed to bile is 111
reality butyric acid.  This disagreeable effect
of butter is easily got rid of by taking twenty
or.thirty grains of  bicarbonate of soda or pot
ash.  Butter is  the  chief of  our fatty foods.
It is composed  of carbon,  hydrogen, and a
little oxygen.  It  is consequently  more  ca-
pable of maintaining animal heat  and force
than sugar or starch.  One pound of  butter
will  go as far in that respect as two pounds
of either starch or  sugar.   Butter  is not so
easily  digestible as  the last, and frequently
disagrees with those who have a feeble diges-
tion.  When butter is eaten in larger quanti-
ties than is necessary for the purposes of the
system it leads to the deposition of fat in the
tissues,  and persons become corpulent.   This
can only be remedied by taking less butter or
leaving it off altogether.
C.
   CjEjCUM, a little sac formed in the course
 of the intestines.  (See Intestines.)
   CESAREAN SECTION is an operation
 which has been adopted in very extreme cases
 to save the life of the child during a  confine-
 ment ;  in some cases, as  in great deformity
 of the  pelvis, where  the  child cannot  pass
 down  in  the  ordinary way, and the  medical
 man fails  to  extract it by any other method,
 this operation may be done to save the life of
 the mother or child, or  both.   It has been
 done in some  cases of rupture of  the womb
 during child-birth.  The operation consists in
 making an incision  in the lower  part of the
 abdominal wall large enough to introduce the
 hand, and then an opening can be made in
 the womb and the  child  can  be  extracted.
 This procedure is in itself very fatal, and is
 only justifiable as a last  resource and after
 mature deliberation.
   CACHEXIA  is the term applied to that
 condition of profound disheaith which accom-
 panies certain  morbid states of the system.
 Thus with cancer in the  latter  stages of the
 malady the patient  becomes thin, the color
 becomes sallow, or of a dusky yellow hue, the
 features are sharpened, and ttfere is a general
 expression about  the patient  of hopelessness
 and care which is very striking.   This condi-
 tion is  described  as a cachexia.   So, again,
 among those who have long been  exposed to
 malaria or the poison of ague :  the skin  as-
 suming a dirty whitish hue.  All work is done
 with an effort  ; there may be no distinct par-
oxysm  of  fever, but there is a  fevcrishness
  which is very striking, this too  is spoken of
  as  a cachexia.   It is plain, therefore,  that
  though the word is generally modified by an
  adjective, it means the peculiar  state of  con-
  stitution induced  by such diseases as those
  referred to.
   CAFFEINE.  (See Coffee.)
   CAJEPUT  OIL is an  oil of a beautiful
 bluish green tint, obtained by  distilling  the
 leaves of a tree growing in the Moluccas.   It
j is powerfully stimulant in character, and  is
 used both externally and internally.  Exter-
 nally, when mixed  with olive oil, it may be
 rubbed into  a  part as a liniment in certain
 forms  of  chronic  rheumatism.  In  some it
 does very much good, in others little or none.
 Internally, a drop or two given on a lump of
 sugar acts as a powerful stimulant and anti-
 spasmodic, and  is therefore  of  much  use in
 certain  forms of  flatulent  indigestion  and
 colic.  A  drop on  cotton-wool  applied  to a
 decayed tooth will often relieve toothache.
   CALABAR BEAN is the product of an
 unknown plant, and has the remarkable prop-
 erty of causing  a contraction of the pupil of
 the  eye when externally applied.  It is used
 in certain diseases of the eye  when the pupil
 is morbidly dilated.  (See Physostygma.)
   CALCAREOUS  DEGENERATION.
 (See Degeneration.)
   CALCIFICATION.    (See  Degenera-
 tion.)
   CALCULUS is a concretion  in any gland
 or organ, whether it be the bladder (urinary
 calc.) ;  prostate   gland   (prostatic   calc.) ; 
CALOMEL
CANCER
 breast (lacteal calc.) ; kidney—salivary glands
 (salivary calc).   The  term,  however, in its
 most common signification, is applied to the
 bladder, stone in the bladder.   (See Concue-
 tions, Gravel, and Stone.)
   CALOMEL.  (See Mercury.)
   CALVES-FOOT  JELLY.  (See Gela-
 tine.)
   CALUMBA.  (SeeCoi.UMRA.)
   CAMOMILE.  (See Chamomile.)
   CAMPHOR, notwithstanding its appear-
 ance,  is a  volatile oil, which, however,  nor-
 mally remains solid at ordinary temperatures.
 It is obtained from the Laurus Camphora by
 the  process of sublimation,  a kind of rough
 distillation.  It is mostly obtained from China
 and Japan.   In medicine its uses are not  very
 well defined, but it is largely used for flavor-
 ing.  To this  end some  lumps of the  sub-
 stance  are  placed in  a  bottle of water and
 allowed to   remain  for a time.   The  water
 acquires the camphor flavor, and is used  as a
 vehicle for other remedies.  It is nevertheless
 highly  esteemed  by  some  authorities,   es-
 pecially abroad, as a stimulant in exhausting
 diseases, such as fevers of the continued vari-
 ety.  It has also been  given in  insanity, in
 asthma and a great variety of other affections,
 being, in effect, one of those  remedies which
 have acquired a reputation in cures whose
 natural course is not known.   It has, how-
 ever, been of undoubted  service in certain of
 the complaints of women, especially in  alle-
 viating pain.  Outwardly,  camphor  is often
 used in liniments applied to lender surfaces ;
 and camphorated spirits of  wine is  a very
 good application for chilblains.   Homeopaths
 have used it in cholera.  The dose of the  sub-
 stance itself varies from two to twenty grains.
 It is best  given  suspended in  mucilage or
 made into pills.
  CANADA  BALSAM is  hardly used in
 medicine, although much employed by micro-
 scopists.  Being a kind of turpentine, a mix-
 ture of oil and resin, its properties are allied
 to the better known oil of turpentine.
  CANCER.—All that modern surgery has
 hithero done with regard to cancer is a defini-
 tion of  it, its structure, kinds, and history.
 It is a  disease  of  itself, as   ascertained by
 pathologists,  and one of the  class of new
 growths.  It is unlike all other tumors, being
 an  infiltration  among  the natural tissues of
 the body, and its peculiar structure is only to
 be discerned by the microscope.  It is in-
 eradicable :  if cut out it  returns, if not at the
 place of operation, in some other part or tis-
 sue.  There are, however, cases where a can-
cerous tumur has been removed at its  first
appearance,  and the patient has enjoyed an
immunity from any return for ten, fifteen, or
even twenty years.  Hitherto  nothing satis-
factory  has  been proved as to its  causes,
neither  individuality, locality, mode  of  life,
or condition.  Domestic  animals and cattle
 are equally subject  to it,  and  pathologists
 have  but slight grounds for suggesting  its
 predisposing causes, such  as its being in a
 small percentage apparently hereditary, its ex-
 istence more frequently in the female sex, and
 in the aged.  Cancer possesses  all the char-
 acteristics of malignancy, so defined by sur-
 geons, namely, constitutional  origin, rapid
 growth,  constant increase,  pain, returning if
 cut out, infiltrating every tissue in its vicinity,
 and invading the lymphatic glands, is liable
 to be  diffused over the body from secondary
 deposits, is attended with cachexia (Cachexia),
 " resists  all  treatment, softens  inwardly,
 ulcerates outwardly, resembles no tissue nat-
 urally  found  in  the body, and ultimately
 proves fatal."  The several forms of cancer are
 called from their special features, a. Scirrhus ;
 b.  Medullary ; c. Melanotic ; d. Epithelial ;
 e. Osteoid ; f. Colloid ; g. Villous.  The last
 two  named, however, are  by some scarcely
 held as  cancer,  a.  Scirrhus.  This form  of
 cancer is probably the most frequent, at least
 in this country, and most commonly affects the
 female breast, though it is  also found in the
 rectum, eye, testicle, womb, skin, bones, and
 salivary glands.   Its chief feature is its stony
 hardness, which is  due  to  an  abundance  of
 fibrous tissue ; it is  nodulated,  becomes ad-
 herent to the overlying  skin, and it has the
 singular  property,  not  possessed in  a like
 degree by any other tumor, of drawing  into
 it  adjoining  structures, is  subject to severe
 stabbing or lancinating  pain, and to ultimate
 ulceration, b. Medullary, or brain like cancer,
 so called -from its  resemblance  to the  sub-
 stance of the brain,  or  stiff  blancmange.
 Encephaloid, or soft cancer, are its synony-
 mous  terms.   This  form of  cancer differs
 form the  preceding in possessing none of that
 peculiar characteristic of drawing toward it-
 self of neighboring structures, but rather that
 of a disposition to distend  and thrust them
 aside by the rapidity of its growth, and by the
 great accumulation of cancer material  in its
 bulk.   It  produces  greater constitutional
 cachexia, and  is more speedily  fatal.  It  is
 most  frequent in the limbs and breast.  It  is
 excessively vascular, and as it nears the  sur-
 face  throws  out huge  fungating bleeding
 masses termed haematoides,  from ulceration.
 c.  Melanotic  Cancer.    The  main distinctive
 feature of this form of cancer is the presence
 of pigment or coloring cells, which give it  a
 black  or  dark  appearance.  The most  fre-
 quent  situalion for melanosis is  the skin of
 the eye, and  is more common in the horse or
 dog than  in  man.  It derives its color, as a
 general  rule, from  the structures in  which
 pigment   naturally   exists.   d.  Epithelial
 Cancer, termed also epithelioma or cancroid,
 so termed because the microscopic cells found
in  it differ less from the cells of the part in or
near which they grow, than those of the fore-
going kinds, and from  their analogy to the 
CANCRUM  ORIS
CANCRUM  ORIS          53
natural epithelial structures.   Its chief situa-
tion is in the skin, in or near a mucous orifice,
e.g.,  lip, nose, anus,  prepuce,  scrotum, or
tongue.  When  it exists  on  the scrotum  it
forms the so-called chimney-sweeper's cancer.
/'.  Osteoid Cancer, a form of cancer occurring
usually in bones, and more commonly in the
lower end of the femur apparently than  else-
where.   It is  very  rapid  and painful in its
growth.  In the form of cancer the stroma is
converted into a very dense fibrous tissue,
and then into a peculiar bone, which is rough
and porous, and very brittle, readily reducible
to a chalky powder  after maceration of speci-
men.   It seems to be singularly interchange-
able  with encephaloid.  f. Colloid  Cancer, a
Iorm  of  the disease not  regarded  by some
writers as includable under the  term cancer.
In appearance it is  jelly-like, about  the con-
s stence  of thin glue or tapioca pudding, of
rapid growth,  and frequently attaining enor-
mous bulk.   It  is most  frequently found in
the intestinal  canal,  g.   Villous Cancel, not
now considered cancerous ; the name has been
associated with a vascular growth composed
of delicate papillae, each containing a vascular
loop,  generally in connection with cancer or
epithelium.
  Treatment.—With regard to the Treatment
of cancer, all that can be done is to  check the
disease as far as possible, and thus  endeavor
to alleviate suffering and prolong life.  In an
article of this nature and compass, we cannot
possibly  enter into the ethics  of the  treatment
of cancerous growths, and, indeed,  they  can-
not but  tend  to one point,  and that is, re-
moval in all cases on their earliest detection.
In advanced stages of the disease,  palliative
treatment, both local and constitutional, must
be had recourse to, but death will  sooner or
later supervene, and all that  can be done is
to make  the end as  easy as possible.
  CANCRUM ORIS is an  ulcerative affec-
tion of the gums and cheeks,  most commonly
met with in children  between the ages of fifteen
months and five years, and seldom observed
in adults.  There are two well-marked forms
of this disease.   The  milder form  occurs in
ill fed and squalid children during the cutting
of one or more teeth.  The anterior surface
of the gums becomes red and  swollen, and
bleeds at the  least  touch.  The  roots of the
teeth are laid  bare. The swelling then ex-
tends to  the inner  surface of the cheek, and
sometimes to the lips, and in  these two situ-
ations several  small but deep ulcers a>-e form-
ed, from which there  is  a foetid discharge.
In the course of a week the swollen gum be-
comes gangrenous and separates from the sur-
face  of  the jaw, exposing  blackened  and
rough  bone.  The  teeth  become loose  and
fall out.  During these changes the tongue is
white and  furred, the  breath foetid, and the
flow  of  saliva from the  mouth  almost con-
stant.  The glands in  the neck are some-
 times swollen and  painful.  There is much
 difficulty in masticating, and also in swallow-
 ing.   It  should be remembered that in this
} affection the  swelling is generally found on
| one side only of the mouth, and that it never
I causes ulceration of the tongue or palate.  In
j these respects  it differs  from  the  diffused
[ soreness of the mouth, produced  through the
 administration of large quantities of mercury.
 The  subjects of  this affection should be  sup-
 ported by strong beef-tea and broth, together
| with wine.  Castor-oil may be administered
| every  other  morning  in  order to keep the
 bowels freely relieved. For the purpose of re-
| moving  the  offensive discharge, the  mouth
I should be frequently washed  with  a lotion
I containing two teaspoonfuls of carbolic acid
 to a pint of %vater.   Undiluted claret  also
j forms a good wash, from its astringent action
 on the swollen gums.  Pieces of alum should
 be given to the patient to  suck, and the gums
 painted twice in the day with a lotion made up
 of half an ounce  of dilute  muriatic acid  and
 half  a pint of water.  Chlorate of potash and
 bark are the  usual  internal remedies in  this,
 as in most other ulcerative affections of the
 mouth.
   The second  or more severe form  of  can-
 crum oris is that  commonly known by the
 name  of water-canker.   It  attacks children
 who have just recovered from measles, and in
 large schools or places where  many  young
 patients are  crowded  together  sometimes
 spreads rapidly after an epidemic of this erup-
 tive  fever.  A similar affection,  and  one
 occurring under similar conditions, is some-
 times  observed in  the external genitals  of
 young girls.  This is called  noma.   The
 affection of the mouth first shows itself as a
 large and doughy   swelling  on one  cheek ;
 the skin over this swelling is tense and shin-
 ing,  and at  its prominent part presents  a
 patch of a violet or dark-blue color.  On the
 inner  surface  of the  swollen cheek  will  be
 found a deep, foul-looking ulcer, the edges of
 which are generally swollen and irregular.
 The gums become  gangrenous and  there is
 a very foetid discharge of dark-red or black
 fluid from the mouth.  In  the further progress
 of the disease,  the cheek is perforated  by the
 ulcer, and the orifice thus  formed is  subse-
 quently  enlarged by rapid sloughing.   The
 little patients, as a rule, do not seem to suffer
 much pain from this affection, but about the
 sixth or  seventh  day become  heavy anO
 sleepy, and finally  pass into a state of coma.
 This form of  cancrum oris is usually fatal.
 The local treatment, to be  of  any service,
 demands energy and skill.   The best  agents
 for arresting the progress of the mortification
 are strong nitric acid, and the actual  cautery
 or  red-hot  iron.  The  patient  should  be
 allowed  plenty of  fresh  air, and wine and
 good nourishment.   It is  necessary to wash
 out the mouth frequently with weak solutions 
54
CANELLA
CARBONIC ACID  POISONING
of  chloride of zinc or lime, or of carbolic
acid.
  CANELLA is the bark of a  tree growing
in the West Indies.  It has a hot cinnamon-
like taste and slightly tonic properties.   It is
not often used by itself, but is  contained in
rhubarb wine.  A favorite domestic remedy,
called Hierapicra, or more familiarly Hiccory-
Piccory, is composed of equal parts of canella-
bark in powder and aloes.
  CANKER OF MOUTH.  (See Cancrum
Oris.)
  CANTHARIDE3, or SPANISH FLIES,
are  mostly  collected  in  Hungary.   More
than one species  are  in  use.   They  are
beetles, and their wing cases, which are long,
have a fine green color.   They are collected
by  brushing the trees, killed by  boiling vine-
gar, and dried.  Before being used they  are
reduced to powder, from which may easily be
obtained a crystalline substance called Can-
tharidine. This powder constitutes the active
ingredient  in  that well-known remedy, a fly
plaster.  The other ingredients are wax, rum,
and fat.  This form of the remedy, though
the most common, is not the best.  Blistering
solutions may now be obtained  which, when
painted  on  to any part  of the body, and a
warm poultice  applied,   more  effectually,
more speedily, and more  painlessly produce
vesication.  Elegant little blistering plasters
prepared in France may  also be obtained in
boxes ready for  application at a moment's
notice.   Cantharides are  rarely given inter-
nally ; even  externally  when long used they
may produce troublesome  symotoms referable
to  the  bladder and kidneys.  They should
never therefore be given internally without
medical  advice.  (See Blisters.)  It consti-
tutes the basis of most stimulant hair-washes,
and the application of a blister to the bald
surface of the head will frequently have  the
effect of producing a growth of hair ;  usually
a few drops  of the tincture added to some
salad oil will suffice.
  CAOUTCHOUC.  (See India Rubber.)
  CAPSICUM, or red pepper, employed  but
rarely in medicine, is  the pod  or fruit of a
plant now frequently cultivated in this coun-
try.  The pod, which is  bright red, is dried
and  reduced  to  powder—the   well-known
Cayenne pepper.   This substance is a power-
ful  stiumlant,  and is chiefly employed as a
condiment ; but there is an authorized tinc-
ture.   Occasionally this is used  mixed with
water as a  gargle.  The  powder is mostly
used  to  excite appetite  by stimulating  the
stomach.  It has  been given as  a  stimulant
in delirium tremens.
  CARAMEL is a term  applied to burnt
sugar, and is principally employed for color-
ing wines and brandies.
  CARAWAY—The fruits of the ordinary
caraway are like  many others  belonging to
the  same natural order, endowed with a vola-
tile oil, which gives them their peculiar odor
and taste.  This oil  may be obtained in a
separate form, and administered in drop doses
for flatulence,  gripes, etc., but the flavor is
very objectionable to  many.
  CARBOLIC   ACID,   or   PHENIO
ACID, is a substance contained  in the very
complex body we call coal-tar, whence it is
obtained  by careful  distillation.   It is met
with ordinarily in two shapes, either in crys-
tals or fluid.  It is not very soluble in water,
but sufficient may be  taken up to endow the
fluid with valuable properties. Applied with-
out dilution to the skin, it produces something
like a burn.  It is,  however, possessed of
powerful  antiseptic properties, being one of
the most powerful agents known as a means
of preventing putrefaction.  To this end it is
very largely employed  for  preventing bad
smells,  for  keeping  wounds sweet, and  for
preventing the spread of infectious diseases.
Carbolic a.cid may be obtained for disinfecting
purposes, either  as crystals, which may be
dissolved in water, or in the form  of disin-
fecting powder.   A solution as useful as any
that can be bought in  the shops may be made
by purchasing  an ounce of the pure carbolic
acid and  mixing it with water, in the pro-
portion of half an ounce to a quart of water,
It is an invaluable  agent,  but on account of
its smell,  which is far from agreeable, other
disinfectants are sometimes preferred to it.
Its most convenient strength as a lotion for
the prevention of smell and  arresting dis-
charge, is one pint to forty of water ; but in
the hands of surgeons it  is used of much
greater strength.  Internally, carbolic acid is
of much value in indigestion and  flatulence,
pain and vomiting of  fermented half-digested
food.   A drop or two of the deliquesced acid
when the  acid becomes fluid by exposure to
the atmosphere may be given in  mucilage
some hours after taking food.  It has been
used in the form of ointment, or dissolved in
glycerine, for the cure  of  itch with  success.
And a strong solution  is a capital means of
getting rid  of vermin in the hair of men or
animals.  It should be well rubbed in, and in
a quarter  of an hour washed out again with
soap and water.  (See Deodorants and Dis-
infectants.)
  CARBON.  (See Charcoal.)
  CARBONIC  ACID  POISONING  is
produced whenever there is an accumulation
of carbonic acid in a room  or building.  It is
probable that death  is  due to the individual
being deprived of oxygen as well as to the
noxious presence of carbonic acid gas.  Car-
bonic acid is always  present in  the atmos-
phere in a small quantity, and it is  partly an
accumulation of this gas which makes a small,
badly-ventilated room smell close and stuffy ;
languor and headache then come on, and un-
less fresh air is  admitted  injurious conse-
quences may supervene.   From  this  cause, 
CARBUNCLE
CARTILAGE
55
 overcrowding  is  injurious,  and these  who
 work together in a room, as dressmakers,
 etc.,  are  often  liable  to headache, anaemia,
 and general debility.  Fresh air  is of course
 the  simple remedy  for this  condition of
 things, while in serious cases of poisoning by
 the gas, and when the patient is found insen-
 sible, removal of the individual into the open
 air is the first thing to  be done, and then arti-
 ficial modes of respiration must be resorted
 to.  For a description of the methods to be
 adopted  for producing artificial  respiration,
 the reader must refer to the article on Drown-
 ing.  Carbonic acid is a gas, and in its pure
 state is poisonous when retained in the blood.
 By itself it is not greatly used in medicine,
 but in the form of soda-water it  is often ex-
 ceedingly useful.  It is  this agent  contained
 in effervescing liquids  which gives them their
 sparkling character, and which enables them
 to be retained on the stomach, which would
 otherwise reject them in  fevers and such  like
 disorders.   It is partly  due to  the  carbonic
 acid  in it that champagne is  frequently re-
 tained when nothing  else is.  As a vehicle
 for  many remedies   and  many stimulants
 there is no belter agent than a solution con-
 taining an excess of carbonic water, the sim-
 plest being the  soda-water aforesaid.  The
 gas  itself has been employed to relieve the
 pain  of cancerous, especially  uterine, affec-
 tions.
   CARBUNCLE is an exaggerated boil (see
 Boil) most frequently situated where the tis-
 sues underlying the skin are of a dense fibrous
 character,  such as  the  nape  cf the  neck.
 Carbuncles vary in size, sometimes  being as
 large as  an orange.  They are very  hard,
 brawny, dreadfully painful, discharging  mat-
 ter from  several  apertures ; and usually at-
 tended with considerable constitutional  dis-
 turbance, such as fever, hectic, etc., the con-
 dition being indicative  of  blood poisoning.
 With regard to treatment, it  must be both
 constitutional and local.   The strength must
 be kept up by brandy,  wine, and ammonia
 and bark ; hot fomentations, opiate poultices,
 and  free incision must be made  through the
 thickened implicated tissues.
  CARDAMOMS belong to the group of
 remedies called stimulants and carminatives.
 The compound tincture of caradamoms is one
 of those  nice  preparations which belong to
 what  might be called the  confectionery of
 medicine.  It  is  used to give coloring and
 pleasant flavor to more powerful  remedies.
  CARDIALGIA signifies pain in the heart,
 or over  the region of the heart,  and  may
 arise  from  various  causes.  (See  Heart-
 Burn.)
  CARIES is an unhealthy inflammation of
 bone, causing it to absorb or ulcerate.   The
most common example of this  condition is  a
decaying tooth.  Any bone, however, may be
affected, and it is generally  caused  by some
i constitutional disorder,  such as scrofula or
| syphilis.  It bears somewhat the same rela-
 tion to bone that ulceration does to the soft
| tissues of the body.   Its treatment is, to rec-
 tify the constitutional condition, and locally
 to remove the diseased bone.
   CARMINATIVES mean remedies which
 are  slightly stimulant in their character —
 which relieve flatulence by  expelling gases,
 and alleviate colicky pains.  They almost ali
 contain a volatile oil, on  which their proper-
 ties depend.  Favorite examples are ginger,
 mustard,  horse-radish, the different  kinds of
I pepper, cinnamon, cloves, anise, coriander,
 peppermint, etc.   (See Stimulants.)
   CAROTID ARTERY.—The pulsations
 felt on each side  of the neck are due to arte-
 ries which  pass from the heart to the brain,
 and are called by this name.  They were first
 called carotid in the supposition that if press-
j ed upon coma would be produced.
   CARPUS, a technical name for the wrist.
   CARRAGEEN MOSS is the name given
: to  a seaweed  known to botanists as  the
! Chondrus crisptis.   When boiled  it  produces
 a decoction  which becomes glutinous on cool-
I ing.  It contains little or no nutritive matter,
'■ consisting principally of the starch known as
 lichenin.
   CARRON OIL.—At one time this mix-
 ture was supposed to be the best remedy for
 burns and scalds.  It is an  oleaginous mix-
| tureof lime-water and linseed oil, which looks
 like the broken  yolk of  an egg.   Its name
j was given  from the  fact that  it was at  the
 great Carron Ironworks, situated in Scotland,
; on the banks of  the Carron River, that it was
| first made, about sixty years ago, and its rep-
! utation was so  great that it was sent from
! thence  all over  the country for the cure of
j burns and  scalds.  Since  that  time, science
| has  entirely superseded this remedy by the
| introduction of others more effectual and less
' disagreeable.
   CARTILAGE,  vulgarly called gristle, is
i a firm, flexible, and highly elastic substance,
 of a  pearly white color.  It is met with in
 joints, and  takes part in  the composition of
 certain  important organs of  the body, hence
 the division into articular and non-articular
 cartilage.   The  articular variety covers  the
 joint-ends of  bones,  favoring  by its smooth
 surface easy movement of the  joint, and by
 its great elasticity, freedom  from shock and
 concussion  during active  exercise of the ex-
 tremities. Non-articular cartilage is  met with
 in the wind-pipe, the  external ear,  the nose,
 and the eyelids.   The ribs terminate anteri-
 orly in long pieces of cartilage which pass in-
 ward and are united to the sternum or breast-
 bone.  Cartilage varies in appearance at dif-
 ferent periods of life.  In foetal life and early
 infancy -it is  soft and semi-transparent ;  in
 youth and adult life, it presents the well-known
 bluish white opacity ; and in old age. it  be- 
56       CASCARILLA BARK

comes hard  and yellow, and in some locali-
ties, more especially in front of the chest, is
converted into bone.
  CASCARILLA BARK is the product of
a shrub growing in the  Bahamas.   It has a
spicy odor, and  a bitter  aromatic taste.   Its
properties correspond,  being tonic and stom-
achic.   It is, however, by some esteemed  as
a remedy  in  chronic bronchitis, and for  the
expectoration of consumption.   The tincture
or infusion may  be used in teaspoonful  and
two tablespoonful doses  respectively.
  CASEINE is the name given to a product
found  in  plants and animals,  and so-called
because it constitutes the basis of cheese (see
Cheese).  It is  one of  the flesh-producing
constituents of plants,  and is found in large
quantities in peas,  beans, and  lentils.  It is
not used in a separate  form.
  CASSIA.—Many medicinal  articles   are
known  by this  general name.   They are the
product of plants  belonging to the natural
order Leguminosiv.   We may give as instances
of such drugs, the  Cassia cinnamonium (cin-
namon), Cassia fistula  (pipe or purging cas-
sia), and Cassia senna.
  CASSIA  PULP is  the pulp of a long pod
or  legume,  which has purgative properties.
Given by itself  it gripes.  It is contained in
the confection of senna, a very useful prepar-
ation.
  CASTOR OIL is the  produce of the seeds
of a plant called Ricinus communis.   The oil
is obtained from the seeds by pressure, which
is applied with or without heat.   That which
is cold drawn keeps longest, and is  preferred
for use.  Castor oil is a mild  laxative,  pro-
ducing  in its action little or  no pain,  and
leaving, after its  effects have  gone off, no
tendency to constipation.  It is on that ac-
count strongly to be commended where only
a slight action of the bowels is required. Like
all oils it is nauseous to the taste, and that is
its  great objection.   Several ways have bet-n
devised of administering it.   The easiest and
quickest way is to administer it in water with
a few drops of brandy, peppermint, or other
agent to take away its  taste.  It may also be
made into an emulsion  with an egg if  pre-
ferred.  According to  age, from a  teaspoon-
ful  to a tablespoonful may be administered at
a dose,  and  repeated in three or four hours if
it fail to act.
  CATALEPSY, or TRANCE, is a condi-
tion so very rare that  few men  have seen it.
  It seems half mental, half bodily.  In cat-
alepsy the patient, very frequently, but  not
always, an excitable hysterical  female,  sud-
denly seems to lose all consciousness of sur-
rounding objects.   They remain fixed in one
position ; but, if that  is altered by any one
standing by, the new  position is maintained
instead of the former.  In this state the indi-
vidual remains for a time, varying from min-
utes to hours, or days, and then suddenly re-
                CATARACT

 covers, knowing nothing of what has passed
 in the interval.  Very frequently it is hard
 to say whether this condition of things is real       .j
 or assumed, and the fact that it might possi-
 bly be real, that the individual might be alive,
 and yet seem dead, and so be interred alive,
 has given  rise to  much  uneasiness  in  the
 minds of  many.   Stories have gone abroad
 of individuals turned in their coffins, but that
 has plainly been due to putrefaction changes.
 Besides,  in those conditions which are likely
 to be most deceptive, the period which elapses
 between  death and  burial is generally suffi-
 cient to establish marked signs of putrefaction,
 such as are altogether  incompatible with life.
 Allied to catalepsy  is  ecstasy,  where the in-
 dividual seems buried  in  contemplation of
 some curious  object.  This, too, mostly oc-
 curs in women, and is  mainly hysterical.
   CATAMENIA.  (See Menstruation.)
   CATAPLASM.  (See Poultice.)
   CATARACT may  be defined as impair-
 ment or loss of vision, due  to  opacity of  the
 crystalline lens.  This affection is occasionally
 met with in new-born infants, but occurs most
 frequently in  old people as a  result of  cer-
 tain  senile changes within the eyeball.   In
 about eighty per cent of the cases of cataract
 the patients are above the age of fifty.   It
 may, however, occur  at any  age  as a con-
! sequence of wound of   the lens, or of simple
 concussion of the eye-ball by a severe blow.
 It has been stated  that diabetic patients,  and
 females who are suckling, are specially liable
 to become affected with cataract. It generally
 affects  both eyes,  commencing in one before
 the other.  In  the  cataract of old people the
 pupils  will  be found opaque,  and of a  pale
 amber or grayish white color.  The opacity is
 most marked  in  the centre, and fades away
 toward the circumference   into gray cloudy
 specks. This amber-colored or grayish opacity
 is due  to contraction  and hardening  of the
 central portion of  the  hitherto  transparent
 lens.  This condition usually comes on slowlv,
 and the sight gets gradually worse for months
 or even years, until  there is almost complete
 blindness.   During the development  of the
 affection the  patient is much  troubled  by a
 mist or hnze  surrounding  all   white or pale
 objects.  This mist is not removed on regard-
 ing the objects  through spectacles.   Black
 spots are often observed as if  floating  before
 the affected eye.  Vision  is improved by a
 subdued  light, while  there is great intoler-
 ance of bright or strong light.   There is oc-
 casionally  much  dazzling  and  agitation of
 regarded objects both in the day time and by
 candle light.  The  flame of a  lamp or  light
 of any kind is surrounded  by  a broad misty
 halo.   Objects are increased in number and
 distorted.   In daylight the patient sees ob-
 jects more readily when the back is turned to
 the window and the eyes  are  shaded  by the
 hand. Pain in the eyeball is rarely complained 
CATARACT
CATNIP
57
 of;  and the patient is not troubled,  as  in
 cases of amaurosis and disease of the retina,
 by prismatic or rainbow-like  halos around
 flame.   The movements of the iris remain
 free during the progress of the disease.  Be-
 fore the sight has been  much impaired, con-
 siderable temporary improvement  may  be
 produced by putting atrophine  drops,  or a
 small disc of atrophized gelatine, into the eye;
 the pupil is dilated and thus permits rays of
 light to  pass through the peripheral and less
 darkened portion of the lens.  The Catop-
 tric Test ok Cataract.—When a lighted
 candle is placed at a short distance  from the
 front of the  healthy eye, three  reflected im-
 ages of the  flame are distinctly seen arranged
 from before backward.  The first and third
 of these images are erect, and when the posi-
 tion of the candle is altered move in the same
 direction.  The middle image is inverted, and
 when the candle is moved upward or down-
 ward, moves in the opposite direction.   This
 middle image is  reflected from the posterior
 surface of the lens, and the third image from the
 anterior surface of this body.  When the lens
 is rendered  opaque by cataract, the  inverted
 or middle image is much obscured and  in ad-
 vance of the cataract altogether absent.  This
 is called the catoptric test, by which cataract
 may be distinguished from amaurosis or blind-
 ness due to  disease of the retina.  Cataracts
 may be roughly divided into hard,  soft, and
 fluid.   Hard cataract  is the most  frequent
 form, and is rarely met  with in persons  under
 thirty-five years of age.  The opacity varies
 in color from pale gray to mahogany. It most
 frequently presents an amber tint.   The dis-
 eased lens is harder and most  opaque at  its
 centre than  at its circumference.  When ex-
 tracted it has the consistence and somewhat
 the appearance of soft bees-wax.   In soft
 cataract the lens is swollen and of a milky or
 bluish white  color.   When fluid the  cataract
 has an uniform grayish white color, and looks
 like a small mass of thick gruel.   Soft and
 fluid cataract may be present at any period of
 life, but in most instances during infancy.
  Treatment.—The treatment of cataract is
 almost  exclusively  operative,   During the
 early stages of the affection  the  failing sight
 may be temporarily improved by dropping in
 a solution of atrophine, or by smearing the
 upper lid with extract of belladonna in  order
 to produce enlargement of the pupil.  When
 both eyes are affected, and the patient strong
 and healthy  and free from gout,  the lens may
 be  removed  with considerable  chance of  a
 successful result.  There are three chief meth-
 ods of operating  on  cataract :  Extraction,
 in which  the  lens in removed through an in-
 cision made  in the cornea ; absorption or solu-
 tion of the lens  by breaking up its substance
 with a needle, and allowing it to become sat-
urated in the fluid of the anterior chamber  of
the  eyeball, which acts as a solvent ;  thirdly,
the old  operation of couching, which consists
in moving the lens backward into the interior
of the eyeball, and, at the same time, depress-
ing it below the level of  the pupil.   Of these
operations,  extraction  is the  one most fre-
quently performed.
   CATARRH  means  simply  a  running,
such as we have from the nose in a cold ;  the
name of  the  symptom has. however, been
transferred  to the  condition which produces
it, and  so one may hear  of  catarrh  of the
stomach,  bowels,  bladder,  etc.  (See Cold
and Indigestion.)
   CATECHU is of two kinds, the puce and
the black. The latter is not now contained in
the Pharmacopoeia ; it is obtained from the
wood of a species of acacia.  The puce catechu
is extracted from the leaves and young shoots
of plants growing in Siam and other parts of
the eastern hemisphere.  It occurs in irregu-
lar pieces,  generally approaching to  cubes.
It contains a kind  of tannic  acid to which it
owes  its  properties.   The substance is a
powerful  astringent, and may be used in a
variety  of complaints, but is most frequently
given for diarrhoea when there is no inflam-
mation  present,  and when it does not depend
on bilious derangement.   For this purpose,
i.e., arresting the  diarrhoea,  the compound
catchu powder, consisting of catechu,  kino,
rhatany, cinnamon, and nutmeg, may be given
in doses of 20 or 30 grains.  For relaxed sore
throat, such as singers and  public speakers
often  suffer from,  catechu, in the form of a
lozenge, is  very beneficial.  These may be
obtained from most druggists, and should be
allowed to melt gradually in the mouth. The
infusion may be used as a gargle, and com-
bined with charcoal, finely powdered, catechu
forms an excellent dentifrice  when the gums
are spongy and expose the  base of the  teeth.
   CATHARTICS  are a class of medicines
that act on the bowels strongly as purgatives ;
such as senna, castor-oil, Epsom salts, gam-
boge, colocynth, etc.
   CATHETER.—A  catheter  is a curved
tube, made  either of silver, india-rubber, or
gum-elastic, for the purpose of drawing the
urine from the bladder in cases of stricture of
the urethra.  The size, or calibre, varies from
a tube the size of a bodkin, to that of a large
lead pencil.
  CATNIP (also called catmint) is a plant that
grows wild in the fields throughout the United
States.  The leaves, which are much used as
a domestic  remedy, are aromatic,  pungent,
and somewhat bitter to the taste.  Cats are
very fond  of them, and are said to use them
medicinally.   The  leaves may be preserved
by drying in  the sun and keeping them in a
dry place. They should be plucked when the
plant  is in bloom.   Catnip  Tea, the form in
which catnip is  administered, is an infusion
made by pouring boiling water on the  leaves
and allowing them to steep.  It acts as a tonic 
 J"                CAUL

and to some extent as an antispasmodic ;  in
a much diluted form,  with a little sugar in  it,
it  is  often  given  to  very young infants  to
sooth them  and to expel the wind from their
stomachs*
  CAUL is a term applied, first, to the mem-
brane  which covers  the  bowels, also called
omentum.   Second, it is applied to the mem-
branes enveloping a new-born babe, when
they extend over the head.  There is a super-
stition that  persons possessing the caul  of a
new-born babe will not be drowned at  sea,
and at the present  day it  is not  an uncommon
thing in England,  to see  a caul advertised for
sale.  The  origin  of  this superstition is ob-
scure.
  CAUSTICS are a number of very differ-
ent substances  which possess   the common
property of  burning and destroying any part
of the living body  with which they may be in
actual  contact.  The  best  known of these
agents,  perhaps, are  sulphuric acid, and the
nitrate of silver, or lunar caustic,  so much
used in surgical practice.  They vary much
in form and composition, and in their modes
of action.  The majority act either  as oxidiz-
ing agents or by withdrawing water from the
living tissues.  They all cause great pain, and
may produce much mischief when applied by
those unacquainted with the special  indica-
tions  for treatment by caustics.  The chief
objects  for  which  these  agents are used  in
surgery are  the following : To set up counter-
irritation ; to keep down overgrown granula-
tions or "proud flesh ;" to arrest the progress
of ulceration ; to destroy cancerous growths
and ulcers ; to open  abscesses ; to stay ab-
sorption in  poisoned wounds.   A  largi ab-
scess just on the point of  burstingand covered
by thin integument can be opened by the ap-
plication to the softest  and most inflamed
part of its surfac?, of a thin  stick of hydrate
of potash orpotassa fusa, care being taken to
prevent the  deliquescent  caustic from flowing
over the surface beyond the seat of  its appli-
cation. A small black slough is formed, which
separates in the course of eighteen or twenty-
four hours, and leaves a free opsning into the
interior of the  abscess.  This  method, how-
ever,  though  less  terrifying, is much more
painful than the use of the lancet in  the hands
of a skilled surgeon.  In  dog-bites it is advis-
able to cauterize the wound or wounds with
some mineral acid applied on a glass tube or
some non-vegetable conductor.  Nitric acid
is generally  used for this purpose, but hydro-
chloric  acid and  the  oil of  vitriol  answer
equally well.
  CAUTERY is  an  agent employed for ap-
plying intense heat to superficial parts of the
body.  There are  three  kinds  of cauteries,
namely, potential, actual,  and galvanic.  The
first term was applied by old  surgeons to the
various forms of caustic applications described
under  the heading of Caustics.  The  actual
         CEREBRAL SOFTENING

! cautery consists in a rod  or knob of iron
! heated  to  incandescence, and the galvanic
 cautery is  formed of wires heated  by  a gal-
i vanic battery.  Surgeons use the actual cau-
! tery with the following objects :  To produce
 counter-irritation ;  to arrest bleeding ;  to de-
i strov cancerous and other tumors on the sur-
j face'of the body ; to stop the progress of hos-
j pital  gangrene, and to destroy the edges of
I large fistulous openings.  The galvanic cau-
 tery is  chiefly used for destroying the wells
 of the long sinuous passages occasionally left
 after  the  discharge  and contraction   of  an
 abscess
   CAYENNE PEPPER.  (See Capsicum.)
   CELLS, minute parts of the structure of
 animals and  plants, always microscopic, but
 assuming various sizes,  forms,  and condi-
 tions.   The essential of every living cell is a
 particle of  matter called protoplasm, contain-
 ing the four elements—nitrogen, carbon, oxy-
 gen, and   hydrogen.  From  such  particles,
 both in  animals and plants, the cell-walls are
 formed. The cell-walls in plants are composed
 of cellulose, and in animals of gelatine.  Ac-
 cording to  their age and functions, cells are
 solid or contain water with  various contents,
| floating or dissolved. All growth takes place
j by the multiplication of cells, and diseases arc
[ produced  by the cells acting  in an abnormal
 wav.
   CELLULITIS.  (See Pelvic Cellulitis.)
!   CELLULOSE is  an insoluble  substance
! which composes the cell-wall of plants.   It is
t the basis of all wood and timber.   Tt is very
 hard in the stones of plums,  apricots, etc.,
 and  very  soft  in  oranges,  pears, and  other
 fruits.  It is constantly taken into the stomach
I with unprepared vegetable  food.   It  is not
i digested in the stomach of man, although it
 seems to supply food material to many of the
 lower animals.  In estimating the quantity  of
| alimentary material in any article of diet the
j quantity of cellulose should  always be dc-
| ducted.
   CEPHALALGIA.  (See Headache.)
   CERATE  is a term applied to an unguent
 in which wax forms an ingredient.  The white
 cerate of  the druggists' shops is  formed  of
 white wax  and pork lard.  Yellow cerate con-
 sists of yellow wax and resin.
   CEREBELLUM.  (See Brain )
   CEREBRAL SOFTENING is a result
 of disease  of the vessels in the brain or  of
 changes taking place in that organ consequent
 upon previous  mischief.   It  is often associ-
 ated with cerebral hemorrhage, and it is one
 of the conditions which  produce apoplexy.
 Hemiplegia, or paralysis  of the arm and leg
 of one side of the body, is then  of common
 occurrence, and this comes  on with insensi-
 bility or coma.  It is a  very serious change,
 indicating long standing disease in the consti-
 tution. It occurs in those who have had gout or
 chronic  Bright's disease, and in those who 
CEREBRO-SPINAL FEVER
CEREBRO-SPINAL FEVER
50
  have been intemperate ; sometimes, also, as a
  natural result of old age and great mental ex-
  ertion.   The mind before an attack is often
  impaired ; the  patient  has  loss of memory,
  giddiness, vertigo, occasional attacks of faint-
  uess, lowness of spirits, and irritability ;  the
  countenance is often sallow, the person thin
  and shrunken, the eyes marked with an arcus
  senilis,  and the general appearance that of
  premature decay.   (See Apoplexy,  Hemi-
  plegia, and Degeneration.)
   CEREBRO-SPINAL  FEVER is  an
  acute, epidemic disease, characterized by pro-
  found  disturbance of  the central nervous
  system, and marked by shivering, giddiness,
  intense headache,  delirium, and spasms of
  various muscles ; there is great prostration,
  and occasionally a purple eruption appears on
  the skin.  This disease is also known as epi-
  demic  cerebro-spinal  meningitis,  petechial
  fever, purpuric fever, etc.  Age does not seem
  to have much influence upon  this  disease ;
  children, young  people, and adults all  suffer
  during an epidemic ; males, however,  seem
  more liable to it than females.  Season has a
  remarkable effect upon this malady ; it occurs
  especially during the  cold  months ; of 216
  local outbreaks  in  France and  the United
  States. 166 prevailed between December and
  May, and by far the majority of attacks have
 occurred during the winter months.  Fatigue,
 cold, overcrowding, foul air, and  dirty dwell-
 ings have been put down as exciting causes
 of this  disease, but at present  very little is
 known for certain on these points.
   Symptoms.—In most cases the patient feels
 indisposed  before the onset of the disease ;
 there  are pains  in the head  and various
 muscles, loss of appetite, and slight shivering ;
 in some  the  onset  is  quite sudden.  Acute
 shivering is followed by severe headache and
 giddiness, then by profuse  vomiting without
 nausea ; with the sickness there is often neu-
 ralgic pain in the abdomen ; after the lapse of
 a short time, often only a few hours, the  mind
 becomes confused, and  the patient grows rest-
 less  ; there is muttering delirium with occa-
 sional cries, or the patient falls into a state of
 apathy  and stupor, or he may be violently
 delirious. With this mental disturbance there
 is pain along the spine and limbs, and chiefly
 in the muscles at the back of the  neck and
 along the spinal column ; the head  is drawn
 backward  in consequence  of  the pain and
 spasm,  and this  retraction of the  head is a
 marked and common symptom.  As the dis-
 ease advances, other groups of muscles may
 be affected  in  a similar manner, the  trunk
 often being curved  backward, and the legs
 bent upon  the thighs ; the sensibility of the
skin  is also increased.  The expression shows
acute pain, or is distorted by spasm ; the eyes
are suffused and the face pale, with occasional
flushings.  The  temperature of  the body is
higher than usual, and the  pulse  weak  ; the
  tongue is sometimes clean,  sometimes  foul,
  and the  bowels are either costive or loose ;
  these two latter signs  vary in different epi-
  demics.   Purpuric spots appear on the skin,
  and do not disappear on  pressure of the fin-
  ger ; at first purple and  circumscribed, they
  soon become black and extend their margins,
  so as to form dark blotches; this is a bad sign,
  and then the patient may be in a state of col-
  lapse  and  insensibility,  and death may take
  place very rapidly; in other cases hemorrhage
  takes  place trom the mucous membrane  of
  the mouth, nose, and intestines.   If the dis-
  ease tends to  a fatal  result the spasms in-
  crease, coma comes  on, and death may ensue
  in from twelve hours to seven or eight days ; if
  life exist longer, inflammation of the eyes and
  ears may be set up,  as. ulceration of the cor-
  nea and deafness ; or paralysis of one side or
  of one limb may ensue, or there may be an
  inflammatory state of the joints.  If the dis-
  ease go on favorably, recovery may take place
  in three or four weeks, but if the progress is
  interrupted  by any  complication,  convales-
  cence is much retarded.  Inflammation of the
!  lungs,  pleura,  and   heart,  swelling of the
 glands of the neck, and under the ear, disease
  of the eyes  and  ears, bed-sores, and joint
  affections,  are met with  as complicalions in
 this malady.   The rate of mortality varies in
  different   epidemics  ;  the  minimumrate  is
 twenty per cent, and it  has been  as high
 eighty per cent.  Cerebro-spinal fever may be
 mistaken  for  typhus fever, but the history,
 rash, and progress of the disease will clear up
 doubt ; spinal  meningitis and cerebral men-
 ingitis  may much resemble this malady, but
 the onset  of cerebro-spinal fever is so much
 more rapid, and the  fact of its coming as an
 epidemic will help to solve any difficulty ; be-
 sides, no rash is met with in the last two cases.
   Treatment.—1. Preventive.—Since so little
 is known as to the causes of this malady, all
 preventive efforts must  be limited  to those
 sanitary measures which are applicable to all
 epidemic   disorders  for  the  purification of
 houses  and  localities.   2. Curative.—The
 treatment of cerebro-spinal fever by remedies
 is very unsatisfactory ; it is doubtful if the ad-
 ministration of any medicine has been benefi-
 cial in  doing more than relieving symptoms ;
 for this purpose opium or morphia has been
 given to allay pain and spasm.   Sulphate of
 quinine in  large doses,  and given early,  ap-
 pears to have benefited some cases ; bleeding
 and mercurial  preparations are of no value,
 and may  do harm.  The diet must be gen-
 erous and  nourishing, and consist of milk,
 beef-tea, and soup, etc., but oft?n the patient
 can only take food with  difficulty ; the object
 must be to sustain the vital powers during the
 great prostration which marks the acute stage
 of  this  disorder.  During convalescence the
 usual principles of diet  must be  adopted
 which are detailed under  the  head ot Fever. 
GO  CEREBRO-SPINAL MENINGITIS
CHEESE
  CEREBRO-SPINAL   MENINGITIS.
(See Meningitis.)
  CEREBRUM.  (See Brain.)
  CERVIX, a neck, is applied in anatomy to
bones,  as  cervix femoris,  the  neck  of the
thigh-bone,  and  cervix uteri,  the neck of the
womb.
  CEVADILLA.  (See Sabadilla.)
  CHAFING.   (See Intertrigo.)
  CHALK, or impure  carbonate  of lime, is
only  used in  medicine  when  it has been
thoroughly washed and  purified,  when  it is
called prepared chalk.  It  acts partly  by ab-
sorbing and  partly by what might be called
its  drying  properties.   It is mostly  used in
summer diarrhoea in  the form of  Chalk-mix-
ture, consisting of chalk, gum acacia,  syrup,
and cinnamon water.  Of these chalk is al-
most the only active ingredient, and should be
given in doses of twenty or thirty grains, or
more. It is not desirable to continue  its use
for too  long a time,  as  if the diarrhoea does
not speedily yield to it, other and more power-
ful remedies should be given.   Chalk  is also
used as the   basis of most  tooth-powders,
either as prepared chalk or  as precipitated
chalk, the latter being a finer powder.  If the
gums are at all spongy, a little rhatany pow-
der may be added, or a little  powder  of cin-
chona bark and some flavoring agent ; orris-
root is perhaps that most used.  Chalk is also
used with advantage as an application  to raw
and weeping surfaces, such as occur  in the
folds of fat infants ; but on the whole oxide of
zinc is preferable.
  CHALK STONES.—A  white, insoluble
substance,  deposited  in the textures  of the
bones, joints,  or areolar tissue, of  gouty per-
sons ; generally  in the  feet  or hands.   Its
chemical composition is lithate of soda.  The
swellings  produced  are  very painful  if in-
flamed,  and discharge freely ; simple  sooth-
ing dressings  should be applied, and suitable
constitutional treatment  be adopted.  Their
removal is rarely admissible.
  CHALYBEATE.—Anything  containing
iron.  (See Iron, Mineral Waters.)
  CHAMOMILE is the  flower  of the An-
themis nobilis, a plant somewhat  resembling
a daisy.  The single flowers,  i.e.,  those  hav-
ing most yellow  in  the centre, are the best.
It has long been a favorite in  domestic prac-
tice, given as infusion or tea for a variety of
complaints.   In  reality  it  is  not  to  be de-
spised as a tonic, although there are other
and more powerful remedies.  The tea  should
not be given warm, or it will probably cause
sickness and vomiting.
  CHAMPAGNE.  (See Wines.)
  CHANCRE.  (See Venereal  Diseases.)
  CHANGE OF LIFE.  (See Menstrua-
tion.)
  CHAPS.—Usually, the disagreeable  condi-
tion of the  skin known as  chapping is  pro-
duced by insufficiently drying  it after  wash-
ing, and exposing it in a wet or damp state to
the influence  of the weather and the winds.
Persons affected with chapped  hands should
be very careful not to wash them  too fre-
quently, and to dry them very carefully, rub-
bing a little glycerine over them before taking
them out of the water, or dusting a little pow-
der over after drying, to remove any moisture
that may remain.  Sometimes chaps are the re-
sult of a scorbutic state of the body, in which
case genera] treatment is necessary, as in  the
case of persistently chapped lips, which  are
sometimes very painful.  Smoking a pipe will
sometimes produce a very  painful crack in
the lip which is very difficult to  heal.
  CHARCOAL, or  carbon,  occurs in nat-
ure, as black lead or plumbago, but  is  ordi-
narily made artificially from animal or vege-
table substances.   Wood  charcoal is mostly
employed externally, and that most frequently
in the form of  poultice, combined with linseed
meal  and  bread.   This poultice  is  of very-
great value when sores are foetid and  parts
are sloughing  away, keeping them moist and
warm, while preventing smell.  The powder
may be used with similar intent.  It is some-
times given internally, when patients are suf-
fering  from organic  disease of the  stomach
and intestines, accompanied with  the forma-
tion  of fouls-melling gases and acrid fluids.
For  this  latter  purpose,  however,  animal
charcoal or purified  bone-black is most fre-
quently given, and it is also recommended as
a  temporary  antidote  for certain  organic
poisons,  as  aconite and  strychnine.   In
either case a tablespoonful should be given sus
pended in water.   It  is one of the most  valu-
able disinfectants for household  purposes, and
should always be employed when dead bodies
are deposited in coffins.
  CHARPIE, a French name  given  to a
coarse kind of lint, or tow, which  is prepared
from coarser materials than are employed  for
the manufacture of lint.
  CHEESE, an article of diet made from the
milk  of various animals.   The milk of  all
animals contains water, saline matters, sugar,
butter,  and caseine.  Cheese  consists  of a
mixture of the two latter substances.  When
milk is allowed to stand,  and acid or fermen-
table substances are  added to  it  the caseine
and butter separate  in  the form of  what  is
called curd.  This curd on  being strained is
converted  into cheese.    Cheese  is  always
made in this  country from cow's milk.  It
has a very different appearance and taste  ac-
cording to the way in which it is prepared, the
pressure applied to it, the time it is kept, and
the substances added to it.   When  curdled
speedily and floating in the water and sugar,
which  is  called the serum  or  whey of the
milk, it is called curds and whey.  The butter
when removed from milk is called cream, and
when milk is curdled quickly by heat and  the
cream  taken off, it is called clotted cream. 
CHEST
CHEST
Gl
 When  the curd is  removed with  the  butter
 from the milk,  and gently pressed, the prod-
 uct is called  a cream  or  soft  cheese.   All
 these cheeses contain the caseine or curd in a
 form in which it can be easily digested, and in
 all cases where a fatty and nutritious diet  is
 desirable they are to be highly commended.
 They may be often used on account  of the
 butter they contain, with great advantage as
 substitutes for cod-liver oil.   When cheeses
 are made  hard they are allowed to stand
 longer,  and then submitted to  pressure  for
 varying periods.  During  this  process they
 undergo various changes.  In some a sweet
 substance is separated from the cheese which
 collects in little vesicles  in the cheese, such
 as are characteristic of Gruyere and  Dutch
 cheeses.  In others a process  of moulding
 sets  in  which alters very much the flavor.
 Frequently a portion of the butter is converted
 into butyric acid  which gives a strong flavor.
 Cheeses vary  according  to the quantity of
 butter they contain, and are valued and high-
 priced as this  substance  prevails.   In some
 cases,  as in double Gloucester and Stilton
 cheeses, the cream of one milking is added to
 another milking, thus doubling  the  quantity
 of butter.   In Suffolk a contrary practice pre-
 vails,  the cheese being made after the cream
 has been taken  off and made into butter.
 Caseine when once dried becomes  very hard
 and indigestible, hence the bad favor of Suf-
 folk cheese.   Cheeses  differ in color accord-
 ing  to  the quality  of  the food eaten  by the
 cow, and as colored cheeses  have been  erro-
 neously supposed to be rich cheeses, in Chesh
 ire they adopt the practice of adding annotta
 to the cheese.   In some  countries  they  add
 flavoring substances to cheese.   In Germany
 a favorite  cheese, called  Schabzeigar, is
 flavored with the common melilot.  Cheese is
 a very nutritious article of diet, on  account of
 the large quantity of caseine it contains.  The
 indigestibility of the caseine, however,  sets a
 limit to its use.  The caseine is, however, ren-
 dered  more digestible  by the  butter it con-
 tains, and the richer cheeses are therefore the
 best for food.  Mixed with other food cheese
 has a tendency to promote digestion.  This
 is, perhaps, better effected by decaying than
 by fresh cheese : hence the practice of taking
 decayed cheese,  especially at the end of a
 meal.  (See Milk.)
   CHEST.—The chest is one of the three
 large cavities of the body, and contains  not
 only the  heart and lungs, but thegreat vessels
 which convey the  blood  to various  parts of
 the system, the oesophagus, which carries the
 food to the stomach, and other smaller but
 important  structures.   In the  skeleton,  the
 chest, or thorax, is  seen  to  be bounded be-
 hind by the spinal column, and  in front by
 the sternum or breastbone, while  its lateral
 boundaries are formed by the ribs which  are
affixed behind to the spine by movable joints
 and in front join the breast-bone by their car-
 tilaginous prolongations.  Thus a cage or box
 is formed which is  capable  of movement in
 three directions, viz., upward,  outward, and
 forward.  Above, the chest is much dimin-
 ished in area, and is bounded by  the  struc-
 tures which form the  neck ; below, the dia-
 phragm closes the thorax and separates its
 contents from those of the abdomen.  In the
 living subject,  the chest is  lined by a  thin,
 smooth membrane, called the pleura on which
 the  lungs can glide with  ease, while, exter-
 nally, the ribs  are  covered  by the skin ; be-
 tween  these  two  coverings are  numerous
 muscles, called  the external and internal in-
 tercostal  muscles, by which  many  of the
 movements of  the chest  are performed and
 respiration  is enabled  to be carried on ; they
 are  so called because they lie between the
 costae or ribs  ; the action of the external set is
 to raise, and  that of the internal set is to de-
 press, the ribs.   The  diaphragm is the most
 important muscle of respiration ; it is convex
 toward the chest, while its hollow or concave
 surface looks  toward the abdomen  : it is per-
 forated in a few places so as to allow vessels
 to pass from the chest to the abdomen and vice
 versd :  thus the  descending aorta and oesoph-
 agus pass through it close together in front
 of the spine, the one to send the blood to the
 lower part of the trunk and legs, and the other
 to communicate immediately afterward with
 the  stomach.   Another  opening allows  the
 inferior vena cava  to pass through  to the
 heart ;  this  is the large vein which  brings the
 return  column  of blood  from the lower ex-
 tremities  and  abdominal organs ;  besides
 these structures, a few nerves and lymphatics
 pass through.  The  diaphragm, like all mus-
 cles, has  the power of  contraction,  and its
 fibres are  so arranged  that during inspiration
 it descends and allows more air to enter the
 chest, while,  in doing so, it compresses the
 abdominal contents, while during expiration
 it rises, and so lessens the area of  the chest.
 The contents  of this cavity are  numerous and
 important ;  at the back part,  and therefore
 just in front of  the spine, is  the gullet or oes-
 ophagus,  a   hollow, muscular tube,  which
 allows food to  pass directly down from the
 mouth to  the  stomach  ; close to and in front
 of this tube  is another  shorter one, called the
 wind-pipe or trachea, which, soon after enter-
 ing  the" thorax,   divides into  two  branches
 called bronchi, and these,  entering the lungs,
 break up  and  subdivide into a vast number
 of smaller branches, which end in  small, di-
 lated, closed extremities called air-cells or air-
 vesicles ;  as they become smaller and smaller,
 so the wall of  the tube becomes thinner and
 thinner, until  at  last it  is of extreme tenuity ;
 and this is important, because the air can then
 readily  interchange  gases  with  the blood
through this delicate membrane, for the blood
runs outside the  air-cells in vessels with ex- 
G;2
CHEST
CHICKEN-POX
tremely fine walls also.  In this way respira-
tion is carried on, for during inspiration oxy-
gen is carried from  the external air down  the
wind pipe and  bronchi into the  ultimate air-
cells, and then through their thin wall into  the
blood ; while  carbonic  acid, which is  not
wanted in the organism, is carried away in the
opposite direction  during  expiration.  The
greater portion of  the  cavity of the chest is
filled up by  the lungs.  (See Lungs.)  The
heart is seated in front of the chest and at its
lower part, just between the lungs ;  it is made
up in four compartments, the two right being
quite distinct from the two  left cavities  in
health.  On the right  side  the heart receives
the venous blood  from the  inferior  vena
cavae, as before mentioned,  and also from
the superior  vena cavae, which,  in a similar
way,  brings the venous blood from the head
and neck and upper extremities ; it then sends
it on  to  the  lun^s  through  the  pulmonary
arteries to  be aerated.  On the left side  the
heart receives the blood from the  lungs  and
sends  it on  into the aorta, a large  vessel
which,  after  ascending about  two  inches,
curves backward and  then passes straight
down to the abdomen by the side of the oes-
ophagus ; in its course in the chest it  has  the
shape of  a syphon-tube.   Close  by this large
vessel runs a  very small one. the thoracic duct,
which comes  from  the abdomen, and, enter-
ing the blood at the root of  the left side of  the
neck, supplies that fluid with important  ele-
ments.  There are many  minor  structures
which do not require notice here.
  Such being briefly a statement of the con-
tents, it is now needful to show where to find
the position  of the heart and lungs  during
lile ;  for this  purpose the  back and front of
the chest may be mapped  out into districts.
On each side are twelve ribs, which can easily
be counted in a thin  person ; above, and in
front of the chest, is a clavicle or collar-bone,
while behind  are the shoulder-blades or scap-
ulas ;  these are points which are  easily recog-
nized by any one.  Take two pieces of tape.
and placing one  end  at the junction of each
collar-bone with the sternum or breast-bone,
let the other  end hang vertically downward,
there will then be a narrow central space and
a wider one on each side ;  next lay apiece of
tape horizontally across the chest just above
the nipples,  and another piece  parallel to it
about  three inches below  or on a level with
the seventh rib ; the lower margin of the ribs
is the lower boundary of the thorax.  In this
way nine spaces are marked out, the side
ones being of equal size, but the central ones
narrower ;  the lateral ones are named on each
side from above downward—sub-clavian  or
infra-clavicular, from being below the clavicle,
mammary  or the breast  region, and infra-
mammary or  the region below the breast ;  the
central spaces are termed upper, middle, and
lower  sternal regions.   Continue  the hori-
zontal tapes round into  the  axillary region.
and  then each is  divided  into three spaces
termed the axillary, lateral, and lower lateral
regions from above downward.  In a similar
way the back may be  mapped out ;  the space
over each shoulder-blade is called the scapu-
lar region,  while  that  between  the  scapula
and the spine on each side is  termed  the  in-
ter-scapular or vertebral  ; below these are  the
dorsal regions, which correspond to the lower
portions  of the  lungs.   Further,  the part
above each clavicle is called supra-clavicular,
and the space over the shoulder-blade  is called
the supra-spinous  fossa.   All these divisions
are, of course, quite arbitrary, and are only of
use for easy reference in describing the seat
of the disease  that may be present.
   CHERRY-LAUREL, the  Prunus lauro-
creasus, is a well-known shrub, the leaves of
which, when distilled, yield small quantities
of prussic acid.  As the quantity varies much,
the old-fashioned  cherry-laurel water, which
owed its  efficacy to the  prussic acid  it con-
tained, is now rarely if ever used, this acid
being such  a  dangerous poison.   It should
not be used in domestic medicine.
   CHICKEN-POX, or Varicella,  is a con-
tagious but harmless disease of childhood, un-
attended  by any  constitutional disturbance,
as a rule, and  after running its course for a
few.days ends in complete recovery.  Often,
several children of the  same  family have it
one after the other, and  it seems to occur in
an epidemic  form at some seasons of  the
year ; it  affects both sexes and all classes  in-
discriminately.  After a period of incubation,
the length of which is doubtful, a number of
little red points suddenly appear on the skin,
and in the course  of twenty-four hours each
has become a small blister, or vesicle, raised
above the surface  and surrounded by a pink
areola or zone.   Each vesicle is seen to be
formed of a delicate membrane, and within is
a  little clear,  watery fluid.  The next day,
more red spots appear, which also form blis-
ters, and so on for about three or four days,
fresh crops appear, as the previous ones  at-
tain a maturer stage.  The eruption  is most
abundant on the back and front of the body,
much less so on the face  and head, while very
few  spots appear  on the arms and  legs ; the
small blisters  are  convex, unless they have
burst, which, from their delicate structure, is
no infrequent occurrence, but  even they are
different  from the central depression  seen in
the pustules of small-pox, and a careful ex-
amination will always show one  or two con-
vex vesicles which are still entire.  In about
a week the  vesicles begin to wither and dry
up, and  in a  week or  ten days longer the
scabs fall off, leaving, as a rule, no scar, but
if  they are picked  or irritated, a small white
depression may be left in the skin.    Eczema
may be  produced by  rubbing the vesicles,
therefore the child should be  kept from pick- 
CHICORY
CHILLS
G3
 ing  the  scab.  If the child be in  bad health
 previously, the scabs may fall off and leave
 circular  ulcers which may take some  time
 longer to heal, and then scars are sure to re-
 sult, but this is a rare occurrence.  Asa rule,
 the child need only be  kept in the  nursery,
 and not in bed  all day long ; occasionally,
 the little patient is restless and feverish,  but,
 in most cases, it will play about as cheerfully
 as usual,and appear to have nothing the matter
 with  it.  The  temperature is generall}' no
 higher than  in  health,  the tongue clean, and
 the appetite good.  For a few days  the child
 may be kept in-doors, and the diet should be
 plain and simple.  This disease  is by many
 called the  glass-pock.   Vaccination  will  not
 prevent  this disease  occurring,  nor does it
 seem to  have any connection with small-pox.
 One disease  will not  prevent the  other from
 attacking the same individual.  The absence
 of pain in the back, fever, and sickness, which
 are so common in small-pox ;  the rapid devel-
 opment of the rash, which is mature in 24 or
 36 hours, which  comes out  in crops, and is
 more common on the body than on  the face,
 will help to  distinguish  this mild complaint
 from small-pox.   However, when small-pox
 occurs in a  modified form, it  is occasionally
 difficult to know one from the other.
   CHICORY.  (See Coffee.)
   CHILBLAIN  is  a very  common  and
 troublesome  affection in this  country during
 the winter months.  It  commences as a mild
 and superficial  inflammation of the skin in
 certain parts of the body, by preference  the
 feet,  hands,  ears, and  nose, and afterward,
 when neglected, or badly treated, is converted
 into a blister or a deep  sore.  The subjects of
 this complaint are most  frequently young
 females who have a soft and tender skin, and
 who perspire much, and its exciting cause is
 a sudden transition  from  extreme  cold to
 warmth,  or  warmth  to cold ; generally  the
 former.  The combination of moisture with
 cold, the friction  of coarse stockings, and the
 pressure of tight and badly-made boots  are
 also to be regarded as active conditions in the
 causation of chilblain.   The most  common
 form cf chilblain is a small red patch on the
 skin, to which the patient's attention is  first
 called  by a sensation  of heat and itching.  If
 this has been neglected  or scratched, and no
 pains taken to regulate the temperature of the
 affected  part, the  inflamed  patch  becomes
 darker in color and vesicates or blisters, this
 change being attended by intolerable itching.
 If the chilblain be still allowed to go on with-
 out treatment, it passes  into the stage of ex-
 coriation, and finally  into that of  ulceration.
 The  skin becomes raw and discharges  mat-
 ter, and a deep open sore is formed,  which in
 unhealthy subjects extends  below  the  skin
and becomes very rebellious to treatment. In
badly-nourished and neglected children of the
poorer classes, the affection in some instances
 rapidly  progresses  to  a state  of  gangrene.
 Much may be done  to  prevent chilblain.   At
 the approach of  winter those  who are liable
 to become thus affected should endeavor to
 harden the skin of the extremities, and to ac-
 custom the feet to pressure and friction.  The
 feet, as well as the hands, should be frequently
 washed with cold water, or, if this cannot be
 used on the lower extremities without danger
 or discomfort, a  solution of alum, or  spirits
 of wine should be rubbed into the skin night
 and morning.  The  socks or stockings should
 be thick and warm, and the boots loose  and
 furnished with good soles.  Sudden exposure
 to cold and wet should  be  carefully avoided,
 and the temptation guarded against of  sud-
 denly bringing a benumbed hand or foot into
 close proximity to afire.  Wet feet should be
 well washed with fresh cold water and then
 scrupulously dried.
   Treatment.—The chief point in the treat-
 ment of chilblain is to avoid any fresh expos-
 ure to the exciting causes of the affection.
 The painful and inflamed part must be guard-
 ed  against  extremes   of  temperature,  and
 against friction and pressure.  In the mildest
 form of the complaint,  when there is a faint
 inflammatory blush, and some slight itching,
 the inflamed part should be well washed  with
 spirits of wine and cold water, carefully dried
 and then painted over with a lotion composed
 of one drachm of carbolic acid, one ounce of
 glycerine, and four ounces of water.   This
 lotion should be applied every hour by means
 of an ordinary camel's hair brush. When the
 chilblain is more inflamed and painful, either
 of the following lotions will  prove service-
 able : spirits  of  turpentine,  two drachms ;
 castor  oil three drachms ;  collodion,  two
 ounces ; or, camphor, one drachm ;  eau de
 Cologne, three ounces.   When there is much
 blistering, simple starch powder, or zinc oint-
 ment will be found the best applications.  An
 ulcerated chilblain  requires poulticing, and,
 when there is much discharge and the sore is
 covered by large  granulations  or proud flesh,
 the application of Peruvian balsam, carbolic
 acid ointment,  or wine of aloes. . In cases
 where  the sore  is deep and  obstinate under
 treatment, and the skin around inflamed, at-
 tention should be paid to the general health of
 the patient, and wine  and good nourishment
 liberally supplied.  When the  discharge from
 the sore is very foetid, one may combine  with
 the above-mentioned  dressing a solution of
 chloralum, or one of permanganate of potash,
 or  apply  a  layer of cotton wool, or carded
 oakum powdered with  charcoal.
   CHILDREN. (See  Diet.)
   CHILD-CROWING. (See Laryngismus
 Stridulus.)
   CHILLS are always one symptom of  mis-
 chief to the system  which  should not be
 neglected.   Sudden shiverings, known by this
i name, are often  premonitory of an attack of 
04       CHILLS AND FEVER
CHLOROFORM
fever of some kind, and it is wise to take early
notice of the warning, and endeavor either to
ward off the enemy or to mitigate its violence
by the administration of a hot bath and good
rubbing,  so as to restore action to the skin, a
mild purgative, a basin of gruel, and a warm
bed. These precautions may frequently break
the chain of morbid actions  in  the system,
and prevent the threatened disease making its
appearance.
  CHILLS AND  FEVER.   (See  Inter-
mittent Fever.)
  CHIMAPHILA, the name given  to the
American Winter  Green,  Pytola umbellata.
This plant has bitter properties, and is cele
brated as  a tonic and anthelmintic.
  CHIN-COUGH. (See Whooping-cough.)
  CHIRETTA is the  entire plant  of the
Agathotes Chirayla,  growing  in  Northern
India.   It is imported in bundles with flowers
and roots attached.  The plant is very bitter,
with a somewhat peculiar twang about it, and
is one of the safest tonics which could be rec-
ommended  for  domestic  use.   Combined
with an  acid  like the dilute   nitro-muriatic
acid, it may be given with great advantage in
cases of defective appetite where there is no
organic mischief.  The dose varies from one
to two  ounces of the infusion.
  CHLORAL is  formed by  the  action of
chlorine on alcohol, and is a dense colorless
liquid,  with a caustic taste and a suffocating
odor.  It has a very soothing  effect upon the
nerves, and  is now extensively used  in the
treatment of nervous diseases, and  as  a nar-
cotic.  The dose is from  10 to 15 grains  in a
little water ; and more than this should never
be taken except as prescribed by a physician,
as it is a very dangerous remedy.  The signs
of an overdose are slow,  noisy breathing,
with excessive drowsiness  or unconscious-
ness.  The  Treatment of one suffering from
an overdose is artificial respiration,  as  de-
scribed in the article on Drowning.
  CHLORIC  ETHER,   now  known  as
spirits of chloroform, consists  of a mixture of
chloroform and alcohol, and  is  the form in
which chloroform is most frequently given by
the  mouth.   Its properties are, of  course,
similar  to those of  chloroform,  but as the
latter is  chiefly administered  by the  lungs,
that is to say,  by inhalation, a word may be
said as to the  uses of chloric ether. As a
remedy it is  of  great  value where there is
much sickness and disturbance of  stomach,
and it is a useful adjunct to nauseous medi-
cines, frequently enabling them  to be kept
down when without it they would inevitably
be ejected.  It is also of great use in  certain
spasmodic affections, as cough and prolonged
hiccough, asthma, and the like.  For a dose, 20
or 30 drops  may be given in sugar, or along
with some other substance of the same kind.
•  CHLORIDE OF  LIME.  (See  Chlo-
rine.)
  CHLORINE  and Chlorinated Lime may
best be considered together, seeing that the
latter is but a convenient form whereby the
other is rendered portable.  Chlorinated lime,
commonly called chloride of lime, is prepared
by pouring gaseous chlorine over quick-lime.
which absorbs the gas and acquires certain of
its properties.   It is mostly used as a disin-
fecting  agent.   It acts by virtue  of the chlo-
rine,  which  it slowly evolves when exposed
to the atmosphere, or gives it more speedily
when spread in  a saucer or other flat  vessel
(non-metallic), and  a little ac'd, such as hy-
drochloric acid,  is added.  Chlorine acts as a
disinfectant by virtue of its  power of oxidiz-
ing decaying bodies,  and  being volatile  it
readily attacks those in  the air as well as on
more solid objects exposed to its  fumes. Un-
fortunately these fumes are rather irritating to
the throat and the eyes, and frequently can-
not be  borne by the sick ; but for ordinary
purposes, such as  cleansing  close rooms,
there is nothing more effectual  than chlorine
generated from  chlorinated lime.  But as it
attacks many things, being a powerful bleach-
ing agent, and readily  destroys  colors, and
affects metal-work, including  gilding, it is
somewhat  at a discount;  but  in privies,
workhouses,  ships, etc., it is of much value.
The mode in which it should be used has
been already hinted at.   To keep down ordi-
nary smells the powder need only be exposed
in a flat dish, and renewed from time to time.
For the purposes of active  disinfection it is
better to add to the lime some acid, and shut
up the doors, windows, and chimneys for a
time,  taking care that the place has been well
ventilated before  re-entering.    Chlorine  is
also used  as a gargle, especially  when  there
is much fcetor from the throat,  as in scarlet
fever, diphtheria,  and the like.   Here it  is
exceedingly  useful.
  CHLORODYNE is  a patented remedy
for neuralgia, recently  introduced, and sup-
posed to  consist principally of  chloroform,
morphine, Indian  hemp,  and  hydrocyanic
acid.  The dose  for adults is 20 to 30 drops.
  CHLOROFORM is  produced in  the
crude state by distilling rectified  spirit  from
off  chlorinated  lime.   In appearance,  it   is
a clear, transparent, watery-looking liquid.
not, however, mixing with water, and if poured
on its surface, forming a layer  at the bottom
of the vessel.  Its odor is also peculiar.  As
is well known, the mode in which chloroform
is commonly administered  is  by inhalation,
and, as is also well known,  its  use is not un-
attended with danger.   Its administration is,
therefore, a  matter of importance, not to be
rashly undertaken  save by  skilled persons.
No exact quantity can be assigned as  proper
to be given, as some people speedily become
insensible under its influence, others  again
requiring  a  very much longer  time,  and  a
much larger quantity of the drug. Ordinarily 
CHLOROFORM
CHOKING
65
 the  first stage of chloroform inhalation gives
 rise to  pleasurable  sensations, unless  the
 chloroform  be allowed to irritate the nostrils
 or  interior  of  the mouth,  or  the  patient is
 frightened and  restless.  There is  no loss of
 consciousness,  but often a sense  of  relief
 caused  by comparative freedom from pain.
 This is followed by another stage, where there
 is often a good deal of excitability.   The  pa-
 tient may laugh and talk at  random, and will
 sometimes fight and  struggle.   This is most
 marked in powerful individuals.  There is also
 a loss of sensibility, but hardly of conscious-
 ness, though sensations of  pain are greatly
 lessened.  There  is  still power of motion,
 and, as has been said, struggling is commom
 Beyond  this stage the use  of chloroform in
 midwifery practice should  not in  ordinary
 cases be carried,  otherwise the labor will be
 retarded.  Of course, if operative interference
 becomes necessary, anaesthesia must  be car-
 ried to complete insensibility and motionless-
 ness.  If we divide the ordinary  results of
 inhaling chloroform  into three groups,  the
 total insensibility and  complete loss of vol-
 untary  motion  constitutes  the third ; but in
 strong young men there often intervenes a
 condition apparently of  complete rigidity,
 sometimes accompanied  with trembling, and
 the patient will become dark in the  face.  To
 those unacquainted with the use of chloroform
 this condition is sufficiently alarming, but it
 speedily passes  away, the  limbs become re-
 laxed and totally devoid of power, and respir-
 ation is resumed,  though often stertorously
 for a time.  Now  is the time  for operation ;
 there is  neither sense, feeling, nor power of
 motion.   Beyond  this stage the inhalation of
 chloroform  should never be car.ied.   Even
 this may be dangerous, for sometimes sud-
 denly the tongue falls back,  breathing ceases,
 and the pulse stops, and death may result be-
 fore efficient aid can be rendered.   Should
 this come to pass, artificial respiration (see
 Drowning) should be  used ;  the  patient
 turned on  his face and rolled from  side to
 side ; water should be  thrown  on  the face,
 and smelling-salts applied  to   the  nostrils.
 The application of  electricity to the diaphragm
 and side of the neck is also of great service,
 but prompt  measures are  always  the best.
 Often, as the patient begins  to recover sensa-
 tion, there is a  fit of vomiting, which may
 troublesomelybe repeated.  To avoid this the
 purest chloroform  alone should be used ;  the
 patient should have eaten  nothing for at least
 four or  five hours, and  the  last meal  should
 have been light.    Ice, or iced champagne, or
 brandy and iced water are the  most grateful
 remedies for the sickness.
  Besides being used  to produce insensibility
 in operations,  chloroform is largely used to
enable  the  practitioner  to  make  a correct
diagnosis when there is much pain and spasm.
 It has also  been  given  in  asthma (though
here, and used in this way, its  use is at least
liable to abuse), and in  tetanus.  In this last
named  disease, commonly  known as lock-
jaw, the remedy promised to be of use, and
patients have been  partially kept  under its
influence for long periods.    Recovery has
in many  instances followed ;  but  as it has
done so with multitudes  of  other remedies,
chloroform  cannot  be  relied  on as having
been the curative agent.  In spasmodic and
irritable strictures of the  urinary  passages,
chloroform often proves of very great service
in enabling  an instrument  to  be  passed.
Tic douloureux and other forms of  neuralgia
often yield  to  its influence,  which should
not, however, in these  cases be carried be-
yond the first stage.   So in toothache arising
from a decayed tooth, chloroform often  acts
a double part; to the part itself it acts as an
irritant,  and  so in  many cases does good,
while the  sedative  effect which follows  is
none the  less  beneficial.   Next,  perhaps,
after its use in cutting operations, chloroform
has been of most signal service in  enabling
the surgeon to reduce dislocation and stran-
gulated hernia or ruptures. In  such cases the
patient  should be  brought thoroughly under
the influence of the vapor before anything  is
done.
  CHLOROSIS is a disease  in  which the
patient  becomes of a yellow or sallow tint,
and  in which there is a diminution of the col-
oring matter of the blood.  It  occurs chiefly
in young women who lead sedentary lives, or
sit in close workshops, or in  any place where
light and ventilation are deficient ;  such peo-
ple have a dark border under  the eyes,  pale
complexion,  a feeling of lassitude and weak-
ness, headache, pain in the back and amen-
orrhoea.  The treatment  is the same  as for
anaemia, and, in fact, chlorosis is but a variety
of the  same complaint.  Anamia  is a term
used  when  the patient becomes pale  from
other diseases, as cancer,  consumption, and
kidney  disease ; chlorosis is  used when the
alteration in  the blood is the  primary change,
and not dependent upon mischief elsewhere.
(See Anaemia.)
  CHOCOLATE.  (See Cocoa.)
  CHOKE  DAMP, a name given by miners
to Ml irrespirable gases ; but  it more espe-
cially applies to carburetted hydrogen.  Car-
bonic acid gas is called fire-damp.
  CHOKING is an  accident  liable to hap-
pen  to  hungry persons  eating  hastily, or to
children, and requires the greatest self-control
and  presence of mind on  the  part  of those
who are present.   The situation is one of ex-
treme terror, and without some previous in-
struction, time is apt to  be lost  in sending for
aid which may come too late. The substance
which causes the choking may either be at the
top of the throat, at the  entrance to the gullet,
or lower down.  If at the upper part of the
throat,  prompt action will often remove it( 
G6
CHOLERA
CHOLERA
  cither by thrusting the finger and thumb into
  the mouth and pulling the obstruction away ;
  or, if it  cannot be  reached  so as  to pull it
  away, a piece of whalebone, a quill,  or even
  a  pen-holder—anything at  hand—should be
  seized and pushed down as a probang, so as to
  force the substance down the gullet.  If it be
  impossible to do this, tickling the back of the
  mouth with a feather, so as to produce sudden
  retching, will  sometimes dislodge it, a sharp
  blow on the back  will perhaps  displace it or
  a sudden splashing of cold water in the face,
  causing  involuntary  gasping.   Even  with
  every willingness and dispatch, the patient
  may become insensible before relief can be
  afforded, but it must not be  assumed for cer-
  tain that death has  taken place ; for it may
  only be a condition of suspended animation,
  and the usual remedies in such  a case—such
  as dashing cold water in the face and on the
  chest, applying ammonia to the nostrils, and
  inflating the lungs by bellows, etc., should be
  continued till medical aid arrives.
     CHOLERA is of two kinds, what is known
  as  cholera morbus, a disease  bad  enough
  but  not  particularly fatal, and that terribly
  fatal disorder Asiatic, malignant, or epidemic
  cholera.  In this country this last disease'has
  almost invariably  prevailed  in its worst form
  in  poor crowded dwellings,  among  those
  whose food supply was bad ; whose hygienic
  conditions were  otherwise unfavorable, but
  especially  among those who had  a tainted
  supply  of  water.  Very  frequently  when
  cholera prevails diarrhoea also does  so, and
  an epidemic of cholera is frequently ushered
  in by an unusual prevalence of the  other
  malady.   In point  of fact  in a case of ordi-
  nary, though by no means of maximum inten-
  sity the disease is ushered in by an attack of
  diarrhoea.  This may last a longer or a shorter
• period, but speedily the matters passed by the
  bowel alter in  character.  They assume a
  peculiar  flocculent  or  rice-water character.
  Vomiting, too, comes on, the fluid being thin
  and colorless.  Then follow severe  cramps,
  especially of the abdominal muscles and legs,
  which become like rigid cord.  The flow  of
  urine ceases, breathing and circulation are so
  much impaired that the  body  becomes icy
  cold on the surface, the tongue is cold, and
  so even is the breath.  The lips arc blue and
  shrivelled,  the face pinched,  the  voice  is
  hardly audible, the very eye-balls are flat-
  tened.  This is called the cold or algid stage
  of  the disease.   The  condition may go on
  getting worse till the heart stops, the patient
  being quite conscious to the end. Frequently
  it is impossible to tell  whether the patient is
  to  live  or die, when  suddenly the sickness
  lessens, the  body begins to  get warm, the
  face flushes, and restlessness subsides.   The
  patient  seems on the very  verge of getting
  well. But sometimes the urine does not flow,
  or there may  be congestion  of the lungs or
brain, and so, though reaction has set in, the
man may yet perish.  Thus  in an  ordinary
mild case of cholera a man will  pass through
three stages :  First,  that of premonitory diar-
rhoea ;  secondly,  that  of  collapse ; and.
thirdly, that of reaction  probably  in about
forty-eight hours.   It is no part of  our duty
to enter into any discussion of the immediate
cause  of  these  extraordinary symptoms.
There can be  no doubt of this, that the dis-
ease is produced by some  particular poison.
This poison may be transmitted through the
air by water, or communicated  by  one indi-
vidual  to another.  There can  be  no doubt
that the  discharges are one  main source of
this poison,  and hence  should be most care-
fully disinfected.
  Treatment.—With regard to  treatment,
much is in dispute.  But about this there can
be none : viz., that prevention is better than
cure.   Accordingly he who would  avoid
cholera during a cholera season, ought to live
by rule and method.  First see that his water-
closets are in good order, and that every pre-
caution is taken in cleansing and disinfecting
them.  Carbolic acid is best for this  purpose.
See that the house is clean, sweet, and airy  ;
let not foul or'decaying matters of whatever
kind remain upon the premises.  See that the
water supply is pure ; if necessary, boil it and
pass it through a charcoal filter before use for
drinking.  Let  no stale meat or vegetables, no
sausages, game, or substances likely to create
digestive  disturbance  be  used ;  especially
avoid unripe fruit, prolonged abstinence from
food,   excessive fatigue.   Should  diarrhoea
come on at such a time it had better be stop-
ped, except it  be due to some irritant matters
in the bowels, when a small  dose of rhubarb
or grey  powder may  be  given to remove
these, and an astringent subsequently admin-
istered to keep it from acting too powerfully.
Above all avoid strong aperient  medicines
of every  kind.  The astringents to be used
sould not be  powerful  ; chalk mixture,  sul-
phuric acid,  lemonade, or these  with a little
opium  added, are best.  Except in  the eyes
of a skilled  practitioner, nothing more must
be done.  No diarrheva in cholera time is to be
neglected.  This is a standing rule.  Should
collapse come on not much is to be done. It
is quite useless to give medicines internally,
they only accumulate there, for they are  not
absorbed.  The only thing is to try to keep
up the  heat in every way which will not dis-
turb ox fatigue the patient  ;  that is  material.
The patient is consumed with thirst, and there
is no reason under the  sun for refusing him
drink, if of a wholesome kind.   The thing is,
wait for the reaction.  Should that occur, the
life or death of the patient is, to a very great
extent, in the hands of his attendants.  Above
all he must be kept quiet.  If his head trouble
him and  his face is  flushed,  apply cold to it.
If there is much sickness let  him have a little 
CHOLERA INFANTUM
CHOREA
G7
 ice or ice-water.   If his lungs get gorged,
 warm poultices or turpentine  stupes will be
 best.   But the great anxiety is the kidneys,
 if they go well all may be well, but if not cer-
 tainly not.  If they do not  act warmth  must
 be tried, perhaps as a warm  bath, but this
 is a delicate matter and requires caution.  If
 they are acting well and the patient requires
 a stimulant, let  him have  some sal volatile.
 The greatest care must be taken  for a few
 days in fear of a relapse.  The food given is
 of special  importance ;  broths,  soups,  and
 jellies may be given, but certainly  not  meat.
 Small quantities, too, at  a time must be given
 and repeated as  frequently as necessary.  In
 the collapse a choleraic patient may be said
 to be in the hands of God ; after,  to a  very
 great extent, he is in the hands of his attend-
 ants.
   CHOLERA  INFANTUM is  a disease
 very common during the summer months.in
 children under two  years old.   It  is caused
 by improper food, or too much food, impure
 air, and  hot  weather ;  never by teething
 alone,  though this aggravates it.   Its first
 symptom  is usually a  slight feverishness,
 which is followed  by a  diarrhoea  with thin
 watery discharges, and a little later by vomit-
 ing.  Sometimes the vomiting and diarrhoea
 begin at the same  time and  these are the
 worst cases.  Within a  few days emaciation
 begins, the hands and feet become cold, the
 head and  surface of the abdomen  hot, the
 face pale and  shrunken, the eyes  dull and
 heavy, and the pulse irregular and quick ;  by
 degrees the child becomes sleepy, and finally
 sinks into a state of insensibility.
   Treatment.—At the first symptom of chol-
 era infantum, put the child into a warm bath,
 or apply flannels dipped in  hot water to the
 bowels, and keep the  child in an ordinary
 posture.   Dissolve  a teaspoonful  of  gum-
 arabic in an ounce of peppermint water, and
 give a teaspoonful every half hour.  A milder
 astringent  may be made  by mixing together
 three ounces of chalk mixture, half  an ounce
 of tincture of kino (or catechu), and half an
 ounce  of compound tincture of cardamoms ;
 of this mixture the dose  for a child  eighteen
 months  old is one  teaspoonful  every  two
 hours if  the discharges are frequent, and  at
 longer intervals  if not—care being taken to
 shake the bottle well before pouring out the
 medicine. If there is much thirst,  give  6 or
 10 drops of brandy in a teaspoonful of water
 or mucilage, every 15 or 20 minutes.  It is of
 the greatest importance that the stomach  of
 the child be at rest ;  hence, no  food or drink
 should be  given  for some  hours.   Further
 than this nothing can be done without the
advice  of a  physician,  and this should be
had at the earliest possible moment.
  CHOLERA   MORBUS   is   frequent
enough in the summer months. It may almost
invariably be traced to some injudicious arti-
 cle of food,  some  unhealthy occupation, or
 some distinct cause. The symptoms are vomit-
 ing and purging ; the vomit being bilious and
 utterly  unlike  the  colorless  vomit  of  true
 Asiatic cholera.   The question to be decided
 is usually this.   Has the vomiting and purg-
 ing lasted long enough to expel the offending
 matters ? if so, they had better be stopped ;
 if not, something should be given to favor
 their  expulsion.  Rhubarb and gray powder
 are perhaps the best things  to give, if laxative
 medicine is necessary ; if not, a few  drops
 (ten or so) of laudanum and sulphuric acid, or
 five grains of Dover's powder, or ten or fifteen
I grains of compound chalk and opium pow-
 der, will be best to stop the purging.  Ice or
 an  effervescing drink  will be  best to allay
 sickness, should these be required.  The  dis-
 ease may prove  fatal to children,  but rarely
 to adults.
   CHOLAGOGUES  are  medicines which
 act on the liver and increase the flow of bile.
 Among  the most powerful of these, notwith-
 standing recent  assurances to the contrary,
 we  must still place the  various preparations
 of mercury, such as blue pill—mercury with
 chalk and calomel.  Podophyllin is undoubt-
 edly of use in the same way.  When the liver
 is unloaded, such remedies  as purgative salts
 likewise increase the flow of  bile, and other-
 wise do  good.
   CHONDRUS  CRISPUS.  (See Carra-
 geen moss.)
   CHOREA is a disease generally met with
 in children between seven and  twelve  years
 of age, but occasionally it occurs in adult life.
 This disorder is often dependent on a  fright,
 as the sight of a fire,  the  bite of a dog, or
 falling into a river, and then the disease will
 appear in the course of two  or three days by
 twitchings of the arm and leg and the muscles
 of the face ; generally one side is more affect-
 ed than the other, and sometimes the choreic
 twitchings  are  confined  to  one side.  The
 twitchings of  the muscles  are worse when
 any one is observing  them, or when the child
 is excited ;  they are better when the  patient
 rests in  bed,  and they always cease during
 sleep.  Since  the child  cannot  control  its
 movements, it is unable to write properly, or
 walk across a room, or take hold securely of
 any object ; the  tongue is protruded  and
 drawn back with a jerk, and the head is never
 steady, because the muscles of the neck jerk
 it  about  constantly.  In most cases the  ap-
 petite  is not affected, nor does the general
 health seem much impaired ; there is, as a
 rule, no fever, and generally a recovery may
 be looked for ; in a  few cases, which are of
 somewhat rare occurrence, the twitchings  are
 so violent that the elbows, knees, and hands
 become sore and abraded by constantly strik-
 ing surrounding objects ;  there may be fever,
 delirium, and  sleeplessness  ; these  are signs
 of grave importance, and  are  usually associ- 
68   CHRONIC  HYDROCEPHALUS
CINCHONA
ated with  heart  disease, or follow on an at-
tack of rheumatic fever.
  Treatment.—Chorea, or, as it is popularly
called, St. Vitus's dance, is a very curable dis-
ease  in  ordinary  cases ; sometimes  it gets
well of itself ; more often it persists for some
weeks or even months, and makes the patient
weak and  pale.  Early  treatment is always
advisable, and  it should consist  of taking a
cold bath every morning, to be  followed by
friction with a rough  towel ;  tonics are of
great service, and more especially those con-
taining iron.   A simple but nourishing diet
should be given, and a certain amount daily
of outdoor exercise.   For those  cases in
which fever and delirium are present,  very
little hope  can exist as to a favorable result,
and  a different  treatment must be adopted ;
for such,  rest  in bed, sedatives  to allay the
sleeplessness, and a fever diet are desirable.
Chorea occurs in nervous excitable children,
and in those whose parents or other members
of the family have suffered from nervous dis-
eases, as paralysis,  epilepsy, and neuralgia.
  CHRONIC HYDROCEPHALUS.  (See
Hydrocephalus.)
  CHYLE is the fluid  found in  the lacteals
of the small intestine ; it is absorbed by these
small vessels as the food passes down the in-
testinal canal, and is of a milky, opalescent
appearance, from containing a large quantity
of finely-divided oily matter ;  after passing
through the mesenteric  glands, where  it un-
dergoes certain changes, it  enters  the recep-
taculum chyli,  and  then goes on to join the
blood-current by ascending the thoracic duct.
  CHYME  is  the  name given to the par-
tially digested food after it has left the stomach
and while passing down the intestinal canal ;
during its passage various soluble substances
are absorbed by the vessels  of the small in-
testine, and the remainder, which is called
faeces, leaves the rectum as excreta.
  CICATRIX.—A  wound or sore invaria-
bly leaves after healing,  a distinct mark upon
the skin.   This mark is called  a cicatrix or
scar.   It is of a pale pink or white  color, is
made up of firm gristly material, and is  cov-
ered  by  a transparent, smooth, and  shining
layer of cuticle.  These are the characters of
the ordinary cicatrix observed  in the seat of
a  superficial burn,  an  incised  wound, or a
simple ulcer upon the leg.  But the appear-
ances of cicatrices vary immensely according
to the part of the  body on  which  they are
seated, and the nature and depth of wound or
ulcer from which they have been developed.
The scars from burns, from scrofulous sores,
and from malignant or lupoid ulceration, have
each  theii  special characters  by  which  the
nature of  the previous disease can be deter-
mined after the lapse of seveial years.   After
a  sore has healed,  the resulting cicatrix al-
ways undergoes certain changes.   It loses its
ruddy or pink color  and becomes whiter ; as
it gets older it glides more freely over the tis-
sues beneath, and at the same time  becomes
smaller in  superficial extent,  drawing  upon
the neighboring soft parts so as to produce in
some instances,  especially after deep burns,
much distortion and deformity. The principal
change accomplished in scar-tissue in course
of  time is a gradual softening and  assimila-
tion both  in  appearance  and  function  to
healthy skin.   Scars frequently become dis-
eased. They are sometimes the seat of severe
pain, which is  more intense  in damp, cold
weather.  Obstinate ulceration and cancer are
frequently  met  with  in  the seats of  old
wounds.   The  deformities  produced by  old
scars have  been  more  fully described  under
the article Burns.
  CIDER is  a  fermented  beverage  made
from the juice  of apples.   Perry is made in
the same way  from pears.  The quantity  of
alcohol  contained in cider  and perry varies
according to the amount of sugar in the  juice,
and the completeness  of  the fermentation.
The lower  priced cider contains about half an
ounce in the pint, while the  higher priced and
that which  is bottled .contains from one ounce
to  two ounces of alcohol  in the pint. The sugar
in  cider  varies.  That  which is called hard
cider contains  only a  small  quantity,  while
sweet cider contains from ioo to 150  grains
in   the pint.  Cider and perry contain  malic
acid. The quantity of  this  acid contained in
a pint is about  150 grains.  It acts  on the sys-
tem in the  same way  as tartaric and  citric
acids.  (See Citric Acid.)  There is nothing
special in  the  action of cider on the system.
It  may be lrequently taken with advantage
instead   of  beer, especially the hard  cider,
which contains  less sugar, and saline constit-
uents which differ  from those  contained  in
beer.  Perry has more  flavor  than cider, and
more care is taken in its preservation.
  CINCHONA, belter known par excellence
as  bark, is the product of different species  of
trees growing naturally  in the Andes of  South
America, but now cultivated in  Java and Ja-
maica, and with great success in India. Three
varieties of  bark  are  recognized in our  Phar-
macopoeia,  but many  more  in  commerce.
The officinal varieties are the yellow, the pale,
and the  red.   In these are found two chief
alkaloids, viz., quinine andcinchonine ; most
quinine being found in  yellow bark,  mostcin-
chonine  in pale bark,  while the red bark
yields both.  It is chiefly to these substances
that the barks owe their great virtue, although
there are others also contained  in the differ-
ent kinds of cinchona of some value.    Qu>-
nine is used in  medicine as a sulphate, cincho-
nine as a hydrochlorate, the alkaloids  them-
selves being but  little  soluble.  Of the two,
quinine is  the  more  powerful, and  the more
employed,   but  cinchonine  is  very  much
cheaper, and  has the  properties  of quinine
only in a smaller degree.  It is,  however, apt 
CINCHONA
CIRRHOSIS  OF THE  LIVER    69
to upset the stomach.  The  discovery of the
properties  of bark was made  in  a curious
fashion.  As the story goes, an  Indian sick
unto death of the fever of the country, drag-
ged himself from the spot in the forest where
he had fallen exhausted, to  the nearest pool
to quench his thirst.  In  this pool a tree had
fallen and its waters were strangly bitter, but
their  effect was  magical, the  fever fit left,
and  as the man returned to  drink again and
again he was speedily cured.   This led to the
discovery of the  effects of,  as it was then
called, Peruvian  bark, and  on the occasion
of the illness of the viceroy's lady, it was rec-
ommended.  The effects were so satisfactory
that, returning to Europe, the viceroy carried
with him some of the bark, whose praises were
soon  spread abroad, and to it his own name
of Chinchon, slightly modified,  was given.
From that date to the  present  day the tropi-
cal fevers  which used to be so deadly have
been comparatively kept under hand.   These
fevers are  of the  intermittent or remittent
type, coming on or growing worse at certain
definite times, and it is just before these that
quinine should  be given, and that too in a
good large dose  of  not  less  than 5  grains.
Smaller doses should  be given  during the
whole of the interval.  Quinine does not ap-
pear to have any power of arresting what are
called continued fevers, such  as  typhus and
typhoid,  but it is of undoubted service during
the period of convalescence, and it is now
considered to have the power of reducing high
temperature  even in these diseases.   It is
perhaps for this reason that some are fond of
giving it in rheumatic fever, where, however,
it as a rule  does no great good.   In neural-
gia and tic douloureux, especially when they
come on at stated periods, quinine is often of
immense service, as indeed it is in all affec-
tions  coming on  periodically.   Brow ague is
one of these.  As is well known, quinine is the
great remedy in  most  forms  of  debilitating
disease, especially for the sake of giving an
appetite, when that is  defective, and so im-
proving the nutrition of the body.  For this
purpose, a  grain  or two grains should be
given for a dose, a few drops of  dilute sul-
phuric acid  being added to enable it to dis-
solve more speedily.  It is however to be
noted that  a solution so prepared does not
keep well,  as a  kind  of fungus forms and
grows on  it.  When  given  in  very  large
doses, quinine produces a singing in the ears
and throbbing in  the  temples which  is far
from pleasant.  These  are signals for a dimi-
nution in the dose given.   Quinine is now
usually prescribed instead of  bark, except in
certain instances.  To give bark in the form
of powder, as was formerly the practice, is to
administer large quantities of  utterly indiges-
tible woody  matter, but  in certain  forms  of
disease  accompanied  with   great debility,
nothing better can be given than decoction of
bark, with carbonate of ammonia in large and
repeated doses.   A draught of this kind will
also frequently  relieve headache  and give
appetite.  There is an old rule, that quinine
should never be given with a furred tongue,
but that is nowadays  frequently disregarded.
  CINNABAR  is the red sulphuret of mer-
cury found  native, and is one of the chief
sources of that metal.
  CINNAMON BARK, as used in medicine
and confectionery, is the inner bark  of the
young shoots of a  tree  growing mostly in
Ceylon.  The trees are generally pollarded so
as  constantly to supply  a series of  young
shoots. From it is distilled an oil called oil of
cinnamon, which has got the fragrance of the
bark as  well as its pungency.  In medicine
it is mostly used as cinnamon  water,  which
may be made from the bark or oil.  This with
many is a favorite behide  of unpleasant rem-
edies.  The powder is also used as an adjunct
to relieve flatulence or prevent griping. The
dose of  the  bark is immaterial ; that of the
oil is from one to five drops.
  CIRCULATION   OF BLOOD.   (See
Heart.)
  CIRCUMCISION, the operation  of re-
moving the foreskin.   In  the  practice of the
surgeon this  proceeding is frequently  neces-
sary, either  from preternatural  length of the
foreskin, or for disease.   The operation has
been practised by the Jews from the earliest
times ; doubtless on  account of the resulting
cleanliness and  probable  immunity from in-
fection of venereal disorders.
  CIRRHOSIS OF THE LIVER  is the
name given to a disease in which that  organ
becomes smaller and  firmer  than usual.  It
is known  more commonly  as  the  " hob-
nailed" or " gin-drinker's liver."   The first
named is derived from the fact that the sur-
face of the  liver in these  cases  is rough and
uneven, and the  second name denotes the too
frequent cause of the disease.   Cirrhosis oc-
curs but rarely in children, but is not uncom-
mon in adult life.   Among the many evils
caused by drunkenness, this gradual wasting
of an important  organ, together with an in-
crease in the  fibrous tissue of the viscus, must
take its  place ;  in   other cases  it  seems
brought about by syphilis, or in other diseases
where there has been going on for some time
a deterioration of the  blood.   This disease is
always chronic in its course and begins  some-
what insidiously.   Loss of appetite, sour ris-
ings from the stomach, a feeling of sickness
in the  morning, and  foetid breath are often
the earliest signs ; these are, in fact, the usual
signs of dyspepsia, and the skin, in addition,
may have a  slightly jaundiced color.  The
patient may go on for many weeks or months
without being much  distressed, but he  will
notice  that he is gradually losing flesh  and
that his strength is failing.  After a time, the
abdomen will become distended, because the 
70    CIRRHOSIS OF THE LIVER
CLERGYMAN'S  SORE THROAT
circulation through  the  liver is obstructed,
and the serum in the over-full vessels behind
passes through their walls and causes an ac-
cumulation of fluid in the abdominal  cavity ;
the patient is then said  to have " dropsy in
the abdomen," and the term "ascites" has
been applied to this by  medical men.  (See
Ascites.)  The veins, also, over the  surface
of the abdomen  become very full, and  the
skin  is marbled  over with  blue  ramifying
lines.  The patient is usually emaciated, and
the skin  has  a  sallow,   yellow  color;   the
pinched expression of face and the absence of
fat under the skin contrasts markedly with the
distended abdomen.  The patient feels weak,
and cannot undergo any exertion ; his appe-
tite is bad, and the tongue dry and red ;  the
presence of the dropsy prevents him  breath-
ing with ease, and the tightly-stretched skin
gives him pain ; generally, too, the intestines
are very full of gas, and so flatulence adds to
his discomfort.
  Treatment.—Much  good   may  often be
done  by  treatment  if the  case is taken  in
time ; in the early stage,  before dropsy comes
on, the patient must abstain from any excess
in stimulants, and take them  only in modera-
tion ; since he is  also troubled with dyspep-
sia, the food he takes must be light and nutri-
ent ; cold milk for breakfast is generally well
borne on the stomach, with some dry toast or
biscuit or  bread  soaked  in it.   Mutton and
roast beef may be taken,  but  pork,  salt beef,
cheese, pastry, and vegetables are  not good.
If a chop or steak or a piece from a joint can-
not be taken,  strong beef-tea  or broth, or
chicken, etc., may be given ;  the object being
to supply the individual  with food which is
nourishing in quality and capable of easy di-
gestion.   Coffee is better than tea,  and cocoa
with milk forms  a pleasant  beverage.  Rich
food and made-up dishes should be avoided.
The  mineral acid (as hydrochloric or nitric
acid) may be given with  some bitter infusion
twice a day, and  sometimes  this checks  the
tendency to drink and improves the appetite.
An occasional aperient should be given, and
for this purpose  a rhubarb  mixture may be
prescribed.  Should, however, the  patient be
so far advanced  in the disease as to have
dropsy, means must be taken to relieve him
of the  fluid, while at the  same time his gen-
eral health is supported.  When there is much
ascites, the urine passed  in a  day is high-col-
ored, diminished in  quantity, and  deposits a
pink sand on standing ; this, as well as the
pain in the abdomen  and  the difficulty  of
breathing arise from the pressure of the fluid ;
hence the object must be to remove the fluid
as far as possible ; for this aperients may be
given which produce copious watery evacua-
tions ; such drugs are  called hydragogues,
and among them may be named jalap, scam-
mony, colocynth, and elaterium.  As the pa-
tient will probably be thirsty, a drink made of
lemon-juice, cream of tartar, sugar, and boil-
ing water is very grateful, and, while relieving
thirst, it aids  also the action of a purgative.
If the dropsy be so great that drugs seem to
be of insufficient avail, recourse may be had
to tapping the abdomen  and letting out the
fluid.  For a time the person will recover in
a great measure, but at some future period the
fluid may again be  effused, and after every
tapping there is a diminished chance of ulti-
mately doing much good ; yet in many cases
careful diet and judicious treatment may pro-
long life for many years.
  CITRATES are  favorite forms of giving
many remedies, as  they can  ordinarily be
given in an effervescent state, enabling them
to be more readily retained  by the stomach.
The most common form is technically known
as  Citro-tartrate of Soda.   To this  many
remedies may be  added : it is itself a gentle
laxative, and is often used as such in doses of
about sixty grains or more.  Citrate of Mag-
nesia is a popular preparation.
  CITRIC ACID  is the  substance which
gives the  pleasant  acid  flavor to oranges,
lemons, and most of our  fruits.   It is found
pure in  the lemon, citron, and other fruits of
the  natural order Aurantiaceir.   It can be ob-
tained pure and in  a  crystalline form from
the  juice of any of these fruits.  Its action on
the  system is like  that  of other  vegetable
acids.   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, lime-
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 compelled  to take a supply of
lemon or lime-juice and let the sailors take at
least half an ounce a day.   The crystallized
citric acid does not appear  to act as an anti-
scorbutic.  Citric  acid and  the  juices which
contain it are employed for making efferves-
cing  draughts,  when mixed with  alkalies.
Fourteen grains  of citric  acid, or  half an
ounce  of lemon-juice,  mixed  with  twenty
grains of bicarbonate of potash, makes, with
one ounce of water, an excellent effervescing
draught.
  CITRON  is the  fruit of a variety of the
Citrus medica, or common  lemon.   Its juice
contains citric  acid, and its  peel, or external
covering  of the fruit, is  preserved in sugar,
and called candied citron peel.  The peel of
all  the fruits  of the  orange iamily of  plants
contains a volatile oil, which gives it a pleas-
ant flavor, and renders it slightly stimulant.
  CLARET.  (See Wines.)
  CLAVICLE.  (See Collar-bone.)
  CLAVUS, the peculiar choking feeling felt
in the throat in hysteria and in allied  nervous
affections.  (See Hysteria.)
  CLERGYMAN'S  SORE   THROAT.
(Sec Sore Throat.) 
CLIMACTERIC
CLIMATE
71
   CLIMACTERIC is a term  derived from
 ancient writers on disease.  It was suggested
 that there was a tendency in the human body
 to certain  diseases  at the end  of definite
 periods.  This  period  was usually fixed at
 every seven years, when peculiar diseases oc-
 curred.   The ninth period, or  sixty-three
 years of age,  was the time of the commence-
 ment of what was called the " grand climac-
 teric."  In some instances teeth appear be-
 tween the sixty-third and eighty-first years of
 age,  after the disappearance of  the second or
 permanent  set  of  teeth.   This   is called
 " climacteric teething." Forthe "climacteric
 period " of  women, see Menstruation.
   CLIMATE is used  to express a multitude
 of conditions, some known, some unknown ;
 but on the whole the idea of heat or tempera-
 ture is uppermost.  Next to that comes hu-
 midity or dryness, so that we speak of a hot
 climate or  a  coid climate,  a moist or a dry
 one.   But  to know  whether a given place
 possesses a good climate,  that  is  to say, on
 the whole a healthy one, we must know some-
 thing more  than is told by the  thermometer
 and rain gauge.  Then, as  regards cold, it is
 quite possible, by shutting  up an invalid for
 the winter and by exercising due care, to  keep
 the surrounding atmosphere at  any tempera-
 ture we like and maintain it  evenly so.   If we
 send him abroad we seek  to send him to a
 part of the world where not  only will the  tem-
 perature be tolerably high all the year round,
 but where it will be so even that he  will be
 able to spend a considerable part of his  time
 out of doors.  But it is quite plain  that if we
 send a sick man to a place where one day
 there is a high  temperature and  next day a
 low one, though the mean temperature be
 high, he will be unable to  go out  when  the
 temperature is low, and will be fatigued by
 the heat when it is high.  Such a climate will
 be to him worse than useless, he had far bet-
 ter have remained at home.   It  is not, there-
 fore,  the mean temperature of a  place we
 have to study, but its extremes, its highest
 and its lowest points, and we must judge  of
 its eligibility by  these.   But this is not all.
 Still air, whether hot or cold, is much more
 bearable than  is moving air or wind.  So we
 may have a windy place with a tolerable  tem-
 perature in  the shade altogether unsuited  to
 the wants of the invalid.  Moreover, the sit-
 uation of the  proposed resfdence  must be
 considered  with   regard  to  the  prevailing
 winds ; even in windy regions some sheltered
 nooks are to be  found  which will  possess a
 vegetation characteristic of regions  possessed
 of a much higher temperature.  So, too, with
 regard to humidity, the  rain  gauge is no great
 criterion.  In certain regions a vast  quantity
 of rain pours down, fills up the rain gauge for
 two or three  inches, and then  passes away
not to return for many weeks. In  other regions |
it rains more or less every day, and the whole
I atmosphere is  impregnated with moisture.
| Here there may,  by the rain gauge,  be a
| smaller rain-fall than in the other instance,
 but the climate will be as different as may be.
| Nor is it only the mode in which the rain falls
 which has to be taken  into consideration ;
 the mode in  which it disappears  after falling
 is of the first importance.   Here soil comes
 in.   Suppose the  soil a clay  soil up to the
 surface,  the  rain-water  cannot  percolate
 through  this, and so  if the  land slopes it
 runs off at  once, if the land is  flat it lies on
 its surface.   H instead of a clay soil we have
 a sandy one, the rain-water will sink through
 the porous  earth almost as soon as  it has
 fallen, but  its ultimate destiny depends on
 other circumstances. If the sandy soil slopes,
 the water will speedily run off, but if it forms
 a valley, let us say, and  has beneath it a bed
 of clay, the ground  water will only  sink as
 far as the clay and remain there concealed to
 view, indeed, but as actually present as if it
 were above the ground instead of below it.
 In  certain districts,  instead of  the  surface
 being made up  of sand or gravel, it  is com-
 posed of vegetable debris, resting on a sub-
 soil of mud.  This constitutes  a  marsh, and
 such an association of things gives rise, under
 the influence of the sun's rays,  to a power of
 unknown nature,  but  well known  by  its
 effects, what we call  malaria.  The exact im-
 port of ground water with regard to health is
 not yet clearly known ;  but enough is known
 to render it an important element in forming
 an estimate of climate. Certainly, for invalids
 suffering from diseases  like consumption or
 chronic rheumatism, localities  characterized
 by excess of ground water are to  be avoided.
 Exposure to the sun is another  thing to be
 taken into account, though not, perhaps, quite
 so much as exposure to the prevalent winds.
 Finally, in forming an estimate of the value of
 a given place as a health resort, we must not for-
 get to take into account the  conditions which
 man himself imposes on a locality.  The very
 great importance of drainage in adding to the
 healthiness  of  a locality is daily becoming
 more and more appreciated.  It has been as
 clearly demonstrated as a thing can be, that
 bad drainage brings in its train diseases of the
 class called  Zymotic.  Better  far a situation
 which does  not  promise so much in point of
 climate than  a town,  however  eligible in
 other respects, which is totally  deficient in
 hygienic  necessities.   Taking  the two  great
 factors in  climate as  our guide, we might
 classify climates by  them,  especially if  we
 take into consideration one other alluded to,
 viz., wind.   Where the  atmosphere  is moist
 and the temperature  tolerably  and uniformly
 high, we have a climate which  is commonly
 called relaxing.  Supposing,  now,  the tem-
 perature  is  high and the air excessively dry,
 vve  have a  kind of climate of which  Nice
 affords a good example.  It is customary to 
7^              CLOTHING

call such climates exciting.  Taking  now the
element wind into consideration, we  find cer-
tain climates  characterized by stillness  of
atmosphere and tolerable dryness, without this
being excessive.  Finally, we have climates.
tolerably common in this country, where they
are ordinarily associated with sea air.  These
are  characterized  by  a  temperate  atmos-
phere, neither  too  hot nor too cold,  fresh I
breezes, and the absence of all oppressiveness
or humidity.   Mountain air, too,  belongs to j
this class, which  is  denominated  bracing. \
Bracing climates  are, perhaps,  more used by I
tired people than  by invalids.  At the present
day, when competition is so keen and work is
so continuous, it  has  come to  be recognized
by  many that the only conditions on which
the pace of the world can  be  kept  up is by
taking a  long annual  holiday.  Such men,
wearied out by their exertions, seek a climate
instinctively which  would be  unsuitaole for
an  invalid.   As  to the others, it is  hardly
possible  to lay down rules, for this is daily
becoming more apparent, that the selection
of a climate in a given case is, to say the very
least of it. quite as important as the selection
of a medicinal remedy, and a physician should
always be consulted 'in regard to  it.  The
kind of climate best adapted for  an invalid
having been settled on, it is desirable that he
should undertake his journey with due care and
attention. The grand rule is to avoid fatigue
as far as  possible.   It is of  much less  impor-
tance to arrive at the destination rapidly than
to arrive at it in a condition to be benefited by
the change.  Short journeys and  long rests
should be the rule ; but the application of the
rule must, it is plain, be regulated  by circum-
stances   and  the  condition of the  patient.
Flannels next the skin should always be worn
on  such  journeys, and  frequently also after
the destination has been  reached.   A  small
medicine chest is often found very useful, ex-
cept the  patient be going to regular invalid
resorts where the English pharmacy is always
obtainable.  The maladies  most likely to be
improved by change of climate are  diseases
of the lungs or chronic bronchitis, consump-
tion, inflammation of the air-tubes and larynx,
asthma, neuralgia, gout and rheumatism, de-
rangements of the functions of the womb, and
certain  diseases  of  the  kidneys.  Delicate
strumous children are often very greatly bene-
fited by  change of air,  especially to the sea-
side,  if an appropriate place  can be  found. !
Above all. change  is beneficial in convales- J
cence from acute disease.   For this purpose j
no special climate need  be chosen—change is j
the great thing, and so it is when intended to i
prevent serious illness, especially of a mental j
kind.  (See Health Resorts.)             j
  CLOTHING  is, perhaps,   too  much  a |
matter of fashion to be touched on with great I
advantage in  a work like this.   Nevertheless, |
certain sound rules may be laid down.  In
               CLUB-FOOT

civilized  lands  certain materials and shapes
are supposed to be incumbent on every one,
whereas abroad every one endeavors to suit
his dress to the climate.   The great thing is
to avoid extremes of heat and cold, and if we
are unable to change  our clothes to suit  the
altered conditions, we must endeavor to wear
such as will suit either emergency.  There is
only one thing  which will  enable everybody
to do  this, and that is  flannel.  It by no
means follows that the flannel need be thick,
it may be  as thin as possible,  yet  from its
power as a non-conductor of heat it will enable
any one to step from a strongly heated room
into the cold air with impunity.   In winter it
is desirable that we should not wear the same
clothing  in-doors as we do out, hence  the
general use of great coats.   One of the most
important  articles  of clothing for health's
sake  is shoes.   It  is of the  utmost impor-
tance, especially to delicate  people, to keep
the feet dry.  For this purpose  nothing is so
serviceable as  India-rubber  goloshes.   In-
deed, that material is now being used for sim-
ilar purposes in a variety of ways.  The end
is the same in all to keep  the body dry.   If
it cannot be kept dry the great rule is, change
as speedily as  possible ; but when men  in
full health have for a long time been exposed
to the elements,  they may do much as they
please.
   CLOVE-HITCH is  a knot in use among
surgeons for the purpose of reducing disloca-
tions ; on account of the very firm hold it has
upon the limb to which it is applied.  It may
be made either with a cord  or a jack-towel.
It is made thus :  a good-sized loop is  taken,
held by both hands, that portion  held in the
right hand is then twisted under that held in
the left, again looped and twisted upon itself,
and the resulting loop placed upon the former
one ; the limb  is then  placed in the double
loop thus formed, and the two ends drawn up.
The knot thus  formed cannot slip.
   CLOVES are the unexpanded flower-buds
of a tree growing in the  East  Indian Islands.
They yield an  oil, generally when we sec it,
brown, but at first  much lighter in  color.
This has the hot burning taste of the cloves,
which, indeed, chiefly owe  their properties
to it.   Their virtues are described as stimu-
lant,  aromatic, and  carminative ;  they  arc
useful for relieving flatulence  and the disten-
sion it causes.  The oil is sometimes given to
prevent  purgatives  griping,  but most   fre-
quently is used to  allay the  pain of hollow
teeth.  A drop  poured on a bit of cotton wool
is introduced into the orifice to alleviate the
pain.
   CLUB-FOOT, or  talipes,  signifies a  de-
formity of the feet,  caused by the contraction
of the muscles or tendons of the leg ; mostly
congenital.   The different  forms  are:  I.
Talipes equinus,  that is, when  the  heel is
raised and the individual walks on the ball of 
CLYSTER
COD-LIVER  OIL          73
    the  foot.  2.  T. varus, when  the  patient i
    walks on the outer edge of the foot.  3. T. I
    valgus, when the inner edge is trodden on ; j
    and 4, T. calcaneus, when  the  patient walks I
    on the heel.  The treatment of these cases j
    requires surgical and mechanical interference,
    such as the cutting of the tendons which in-
    terfere with the proper  direction of  the foot,
    and the application of suitable apparatus.
       CLYSTER.   (See Enema.)
       COCCULUS  INDICUS is the fruit or
    berry of a climbing shrub growing in  India ;
    and the East Indian Islands.   It contains an j
    active principle called Picrotoxine.   In medi- j
    cine cocculus berries are only used reduced to j
    a powder, and made into an ointment for the j
    destruction of vermin on the heads of children j
    or the coats of  domestic  animals ; and for
    this but rarely.  Nevertheless large quantities j
    are  imported, and are  used  by brewers to j
    adulterate beer,  thereby adding to its intoxi- |
    eating qualities.
       COCHINEAL  can hardly be said to be a j
    medicine.  It is, however, used to color cer- j
    tain tinctures.  It is the product of  a certain I
    insect found on the cactus growing in Mexico. !
    Carmine is prepared cochineal.
       COCOA  is prepared from the seeds of a ]
    plant  known to  botanists  as  the Theobroma \
     Cacao, and  is a native of South  America, j
    The seeds, several of which are produced in a j
    long pod,  are roasted  before being  used, j
    When thus  prepared they are called cocoa
    nibs,  and are sometimes  boiled, and  made I
    into  a decoction in this  form.  More fre- j
    quently, however, the  seeds are crushed and j
    made  into apaste, and sold as " cocoa paste."
    When flavoring  matters, such as vanilla, are |
    added, the preparation is called " chocolate." i
    Cocoa and chocolate are the same substance, I
    but  the  latter is flavored.  Sugar is  some- 1
    times added to cocoa, and always to chocolate J
    when  sold in the  form of a  sweetmeat, of !
    which there are great varieties.  While cocoa j
    differs greatly from tea  and coffee in its com- J
    position, it  nevertheless resembles  them in j
»    possessing  an  alkaloid  called theobromine, j
    which acts in the same manner on the system
    as theine (tea).   In addition to this substance 1
    cocoa  contains a half part by weight of a  fixed j
    oil or butter, which gives a very decided char- ]
    acter to its action on the system. Cocoa also J
    contains in every pound three ounces of flesh- j
    forming matter, so that it constitutes a food j
    at once  heat-giving and flesh-forming, and
    admirably adapted to  all  the wants of the
    system.  Cocoa as an article of diet, is to be
    recommended in all cases whdre a nourishing
    and  heat-giving  diet is  required, and  with
    milk and sugar forms a very healthful  food
    for breakfast or  supper.   The  fat does not
    agree with some persons, and  it is  in  these
    cases that an infusion or decoction of the
    "cocoa nibs" is recommended.  The  pre-
    pared cocoas which are  advertised, generally
contain an addition of starch in the form of
arrow-root,  sago, or  tapioca, and are to be
recommended no farther than as they dimin-
ish the original quantity of fat in the cocoa.
  COCOA  NUTS  are  the produce  of  a
species of palm which  grows  in  the East
Indies and Ceylon.   The seed is large with
a thin shell.  The  shell is  lined  with a white
flesh, and the interior contains  a fluid which
is called the milk of  cocoa nut.  The flesh
contains oil and albumen, and is used  exten
sively  as an  article  of diet in  the countries
where it  grows.  It is eaten in this country to
a limited extent, and made  into puddings,
cakes, etc.  Like the kernel of all nuts, it  is
not very digestible, but is not injurious.
  CODEIA  is one of the alkaloids contained
in opium (see Opium).  It has recently been
recommended in diabetes.
  COD-LIVER  OIL  is  one  of  the most
valuable  remedies  we possess, and   yet it
should be looked upon rather as a  food than
as a medicine.   It is prepared from the liver
of the cod-fish, which at  certain seasons of
the year  is richer in oil than at others.   Other
kinds of livers are employed, but those of the
cod yields oil most abundantly.   It is  essen-
tial  to understand that about  cod-liver oil
properly prepared there is nothing disagree-
able either to the smell  or the taste.  The
great virtue of cod-liver oil probably  lies in
its easy digestibility.   It  has been  supposed
to derive its useful character from  the small
quantity of  iodine and bromine it contains,
but this is out of the question.   Probably  in
those cases where it does so much good, it re-
establishes the balance of nutrition, enabling
other substances to  be made use  of  in the
animal economy which were before rejected.
Under its use patients  sometimes marvel-
lously increase in weight and improve in. gen-
eral  appearance, their blood becoming richer,
and  their complexions ruddier, even though
they are taking no iron.   Its use is  thus indi-
cated in a great variety of exhausting diseases,
especially those where there is chronic wast-
ing,  with gradual  emaciation.  Individuals,
too,  with swollen glands, which themselves
interfere with nutrition, are almost invariably
benefited by its administration, and  one of
the  most obstinate  complaints  known—
chronic  rheumatism  and  rheumatic   gout—
frequently yield to its influence.  Where there
is scrofula, and a tendency to  phthisis, cod-
liver oil is invaluable ; it has, indeed, enabled
us to  combat  these diseases with  no slight
hope of success.   Even  in advanced pulmo-
nary consumption, its  effects are wonderful.
Nor  is it of less value in treating the diseases
of bones and joints occurring  in scrofulous
persons.  In the wasting diseases of child-
hood,  there  is  no remedy to  be  compared
with cod-liver  oil.   In rickets  and  chronic
hydrocephalus,  i.e.,  water in the  head, its
effects are very marked,  but perhaps even 
74
COFFEE
COLD
 more so in the disease known as tabes mes- j
 enterica,  where nutrition is impaired by dis- j
 ease of the lymphatic glands in the abdomen.
 It is a common assertion on the part of  pa- j
 tients, that they cannot take the oil because it
 makes them sick.   The first thing to be done
 under such  circumstances  is to secure  the
 purest  and  most palatable  oil possible ; it
 should  be perfectly clear, and  have not the
 slightest trace of rancidity about it. Good oil
 has a slight fishy smell and  a  slightly fishy
 taste, that is all.   Next, it should be given in
 small doses ; let the patient begin with a tea-
 spoonful, or even less, a few drops, if neces-
 sary, only begin without making him sick.
 It may be given in anything the patient fan-
 cies, water, milk, orange wine, curacoa, etc.,
 and it is best given within half an hour after
 a meal ; some  like  it best immediately after.
 Even this may upset the stomach, and then
 it must be tried the last thing at night, after
 the patient has lain down in bed.  The patient
 once accustomed to it, the dose must be grad-
 ually and carefully  increased, taking care not
 to overload the stomach, until he can take a
 tablespoonful or more three or four times a
 day.  When everything fails, it is to be rub-
 bed into  the stomach  and bowels with  the
 hand or a warm flannel.  This plan  is espe-
 cially adapted for children.  Supposing, how-
 ever, that cod-liver oil cannot be borne, and
 that the smell produced by its inunction is too
 objectionable, what is to be done ?  Then two
.other oils may  be tried, viz.,  almond  oil and
 the best salad oil ;  in no case should second-
 rate materials  be tried.   Or  again, that old- i
 fashioned remedy, rum-and-milk, maybe rec-
 ommended.  Either so  or  in a more aristo- j
 cratic mixture of champagne and cream.
  COFFEE is the name given to the seeds
 of a plant known  to botanists as the Caffea
 Arabica,  and  belonging to  the order  Cin-
 chonacece.  The seeds  are  contained  in a
 berry, which when  ripe  is of  a red color.
 Each berry contains two seeds, which is cov-
 ered over with  a tough membrane called the
 " parchment."  The seeds vary in size, and
 the best are pbtained from Yemen, which yield
 the  best  Mocha coffee.  They are  brought
 into this country in their green state, and sub-
 jected to a process of roasting. They are then
 ground and boiled, and made into the decoc-
 tion which we call coffee.  The coffee beans
 or  seeds contain an active  principle, called
 caffeine, which is identical with theine which
 is contained in tea.   This  substance  acts
 powerfully on the nervous system, and is un-
 doubtedly the  agent which makes coffee an
 acceptable article of diet.  During the roast-
 ing of the coffee bean, the constituents of the
 seed are converted  into certain empyreumatic
 oils, one of which, called caffeic acid, gives a
 peculiar odor to the roasted seeds. These oils
 are  stimulant,  and give the  flavor to coffee.
 The action of coffee is sedative and stimulant,
and when taken with milk and sugar it is one
of the most popular and beneficial of  bever-
ages.   In cases of narcotic poisoning, after
the stomach has been emptied of the  poison
by emetics or the stomach pump, the admin-
istration of strong  coffee without milk or
sugar is an excellent remedy.  Coffee is often
adulterated  with chicory.  There  is no ob-
jection  to chicory on the score of  its action
on the system.  It,  however,  contains  no
caffeine, and only diminishes the taste of the
caffeic acid of the coffee.  Some persons pre-
fer to add a little chicory to their coffee, and
there  is no objection to  the practice, but they
had better be bought separate.
  COLCHICUM, as employed in  medicine,
is  either the bulbous  underground portion
(more correctly termed  a corm) or  the seeds
of the meadow  saffron.   From the  corm are
prepared an extract and a wine of colchicum,
and from the seed a tincture.  Whatever prep-
aration is  used, 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 purging.   The  specific
action of colchicum is, however, on the pain
of the gouty paroxysm,  which it relieves in a
marvellous  manner.  Nor is the  mode in
which this is brought about at all well known,
for small doses will have  this effect, even
without any purging, which is ordinarily ben-
eficial to the disease.  Its use is nevertheless
followed by some prostration, and a tendency
tofaintness, which is far from agreeable, even
though the pain has gone.  It is sometimes
used in acute rheumatism, but does not pro-
duce the same  wonderful effects as in gout,
what  good it does being probably due to its
reducing action on the heart.   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 and more violently after being choked
off with colchicum, than had it been allowed
to exhaust itself, or other remedies, as alka-
lies and alkaline purgatives,  employed.   Of
the ordinary extract, about a grain  should be
given for a dose, of the wine and tincture 10
or 15 drops every  four hours.
  COLD, of which catarrh is the most prom-
inent symptom, is perhaps the most frequent
malady in this country.   Its causes are man-
ifold, and the consequences of catching cold
are infinitely various, from merely a slight
temporary inconvenience  to speedy  death.
A fatal result is not, however,  likely to hap-
pen except damaged organs be attacked, but
then a very slight cause may suffice to bring
about fatal results.   Colds are frequently felt
to date from some particular period, but fre-
quently their onset is  not appreciated for a
time.  Very likely there is some shivering and
sneezing, with  lassitude,  pains  in  the back. 
COLIC
COLOCYNTH
75
 loins, and limbs, with tightness  of the fore- I
 head, and an unnaturally dry state of the lips j
 and  nostrils.  These speedily give  way  to j
 excessive  discharge from the nostrils,  first
 watery and acrid, later mucus or mucous and
 purulent matter.   There is  hoarseness and j
 slight sore throat,the eyes water,feverishness, j
 loss  of  appetite,  thirst, and  quick pulse.
 Sometimes small vesicles, called herpes, ap-
 pear on the lips or aboutthe nose.  These symp-
 toms do not last long ; they either pass away,
 or become aggravated if the  inflammation
 passes onward into the interior of the lung. If
 the latter, there  will probably be some diffi-
 culty in swallowing from the pain of the in-
 flamed parts, and there may be  loss  of voice
 —temporary  merely—and some difficulty in
 breathing.  Not much treatment is required
 for such cases, though most people do some-
 thing for them ;  as  already pointed  out, in a
 great majority of cases they pass away in due
 course, though they may recur again, and if
 the individual is subject to them, not only
 must greater care be taken to escape catching
 cold, but every endeavor must be used to get j
 rid of them  speedily,  lest they affect  the !
 lungs.   Various  plans are used  with various J
 success ; perhaps the best is  for the patient to j
 put his feet in hot  water, take ten grains of j
 Dover's powder,  with a good glass of  " some- I
 thing hot,"  and get  straight into bed.   If
 the throat is bad, a water compress had better
 be used.   Most likely the patient feels better
 in  the morning, whether from the attack pass-
 ing away,  or  the result of the remedies.   A
 seidlitz powder,  or some such slight  laxative i
 had better be taken,  and the patient may I
 return to his usual routine. (See  Influenza.)
   COLIC is a form of disease characterized j
 by a severe twisting pain in the bowels, espe- j
 cially in the region of the navel, and occur- j
 ring in paroxysms. This pain,  though severe j
 for the time being, and alarming, is not really j
 of  a  dangerous  character.   It  indicates no j
 inflammatory mischief, and whereas the pain
 of colic is relieved by firm pressure, that from
 inflammation  in  the same region is greatly i
 aggravated thereby.  The complaint is ac-
 companied by constipation, and frequently
 by vomiting, but there is  no fever,  and  no
 quick  pulse as in  inflammation.  Such  at-
 tacks commonly arise from some indigestible
 article of food, or  some portion of  the food
 has decayed in the  bowel, and  given rise to
 foul gases, which distend  the bowel and give
 rise to pain.   As a rule  such painful condi-
 tions are signs of intestinal disturbance which
 necessitate some  opening medicine, of which
 for this purpose castor oil is best.  An ounce
 may be given  with a few drops of laudanum,
 not more than ten—or a little spirit of chloro-
form—or yet  again  it may be  followed by a
glass of hot spirit and water.  Such means
speedily give  relief.   (See  Flatulence.)
 Besides this simple  form of colic, there are
  others  associated with  the  introduction  of
  mineral poisons into the body.   Chief among
  these is lead colic or painter's colic, to which
  also other names have been given.  Among
  painters, especially those engaged in working
  white or red lead, and who are not  exceed-
  ingly cleanly in their habits, the  disease is
  of frequent occurrence.  (See Lead-Poison-
  ing.)
    COLLAPSE.  (See Shock.)
    COLLAR-BONE  is the bone which on
  either side  is situated between  the sternum
  and the shoulder-joint.  (See Fracture.)
    COLLODION is the product of gun cot-
  ton dissolved in  ether and spirit.  When ex-
  posed  to the air, the  ether  speedily evapor-
  ates, and leaves the dissolved gun cotton in
  a thin film on the surface to which it had been
  applied. This film is air-tight, and has a con-
  siderable contractile power, hence it is useful
  for cuts or  other trifling  injuries about  the
  face, and,  indeed, may be applied to any sur-
  face from  which it is  desired to exclude the
  atmospheric air.   Thus herpes,  erysipelas,
  burns,  sore nipples, chapped hands, bleeding
  from leech-bites,  etc., may be  successfully
  treated. A  preparation called   flexible col-
  lodion,  made by adding Canada 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.
   COLLYRIUM is   a  Greek  word, signi-
  fying anything that will stop a running or
  disease  of  the eyes.  Collyriums are of two
  kinds ;  one  to  subdue  inflammation in  the
  ball or coats of the eye, and the other of a
  stimulating nature, such as is used in chronic
  affections of the organ, to excite the vessels
  to a healthier action.   A very usful eye-water
  for inflamed eyes is  made of  rose-water,
  sulphate of  zinc, and  sugar  of lead ; shculd
  it cause pain, it is too strong,  and may be
  reduced by  the addition of  water.  Lotions
  for weak eyes that require  stimulating are
  made by mixing about  6 grains of sulphate
  of copper with  6 ounces of  water or elder-
  flower water.  Nitrate of silver  in solution,
  very weak, is also a valuable application, but
  must be carefully used.
   COLOCYNTH is  the pulp of a  kind of
  gourd growing  along the southern and  east-
  ern shores  of the Mediterranean.  The fruit
  itself is  shaped something like an orange, and
|  the pulp is  exceedingly tough and felt-like.
|  It is only used in the form of pill, but there
I  is an extract for combining with other similar
i  substances,  and a pill containing hyoscy-
|  amus as well as colocynth.   Colocynth itself
j  is a powerful purgative, giving rise to much
  griping  and plentiful watery evacuations, but
I  it is seldom if ever given alone, being  ordi-
  narily combined  with  other  purgatives and
 some carminative.  It  is mostly  used when a
 speedy  and effectual opening of the bowels is 
7G
COLOGNE
COLUMBA
desirable.  It is too  irritating to be used as
an habitual purgative, but on occasions there
are few  more effectual  than three or four
grains of compound extract of colocynth,
with one or two grains of calomel, or, better
still, two pills may be made, each containing
four grains of the pill of colocynth and hyos-
cyamus, with  one  grain of calomel.   This is
a very desirable compound when the liver is
deranged from overloading of its portal ves-
sels, or when the bowels have been long con-
fined and iheir action is irregular and torpid.
  C0L03-NE. (See Eau de Cologne.)
  COLON.  (See Abdomen )
  COLOR -  BLINDNESS  is  a   subject
which, but recently well understood, promises
to become  one of  the most  important in the
science of optics.  The structure and mode
of action of  the  eye are explained in the
article on Vision  (which see).  People  are
color-blind when their retina will not perceive
some of the rays of light.  Light is made up
of three primary colors, which when overlap-
ping in the  spectrum are known as the  col-
ors of  the rainbow.  Each color is produced
by the different velocity with which  the un-
dulations of the imponderable  particles  that
fill  ali space  beat upon  the eyeball.  The
eye can only  see those colors which represent
a certain velocity of  the  undulations, and in
ordinary vision these colors are  red, blue,
and  violet,  with  their  compounds,  green
(blue and yellow), orange (red and  yellow),
and purple or violet (red and blue).   Accord-
ing to what  is known as the Young-Helm-
holtz  theory  of vision, there are  in  the eye
" three kinds of nerve-fibres : stimulation of
the first  produces the sensation of red ; of
the second, that of green ; of the  third,  that
of violet."   All three kinds  of  fibres  are ex-
cited,  however, by each  color  of the spec-
trum,  as  there is no spectral color "  into
which  but  one primitive color enters exclu-
sively."  The most frequent forms of color-
blindness are those of insensibility to red or
green—violet-blindness being extremely rare.
The insensibility is due to the absence of the
nerve-fibres requisite to the  perception of the
given fundamental color  ; and  it is  a struc-
tural  defect  which   when  congenital,   no
amount of training  or  practice  can cure,
though there are means of alleviating the re-
sulting inconveniences.  The effect of  red-
blindness (also called Daltonism) is that green
and red do not appear to be different colors,
but simply different shades of the same color.
Not only so,  but " the whole chromatic  sys-
tem will be upset," though of many colors, as
of yellow and of violet, the perception of  the
color-blind will not greatly differ from that of
the normal vision.  " All  colors containing
their  defective one will  be  grayish, and this
in proportion  to their individual amount of
defect. The red-blind, for  instance,  will see
only such colors as can be  produced by  the
combination  of  green and  violet.   Spectral
red,  which  feebly  excites  the   perceptive
organs of green and scarcely at  all those of
violet, must consequently appear to the red-
blind a ' saturated ' green of a feeble inten-
sity.  Feebly  luminous red does  not excite
the perceptive organs of green, and  it there-
lore  seems to them black."
  Color-blindness  is of much more  frequent
occurrence than could have been  supposed
until adequate tests for it were devised.  As
the result of over ten thousand testings among
New England teachers and scholars, Dr. B.
Joy  Jeffries estimates  that   in  the United
States  from three to four in every hundred
males  are color-blind ; and this agrees with
Professor   Holmgren's  investigations   in
France and  elsewhere.  Among  females the
percentage is very much smaller.
  Tests for Color-Blindness.—The simplest
and  most  effective test is  that devised by
Professor  Holmgren, of  Upsala,  Sweden.
It consists in requiring the person examined
to match a sample color with shades from a
large number  of differently colored worsteds
placed before him together.   All  mention of
the names of colors should  be avoided ;  for
the nomenclature is so imperfect  and so  im-
perfectly or differently understood  by most
people that it is a sure source of confusion
and  mistakes.   It should  never be forgotten
that a person may be perfectly able to recog-
nize colors and shades of colors,  and yet  not
be able to name them when shown him.   To
match a piece of red or green worsted placed
in his hand, without naming its color, is  the
sure test ; and  it cannot be  evaded by any
device to which a color-blind person will be
apt to resort in order to conceal his defect.
  It will be seen, of course, that  color-blind-
ness  is of  practical importance  as well as
physiological interest.  No color-blind person
should be employed in railway or marine ser-
vices where the  safety of hundreds  may  de-
pend upon  the correct interpretation of a
signal which he is utterly unable to  distin-
guish.
  COLOSTUM.   (See Milk.)
  COLOTOMY,  an operation  devised  for
opening the bowel  in the left loin, in cases
where there is an obstruction in  the  lower
part of the intestines.  (See Obstructions.)
  COLUMBA  is the  product  of a  plant
growing in Zanzibar and  Eastern  Africa.
The part used in medicine is  the root, which
is shaped  not unlike a carrot.  This is  sliced
and  dried and is imported.  It contains a large
quantity of starch,  and hence certain of  its
preparations are apt to spoil.  In itself  it is
an excellent tonic, very mild and unirritating
to the stomach, and as it does not  blacken
with iron constitutes  a  remarkably  good
vehicle for that remedy.   When the stomach
persistently rejects other and more  powerful
tonics this will often be retained, and the best 
COMA
COMPOSITION HUMAN BODY   77
 mode of  taking it is  in  an  effervescing
 draught, a  teaspoonful of the tincture for a
 dose.  The  infusion is also much used—it
 should be  freshly prepared.  The  powder,
 combined  with carbonate of soda and rhu-
 barb,  is an excellent  domestic remedy for
 irritative  dyspepsia—15 or  20  grains  might
 thus be given.
   COMA is a  state  of deep  sleep or insensi-
 bility in which the patient lies  perfectly un-
 conscious of what is going on around.   It is
 caused by a great many conditions, and these
 will here be shortly enumerated ; it is  not a
 disease, but a symptom of disease, and there-
 fore  the  reader must  refer to  the  diseases
 mentioned if he wish to have a more detailed
 account.  1. Coma may proceed from drunk-
 enness, because  the blood is for a time poi-
 soned, by the amount of alcohol  taken, and
 the brain suffers in  consequence ; this  state
 usually passes  off in  a few hours ; there is a
 history of the patient having taken too much ;
 the breath will  smell of spirit or beer, the face
 is flushed,  the breathing is noisy,  accom-
 panied with puffing of the cheeks, and the man
 will be im a helpless stupid state.  It is often
 difficult to distinguish this state from apoplexy
 or from fracture of the skull, but in the  latter
 case there will  be a history  of a fall, and in
 both it will be  very difficult  to rouse the pa-
 tient, while a drunken man can be roused if he
 be galvanized,  or put under  a stream of cold
 water, or made to vomit.   Yet in all cases of
 doubt, the patient should be placed quietly
 on a bed or mattress,  and  not taken about
 from  a hospital to a police cell, or.from one
 place  to  another ; a  few hours  will  soon
 suffice to make sure of the nature of the com-
 plaint, as by that time the drunkard will have
 recovered.  2.  Coma may result  from  apo-
 plexy, or in other words from a clot of blood
 in the brain, or white softening of that organ,
 or from a plug in the  vessels supplying it.
 The patient will then fall down insensible and
 there will be paralysis of the  arm and leg of
 one side (Hemiplegia), or the mischief may
 be so great that he lies in a passive state, and
 all the limbs are paralyzed and drop by their
 own weight when they are raised.  (See  Apo-
 plexy and  Hemiplegia.)   3. Coma comes
 on in  cases of poisoning by opium or car-
 bonic acid ;  the one may be induced  by tak-
 ing morphia or laudanum, the other by ex-
 posure to the gas, as  when persons have been
 suffocated by burning charcoal in a non-ven-
 tilated room.  In cases of opium poisoning
 every means should be used to rouse the pa-
 tient by walking him about, slapping him with
 towels, giving hot and strong coffee, ana ap-
 plying mustard  poultices to the calves or hot
bottles to  the feet ;  where carbonic acid is
 the poisonous  agent, the   person affected
should at once be taken  into the open air, the
mouth opened,  and  the  tongue drawn  for-
ward, and  artificial respiration must  be re-
 sorted to.  (See Drowning.)  4. Coma  is
 often met with in the last stage of kidney dis-
 ease ;  the urine is diminished in quantity and
 perhaps  hardly any  is passed ;  the patient
 complains of headache, sickness, convulsions,
 and in three  or four  days  he  may pass
 through  a  state of  stupor into  coma and
 death.  Purgatives, cupping over the loins,
 and diaphoretics may be used, but not with
 much  hope to  the patient.  5. Coma ensues
 from  a blow on the head with or without a
 fracture of the skull ; in such  cases  blood  is
 generally poured out  between  the dura mater
 and the skull, and this, pressing on the brain,
 will cause  the  insensibility.  Little can  be
 done   beside  keeping the person  perfectly
 quiet  in bed, and applying ice to the head.
 (See Fractures.)   6. All the forms of Men-
 ingitis  are accompanied  by  coma before
 death, and this condition is  also met with in
| many cases of fever, as typhus, typhoid, and
 scarlet  fevers, pyaamia, etc.   (See  Menin-
 gitis, etc.)  7,  After an epileptic fit the indi-
 vidual is insensible and in a comatose state
 for a short time varying from a minute or
 two to twenty minutes or half an  hour ; but
 the coma soon passes off, and no special treat-
 ment  need be  adopted for that  symptom.
■(See Epilepsy.)  During an hysterical  attack
| the patient may go  off into an  insensible
I state,  but the timely  administration of cold
| water, or  a galvanic  current will usually
 have a most beneficial effect.  Finally, some
I persons may feign this condition  for a short
 time from  a morbid desire to create sym-
 pathy ; any of the usual methods of causing
 pain will expose the  imposture, and prevent
 perhaps the recurrence of the maladv.
   COMBUSTION, SPONTANEOUS, rests
 upon   somewhat  doubtful   authority.  At
 various times it has been reported that indi-
 viduals have taken fire and been consumed
 to ashes.  Such a fate is described  in one  of
 a popular novelist's works, but if ever such a
 case did occur no one certainly has heard of
 one recently.   The fact, however, that the
 bodies of living persons, may, under excep-
 tional circumstances, attain to an  extraordi-
 nary combustibility, rests on somewhat better
 authority. Such a condition, however, though
 often  confounded  with the former, implies
 something  totally different.  The individuals
 who have been supposed to  attain to this
 superior combustibility have ordinarily  been
 inordinate spirit drinkers.  Cases have  been
 recorded where such  individuals were par-
 tially   consumed—the burning commencing
 from comparatively  slight causes.
   COMPOSITION  OF  THE  HUMAN
 BODY.—The human body is composed of the
 same elements as are found entering into the
 composition of  the mineral substances  found
 on  the earth's  surface.  The  following is a
 list of the  quantities of the various elements
 found in a human body weighing 154 pounds : 
78   COMPOSITION HUMAN BODY
COMPOSITION  HUMAN  BODY
                        lbs.    ozs.  grs.
   Oxygen................   m     o     o
   Hydrogen..............   15     o     o
   Carbon................   21     o     o
   Nitrogen...............    3     9°
   Phosphorus...........    1    12   190
   Sulphur...............    o     2   217
   Calcium................    2     00
   Fluorine................    020
   Chlorine..............    o     2   382
   Sodium................    o     2   116
   Iron....................    o     o   100
   Potassium..............    o     o   290
   Magnesium............    o     o    12
   Silicon................    002

     Total...............   154     o     o

It will be seen that the four first elements are
oxygen,  carbon,  hydrogen,  and  nitrogen.
These are  non-metallic  elements, and enter
largely  into the  composition of  all organic
beings.   It is by the presence and abundance
of these elements that plants and animals are
distinguished from  minerals.   No organic
being can be  developed without  these  four
elements, hence they have been called organic
elements.  The next elements of importance
are undoubtedly phosphorus and  sulphur.
They are both found associated with the four
organic elements in such compounds as case-
ine, fibrine, and albumen,  hence they may be
very properly called pseudo-organic elements.
Chlorine, fluorine, and silicon are non-metallic
elements.  The  rest are  metals.  Of these
sodium is most abundant, and iron  and  sili-
con  are  least;  so.  Nevertheless,  they  are
necessary.  Thus  iron,  although  in  small
quantity, produces disease when  it is absent,
and there is no set of diseases more easily
detected and none so easily remedied as those
dependent  on the  absence of  iron  in  the
body. Even the absence of the small quantity
of silicon is accompanied by diseased  condi-
tions. Thus the enamel of the teeth in a heal-
thy condition contains silicon,  but if this is ab-
sent the enamel  is not properly formed,  and
the  teeth quickly wear   away and become
comparatively useless.   The elements, how-
ever, are not found in the body in their pure
state, but are  mixed together, forming  the
following compounds :

                        lbs.   ozs.   grs.
   Water..................  ui     o     o
   Gelatine................   15     o     o
   Fat.....................   12     o     o
   Albumen...............    430
   Fibrin  .................    4     4      0
   Phosphate of Lime.....    5    ij      0
   Carbonate of Lime.,....    100
   Fluoride of Calcium___    030
   Chloride of Sodium ...    o    3    376
   Chloride of Potassium..    o    o      10
   Sulphate of Soda.......   o    1    170
   Carbonate of Soda......    01-2
   Phosphate of Soda......    o    o    400
   Sulphate of Potash.....    o    o    400
   Peroxide of Iron........    o    o    153
   Phosphate of Potash___    o    o    100
   Phosphateof Magnesia.    o    o     75
   Silica..................    o    o      3

    Total................  154    o      o
There are many other substances  belonging
to both  the  organic and inorganic series of
compounds  which  have been described by
chemists, but the above are  the principal per-
manent compounds  found in a human  body.
Water is composed of oxygen and hydrogen
gases, and constitutes four parts of the bulk,
and  sometimes  even more, of  the  whole
organic kingdoms.   Water is the great agent
by which the food is  dissolved and taken up
and  discharged from the body.   Gelatin  is
composed of the four inorganic elements, and
is found in the  cell-walls of the animal tissues.
It is  especially abundant  in the  bone-cells
and the skin.   It is soluble in hot water and
is identical in  composition in  the  human
body and that of the lower animals.   Fat is
a compound of carbon, hydrogen, and oxygen.
It is distributed over the body in the adipose
tissue, and its increase is the principal  cause
of obesity.   It is also found in the marrow of
the bones, in  the joints,  and  other  parts.
Albumen contains the four organic elements.
It is  found in  the  blood, and  the principal
substance entering  into the composition of
the nerves.  Fibrin  differs but very slightly
from albumen.  It is not found  dissolved in
the blood like that substance, but is suspended
in it and coagulates when blood is allowed to
stand.  It enters into the composition of the
muscular tissue.  Phosphate of lime is found
in the bones.   A half part,  by weight, of the
human skeleton is composed of phosphate of
lime.  Carbonate of lime  is  found also in
bones,  in the proportion  of about ten per
cent.   It constitutes almost wholly the skele-
ton of corals and shell-fishes, where but little
phosphate is found.  Fluoride of calcium  is
also found in the bones of human beings.  It
is often found  in large quantities in  fossil
bones, and the quantity of  fluoride is said to
be a guide to the age of  the bones in  which
it is found.   Chloride of sodium is found in
the blood.  It  is necessary to  the life of
human  beings as  well  as all other animals.
This salt, which is found in  sea-water, deter-
mines the existence  of those forms of  plants
and animals which live in the sea.  Its use is
universal among mankind, and they suffer
from disease when deprived of \t.-  Carbonate,
sulphate, and phosphate of soda, are other forms
of sodium which are  found  in the  blood and
tissues of the human body.  Chloride of potas-
sium, and the same salts, as of  sodium, are
also  found in the body, but are not so abun-
dant as  the latter.   Nevertheless,  the  small
quantity of potassium is  necessary to the
proper nutrition of the capillaries and vessels
of the body. When persons are kept long on
salt meat it is well known that they get scurvy,
and this seems to arise from  the absence of
potass salts  in the  food.   A still smaller
quantity of  magnesia than of  the alkaline
metals is constantly found as a constituent of
the human body.  (See Food.) 
COMPRESSION
CONCUSSION           79
  COMPRESSION  is a term used by sur-
geons  to imply  pressure  upon the  brain
caused through severe injury. The symptoms
indicating this condition are :  total insensi-
bility and loss of motion,  slow, noisy, and
deep respiration, a slow and laboring pulse,
partial or general palsy, one side of the body
being usually  paralyzed,  involuntary  dis-
charge of the contents  of the bowels and re-
tention  of urine, dilatation of the pupils, and
closing of the eyelids.  These symptoms are
sometimes associated  with  delirium, restless-
ness, convulsions and vomiting.  The causes
of this state  are  various :  it may be due to
fractured skull and depression of bone upon
the surface of the brain, to effusions of blood
within the skull, to internal suppuration  or
to the presence of some foreign body,  as  a
bullet or piece of exploded  gun barrel.  The
condition is a very serious  one, and in most
instances terminates in death.
  CONCRETIONS  may  occur in  many in-
ternal organs,  but the  most  important  are
those which occur in the intestine,  gall-blad-
der, and kidney  and urinary  bladder.   In-
testinal  concretions,  or calculi, are of rare
occurrence in the human being, but  in rumi-
nant  animals they are  not uncommon.   In
man they occur  in the great  gut  most fre-
quently.  They consist  for the  most part  of
imperfectly  crystallized salts and indigestible
fibrous  or  other  matters arranged  round  a
nucleus which may be a gall-stone, the  stone
of a fruit, or  any such foreign  body.  Some
concretions consist entirely of hardened faecal
matter, or if  chalk and  magnesia have been
largely swallowed they  may form something
of the kind.   Hair,  cotton, and paper may
be  found in  mass, having been swallowed
owing to a depraved appetite.  In animals
balls composed of hair which has  been re-
moved by licking, are perhaps the most com-
mon form of concretion.   These may  occur
either in the stomach  or  in the intestines.
Most frequently  these masses  are  only dis-
covered after death, but it is  quite possible
that they may gradually increase to such a
size as to obstruct the tube and so give rise
to signs of intestinal obstruction  which may
prove fatal.   Occasionally  these concretions
are passed by the bowel, or if they get very
low down they may be broken up, but they
are at  all  times dangerous.   (See Gall-
Stones and Stones.)
  CONCUSSION is a term  used by sur-
geons to express a severe shattering of some
internal  organ in consequence  of  a fall  or
heavy blow.  It is a condition that gives rife
to certain definite symptoms, varying accord-
ing to the particular organ injured, which
though severe and alarming are less  grave J
than those resulting from actual rupture and !
laceration of tissue. It is probable,  however, i
that the symptoms of concussion are always i
due to some local injury, and  not merely to '
an excessive vibration of the minute elements
of the tissues.  In concussion of bone, for
instance, there is frequently some separation
of the external membrane or periosteum, and
in concussion of the brain rupture of the small
blood-vessels  and effusion  of  blood.   The
best-known  form of this injury is concussion
of the brain. This condition varies very much
in intensity, and may manifest itself either as
a simple  stunning  or by  complete  bodily
prostration and  loss of consciousness.   For
the purposes of description it may prove con-
venient to give two typical forms of concus-
sion,  although it must be remembered  that
in most instances the symptoms of one  form
will be found to coexist with those of another.
In all instances  the symptoms of concussion
follow an injury either from direct or indirect
violence to the head. In the first form the
patient experiences  a sudden weakness and
muscular  trembling in the  limbs, especially
the lower, and cannot walk without stagger-
ing ; at the same time there is a ringing sound
in  the  ears, and dimness of sight.  These
symptoms soon pass away after the  patient
has rested for a time in a darkened room. In
the second form of concussion, the  patient
becomes deadly  pale, and is at once deprived
of consciousness, of hearing, and sight, and
of the power of motion.  The skin  is cold
and the pulse weak.  The eyelids are  closed,
and the arms  and legs  bent upon the body.
The breathing is slow and regular, and the
patient, when  spoken to loudly and called by
his  name, will open his eyelids or give some
other sign of recognition.  It is important to
bear in mind  these  two  facts, as they serve
to distinguish concussion from  compression
and other more  severe injuries of the brain.
In  some cases  there is slight and transient
shivering.   This state lasts in the majority
of instances but a short time after the injury,
generally about one hour, when the  patient
wakes up for a time and then  passes into a
lethargic condition, which varies in duration
according to the age and constitution of the
patient and the  severity  of  the  injury.   Re-
covery from the early and intense symptoms
of concussion  is indicated by increased tem-
perature of skin, and by movement of the
limbs, but chiefly by vomiting, which should
be looked upon as one of the most favorable
symptoms of this injury.  Uncomplicated con-
cussion is by no  means that  fatal disease one
would be inclined  to conclude irom news-
paper reports.   It is doubtful whether it ever
causes death directly. It often leaves  in its
train, however, a set of symptoms and certain
chronic affections which  may render  the pa-
tient permanently disabled,  or even bring on
early death.   The  following are  occasional
sequelae of simple  concussion : irritability of
the brain marked by a hasty violent temper,
or by speedy excitement  after drinking spirits
or wine ; loss of memory ; temporary or per- 
80           CONCUSSION

manent insanity ; loss of sight and of hear-
ing ; muscular weakness and genera! trem-
bling ; loss of flesh and general debility ; in
flammation of the membranes of the  brain.
These affections are due in many cases to in-
discretion on the part of the patient, who as
soon  as the  symptoms of concussion have
passed away, but while  the brain is still slug-
gish and  enfeebled, returns  to his  former
habits and probably undertakes the duties of
some responsible post.
  Treatment.—The following are the chief
points to be remembered in the treatment of
concussion : to place the patient upon a bed
or couch  In  a darkened room ; to  free the
neck and chest from all articles of daily cloth-
ing ; to keep  the head  raised ; and to apply
cold wet cloths over the forehead.  In cases
where there is intense  prostration,  and the
surface of the body is cold,  the patient should
be placed  in  bed, between blankets, and hot
water bottles be placed near the feet and arm-
pits.  Friction with the hand  may  also be
used to  keep up  the circulation.   Spirits and
other stimulants must not be giveit.  As soon
as the patient has become sensible, some hot
broth or beef-tea, may be administered. The
after-treatment of concussion consists in per-
fect rest, both of mind and body, free purga-
tion, and a mildly nutritious diet.  Alcoholic
stimulants are still to be avoided.  If severe
headache  come  on, or slight impairment of
the mental faculties be  observed, a blister or
strong mustard poultice should be applied to
the back of the neck, and the bowels be freely
opened.   In the treatment of concussion, as
of other severe injuries of  the head, there is
no urgent necessity for removing all the hair.
Cold may be readily applied to the head by
means of ice  or cold compresses over the
forehead and,  in the female, considerable re-
lief may be given by allowing the long hair
to keep moist by constant immersion in a
vessel  of  cold water.   In  concluding these
remarks upon concussion  of the brain, it is
necessary to state that in very many instances
this affection is complicated with or followed
by  certain symptoms   that indicate  serious
injury to the skull or its contents.  Hence the
popular dread in cases  of  this kind, and  the
frequent reports of death  from this cause,
which is due not to concussion merely, but to
concussion plus compression or laceration of
the brain.   Even stunning may be followed
by fatal brain  mischief.   In all cases  of sup-
posed concussion, therefore,  the treatment
should be directed with  great caution, judg-
ment, and skill.
  Concussion of the Spinal  Cord.—Of  this
affection there are two forms ; one in which
several  well-marked symptoms  immediately
follow a severe blow upon the spine or a fall
upon the buttocks or back ; and the other in
which the  injury, generally a violent shaking
of the whole body, gradually results in  the
               CONGESTION

 course of months in paralysis of the lower
 extremities and other grave disorders.   The
 latter affection will be described in the article
 on Railway Injuries.   The first or acute
 form  of  spinal concussion is  marked by the
 following symptoms  : pain in the back at the
 seat  of injury,  general  bodily  prostration,
 weakness of the lower limbs, and difficulty in
 walking, numbness in the feet, and diminished
 sensation of the skin of the lower extremities,
 difficulty in making water, swelling of the ab-
 domen due to distension of the intestines with
 gas.   These symptoms usually subside in the
 course of two or three weeks, and the patient
 makes a good recovery.   In some instances,
 however, concussion of the spinal cord ter-
 minates in permanent weakness or even com-
 plete palsy of the lower limbs with  retention
 of urine. ' The  treatment  of this injury con-
 sists in keeping the patient in  bed, and in
 cupping the back or loins or applying leeches,
 and afterward by giving  tonics  and nourish-
 ing food.
   CONDIMENTS. — Those   substances
 which are added to food withwhich salt is taken
 are called by this name.   They are mostly de-
 rived from  the  vegetable  kingdom, and con-
 tain peculiar vegetable oils.  These oils have
 not only their  own  flavor,  but they act as
 stimulants  in the system. They act  benefi-
 cially by their effect  upon the  nerves  and se-
 cretions of the stomach.  The principal vege-
 table  condiments are, pepper, Cayenne pep-
 per,  mustard,  horse-radish,  cfnions,  garlic,
 peppermint,  thyme,  caraways,  anise,  dill,
 fennel, samphire, and others,  most of which
 are separately noticed in this volume.
   CONFECTIONS arc preparations   of
 medicines ordinarily semi-solid, and contain-
 ing sugar or honey. They are chiefly used •
 for making pills, and some of them have no
 active  power ; confection of  roses, for  ex-
 ample.   Confection of senna is a useful  pur-
 gative.
   CONFINEMENT.    (See Labor.)
   CONFLUENT  SMALL-POX is said to
 occur when the pustules run together  and
 form  large and unsightly  scabs. (See  Small-
 Pox.)
   CONGESTION implies a fulness of blood
 and a retarded circulation in a region or organ
 of the body. This condition is called by path-
 ologists local hyperemia, while a tendency to
 general fulness of  blood—an  excess, as  it
 were, of this fluid in all parts of the body—is
 called plethora.  In local  congestion  the fol-
 lowing changes take place :  The amount of
 blood circulating through the  affected part is
 much increased ; the temperature  is raised,
 and there is usually pain and a sense of heavi-
 ness ; the veins and the minute tubes between
j these   vessels  and  the   arteries are over-
 distended with  blood,  which   is frequently
I poured  out through rents  into the  tissues
 around ; the  blood  is of  a darker color.  In 
CONIA
CONSTIPATION          81
 advanced local  congestion there is complete
 arrest of the circulation in many of the minute
 vessels.   The principal  cause of local  con-
 gestion is obstruction to the return of blood
 by the veins from  the  affected part  of the
 body.  The obstructing or compressing agent
 may be present  either internally or upon the
 surface of the  integument.   In addition to
 this, debility from fever or some other severe
 illness, mal-nutrition,and senile decay,are fre-
 quent causes of local congestions.  Internal
 piles from obstruction  to  the  circulation
 through the liver and the veins of  the abdo-
 men, swelling of the feet during a prolonged
 convalescence, and the inflammed and ulcer-
 ated legs so frequently observed  in old  per-
 sons are well-marked instances of congestion
 due to the above causes.   The  treatment of
 painful congestion consists in the removal of
 any cause of obstruction  to the blood-flow, in
 application of leeches or cupping glasses to the
 affected part, and in attention to  the general
 health and condition of the patient.  The de-
 tails of treatment will be  treated more fully in
 articles on Hemorrhoids, Ulcers, and Vari-
 cose Veins.
   CONIA is the active  principle of Conium
 maculalum, or Hemlock.  (See Hemlock.)
   CONJUNCTIVA is the  anatomical name
 for the thin and  sensitive membrane that  cov-
 ers the front of the eyeball,  and  is reflected
 above and below along the posterior surfaces
 of the lids.  At the inner junction of the eyelids
 this membrane forms a small red fold  called
 the semilunar fold, which represents in  man
 the large nictitating membrane or thirdeyelid
 found in birds.   In children  the conjunctiva
 is quite transparent, but as  age  advances it
 becomes dusky  and yellow, and is rendered
 more and  more opaque  by the  presence  of
 large blood-vessels.
   CONSERVES are preparations in  many
 respects  analogous to  confections, and used
 like them.
   CONSTIPATION is a symptom which is
 often attended  with much  discomfort   and
 pain to the patient, and one which may be due
 to disease of  the bowels, or to an imperfect
 performance of their function. In the natural
 course, the food, after digestion by the  stom-
 ach, passes down into the intestines, and by
 the contraction of their muscular coats,  it is
 propelled  onward, to be discharged once or
 twice a day  from the rectum as excreta or
 faeces.  Any disease, as ulceration or cancer
 of the bowel,  which obstructs the passage of
 the food,  will therefore  cause constipation,
 and any condition which produces a paralyzed
 or sluggish state  of the muscular walls of the
 bowel will likewise cause constipation by re-
 moving or interfering with  the propelling
 power. Remedies which increase the contrac-
 tile power and cause a more rapid flow of the
excreta are termed purgatives,  i.  Habitual
constipation is not unusual in women after a
 confinement, in people of a nervous tempera-
 ment, and in those who lead a sedentary life ;
 those, also, who are in the habit of frequently
 taking opening medicine, pills, etc., are liable
 to it, and nothing is to be  more  deprecated
 than the custom adopted  by some of con-
 stantly taking some aperient.   In such cases
 an altered diet will nearly always  suffice, and
 cause no after  ill  effects.  A glass of cold
 spring water taken first thing the morning has
 a most beneficial effect on some ; brown bread
 has  a marked laxative action,  and should  be
 eaten instead of white bread ; roast apples,
 figs,  prunes, and stewed  fruit  are  valuable
 auxiliaries.    With  these  simple remedies
 should be combined a sharp walk  every day,
 and  when advisable, a cold-water batn should
 be used every morning ;  some adopt the habit
 of smoking a pipe after breakfast for the pur-
 pose, and this, no doubt, is serviceable ; but
 probably the  benefit is due to the regularity
 which it induces, and habit is a most  impor-
 tant element in preventing constipation ; no
 one  should  postpone the  process,  and  in
 health the performance of the function ought
 to occur regularly about the same  hour every
 day.  An occasional aperient may be required,
 and  then a mixture containing Epsom salts or
 some similar preparation can be ordered ; the
 effervescent  citrate  of  magnesia is  often
 given, and better  still,  for those who can
 afford it, a wine-glass or two of Pullna water
 may be taken first thing  in  the morning with
 great benefit.  By the use of these means,
 habitual  constipation may  nearly always  be
 cured, if it has not lasted too long.  Some
 advise the use of injections  or enemata daily ;
 but this process is disagreeable and not  gen-
 erally adopted in this country.  In children
 a similar treatment may be adopted, while in
 infants  an altered diet, and a little magnesia
 occasionally mixed with the milk,  will suffice
 for a cure.   Many boys have been  dosed with
 brimstone  and  treacle with  the  object  of
 " purifying the blood," but adoption  of the
 above plan is far  better.   2.  Constipation
 may come on from some growth or ulceration
 in the intestines which prevents the  progress
 of the excreta ; there will  be  then  more or
 less  vomiting,  which  will for  a time relieve
 the distension, pain over the seat of mischief,
 swelling of the abdomen, loss of flesh, and
 frequent sickness will accompany  the consti-
 pation.   If the obstruction be high up, as in
the  stomach,  nothing can  be  done  for the
constipation ;  if low down and in the rectum,
means may  be  taken to make an  artificial
opening in the loins to let out the faeces, but.
this can  only be done in extreme cases.  (See
Colotomy.)   3, Constipation may be only
occasional,  and  due  to  taking indigestible
food, as  nuts, unripe fruit, etc., or to  taking
too large a quantity at once ; the tongue will
then  be  foul and white or yellowish, the ab-
domen full and painful, and a feeling of sick- 
 82          CONSUMPTION

 r.ess may ensue.   If the pain is very intense,
 so as to make one suspect enteritis, an opiate
 should  be given to allay the  urgent symp-
 toms, and the constipation may be left alone
 for two or  three days ; then a small dose of
 castor oil or some mild purgative may  be
 given. In cases of peritonitis, some liver dis-
 eases, emphysema, and other  chronic affec-
 tions, this symptom may prevail, but the treat-
 ment must  then  vary  with the special cause.
 A regular action of the bowels  should  always
 take place in health every day,  and  for his
 purpose, fresh air, light, active exercise, and
 a wholesome diet  are  the best provocatives.
 No doubt, occasionally a purgative is required,
 but they should not be taken indiscriminately,
 as they tend to induce after a lime the  very
 condition for which in the first  place they are
 given.
  CONSUMPTION is the disease to which
 technically the name  Phthisis,  or wasting, is
 applied.  By it is meant that form of lung dis-
 ease where first of all there is a deposit of new
 material in the substance of the lung.  After
 a time this softens and breaks down.  It is
 expectorated and leaves behind  cavities.  This
 process is accompanied by fever of a peculiar
 kind, and  general wasting of  the  body ;
 whence the name. Such is the  pathologic his-
 tory of  the disease, deposit and subsequent
rsoftening ; but the deposit is by no means al-
 ways of the same kind,  though that was taken
 for granted up to a very recent period.  The
 processses which lead to this deposit  are two
 in number—one is inflammation  of the  lung
 substance, and the other is a deposit of a new
 growth called tubercle.   Most  frequently the
 two processes are associated, for the deposit
 of the new growth sets up inflammation and
 its consequences.  When the substance of the
 lung becomes inflamed, we have  to deal with
 a very different set of phenomena than when
 the air passages alone are so  affected.  The
 disease may assume a  very acute form, such
 as cannot be mistaken,  or it may steal on in-
 sidiously, especially if it spreads  from the air
 tubes to  the lung substance.  The  conse-
 quence of such an inflammation is the chok-
 ing up of the little cavities of which the  lung
 consists in a portion of its substance, and the
 material thus deposited  may  either remain
 there for a length of time, or at once proceed
 to soften and break down.  In  this process
 the damaged material of the  lung too  may
 take  part.  It may  soften as  well  as the
 newly-deposited   substance,  and  breaking
 down and being expectorated,  leave behind a
 cavity in the substance  of the  lung.   This
 process may go on quickly or slowly, some-
 times very slowly, especially if other changes
 go on at the same time, such as indurate the
 texture of the lung, as what has been called
 fibroid phthisis, a very slow form of the  mal-
 ady.  But again there  may be a deposit  of
 new substance,   the  process  being  by  no
             CONSUMPTION

means inflammatory,  and this new  growth
which is  laid down in the substance of the
lung is called tubercle.  Once deposited, its
history is the same, or nearly so, as  that of
the  inflammatory  material  laid  down  in
the .lung cavities.   It softens  and  breaks
down, the injured  texture  of the lung do-
ing so  also,  and  so  a cavity is  formed.
There is yet another mode and kind of de-
posit.  That due to syphilis.   This  is, per-
haps, if a diagnosis can be  made, the most
hopeful variety of the disease.  To both the
former  varieties  of disease  there may be a
strong hereditary proclivity ; if so, this is a
circumstance which tells most unfavorably on
behalf of the patient,  for there arc few dis-
eases in which a hereditary character is more
prominent than that which commonly goes
by the name of pulmonary consumption.  It
is of the very first  importance that this dis-
ease  should  be  diagnosed   in  the  earliest
stages, for it is then that certain of its forms
may be treated with tolerable confidence of
success, and all can be dealt with to most ad-
vantage.  That form which promises most by
timely treatment  is the inflammatory form,
especially that which comes on  in a patient
who has long been in  depressed health from
whatever cause.   It commonly begins with a
slight cough, which, however, persists, and
will not go away, and the patient gets gradu-
ally thinner.  The  respiration indicates fee-
bleness,  being wavy in character, or even
jerking.   Besides  this, there  arc  certain
sounds  only to be appreciated by a skilled
car.   If  with all this, there  is a bad family
history, the case  is one demanding prompt
action.   This may be taken with good hope
of success.   Fever, heat of body, best indi-
cated by the thermometer, is a most  impor-
tant elerrfent in such cases.   If it keeps high,
the chances do not improve  ; if it gradually
diminishes and totally disappears, the patient
may be said to have regained his health.
  Take now a case of tubercular  consump-
tion.  It  may arise from the former,  or it
may be developed from the products of some
long standing disease of other organs, or one
lung may infect the other.   This form is not
so common as the other.  Its origin is very
insidious ; but having  begun  it  goes on.
There is  considerable uneasiness.  At night
the temperature is high ; and there are trou-
blesome  night sweats.  There is a persistent
cough, and very likely pain in one side.  The
appetite  is  very  capricious, and very likely
there is  diarrhoea.   With such cases, too, a
huskiness, or even loss of voice, is  by no
means uncommon.  This rarely occurs in any
other variety of consumption, and so may be
looked upon as proof positive of the existence
of this form, if any consumption be present.
For the public, however, it is of less  conse-
quence to know what variety of consumption
the patient labors under, than to know that 
CONSUMPTION
CONSUMPTION           83
he has got some form of the disease, or is
likely to have it, if the malady he labors un-
der is not arrested.  Accordingly, an abstract
of the commonest signs are now given : for
we desire to impress the public very earnestly
that it is in its earliest stages that consumption
is remediable.   The  earliest symptoms  are
very probably connected with digestion ;  the
appetite becomes capricious ; there are pains
in the chest, with some cough  often dry  and
hacking, with a small quantity of frothy ex-
pectoration,  There  is debility,   flushing of
the face on the slightest  exertion ; at other
times the countenance is  pale, except there
be a hectic patch of red in the middle of the
cheek.  The eyes look unusually white  and
pearly ; there is some fever at  night, and a
tendency to night sweats.   Very likely there
is some spitting of  blood.  This  occurs  in a
very considerable proportion of cases, and is
often the earliest symptom calling for atten-
tion.  Provided it is clear  that the blood does
not come from the gums or throat, any bleed-
ing by the mouth, especially in a young  per-
son, demands attention.   As the disease ad-
vances emaciation advances, so that the joints
become enlarged by shrinking of the limbs,
and the fingers  commonly become clubbed at
their points.  The night sweats and diarrhoea
are the  great means of reducing the bodily
strength and substance ;  but  in some  in-
stances, excessive expectoration  aids materi-
ally in this untoward process.   At the same
time the  capricious appetite and the imperfect
digestion leave  the bodily supply  very  de-
ficient.  During all this time the spirits of the
patient are good, and it is often distressing to
see one  doomed to an early death talking of
the future in a tone of assured confidence.   A
very troublesome complication often seen is
fistulae in the lower bowel, which, if not re-
lieved  taxes the patient's  strength sadly.
On the other hand, there is always a risk  that
if an operation  be attempted the wound  will
not heal, and so the latter risk is worse than
the first.   Usually, if the  disease be not ar-
rested, the patient dies of exhaustion ; some-
times he is suffocated or bleeds to death,
consciousness continuing to the last.  But  this
result is by no means necessary ; and  the
dread of the disease as being universally  and
unerringly fatal, which was wont to prevail,
has been shown  to be without just founda-
tion.  Undoubtedly, if a patient  with a  bad
family history is seen for the first time when
the disease  is well advanced we have little
ground for hope.  True, also, that the tuber-
cular form of the disorder is less amenable to
treatment than is the inflammatory. Yet  due
care being  exercised, there are  few cases
which cannot be benefited  ; a goodly number
can be cured completely, or, at all events, the
lungs so healed  that  each  may be enabled to
lead a good long life  in moderate comfort.
  Treatment.—The  first  and  greatest point
of all is the selection of the conditions under
which the patient is to live.  Unfortunately,
in too many instances, this is  not possible ;
but where it is possible, and the disease is in
an  early stage, much may be done.  On  the
continent of  Europe,  there  may be found in
different health resorts, people who have all
their lives had bad chests, but  who by wan-
dering from health resort to health resort, ac-
cording to the season of the year,  are able to
maintain life comfortably.   If such a thing is
not possible, we  must try next to select  the
most favorable conditions possible.   The first
great point in selecting an abode is the avoid-
ance of  damp ; it should be situated on a  dry
and porous soil.  This is even  of greater  im-
portance than temperature, though that too is
important,  inasmuch as fresh air is a neces-
sity, and daily exercise in the open air even in
winter is a thing very greatly  to be desired.
Such  patients must take the greatest possible
care  of themselves—no risks  must be run.
They must live plainly ; but their food must
be nutritious.  They must avoid excitement,
but cheerful society is of the greatest possible
value.  They must  not fatigue themselves,
but daily exercise is incumbent.  They must
not be exposed to too great heat ;  but cold is
even more  to be  dreaded.   Hence the rule,
which is a good one, always to keep indoors
between sunset and sunrise. They must try to
keep  the skin  open ;  but  they must avoid
perspirations.  Hence baths must  be regu-
lated in  temperature for the individual—tepid,
cool,  or cold, as  the  case may  be.  The
bowels  must be  kept open, but if they  are
loose, the diarrhoea must be checked.  Final-
ly, such patients are on no account  to go with-
out flannels ; while the outer clothing  should
be changed, if desirable, to suit the different
periods  of the day and year. At all times it
must be warm, so as to avoid risks from cold.
For those in the very early stage  of phthisis
nothing perhaps does so much  good as a  sea
voyage  in a mild climate—to the West Indies,
for instance,  though many  prefer  the longer
voyage  to Australia or New Zealand ; often
these do great good, but they must be  under-
taken early, or the result will be the reverse
of favorable.  Change of  climate  in females
is apt to provoke derangement of the men-
strual function.   This  should be seen to, as
any excessive flow would be very weakening.
This,  moreover, has to be borne in mind, that
in consumption this function almost entirely
ceases,  and  generally  does so  altogether.
(See Climate and Health Resorts.)
  Patients,  the  subjects  of   consumption,
have often, early in the disease, a rooted  ob-
jection to fat as an article of food.   This is
the more important, as of all substances it is
to them the most  necessary.   If therefore,
they refuse to take fat as food, we must  en-
deavor to give it as medicine.   The form of
fat which is most easily digested is cod-liver 
84           CONSUMPTION
CONTUSIONS
oil.  If this be given, it  need have no disa-
greeable taste, beyond a slight fishy flavor
which t® many is agreeable. It is to be given
to the patient cautiously.   Often one will say,
" I cannot take cod-liver oil ;  it always makes
me sick. I have tried again and again always
with the same results." You inquire, and find
they have been endeavoring  to  take  one
or two  tablespoonfuls at a time.  As a mat-
ter of course they get upset ; but  if  they re-
duce the quantity to a teaspoonful, or even a
few drops, they gradually get accustomed to
it, and can take almost any quantity.  Cod-
liver oil is, however, lood,  rather than medi-
cine, and the best time  of taking it.  is just
after a meal.   The fish oil used in this way
should be entirely devoid  of color ; every trace
of color is  an impurity.   Next  to cod liver
oil  as  a remedy comes  iron.   This,  too, is
best dealt with as a food ; that is to say, given
along with the meals.  The best preparation
is the reduced  iron, which can  be taken in
soup.  If this  is not attainable, the  freshly
prepared carbonate  should be  given.   Next
to these  remedies, to be  taken  along  with or |
just after food, to add to  the value of food, I
comes  anything  which  will aid digestion.
Pepsine, as procured from  the pig's stomach,
is for  this  purpose exceedingly  useful, en-
abling the food to be digested with ease and
comfort, when otherwise it would only  pass
into the intestines, there  to putrefy and fer-
ment, and so set up diarrhoea.   Four or five
grains may be taken  for a dose just after a
meat  meal.  If that does not  suit,  meat
digested beforehand  might be tried.   When
cod liver oil cannot be taken, other kinds of
oil may be tried.   Of these the best are cream
and salad oil.  When no oil can be taken rub-
bing it  into the skin does  good ;  but it cre-
ates a horrid  smell, which is very trying to
the poor patient.  'Syrup of the iodide of iron
may be given along with the oil, and often
does  good.   Iodide  of   potassium  seldom
does, except the disease be  syphilitic in its
origin.  -If prescribed at all,  it had better be
given in decoction of bark.  But of bark, the
best preparations are the compound tincture
and the liquid extract, given in doses  of a
drachm or so three or four times a day.  It is
often well to combine some acid with the
bark ;  the best is the  dilute  nitro-muriatic
acid, in doses  not exceeding twenty  drops.
If the perspirations be very troublesome, it is
customary to give dilute  sulphuric acid ; but
any acid does good.  On  the other hand, it
is very  frequently good  to give alkalies in-
stead of acids.  These  certainly, combined
with bitters, very  greatly strengthen  the ap-
petite and aid digestion.    Liquor  potassae is
commonly given  in  doses  of  5, 10, or  20
drops, sometimes with bark, sometimes with
gentian, or  other bitter.  Certain remedies
called  hypophosphites have  been highly ex-
tolled  in the earlier stages of the disease.
Their value is  uncertain, though  they  often
seem to  do  good.  Counter-irritation  is a
means of treatment which has been unjustly
decried and  unduly lauded ;  undoubtedly it
does good if employed  judiciously,  viz., so
as not  to weaken  the  patient.  It is of most
benefit when the pleura is concerned, and the
patient cannot  lie in certain positions on ac-
count  of  pain.  It must,  however   be  em-
ployed cautiously ; best  by some liniment as
croton  oil  and  turpentine mixed.  Flying
blisters,  kept  on  for  only  a  few  hours;
these  speedily  create   counter-irritation,
while they do not cause it  to  such an extent
as to be injurious.
  Of the complications to be deait with one
or two  yet remain  to be  noticed.  First
comes  bleeding.   This it  must ever be re-
membered is a very  serious matter, for  it
may be the cause of death.   When it comes
on, absolute rest must be  enjoined, cold ap-
plied to the chest, ice taken  internally, and
gallic acid with sulphuric acid  freely imbibed.
Oil of turpentine  is also of service,  though
perhaps  less  directly.  Night sweats  have
been alluded to ;  mineral acids, if not other-
wise forbidden, are best for them.  Diarrhoea
must.be dealt with carefully.  It must never,
however, be  allowed to weaken the patient;
chalk,  opium, and acids  are the best reme-
dies.   If the throat is bad, nitrate of silver is
the best  application.   For the cough a little
opium, or hyoscyamus,  or belladonna may
be given ; but it, is better treated on  general
principles.
   CONTAGION, a  name  applied to the
poison which is supposed to be the cause of
many  fevers, and  also to  the mode in which
it spreads, viz., by contact with the  infected
person.   Scarlet fever, measles, typhus fever,
etc., are  thus  said to be contagious,  because
the disease will spread  from one person to
another who comes in close proximity to the
one affected.   (See Fevers.)
  CONTINUED  FEVERS is a name ap-
plied to a group of febrile disorders in which
the duration of  the feverish period is prolong-
ed for  several days or weeks.   The group in-
cludes typhus,  typhoid, and relapsing fevers.
(See Fevers.)
  CONTUSIONS.—By this term is generally
understood a form of injury in which there is
more or less laceration of  the soft parts near
the surface  of  the body, while the skin re-
mains unbroken.   In fact, the term may be
applied to any  injury caused  by heavy pres-
sure, or a sharp blow, so  long as there is no
external wound.   When,  in connection with
much  crushing and tearing of the soft parts,
the skin is broken, the injury is then called
a contused wound.  With  fracture of bones,
dislocation, sprains, and other injuries from
violence, there is always some  amount  of
contusion.  There is pain  over the seat of in-.
jury, increased by pressure or  movement of 
CONVALESCENCE
COPAIBA
85
 the limb ; there is also considerable swelling,
 with more or less discoloration, due  to rup-
 ture of  blood-vessels, and accumulation of
 poured-out blood.  Contusions vary much in
 extent and severity, from simple bruising of
 the skin to  complete disorganization of the
 whole thickness of a limb.   The prospects of
 speedy recovery from a severe contusion de-
 pend in the first place  upon  the amount of
 laceration in the subcutaneous soft tissues,
 and in the second upon the age and general
 condition of the patient.   In children and
 healthy  persons, very  large  collections  of
 effused  blood are absorbed  with  rapidity,
 provided lhat there be no communication
 with the external air through  a wound in the
 skin.  In persons with a tendency to so-called
 rheumatic pains in the limbs  and back, con-
 tusions are frequently followed by persistent
 stiffness of the injured part, and a dull heavy
 pain, which is more severe during wet weath-
 er, or with  an  easterly  wind.  When the
 system  has  been weakened by chronic alco-
 holism, bad or insufficient nourishment, or by
 some chronic disease, the contused parts be-
 come inflamed, and the seat of a large dif-
 fused abscess.  In  the  most severe cases of
 contusion, where all the soft  parts of a limb
 are crushed and thoroughly disorganized, and
 the large blood-vessels  torn, gangrene is an
 inevitable and often fatal  result.  The treat-
 ment of contusions and contused wounds is
 described fully in the  articles on Bruises,
 Dislocations,  Fractures, and  Railway
 Injuries.  It consists chiefly in rest of the in-
 jured limb in an elevated position, in the ap-
 plication of  cold lotions or iced  water, and
 tincture of arnica.   In  cases of superficial
 bruising, the  last named agent is of great ser-
 vice.
   CONVALESCENCE means the  period
 of recovery from an acute or chronic disease.
   CONVULSIONS may  be Said  to  mean
 violent and involuntary  contractions  of the
 muscles of certain parts of the body or of the
 whole  of it, lasting for a longer or a shorter
 time, and very frequently returning in parox-
 ysms.  Sometimes the convulsions or muscu-
 lar contractions last a considerable length of
 time without  relaxation.   To  such  a  spasm
 or convulsion the term tonic has been ap-
 plied, and is such as characterizes the disease
 called lockjaw or tetanus.   Common  cramp
 is an affection of the same kind, but of more
 limited duration, and affecting only a small
 part of the body.' Again, if the spasms alter-
 nate with relaxations, as occurs in what are
 sometimes called the jumps, the spasms are
 described as clonic.  Such spasms or convul-
 sions associated with complete insensibility
 constitute an epileptic  or  epileptiform seiz-
ure.  The causes of convulsions are manifold,
but it would  seem  as  if there is  a certain
amount of evidence to support the notion that
all act by suddenly depriving the motive part
 of the brain of a due supply of blood. ' This
 arrest of blood-flow may be brought about in
 many ways, by plugging of the vessels, by
 powerful contraction  of their muscular coats,
 etc.   Sometimes  poisonous matters in  the
 blood as in the condition known as uraemia,
 give rise to convulsions, especially in preg-
 nant women.  In children, too, where the ner-
 vous  system is readily excited, irritation  in
 a remote part of the body may be reflected in
 the brain and cause convulsions.   Such  is
 the explanation of convulsions from teething,
 worms, etc.   In  most instances, convulsions
 are accompanied  by  loss of  consciousness.
 This  is the  case  in  those forms commonly
 called fits, but in  hysterical fits or convul-
 sions there  is no loss of consciousness, and
 the tongue is not bitten.   In dealing with
 convulsions in adults, perhaps the  best plan
 is to wait quietly till  the convulsion is over,
 and then try to prevent its recurrence.   As a
 rule,  interference  with  the individual during
 convulsions  is   mischievous.   He  should
 never be held or further controlled than is
 necessary to prevent him from hurting him-
 self.   His dress  should be  loosened, plenty
 of fresh air allowed to circulate  around him,
 and none save those engaged in looking after
 him  should be allowed  to  come near him.
 As he begins to revive, a little cold water to
 swallow may do good, but as soon as possi-
 ble he ought to be got to bed and undressed—
 if not previously  so—and  left to himself.
 Very  likely he will fall into  a quiet slumber,
 and  when he  awakes  there  should be  an
 urgent inquiry into the cause of the convul-
 sions  ; among which  albuminuria  should
 never be forgotten.  Should he not recover
 consciousness, but  pass  from convulsions to
 coma, as it is called, very probably  the cause
 of the attack has been the rupture of a vessel
 and the effusion of blood into the brain sub-
 stance.   Nevertheless, it is  quite  true that
 uraemia may take the same  course and ter-
 minate, too, in coma, or complete insensi-
 bility, with dilatation of the pupils of the
 eyes.   Salaam or nodding  convulsions  are
 very rare  forms of the  malady, peculiar to
 children.  See  Infantile   Convulsions ;
 Pregnancy ;  Puerperal Convulsions,  and
 Puerperal Fever.
  COOLING MEDICINES. (See Refrig-
 erants.)
  COPAIBA is a mixture of oil and resin ob-
 tained from various species of trees growing
 in South America.  It is of a thickish consis-
 tence  and is yellow in color ; its odor is dis-
 agreeable.   By distillation  the  oil  may  be
 separated from the resin ; this oil is allied to
 turpentine both in  character and  properties.
Copaiba  acts  as a stimulant,  especially to
mucous membranes ;  and as it is discharged
from  the body chiefly by the lungs  and  uri-
nary organs, it  acts  chiefly on the mucous
membranes  of these.   Hence it is  of use  in 
86
COPPER
CORONER'S  COURT
 the  bronchitis of elderly people  who  want
 stimulation, and in  discharges  from the uri-
 nary passages.  It is chiefly used in the treat-
 ment of the latter, but is apt to disorder the
 stomach, so that local  applications to the part
 affected are  generally preferable.   In  large
 doses it produces a peculiar rash on the  skin.
 Sometimes it  is given  for threadworms.  The
 dose of the balsam, as it is called, is about 30
 drops ; of the oil, 10 drops.   The  balsam is
 exceedingly disagreeable to  the taste, and is
 apt to return  for a time.  It is  best given in
 capsules.   It  communicates  its smell to the
 breath.
   COPPER  itself is  not used in  medicine,
 but as copper vessels are  much used in cook-
 ing and are liable to be attacked by their con-
 tents, so  as  to  produce  a poisonous com-
 pound, it is of some importance.   The com-
 pound so formed is verdigris, an impure ace-
 tate ; it gives rise to vomiting and purging.
 This salt is formed  by introducing anything
 containing vinegar  into  the copper,  or al-
 lowing its  contents  to ferment.  Sometimes
 the acids of fats separate, and in like manner
 attack the containing vessel ; for this reason
 nothing should be allowed to  stand  in the
 copper, and it should  be carefully cleaned
 after each time of  using.  The oxalic  acid
 sometimes used for  cleaning  the outsides of
 kettles is a dangerous poison, and should not
 be used.  If anything of that kind be  em-
 ployed, exceedingly  weak nitric acid is best,
 and  the vessel should be  carefully rinsed out
 with water immediately.   Sulphate  of copper,
 better, known, perhaps, as bluestone, is the
 most important  preparation of  copper used
 in medicine.   It occurs in somewhat irregu-
 lar crystals, and is sometimes known  by the
 name of blue vitriol.   It is sometimes given
 internally in small doses  as an astringent  in
 obstinate cases of diarrhoea.   Given in large
 doses it acts as a speedy emetic, and is used
 for this purpose in narcotic poisoning.   Ex-
 ternally it is used as a kind  of stimulant ap-
 plication  to  sores,  which  may be lightly
 stroked with a crystal when indolent and in-
 disposed to heal. It  is also used in  lotion for
 some discharges, or as an application to  flab-
 by ulcers.  The dose as an  astringent  is
 about half  a grain ;  as an emetic about five
 grains.  The strength of the lotion should or-
 dinarily be about a grain or two  grains to the
 ounce of water.  In  poisoning with copper,
vomiting  should  be promoted by copious
draughts of warm water and  a solution  con-
 taining tannic acid prepared,  such as tincture
of galls, tannin itself, or oak  bark,  which
should be given as an antidote to any of the
 substances not expelled by the vomiting which
itself has  produced,  for it may be said at all
times to act as an irritant  to the stomach.
  COPPERAS.  (See Disinfectants.)
  CORIANDER is the fruit of an  umbellif-
erous plant ;  its properties  are similar  to
 those of caraway and a variety of other seeds
 and fruits, etc.   It is stimulant and carmina-
 tive.
   CORNEA.  (See Eye.)
   CORN-FLOUR is a preparation of starch,
 and so called because it was originally pre-
 pared from maize or Indian corn.  The term
 has also been applied to starch prepared from
 rice and other grains.   In the preparation of
 the maize and other grains,  in order to make
 corn-flour, the husk aud gluten of the seed are
 separated by grinding and the action of water.
 In the use of corn-flour as an article of diet, it
 should  always be recollected that it contains
 little else  than the granules of starch (see
 Starch).  Starch acts on the system as a heat
 and force  giver,  but  not as a flesh former.
 Corn-flour should, therefore, always be given
 with milk.   The excellence of corn-flour is to
 be tested by its freedom  from flavor, as that
 which affords least flavor most readily takes
 flavor from other things.
   CORNS.—If a portion  of the  cuticle or
 scarf skin  becomes greatly  thickened, and
 penetrates  into  the  true  skin, causing  great
 pain  and annoyance, it is  called  a  corn.
 Corns are commonly spoken of  as hard and
 soft: the hard are those  situated on the more
 exposed surfaces of the foot, where the cuticle
 gets dry and  hard, and the soft where the cu-
 ticle  is  moist—generally between the toes.
 With regard to treatment, the first thing to be
 attended to is to have the boots or shoes made
 accurately to fit the  feet, of soft leather ; the
 feet should be washed often, and the inside of
 the  socks just  over the corns rubbed with
 slightly moistened soap.   Glacial acetic acid,
 applied to the surface frequently, will gener-
 ally be found to disperse them. Care must be
 taken that the acid is applied to the corn only,
 and not to the surrounding tissue.   The parts
 around  the corn should be covered with  oil or
 soap.  In soft and  painful corns seated be-
 tween the toes nitrate of silver is a useful ap-
 plication.
  CORONER'S  COURT   is one  of the
 most ancient institutions, and took its rise at
 the time of Alfred the Great.  It was origi-
 nally instituted  for the purpose of inquiring
 into the cause of the death of those who had
 suddenly or unaccountably died, or had been
 found dead,  or were known to have been
 slain by others.   In all cases where  persons
 have suddenly  and  unexpectedly died, and
 there has been no medical attendance, or the
 medical man has been called in so late that he
 cannot give a certificate of the cause of death,
 an inquest should  be held.  All medical cer-
 tificates  to be  regular must  be  given by a
 " legally qualified practitioner," and only such
a practitioner can be called on by the coroner to
 make a post-mortem examination of the body,
although a post-mortem examination is most
frequently made in cases of  inquests on per-
sons suddenly dying or found dead.  This need 
            CORONER'S  COURT

  not be done, should the coroner or the jury not
  demand it. The Coroner's Court is called into
  action in various ways. The police are enjoin-
  ed to give notice to the coroner of any sudden
  death, or of persons found dead or dying, or
  any kind of violent death by accident or de-
  sign.   Any person can inform the coroner of
  the death of an individual, if  they suspect in
  any manner  they  have improperly come to
  their death.  The coroner has power to hold
  inquests in cases of natural deaths, if there is
  reason to believe the disease could have been
  prevented,  or was  aided and  abetted by
  neglect or malice, or the breaking of a law.
  Thus landlords are liable for the death of their
  tenants by  fever, if it can be proved the fever
  broke out as the result of bad drains or other
  bad arrangements, which might have been re-
  moved. In all cases of  accident, however
  slight, which  lead  to death, the Coroner's
  Court must be put in action.   Medical  men
  and other persons certifying to death  without
  mentioning the accident, may be proceeded
  against for misdemeanor,  and the coroner
  may order the exhumation of the body for the
  purpose of holding an  inquiry should he
  deem  it necessary.   In  all cases where per-
  sons are in doubt about the necessity of an
  inquest, the coroner should be  appealed to.
  The proceedings in the  Coroner's Court are
  as follows :  On receiving  notice of a death,
 the coroner forwards the notice to a consta-
 ble, who then proceeds to inquire into the cir-
 cumstances  of the death, and forwards all the
 information he can obtain to the coroner. If
 the coroner deems  the case one  for inquiry,
 he sends his precept to the constable requir-
 ing him to  call a jury at a certain time and
 place.   When the jury  is  assembled,  their j
 names  are  called over, they choose a  fore-
 man, and an oath is administered to them to
 the effect that they shall deliver a " true  and
 impartial verdict."   They then proceed with
 the coroner to view the  body,  which is the
 most necessary part of the proceedings, as the
 inquiry can  only proceed  upon view of the
 body ("super visum corporis"), and the dead
 body is a part of the evidence.   At the view,
 the jury are  expected to examine the body to
 see if there be any marks of violence upon it,
 or any other indications  of how  the person
 may have come to his death.  On the reas-
 sembling of  the jury after the view, evidence
 is taken on oath of all parties who know  any-
 thing of the  cause of the death under investi-
 gation.   The coroner determines if a post-
 mortem examination be necessary, and gives a
 special order for that purpose.   Post-mortem
 examinations are not necessary when persons
 have been seen  to be killed or drowned, ex-
cept in cases where it will be thought to throw
light on  the cause of suicide, as revealing a
diseased  condition of the brain.   After  the
examination  of the  witnesses, the coroner
sums up, and the jury deliver  their verdict,
                COUCHING             87

j  which is  entered upon  an inquisition  and
  signed first by the coroner, then  by the fore-
  man, and at least eleven of the jury.   The
  coroner then issues his warrant for the burial
  of the body, which up to that time is in his
  custody, and cannot be removed without his
  sanction.   The coroner has the same power
  in his court as a judge, and can commit per-
  sons to prison for contempt of court, and can
  lock up a jury until  they unanimously agree
  upon a verdict.   If upon the inquest any one
  is found guilty of homicide, he is to be  com-
  mitted to  prison  by  the coroner, and the in-
  quisition with the evidence is turned  over to
  the proper court.
   CORPULENCE.  (See Bantingism and
  Diet.)
   CORROSIVE  SUBLIMATE,  known
 to chemists as perchloride of mercury,  at once
 partakes of the nature of m'ercury (which see),
 and possesses distinctive features of its  own.
 Apart, therefore,  from its property as a mer-
 curial, corrosive  sublimate, as its name im-
 plies, is a powerful irritant or corrosive, and
 is consequently a dangerous poison.   By vir-
 tue  of its irritant character, it may be used as
 a wash or lotion to indolent ulcers, and here
 its mercurial character coming  in, it is of
 much value in those of a syphilitic nature. It
 is also used as a collyrium or eyewash, and
 a gargle in sore throats.  A weak solution
 (one grain or two grains  to the ounce) is an
 excellent remedy for  scabies and  that condi-
 tion of lousiness fo troublesome  in old peo-
 ple.  This lotion  is also the best remedy for
 crab lice.  In a case  of poisoning with coro-
 sive sublimate vomiting is generally prompt,
 and should be encouraged, but the great rem-
edy  to be promptly got ready is white of egg,
an antidote with which it  promptly combines
to form  an insoluble compound.   But there
is no  time to  be  lost, as death may  follow
in a few  hours.   It seems to affect the kid-
neys as well  as the stomach, for in cases of
poisoning  by it the urine is scanty and often
bloody.
   CORYZA.   (See Nose, Diseases of.)
   COSTIVENESS.   (See Constipation.)
   COTTON-WOOL is of use, not only as a
means of  applying remedies directly to some
one spot as, for example, a carious tooth or a
suppurating ear, but is also valuable for pro-
tecting exposed surfaces.   In this way it is
often used for burns, but as the products of
suppuration  accumulate  below it, and are
there confined, some  surgeons object to its
use in this way.  It is of much benefit to the
sufferer when plentifully applied to a joint the
subject of rheumatism or gout.  In such situ-
ations it ought further to be  covered with
oiled silk or gutta-percha  tissue ;  so as  to
form a kind of  steam  bath.   For these pur-
poses carded cotton rather than cotton wad-
ding should be used.
  COUCHING.   (See Cataract.) 
88
COUGH
CREAM OF TARTAR
   COUGH is  an exceedingly troublesome
 symptom of very various diseases.  It may
 arise from  irritaton of  the air passages or of
 the lungs, of any kind, from  the slightest in-
 flammation to the most severe.  It may arise
 from aneurism or heart disease, or it may be
 connected  with indigestion,  or merely hys-
 terical, and due  to no cause in  particular,
 Sometimes, as in  whooping-cough, it  consti-
 tutes the main  part of the disease.   At all
 times it is  a troublesome and sometimes a
 most distressing symptom.  Cough is mainly
 due to a kind of reflex or reflected irritation.
 The  source of this  irritation  may be in  the
 lungs or out of  it, though most frequently in
 it.  This, conducted by some nerve or other
 to the breathing nerve centre, sets up violent
 expiratory efforts while at the same  time the
 chink between  the throat and windpipe is
 nearly  closed.  These efforts are renewed
 until  all the available air is exhausted in the
 chest and the patient is forced to  desist until
 he can draw a breath.   If the  tendency to ir-
 ritation is great,  the inrush  of cold  air  is
 quite enough to set him coughing  again, and
 so on to complete exhaustion. To a worn
 patient, as one in an advanced stage of con-
 sumption, such attacks of coughing are inex-
 pressibly wearing and  to be  avoided  at all
 hazards. True,  they may be avoided by dead-
 ening the sensibility of the part  by opium,
 but this deadens it too to the  healthy  stimu-
 lus of the  secretions  which  need removal.
 On the whole, therefore, the best  thing is a
 regulated temperature, as far as it can be kept
 even, and  inhalation of steam if  advisable.
 These do great good, but they do not and
 cannot  prevent  all attacks, especially  in the
 morning, when the accumulated secretions of
 the night have to  be got rid of.   When the
 coughing is  aggravated by a consistant titilla-
 tion in the  throat, relief may  be had by dis-
 solving a bit of hoarhound or lemon candy in
 the mouth,  and swallowing  the  saliva.   A
 pinch of salt dissolved on  the tongue  is also
 good.  For a child nothing is  better than the
 old-fashioned " Brown Mixture" (obtained at
 any drug-store).   When a  child has a cough
 as accompaniment of a cold, small doses (10
 drops) of syrup of ipecacuanha may be given
 with benefit.  For adults, when a cough ac-
 companies  a cold, the  following  is a good
 remedy : Mix 8  teaspoonfuls of molasses, 40
 of vinegar, 2 of antimonial wine, and 4 drops j
 of laudanum ; take two teaspoonfuls at night
 and one in the morning.
  COUGHING  BLOOD.   (See Hemop-
tysis.)
  COUNTER-IRRITATION.—A  system
 of remedies intended to relieve internal  in-
flammations by the pain  and  action ex-
cited   in  the skin immediately   above the
 part affected. Mustard plaisters, blisters, and
embrocations  are examples of counter-irri-
tants.
   COUP-DE-SOLEIL  (sun-stroke).  (See
 Heat Stroke.)
   COWHAGE, or Cowitch, consists of mi-
 nute hairs from the pod or fruit of a plant grow-
 ing in the West  Indies.  The sharp prickles
 getting  inserted into any  part of  the  body
 give rise to intolerable itching.  It used to
 be given to get rid of worms, on the princi-
 ple, it has been suggested, of tickling them to
 death.   It is not now officinal.
   COW-POX, or Vaccinia, is a disease which
 is met with on the teats and  udder of the
 cow ; it forms an eruption made up of numer-
 ous little blisters with  watery  contents, and
 this fluid when introduced into the system of
 man will produce a similar affection, and such
 persons are not liable  to suffer from small-
 pox.   It was an important observation made
 by Jenner, nearly a century ago, that  those
 who had cow-pox from  milking cows affected
 with this disease  were free from  the danger
 of small-pox, and this great discovery led him
 to adopt vaccination as a means for prevent-
 ing man suffering from that dangerous dis-
 ease.  (See  Vaccination.)
   CRABS,  the  common name for the Pe-
diculus pubis, so  called from  its resem-
blance to the crustacean, is  a loathsome in-
sect, which  gets into the roots of the hairs,
about the pubes, and is characterized by an
 intolerable itching ; it is readily got rid of by
rubbing in any mercurial ointment, the best
being  the white-precipitate (ammonio-chlo-
ride), and  taking  a hot bath  soon  after.
 Prompt measures should be taken to get rid
of these creatures, and in fact all parasites, as
they are exceedingly prolific.
   CRAMP  means violent  and involuntary
muscular  contraction.   It is, perhaps,  most
readily induced by Cold, especially after pro-
longed exercise.  This,  perhaps, is the reason
why it so often occurs in swimmers, and is
supposed  to account for a good many of the
lives lost in water.  The  best remedy is rub-
bing, especially with some stimulant applies*
tion, as spirit, but it is  the rubbing which is
the most valuable part of the process.   (See
Convulsions.)
  CRAZINESS.  (See Insanity.)
  CREAM  is the  name given to the butter
of milk, when cow's or  other milk is allowed
to stand, so that the butter floats.   It con-
sists principally of  butter, and  when placed
under the microscope is found  to consist of
little  globules, which,  from their  peculiar
action on light, give the white appearance to
milk.  Cream is more digestible than butter,
and where it can be procured fresh  is a very
desirable article of diet where fatty food is re-
quired for health.  It may be taken with ad-
vantage in cases where cod-liver oil is needed
but cannot be taken.  (See Milk )
   CREAM  OF TARTAR, or Bitartrate of
Potassa, is deposited in an impure condition
(Argol) in wine jcasks when the wine has been 
CREASOTE
CROTON  OIL
89
 allowed to stand for a time.  The sediment
 is purified by washing, etc., and as cream of
 tartar is employed in  medicine in  various
 ways.   In small doses it is cooling and tends
 to increase the flow of urine ; in larger doses
 it is  a purgative, producing copious watery
 stools.  For the latter purpose it is commonly
 combined with jalap (as compound  powder
 of jalap) or scammony.  Such a combination
 is largely used in certain  forms  of dropsy,
 especially such as depend on acute inflamma-
 tion of the kidney, as after  scarlet fever.  As
 a refrigerant and diuretic,  cream of tartar is
 best given as a habitual drink.   An ounce of
 the substance may be added to a quart of boil-
 ing  water,  sugar added to taste, and a few
 slices of lemon allowed to float in the mix-
 ture ; a wineglass full or more  to be  taken
 now  and again.   The use  of such a simple
 remedy has sometimes a wonderful effect  in
 cures of dropsy,  the more especially  as  it
 may  be used as an  auxiliary to more power-
 ful means.
   CREASOTE is one of the numerous sub-
 stances produced  in the  destructive distilla-
 tion  of  wood for the purpose  of obtaining
 acetic acid.  It is or ought to be a colorless,
 transparent liquid with  a  peculiar odor and
 burning taste.  It  was at one time  exten-
 sively employed in medicine,  but since the
 introduction of carbolic  acid the  purer sub-
 stance  has  greatly superseded  the use of the
 less pure creasote of whose composition we
 know little.  It might  be  expected that the
 virtues of creasote  would  resemble those  of
 carbolic acid in preserving substances from
 putrefaction, and, indeed,  it is  largely used
 for rendering wood  less liable to  decay.  In
 medicine too its properties are analogous, thus
 a drop or two of  creasote  have been found
 most useful for arresting vomiting connected
 with  fermentative  changes in  the   food.
 Again, it has been found of use in arresting
 certain changes within the system,  as the
 excessive formation  of sugar, characteristic of
 saccharine diabetes.  Diarrhoea depending on
 fermentative or putrefactive changes in half-
 digested food may be arrested in like fashion.
 In haemorrhage from the stomach creasote  is
 often of  use, provided, of course, it does not
 arise  from liver disease.   Its vapor, mixed
 with that of hot water, has  been highly com-
 mended  in chronic bronchitis and phthisis,
 with excessive or foetid expectoration.  Car-
 bolic acid may be used in the same way.  As
 an application to wounds and sores, creasote,
 like carbolic acid  when  properly diluted,  is
 very valuable.  As before said, it is a power-
 ful remedy, one or two drops is  enough for a
 dose.   For a lotion or gargle half a drachm
 may be added to a pint of water, with which,
 however, it does not mix  readily and  does
not at all dissolve.   Acetic acid aids the com-
bination.  A drop of  creasote  on a bit of
cotton placed in  the hollow of  a decayed
 and aching tooth almost always  affords re-
 lief.
   CREATINE  is a substance composed of
 carbon, hydrogen, 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-
 different animals.  The flesh of fowls yields
 the largest quantity.   The flesh of fish con-
 tains it in larger quantities than beef or mut-
 ton.  Creatine is obtained in colorless trans-
 parent crystals, and, dissolved in water, it has
 a slightly bitter taste.   It unites with the va-
 rious acids  forming salts.  When creatine is
 boiled  with alkalies,  a  new  alkaloid is pro-
 duced  called  sarkosine.   This substance  is
 also found in the flesh of animals.  If  creatine
 is 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 decomposition of the flesh of an-
 imals.   They are found with the extract  of
 meat, but whether they exert, any power on
 the system is not known.   It is, however, an
 interesting  fact to know that they belong to
 the same  class of substances as quinine and
 theine, both of which exert a great influence
 on  the nervous system and are used in medi-
 cine and  food.   (See Tea, and Meat, Ex-
 tract of.)
   CRIMINAL AEORTION.  (See Abor-
! TION.)
   CROCUS.  (See Saffron.)
   CROTON OIL is  the  oil expressed from
 the seed of a  plant growing in the East In-
 dies.   It is of a  lighter or deeper yellow in
 tint, varying with exposure.  Its odor is un-
 pleasant,  and  its  taste  exceedingly acrid.
 This oil  is extremely  irritant, and as such is
 employed  both  externally and   internally.
 Thus a drop is frequently added to five grains
 of compound  colocynth pill  as a remedy in
 obstinate constipation, or again in seizures of
 an apoplectic nature ; a drop or two is let fall
 on  sugar,  and deposited  in the back of the
 throat to be swallowed.   In either case a co-
 pious action of the bowels ordinarily follows.
 Another very good plan is to add a drop of
 croton  oil to a tablespoonful of castor oil, also
 with a view to increasing  its activity where
 •the bowels  are obstinately confined.  It is,
 however, too powerful to be used as an ordi-
 nary purgative.  Externally, croton oil rap-
 idly brings out a  crop of small pustules, and
 acts as a counter-irritant, but is rather painful.
 It is therefore better to  add a small quantity
 of_ the  oil to some liniment, and rub in the
 mixture.   Thus a drachm  may be added to
 an ounce of soap liniment or turpentine lini-
 ment.  Such a combination is of great use in
 certain stages of consumption, when  there is
 pain in the walls of  the  chest, or again in
 certain forms of neuralgia or muscular rheu-
 matism.  It should be used night and morn- 
DO
CROUP
CURRY POWDER
 ing till a crop of pustules make their appear-
 ance, and after that, at more distant intervals
 for a somewhat longer period.
  CROUP is an inflammatory disease of the
 larynx or upper part of the wind-pipe, and is
 very  common  in  children  between two and
 five  years of age.  It  is  attended by very
 noisy breathing, and  this,  which is a marked
 symptom,  is due  to spasm of the glottis,
 which by  being thus  narrowed, prevents the
 free entrance of air into the lungs.   The child
 feels as if it were going to be choked, and it
 makes violent efforts with  the muscles of the
 chest,  so as to  increase the supply of  air
 within.  Some  children  are very liable to
 croup, and have it several times over ; in such
 it is generally a spasmodic affection, and due
 to some nervous irritation.   The symptoms,
 although alarming at first, will often pass off
 in a few hours.  It is seen also in children
 who have had  measles  followed  by some
 bronchial  or laryngeal affection.  Croup must
 be distinguished from diphtheria, in the course
 of which  disease  a similar noise is some-
 times heard  during inspiration,  but that dis-
 ease is catching, is far more fatal,  and is at-
 tended  with  the formation of a false mem-
 brane  in  the air-passages, and also in the
 throat and nose ; such cases, however,  are
 too often called croup.
  Treatment.—Croup is  a disease in which
 no  delay  should take place in  treatment, as
 imminent danger may ensue from suffocation.
 Hot sponges wrung out of hot water should
 be at  once  applied to  the throat,  and  the
 patient should  be made to inhale  steam by
 putting before him a jug of boiling water.  A
 small mustard poultice may be applied to the
 front of the throat,  and  when the urgent
 symptoms have subsided, a large hot linseed-
 meal  poultice should be wrapped round the
 throat, and renewed, until the breathing is all
 right again.   Vomiting is a source of great re-
 lief in many cases, and for this purpose syrup
 of ipecacuanha may be given in doses of a tea-
 spoonful repeated every 15 minutes until vom-
 iting  occurs.  Medical advice should be ob-
 tained as early  as possible, as domestic treat-
 ment must not  be relied upon in this disease.
 When a child is attacked more than once with
 this complaint,  less fear need be entertained,
 as it is probably spasmodic, and will go  off
 again if treated early.   After an attack care
 should be taken not to  expose  the  child to
draughts ; flannel  should  be worn next the
skin, and  a comforter wrapped around the
throat; regular diet should be given, and the
bowels should be kept open once a day, and
any cause likely to set  up nervous irritation
should be  removed.  For Spasmodic Croup,
see Laryngismus  Stridulus.
  CUBEBS are a kind of pepper cultivated
in Java.   Unlike most other kinds of pepper
the berries retain their tails.  They have a
taste something like pepper, and a disagreea-
 ble odor.  They arc  almost exclusively em-
 ployed for arresting discharges from the uri-
 nary passages, however produced ; but on ac-
 count  of the  unpleasant  and unmistakable
 odor they give the  breath, are not nowadays
 very much employed.  Cubebs have also been
 used for chronic inflammation  of the blad-
 der, and for the relief of internal piles.   The
 dose varies  from  15 grains to  2 drachms.
 An oil is obtained  from the fruit,  which has
 similar  properties.   Its  dose is  about 10
 drops.
  CUMIN is  the fruit of  an umbelliferous
 plant, having properties like Carraway.
  CUPPING  is a method of local blood-let-
 ting, practised  for the relief of inflammation
 and congestion in internal  organs.   The in-
 struments used are bell-shaped glasses, vary-
 ing in size, and a scarificator, which is a brass
 case containing ten or a dozen  lancets, the
 edges of which can be made to start out by
 touching  a spring.   The  operation  is  per-
 formed in the following manner :  After the
 skin over  the  affected part has been  well
 washed with a sponge dipped in hot water, it
 is covered  by one or more  cupping glasses,
 the air within which has just been rarefied by
 the flame of a small spirit lamp, or of pieces
 of blotting paper steeped in spirits of wine,
 and  then ignited.  Up to this point, the  pro-
 ceeding is called dry cupping ; but if it be de-
 sired to draw blood, each glass is  removed,
 the  scarificator applied and discharged, and
the glass again  heated and placed over the
 small lined wounds formed by  the lancets,
 As  the rarified air within the cupping glass
 cools and becomes  condensed, the  skin rises
up as a dome-shaped swelling, and blood is
 sucked   out   from  the  numerous  lancet-
 wounds.   In this way, from 15 or 16 ounces
 of blood may be drawn from the surface of
 the body. As the scars formed after scarifica-
 tion are permanent, and very distinct in con-
 sequence of their number and arrangement,
 it is  necessary to avoid cupping exposed parts
 of. the body.
  CURCUMA.  (See Turmeric.)
  CURRY  POWDER  is a  compound of
 condiments and  spices introduced from the
 East Indies, and is employed to give flavor to
stewed meats, which are usually  mixed with
 rice.  Genuine curry  consists of  turmeric,
cardamoms,  ginger,  allspice,  cloves, black
pepper, coriander, cayenne, fenugreek,  and
cumin.   Of course the flavor of the curry will
vary according  to the  preponderance of  one
or more of these  ingredients.  Although the
constituents of curry powder are unobjection-
able, it may be taken in such quantities, or the
more stimulant substances may be introduced
in such quantities, as to become  injurious to
the stomach and render it powerless to digest
without the curry. Such curry also predisposes
to the drinking of alcoholic beverages, and is
 often taken to produce such a thirst.   Curry 
CUSSO
CYSTITIS
91
 powder, when used  in small quantities, is an
 agreeable aromatic,  and certainly acts bene-
 ficially in  hot climates by  recalling to the
 stomach the circulation, otherwise exclusively
 excited by the action of the sun on the skin.
 Curry powder is much preferable to alcohol
 as a stimulant of the  stomach in hot coun-
 tries,  as it  does not  affect  generally the
 nervous system,  nor  act  destructively  on
 the secreting surfaces of  the stomach  or
 bowels.
   CUSSO, or Kousso., are the flowers of a
 plant growing in Abyssinia, where they are
 largely used  as  a remedy for the tapeworm
 so prevalent there.   The remedy has not been
 very much used  in this country, partly on ac-
 count of its price, partly on account of  its
 adulteration.  Half  an ounce of the flowers
 is to be  infused in half  a pint of water, and
 swallowed,  flowers  and all.  Half an  hour
 after,  a dose of castor oil  (half an ounce)
 should be taken.
   CUT-THROAT  is generally the result of
 an attempt at suicide or murder with a knife or
 razor. In such cases,supposing that the escape
 of blood has not caused immediate death, the
 first object is to  prevent  further bleeding.
 The wound must  be cleansed with a sponge
 and warm water, and  the  bleeding  vessels
 secured  by ligatures.  Next  the edges of the
 wound or wounds should be brought together
 by stitches,  care being taken to keep the
 patient's head forward  by means of suitable
 bandages, so that  the cut edges may be ap-
 proximated.   If  the  air-tube (trachea)  be
 divided,  care must be taken that matter from
 the gullet does not interfere with respiration,
 and supposing the gullet itself be wounded,
 sufficient nourishment  must  be  allowed to
 pass  downward, and possibly a small tube,
 leading from the  mouth, or from the wound
 to that part of the gullet below  the  injury,
 may be required for a time.
   CUTS.  (See Accidents.)
   CYANIDES are  salts of metals and the
 compound radical cyanogen.   Prussic acid is
 a compound of hydrogen and cyanogen. (See
 Prussic Acid.)  The cyanides of the  metals,
 when  placed  in  contact with organic sub-
 stances containing hydrogen and oxygen, are
 accompanied  by prussic acid and an oxide of
 the metals are formed.  Cyanide of potassium
 acts in this way and is often  used as a poison.
 It is employed by photographers for the pur-
 pose of  washing their  plates, and is now a
 common article of commerce.  It is  in this
 way it has come to be used as a poison.
  CYANOGEN.  (See Cyanides.)
  CYANOSIS is a term applied to the blue-
 ness or lividity of the skin which is so often
 observable  in children who are born  with
 malformation  of the heart.    The blueness is
most marked  in the hands and  feet, in the
ears, tip  of the nose, and,  in fact, in those
parts  where the circulation  is slowest and
 most languid.  It is due to the veins and
 small vessels being too full of blood as a con-
 sequence of the obstruction to the circulation
 through the heart.  The malformations  are
 of various kinds, and will hereafter be  con-
 sidered.  (See Heart.)   Such children rarely
 live many weeks, if the  obstruction be very
 great ;  in other cases,  they may go on for
 some months, or even years, but they are very
 liable to die. if attacked by any acute disease.
 Cyanosis is seldom  noticed until a month or
 two after birth, and often it is associated with
 convulsions ;  at the same  time  the  child
 suffers  from shortness  of breath, which is
 worse on coughing  or making any exertion.
 This disease also hinders the development of
 the child, and  hence  the tissues become badly
 nourished.  There is generally some oedema
 or  swelling of the  extremities, because  the
 serum of the blood oozes through the coats of
 the distended vessels into the loose tissue un-
 der the  skin.
  Treatment.—Very little can be done in the
 way of  treatment,  as cyanosis depends  upon
 a condition of things which is incurable ;  yet
 life may be prolonged, and certainly distress
 may be alleviated,  by  taking care  that  the
 child is  not exposed  to whooping-cough or to
 cold, so as to catch bronchitis or pneumonia,
 or to the contagion of  measles and scarlet
 fever.   The child  should be fed in the usual
 way, and may be taken out in the open air on
 fine and warm days.  The extremities should
 be kept  nice and warm by thick woollen gloves
 and socks, and friction with the hand may be
 daily used on  those parts in order to encour-
 age  the flow of blood  through them.   The
 object   of the  treatment is  to  prevent  the
 child  taking any  disease which  might  yet
 farther  embarrass the circulation, while  the
 flow of blood through  the tissues  is kept
 up  by   increasing  the  ordinary  heat of  the
 body  by warmer  clothing.  Persons  who
 have suffered  from emphysema and  bronchi-
 tis, who are short of breath, and have had a
 cough  every winter  for many years, become
 blue about the lips and ears, and  often have
 swelling of the legs.   Here again, these peo-
 ple are  suffering also from an obstructed  cir-
 culation, and  they also are really cyanotic ;
 but usually the  term cyanosis is confined to
 children who are laboring under  malforma-
tion of the heart.
  CYSTITIS  is the technical term for  in-
flammation of  the bladder.  The symptoms
are great pain  in the region behind the scro-
tum or purse, in the groins, and lower part of
the back, tenderness over the bladder.   Very
frequent desire to pass water, attended with
great efforts  to do  so, and  a whitish  ropy
mucus  deposited in  the  urine, accompanied
with feverish  symptoms.  Treatment:  Hot
baths, and hot fomentations, the administra-
tion of calomel, and  castor oil, to  relieve  the
abdominal circulation, the pain to be allayed 
92
CYSTS
DEAFNESS
by opium or morphia, either internally, or as I   CYSTS are tumors consisting of a limiting
a suppository, and copious draughts of bicar- | bag, or sac, which contains either solid, semi-
bonate ofpotassaand lemon juice.  Infusion  solid, or  fluid matters.   (See Ganglion  and
of buchu has also been used with benefit.      | Hydatids.)


                                         D.
  DALBY'S CARMINATIVE is  a popu-
lar  carminative.  It contains carbonate  of
magnesia, tincture of assafoetida, tincture of
opium (laudanum), and the oils of anise, pep-
permint and other volatile oils.  (See Car-
minatives.)
  DALTONISM  is a condition of  the  eye
in which the individual is not able to distin-
guish one  color from another.  Dr. Dalton,
the celebrated chemist, labored under this de-
fect, hence the  name.  (See  Color-Blind-
ness.)
  DANDELION is the root, of  the common
dandelion  of  our fields gathered during  the
winter months.  It yields when cut a bitter
milky juice, to  which  some  rectified spirits
may be  added  to  make it keep  (one pint to
three of juice), and the whole used as a medi-
cine.  The value  of  this remedy,  which is
commonly called taraxacum,  is  exceedingly
doubtful ;  some attribute to it great  virtues ;
others deny  them altogether.   Certain it is
that in the hands of most regular  practitioners
it does not now obtain such a reputation as
formerly.   It is  ordinarily given  in cases
where the liver is supposed to be out of
order, but generally with other remedies of a
more powerful  character.   To give  it a  fair
trial, the juice  above referred to  should be
given in teaspoonful doses three or four times
a day.
  DANDRUFF,  a disease of the scalp, at
tended with the production of scales on the
skin.  (See Pityriasis.)
  DATURA.  (See Stramonium.)
  DEADLY NIGHTSHADE. (See Bel-
ladonna.)
  DEAFNESS is the one common  symp-
tom of a great majority of diseases of the ears
meaning thereby  not absolute,  or  as it is
sometimes called   " stone"  deafness,  but
merely defect in the power of hearing.  Thus
it may  arise from  obstruction of the outer
ear, from  perforation of the  membranes of
the tympanum or drum of  the ear, from  in-
flammation of the middle and inner ear, from
paralysis of the nerve of hearing, or from ob-
struction of the Eustachian tube from what-
ever cause.   A word of explanation  is  re-
quired as to the structure of the ear to under-
stand this aright.   The ear consists of three
portions besides those which we  see exter-
nally.   The opening we see which leads into
the skull is  the outer ear (or Auricle), and it
reaches  to a  certain depth.  There it is  ter-
minated in a membrane which completely
blocks up  the passage, and which is called the
membrane of the tympanum or drum of the
ear.   Beyond this comes the middle ear, or
tympanum,which  contains  air, admitted to
this  portion  of  the  ear by  a tube  which
reaches down and opens into the back of the
throat.  This  tube is  called the Eustachian
tube.   Between the drum of the ear and the
wall of the  innermost  cavities of  the ear
are four little  bones,  which are jointed and
movable, so that being  attached to the drum
of the ear and to a corresponding membrane
between the middle and inner ear, any move-
ment of the one is  immediately  communi-
cated  by them to the other.  In  the inner ear,
or labyrinth, which is filled with fluid, are ex-
panded fine membranes in which the nerve
of hearing terminates, so that any movement
in the fluid is at once communicated  to the
nerve and from the nerve to the brain.  Vi-
brations in the atmosphere being the cause
of most sounds appreciated by us, these  vi-
brations or waves act upon the drum of the
ear, then  through the  small  bones  on the
membrane between the middle and inner ear;
its vibrations set the fluid in motion, whereby
the nerve is affected and the sound appreci-
ated.   Anything  which interferes with this
process will cause deafness.  Hence we may
divide the causes into  those  affecting the
outer,  middle, or inner ear.  Children often
put foreign bodies, as peas, glass beads, slate
pencil, etc., into their ears.  These may, by
obstructing the passages, interfere with hear-
ing.   They should not be  rashly interfered
with if they cannot be removed by syringing
with water.
   One of  the most common causes of deaf-
ness is the accumulation of the  substance we
call wax  in  the  ear.   This sometimes be-
comes very hard and gives rise to noises in
the head, deafness, etc.  It can generally be
removed by syringing with soapsuds.   If not,
put in a drop or two of glycerine and a bit of
cotton wool for a day or two till it soften, and
then try again.  The injected fluid should be
warm, and should not be sent in violently but
gently.  Sometimes  after  fevers  there  re-
mains behind a  discharge from the ears in
children which is apt to give rise to deafness.
The ear may be inflamed  and give  rise to
much pus,  and the tympanum  may be perfo-
rated.   Sometimes the cuticle becomes thick-
ened and the epidermis accumulates in masses
very hard to remove, unless previously soft-
ened by glycerine or warm oil  and liquor  po-
tassae.  In ear  cases syringing is the only
method applicable to removing obstructions 
               DEAFNESS

 which can  be recommended to  the  public.
 Another affection of the outer ear is a fleshy
 growth called a polypus.   These always re-
 quire surgical  treatment, and often  special
 skill, so as to remove them without injury to
 the  parts  concerned.   It has already  been
 pointed out that the drum of the ear or mem- i
 brane of the tympanum may inflame, if so, in
 all probability, the middle ear will become
 affected  in  the same way, as the membrane |
 which lines the middle ear lines also the drum
 on its inner side.  Sudden and intense pain
 is characteristic of this lesion, which  in all
 probability goes on to destruction  of the drum
 of the ear and complete deafness.  There may
 also be a chronic inflammation of the inner
 cavity leading surely to permanent deafness.
 Leeches to the back of the ear generally do
 good in these  affections, but other remedies
 are generally required.  In the acute affection
 it may save the drum to perforate  it and allow
 the purulent fluid in the middle ear to escape.
 Rupture of  this membrane, may  be acciden-
 tal, from blows on the ear, loud noise,  etc.
 Such rupture is shown by the fact, that if the
 patient hold his nose and breathe  out with all
 his might  the air will escape by the Eusta-
 chian tube and outer ear.  Such an injury can
 in great measure be repaired by introducing a
 little cotton wool into the ear, quite down to
 the perforated drum.  This is quite as good as
 much  more  expensive and complicated ar-
 rangements.  Should the discharge  persist,
 the organ must be washed out by a very di-
 lute solution of carbolic acid.
   Another  form of deafness  is produced by
 the growing of the little  bone which  termi-
 nates the series in the middle ear, and which is
 called the  stapes,  to its attachments by bony
 union.  This sadly interferes with its  mobil-
 ity, and consequently with its powers of in-
 ducing  movements in the fluid of the inner
 ear.   The  Eustachian tube, already spoken
 of is not unfrequently blocked up and causes
 deafness.   This happens when we  have  a
 cold.   Sometimes this exceeds the amount of
 deafness ordinarily produced, for in  inflam-
 mation of the back of  the  throat the disease
 may spread upward and affect the  middle ear.
 These maladies are to be dealt with by heal-
 ing the throat in the first instance,  when
 probably the ear  will get well.   There are,
 however, a certain number of cases which re-
 quire other  treatment, but that must be of  a
 skilled kind.  Certain  varieties cf deafness,
 the origin of which  is  not well known,  are
 called nervous.  These so-called nervous deaf-
 nesses are, however, most probably,  due to
 some cause  which we cannot make out.   Thus
 the whole  group of chronic  inflammations
 of the inner ear, now well known and  duly
 appreciated, if not always readily cured, were
at one time  supposed to be due  to nervous
causes.  In  old persons,  in  whom nervous
deafness  is  supposed to be most common, I
              DECOCTIONS           93

there is usually thickening adhesion or other
changes in the bony structure to account for
the  dull  hearing.  Finally, we may  have
complete  deafness  from destruction  of  the
nerve.  That sometimes follows blows on the
head, or fracture rupturing the nerve ; or dis-
ease of the brain, affecting the part where the
nerve  comes or whence it arises.   Little or
nothing is, however, known of diseases affect-
ing the innermost ear of all.   We have pur-
posely said  little as to the  treatment of mal-
adies giving rise to  deafness, for if a little
syringing won't do, measures must be  taken
which  imply great skill, and the risk is great,
for inflammation may readily spread from the
ear to  the brain, and life be forfeited.
  DEATH-RATTLE.  (See Rattle.)
  DEATH,  SUDDEN.    (See   Sudden
Death.)
  DEBILITY, or Weakness, generally is one
of the  innumerable signs of imperfect nutri-
tion or actual disease.  Frequently the onset
of a serious disease is marked by unusual de-
bility,  while  recovery from it is always  ac-
companied  by the same.  Thus  in fever an
individual naturally strong and robust begins
to feel out of sorts, has headache  and what
he fancies is indigestion.   Often he thinks to
shake  off these uneasy feelings by  a good
long walk ; he sets out in good spirits,  but
soon finds to his astonishment that what used
to be the easiest of  tasks has become an in-
surmountable difficulty.  He returns home and
takes to bed, very probably not to rise till he
has  passed  through a  dangerous  encounter
with death.   When he begins to recover and
the fever leaves him, his most marked symp-
tom is debility ; but whereas formerly this
was the  prelude  to  disease and was ir-
remediable till the disease was over and gone,
his debility may now be combated with great
success.   Nourishing  food and  good  wine
will do wonders, but  the food must be very
nourishing and very easily  digested—perhaps
the best to begin with is essence (not extract)
of meat.  Of wine,  perhaps the best to begin
with is  old  Madeira,  but this is scarce.  A
dry sherry like Manzanella will do.  Spirits
are not good, as the stay in good wine is
far preferable ; but rather  give good  sound
spirit and water than  bad wine.  These two
forms of debility are typical of many others,
and-have therefore been  chosen.   The debil-
ity of childhood and old age differ from these
in this—they require considerable warmth as
well as appropriate food,  and  that is all-
essential.
  DECLINE.  (See Consumption.)
  DECOCTIONS  are  preparations of rem-
edies which have  been  prepared by boiling
the substance in water for a longer or shorter
period.  The length of time required for pre-
paring a decoction  should  partly at least de-
pend on the solubility of the substance to be
extracted from the drug.  This and the quan- 
94           DEFECATION
DEGENERATION
 tity of the drug used are generally so adapted
 the one to the other as to make the dose of a
 decoction  about   two  tablespoonfuls.   Of
 course in domestic as in ordinary practice, no
 drug  should  be converted  into  a decoction
 whose properties depend  on a volatile sub-
 stance, as this of course would be expelled by
 boiling.  Most decoctions should be strained
 while hot, otherwise on cooling they deposit a
 sediment.  In the  pharmacopoeia there are
 but two compound  decoctions, that is, decoc-
 tions  which contain  more than one ingredient.
 These are, the compound decoction of aloes
 and the compound decoction of sarsaparilla.
  DEFECATION is a term applied in phar-
 macy to  the  removal of the lees or sediment
 of any liquid.  It is also used  to  express the
 act of discharging the fpeces  from  the bowels.
  DEFERVESCENCE,  a  name  used to
 signify the fall  in the temperature which oc-
 curs when convalescing from acute disease.
  DEFORMITIES.—For  a description of
 the various conditions which may be included
 under this term the  reader is referred to arti-
 cles under the  following headings :  Anchy-
 losis, Club-Foot,   Flat-foot,  Hare-Lip,
 Knock-Knee,  Malformation,  Spina-Bifi-
 da, Rickets, Wry-neck.
  DEGENERATION.—During the devel-
 opment of  the  foetus, active  changes go  on,
 and the simple  elements which are  found in
 the very early stages of the  embryo are de-
 veloped  into the more complex structures
 which are met  with in childhood and adult
 life. But as time goes on, these various struc-
 tures  undergo different changes  and in  pro-
 cess of time  waste  and  decay, so that in old
 age the various organisms  of the  body are
 much less vital, and naturally decay ; old age
 is, in  fact, a  period when vital changes take
 place  very slowly,   and the tissues of  the
 human frame are more  or less in a state of
 degeneration.  But  it frequently happens that
 degeneration  takes place much earlier in life,
 either from hereditary causes,  from  bad  liv-
 ing, or from disease acquired in adult life, as
 syphilis,  excessive  drinking, etc.  Thus an
 individual may be subject to (i) fibrous degen-
 eration ;  (2) fatty degeneration ; (3) waxy de-
generation ; (4) melanotic degeneration.
  (1) Fibrous  changes take place  naturally in
 old age,, but they occur in  those who are the
 subjects of syphilis,  and in those who drink
 much  : such people  are in a state of prema-
 ture decay ; they often suffer from gout,  are
 sallow and shrunken in appearance and of
weak  constitution.   This  iorm of degenera-
tion is met with in various parts of the body.
The liver becomes firmer than usual, is often
of smaller size than  natural, and  passes into
the condition known as  cirrhosis (see Cir-
 rhosis).   The kidneys waste and  become un-
 even and granular on the  surface ; the urine
 is light in color, and there may be found al-
bumen in testing for it ;  such a state is known
 as chronic inflammation of the kidney  (see
 Bright's Disease).  The heart is  generally
 larger than usual from  having more work to
 do, and there is often disease  of the outer or
 inner coat ; sometimes  the valves are diseas-
 ed and death ensues from the serious mis-
 chief  engendered.    The  brain  does  not
 escape ;  in  some  the  membranes become
 opaque and  thickened  and the organ itself
 shrinks ; there is loss of memory, giddiness,
 pains in  the  head,  sleeplessness, and flashes
 of light  before the eyes.  The lungs become
 adherent to the chest wall and the respiratory
 power is diminished.  These changes do not
 take  place equally in  all organs,  and  the
 amount of disease varies much in  different
 individuals ;  in some one organ is more par-
 ticularly affected, in  others, general disease
 is present.  The arteries, too, which convey
 the blood to  the different parts of the body
 share in  the  degeneration ; their inner coats
 become roughened  and  brittle, and  yellowish
 opaque patches are seen ; they are  then said
 to have  become atheromatous.  Often, too,
 there is a deposit of lime salts in the coats of
 the vessels, and then the walls become  brittle
 and may rupture, or the wall may dilate  at one
 point and form an aneurism or dilated sac on
 one side of the artery.   Such vessels are said
 to have undergone  calcification or calcareous
degeneration.   Whenever  the  vessels  which
supply blood  to a part become in this way the
seat of serious disease,  the tissues nourished
by them  undergo  degeneration,  in conse-
quence of not being properly nourished  ; in
 this way coebral hemorrhage may occur from
 the rupture of a diseased artery in the brain,
or white softening of that organ may come on
from the nerve-tissue being badly nourished  ;
 or, again, a thrombus or clot may  form in
 one of the vessels from fibrine being deposited
 on the roughened  internal surface, and then
 also softening may occur.   All these changes
 generally come on in advanced life and  set up
 the condition known as apoplexy ; if recovery
 take place, the patient may still be incapaci-
 tated from work by the  consequent paralysis
 of one side or other, and he is then said to
 be suffering from hemiplegia.
  (2) Fatty Degeneration is of very  common
 occurrence, and is often found in parts  which
 having done their duty in the economy are no
 longer wanted ; thus  it  occurs in a normal
 way in the arteries or womb after a confine-
 ment, for in  this manner  the muscular  ele-
 ments  which were developed  in  that  organ
 while the fcetus or  embryo  was present be-
 come broken down and absorbed by the blood
 and lymphatics.  Fatty change also is met
 with in the liver-cells after a meal, and to a
 less  extent in the  kidney and  even in the
 blood,  but these conditions occur ina healthy
 state.  Fatty degeneration is generally found
 in scrofulous or consumptive people, in those
 who drink much, and in those who are  the 
DEGENERATION
DEGENERATION          95
subjects of any urinary disorders.  The liver
is very often the organ chiefly affected ; it be-
comes larger than usual, of a pale fawn color
and greasy to  the feel.  The changes go on
very slowly, and at first are not noticed by
the patient ; there  is no pain, no jaundice,
and, in  fact, very  little inconvenience ; but
after  a  time  there is  dyspepsia,  loss  of
strength, pallor of  skin, and dropsy of the
abdomen or skin may occur ; often,  too, the
kidneys share  in the mischief  and  become
much larger than usual and the tubes  of those
organs are full of oil ; less water is passed
than usual, and the urine, beside being scanty,
is dark in color, of  high specific gravity, and
deposits albumen on boiling  and a sediment
on  standing.   This change aids in causing the
onset of dropsy and hastens the progress to-
ward  death.   Just  as the  fibrous  degenera-
tion brings on a cirrhosed  liver (see Cirrho-
sis) and the contracted kidney of Bright's dis- i
ease (see Bright's Disease) so the fatty form J
of  degeneration brings  on a fatty liver (see j
Liver) and the fatty form of Bright's  disease, i
But it seldom happens that this change at- j
tacks  one  organ only, and  in general the i
heart, muscular system and vessels suffer,  as
well as the liver and kidney,  and sometimes
it is associated with the fibrous degeneration.
The heart  becomes flabby, and weaker  than
usual, and  often dilates in consequence of be-
ing unable to bear up against the pressure of
the strain ; such people are in general of mid-
dle or advanced life, and are subject  to faint-
ing fits of an alarming nature, to palpitation
on  exertion and general distress of breathing.
This, too, is a common cause of sudden death,
for the left ventricle  may  become over-dis-
tended and then is unable to contract, so that
the patient dies of syncope.   The muscles oL
the body in these cases are flabby and badly
nourished,  so  that there  is loss of strength
and inability for exertion.   Yet the  patient
often looks stout, because there is plenty of
fat  under the skin, and so wasting does not
go  on in that tissue.  The  minute vessels in
the different organs  undergo, likewise, a fatty
change, and may produce symptoms  and dis-
eases  like those mentioned  under the head of
Atheroma, above.
  (3)  Waxy degeneration is much  less com-
mon than the above two varieties.  It is met
with in  rickety or scrofulous children,  in
those who suffer from disease in the joints,
as hip-disease, etc.,  and in those who are the
subjects of  syphilis, inherited or acquired,  or
in those who have had ague, cancer,  or some
chronic wasting disorder.   This form gener-
ally attacks the liver, spleen, kidneys, and in-
testinal  canal.  The  liver is  much larger
than usual,  and is translucent  in appearance  ;
it may become  so large as to fill up a great
part of the abdomen, and  cause a feeling of
weight in the right side ; pain is seldom pres-
ent, and never  severe ; jaundice  does not
occur, and there is seldom any dropsy.  There
is a feeling of fatigue and general debility ;
the appetite is impaired, and the patient may
suffer from dyspepsia ;  the skin is often of a
deadly pallor, but there is not much loss of
flesh ; when the blood is examined under the
microscope or chemically, it is  found to be
deficient in red corpuscles, and more watery
than usual. When the kidneys are affected, the
patient passes a very large quantity of water,
free from deposit or  nearly  so, very pale in
color,  and  containing  albumen ;  often  at
first there may be some  blood present, but
this does not last long ; it is the daily drain of
albumen from the system in these cases which
is so exhausting to the patient.  The result of
the intestinal canal being affected is shown by
a troublesome diarrhoea  sometimes  accom-
panied by bleeding from the bowels, and this
may easily be  excited by any error of diet.
The spleen becomes large, but does not cause
pain, nor, in fact, any symptoms easily notice-
able by the  patient ;  but it  aids in causing
those changes in the blood which are met with
in this disease.  The reader must refer to the
articles on the Liver, Kidney, and Spleen,
for further information  ; the waxy change in
the kidney  forms  one of  the  varieties  of
Bright's disease.  The term waxy is used,  not
to signify the actual change that takes place,
but the common appearance presented by va-
rious organs  when so  affected  ; some have
adopted the term of amyloid or lardaceous de-
generation for the  same affection.   These
three forms of degeneration are all chronic in
their  nature, and may  last for years before
they cause death ; but in the meantime, they
have caused serious changes in various tissues
of the body, and made the  individual very
liable to acute disease.   Often such patients
seem in very good  health, and men wonder
why in the midst of such  apparent vitality,
death may so  suddenly in some cases take
place ; but it is not really the acute change
or disease which kills, but the slowly-proceed-
ing course of events,  which, beginning years
previously, finally carry off the patient in an
unexpected   manner.   These  changes  are
often the result of  follies in early life, and
proceed from an excess in eating or drinking,
or in the too  eager pursuit of pleasure ; and
while for a long time  the system  does  not
seem to be affected by such a course of liv-
ing, yet in the end disease is sure to super-
vene.
  Treatment.—The physician  cannot give
back health, he cannot  restore those tissues
to a normal state ; but  he  may do  much  to
arrest its course, and  to  place  the  patient
under more favorable conditions for preserv-
ing life.   The diet should be carefully regu-
lated and  no excess of any kind be allowed.
Each  meal should be light and nourishing,
and easily digested, consisting of meat once,
and if  possible, twice a day, light puddings, 
9G          DEGENERATION                       DELIRIUM TREMENS
fruit, toast or bread, milk, cocoa or tea  and
coffee ;  salt meat is not so good, nor arc veg-
etables of much service.  A rich dish should
be avoided, and the cooking should  be made
as simple as possible.  A pint of beer a day,
or two or three glasses of sherry or claret, or
some light wine, may be  taken ; but no ex-
cess should be taken.   Open air exercise is
very valuable, and a daily walk or ride should
be  ordered.  Early rising,  and a cold bath
every morning, is of  much service,  it the
patient be well  enough to take one, while late
hours must be  avoided,  and also hot over-
crowded rooms.   Medicines may be taken if
there is much debility, and for this purpose
iron and quinine are the  most  valuable,  or a
mixture   containing hydrochloric  or  nitric
acid, with some bitter infusion, may be taken
before a meal for the purpose of inducing an
appetite.
   A much less  important form of degenera-
tion, and one that calls for no treatment, is
the deposit of pigment in various parts of the
body, and it is  known  as  melanosis or melan-
otic degeneration.  (4.)  Melanosis is the name
given to a condition in which  coloring mat-
ter, or pigment is found in various parts of the
body.   In  infant life  very little  pigment is
met with,  so  that the lungs  are of a pink
color,  and the iris is blue in tint ; but  as
years roll on, the iris becomes  colored of va-
rious tints, and the lungs become of an iron-
gray color, or  even black.  This is quite a
natural process, and is a result of the various
tissue changes  which  occur in advanced life,
so that in old age there  is much more pig-
ment than  there is in  a child.   Nevertheless i
coloring matter may be deposited as a result
of disease.  Thus in  those who work much
in dust,  as coal  miners,  knife grinders,  etc.,
much pigment  is deposited in the lungs.   In
cincer  of  different organs, and more  espe-
cially in  the liver, pigment is found in large
quantities and gives a black appearance to the
disease.  Very  little is known  as to  the cause
of this change, nor are any symptoms caused
by it  which call for any special treatment.
 Sometimes the brain  and spinal cord are the
subject of  this  peculiar change ; it may de-
 pend in  some cases on an alteration in the
 coloring matter of the  blood, in  others  it
 seems  to be influenced  by the inhalation of
 injurious materials by the air-passages  as in
 knife-grinders'  disease.  Under the term of
 degeneration some include atrophy, but this
 has already been considered (see Atrophy).
 By this term should  be meant simple wast-
 ing, without any disease being present in the
 tissue itself, just as when the muscles of a
 blacksmith or  athlete may diminish  by dis-
 ease, or  when  a leg or an arm wastes  from
 paralysis.  Atrophy  occurs   in  almost  all
 forms of degeneration ;  but this is itself part
 of the  disease, and one  condition cannot  be
 dissociated from  the other.
  DEGLUTITION is the act of swallowing
food after mastication, and  is performed by
the joint action of the muscles of the cheek
and tongue assisted by the throat ;  so  that
when the food has been softened in the mouth
and incorporated with the saliva, it is carried
down the gullet by the act of deglutition.
  DELIQUESCENCE  is the condition in
which certain substances  become damp and
absorb moisture from the  atmosphere. Many
preparations of potash are liable to this  con-
dition, unless well protected from the air.
  DELIRIUM means that accompaniment
of acute disease wherein the  mind wanders,
and incoherent talk is the result.  It  is com-
mon  in many  acute disorders,  especially
fevers, and is more  common in  the  young
than the old.  We  speak of  two kinds of
delirium, active and passive.   The active be-
ing something merely indicative of mental de-
rangement, without any tendency to  action,
but in the  fierce delirium of some diseases
there is violent exertion  to get out of  bed,
shouts, and rage depicted in the countenance.
This  is  sometimes  the case  in  certain in-
flammations of the brain.  The other form
of delirium, in which  the mind seems to be
wandering   is generally seen  in  exhaustive
fevers, such  as typhus.  These patients will
often, however, if desired, answer questions
correctly.   The delirium  seems  due  to the
circulation  of poisoned blood or of imperfectly
aerated blood in the brain.  If, therefore, the
circulation  be relieved in  any  way it will
probably pass off at least for a time.   Delir-
ium is most  frequent in the  night and is of
very various omen.   In acute disease it may
merely indicate a sharp attack of the malady ;
but in other instances, as in inflammation of
the lungs,  the onset of delirium is a very bad
sign, showing, as it does, that the lungs are no
longer capable of purifying the blood sent to
them.
   DELIRIUM  TREMENS, or Delirium a
Polu,  is one of the consequen ces  of chronic
alcoholism.   There  may be said to  be two
varieties of the malady :  one of spontaneous
origin after prolonged drinking  ; the other
coming on  as  the  result of an  accident to
those who  are habitual drinkers without being
drunkards.  The malady consists of halluci-
nations, and trembling of  different  parts  of
the body,  which  last may be taken as a sign
of weakness  for the patient has in all proba-
bility eaten  little or nothing for some time
past,  having lived  mainly  on intoxicating
drinks.  The chief symptoms are sleepless-
ness and restlessness, with delirium generally
busy, but not very often violent, except driven
 to  violence  through mortal terror,  for the
 patient  is a terrible coward.   The objects
 seen are very often loathsome creeping things,
 rats and serpents, and the like, in the  exist-
 ence  of   which  the  patient  fully believes.
 When hearing is affected, and that is gener- 
DELIRIUM  TREMENS
DEMODEX  FOLLICULORUM   97
ally  the case, he hears people  calling him
names, taking away his character, and so on.
He will not rest in bed, and is constantly
getting up, but will lie down again quietly if
told to do so. As to his physical condition, the
face is usually pale and wild-looking, the skin
moist or clammy,  the  tongue  coated and
tremulous,  and  the  pulse quick and  soft.
There is complete loss of appetite, and the
bowels are generally confined.   In delirium
tremens there is no great risk of the individ-
ual hurting himself or others, except driven
to it  by mortal  terror, as is sometimes the
case, and then he will stick at nothing.   Dur-
ing the  night he is worse  than during the
day.  This  does not last long ;  if spirits are
abstained from the condition ordinarily ends
in eight-and-forty or two-and-seventy  hours,
in profound  sleep,  from which  the  patient
wakes weak, but in his right mind, and or-
dinarily very repentant.   Occasionally the
condition terminates fatally ; if so the tem-
perature rises and he gets no sleep ;  feeble-
ness  increases  till the delirium is muttering
merely.   Death  commonly  comes in weak
convulsions.   Broadly, it  may  be said such
cases should not occur.  The cause is almost
invariably  excessive spirit drinking,  though
other intoxicating liquors may have a  similar
effect. As a rule, such attacks come on when
the stimulus is withdrawn, and nothing given
to take its place.  The other kind of delirium
tremens is  not unfrequently seen in brewers'
draymen, who might be looked on as splendid
specimens of men, yet if they meet with any
accident they are very liable to a kind of de-
lirium which adds considerably to the risk
from  their injury.
  Treatment.—The  treatment  of  delirium  j
tremens is  a simple thing,  and yet it requires
the greatest possible judgment.  The strength  |
of the patient is  the great thing to look to :  j
if that is good, all should go well.  If the at-
tack is an acute attack, that is to  say,  coming
on after a bouse of six  or eight  days, and if
the patient has eaten  nothing,  or little  or
nothing during all that time, as is very often
the case, the first thing is  to get him to take
food. Here, too, perhaps, it is not advisable
to cut off stimulants entirely, but to  substi-
tute others  for those to which the individual
has been accustomed.  The aromatic spirit of
ammonia and spirit of  chloroform will be
found best.  With these precautions,  giving  |
too a little  brandy,  if necessary, the patient
will do well enough for eight-and-forty hours,
very  miserable,  it may be,  but  in no risk
whatever. At the end of that time, his bowels
having been well opened in  the  interval, let
him have a  good dose of morphia subcutane-
ously, half a grain or so, and be put quietly to
bed.   There is little use of trying to keep him
in bed up to that time ; very likely he will go
to sleep and wake a new man. Tipplers are
more easily or with more difficulty managed.
These, if the)' have had a debauch after a long
course of habitual tippling, make perhaps the
worst patients.  Their appetite and digestive
powers are completely gone, and they have
no reserve of strength ; very likely they have
had one or two attacks previously, but disre-
garded them.  Such  must be  handled with
care ; their  strength must be  kept  up, and
stimulants of any or every kind given, if nec-
essary,   and  the  critical period  must  be
watched  for with care.   If it comes, then
opium in full dose ; or  if it does not come,
opium or chloral must still be given to try to
bring it on.   It is in  such cases  that the injec-
tion of  morphia under  the skin is of most
manifest benefit.  Given by the  stomach it
would very probably not be absorbed ; given
by the arm it must be  (see Hypodermic  In-
jection).  In these cases, too, the tempera-
ture must be carefully watched.   If it go  up,
cold must be applied, best perhaps  in  the
form of the tub pack ; but if the head is very
hot and the face flushed, the shower-bath may
be tried, or  perhaps what is better,  ice  ap-
plied while  the  rest of the body is packed.
But nourishment must be given hour by hour,
or even  at  shorter  intervals, or the patient
may sink.  The other variety is compara-
tively mild,  a little extra  drink may have in-
duced an attack of the "  horrors."   For this,
perhaps, the best remedy is a good  emetic
and purge, or a  good long walk.   Here, too,
the strength must be the  guide as to the treat-
ment.
  DELITESCENCE,  a  term  sometimes
used to signify the sudden termination of an
inflammation.
  DELIVERY.  (See Labor.)
  DELUSION. (See Insanity.)
  DEMENTIA  is that  form  of  insanity
where the mind  gradually fades away or be-
comes a perfect  blank.  It is  a  common
finale toother kinds  of insanity, and a kind of
it occurs in  a considerable majority of very
old people.   The other kind of insanity allied
to it is imbecility or idiocy—but by idiocy we
imply  a total absence of reasoning powers
from the birth, and by imbecility we mean a
marked  absence  throughout  life  of such
powers as are possessed by the  average of
mankind.  In   dementia  there   is   marked
apathy to everything and everybody, though
sometimes the patients  are subject  to fits of
restlessness.  Their manner is what we would
call childish or silly, and they repeat words
without attaching any meaning to them.  De-
mentia  constitutes  the  last stage of many
forms of madness, and is altogether beyond
hope of  recovery.   In old people, however,
there may be a brightening up before death.
(See Insanity.)
  DEMODEX  FOLLICULORUM,   the
name given to a little animal which is found in
the follicles of the skin. The function of these
follicles ii to  secrete  oil, with which  the skin 
98           DEMULCENTS                              DENTITION
is naturally lubricated.  In these follicles, espe-
cially those on the  sides of the nose, the mi-
nute animal in question is found to reside.  It
belongs to the family of mites, and has eight
imperfect legs and is  about the tenth of an
inch in length.  It is perfectly harmless,  only
occasioning a slight inflammation, which pro-
duces a minute pustule and destroys the ani-
mal.  It must not be  confounded with the
itch mite, which is much smaller and quickly
spreads over  the whole body.  (See Itch.)
  DEMULCENTS are a class of medicines
composed of  bland unirritating substances,
most of which form with water a viscid solu-
tion.  They are given  in cases where the ali-
mentary canal is irritated or inflamed,  and
are supposed  to have  an effect on even the
respiratory  passages  when  taken  by  the
mouth.   The  substances  employed contain
sugar, gum, or starch, and sometimes all three
of these are combined.   Pearl barley, Iceland
moss, liquorice, marsh-mallow,  oatmeal, lin-
seed, gum  acacia, and  tragacanth, are a few
examples of this class of substances.   Decoc-
tions of these  things may be made useful ve-
hicles for  the administration of other  and
more powerful agents.
  DENTIFRICE. (See  Teeth.)
  DENTITION, or the process of teething
in children, begins  generally at  the  sixth or
seventh month of infant life, and is not  usu-
ally  completed  until  the twenty-fourth or
thirtieth month.   The first indication of teeth-
ing is shown  by the increased flow of saliva
into the mouth ; at first  the  salivary glands
seem to have  very little to do, and the mouth
has a tendency to become  dry, but about the
fourth or fifth month the mouth will be  seen
to be constantly  filled with  saliva, and the
child continually drivelling.  Teeth have come
through at the fourth, or even as early as the
third month, but in these cases, when the first
are so forward, the  rest come out at the usual
time,  and there is  a longer interval between
each appearance.   The two middle incisors
of the lower jaw generally appear first,  then
the corresponding teeth in the upper jaw, and
next the  lateral  incisors  of  the lower  jaw.
There is no definite order about the cutting of
the remainder, but  usually the four anterior
molars  next  appear,  then  the  four canine
teeth,  and  lastly  the four  posterior  mo-
lars.  Children, therefore, have  only twenty
teeth, and these  are called  "deciduous or
milk" teeth,  because,  during  childhood  they
gradually fall out and make way for the " per-
manent" teeth,  which  are more numerous.
The arrangement of teeth in each jaw of an
infant is, therefore, the following :  i  poste-
rior  molar,  i anterior  molar,  1 canine, i
lateral incisor, 2 middle incisors, i lateral in-
cisor, i  canine, i anterior  molar, i posterior
molar.  The " permanent" teeth are thirty-
fvo  in  number ; each " milk" tooth is re-
placed by a "  permanent one, and in addition
 three molars are developed in each jaw on
 each  side, so  that in adult  life there are two
 rows, each row containing sixteen  teeth in-
 stead ot ten.  The process of development in
 the infant  as  regards dentition does not go
 on regularly, and it often  happens that par-
 ents undergo considerable anxiety by seeing
 several teeth  appear,  and  then  observing
 none appear for some time ; there is seldom,
 however, any real ground for anxiety, for the
 process is one natural to every child, and no
 attempts on the part of the medical man or
 nurse can hurry the course of nature.  Three
 or four  months may elapse  between the ap-
 pearance of the lateral incisors  and the ante-
 rior molars, while a still longer interval may
 intervene between the latter and the posterior
 molars.  Dentition is generally attended with
 more or less suffering and constitutional dis-
 turbance ;  but, on the other hand, there can
 be no doubt that a great  many infantile dis-
 orders are  put down as due  to this cause,
 when perhaps there  is no  relation  between
 the two.   When teeth appear, mothers not
 only suckle their children, but give them thick-
 ened food, or even solid food, under the idea
 that such food is more strengthening for them
 than milk or liquid diet ; and herein  arises a
 great mistake, in consequence of which many
 infants suffer ;  it is not the teething  in  those
 cases that does the harm, but it is because the
 delicate stomach  is overloaded  with food
 which it cannot digest ; an  alteration of the
 diet soon gives great relief.  Yet dentition is
 attended with  disorders of its own.   Many a
 child cuts a tooth without any  more discom-
 fort than an increased flow of saliva and drib-
 bling from the mouth ; at other times the
 gum becomes  tense  and shining, while the
 mouth is hot,  and the  child restless and fe-
 verish ; the position of the new tooth may be
 seen by the prominence of  the gum over it;
 often there are  small ulcerations  on the
 tongue, gums,  or inside the lips.  The child
 may be fretful and cry out as if in  pain, and
 it may sleep badly at night, and perhaps have
 a convulsion.   In yet more severe cases, in-
 flammation of  the gum may occur,  attended
 by considerable fever and disturbance of the
i digestive functions.   Small unhealthy ulcera-
 tions  may occur on the gum just where the
 tooth has pierced, and  these give much pain
 to the child ; such  cases, however, are very
 rare,  and  in general terms it may  be said
j that, with  due care to diet  the  process of
 dentition  is  very simple, attended with but
 very slight constitutional  effects, and very
 seldom fatal in its  result.  Dentition is but
 one of the  many important changes which
 take place  in the system in the development
 from infancy to childhood, and in a delicate
 and complicated framework like that of an in-
 fant,  very slight external  causes will set up
 local  uneasiness and general  derangement;
' errors of diet or a common cold will at once 
DENTITION                               DENTITION             99
give rise to sciious symptoms ; thus it is that
if they are teething at the same time, any dis-
orders are put down to that process, when it
would be nearer the  truth  to look on denti-
tion as  only a part of  the  general develop-
ment  which is  then  rapidly  going on, and
treat the case accordingly.   It was iormerly
a common, but a barbarous custom to lance a
child's gum  frequently, under the idea that
the convulsions, or the fever, or any other de-
rangement that might be  present, arose from
the mechanical pressure of the tooth in its
effort  to pierce the  gum ;  this is quite an
erroneous theory,  and  the foolish practice
gives the infant much pain, and,  in the great
majority of cases, no ease at all.   Undoubt-
edly there are times, when  the gum is much
swollen and red, and the child is  evidently in
pain about the mouth, that lancing the gum
at the affected spot will give relief, but such
cases only  rarely occur ; prominence  of  the
gum over the place where the tooth is about to
come, attended with a paleness of the part, is
quite  a  natural appearance, and  not  one to
call for any operative interference.  When'a
child  has a convulsion  from teething then
" lancing" is  useful,  but then it must  be
clearly shown  that the little patient is really
"cutting a  tooth" at the time, and that the
"fit"  is due to that cause'.
  As  a  rule, medical interference is  rarely
wanted during dentition.  The diet must be
carefully regulated, and  the  mouth may be
moistened with barley-water,  if it is hot and
painful ;  if any ulcerations  are present, a
lotion containing chlorate of potash  is very
useful ; a  small piece of soft  linen may be
dipped in the lotion and then the inside of the
mouth can be dabbed with it.  For the same
purpose borax and water are useful ; many
use borax and honey, but the latter is sweet
and apt to become sour and undergo fermen-
tation, and when this takes place it only ag-
gravates the ulceration.   If the child be suck-
ling it may be kept at the breast, and no other
diet need be given if  the  mother has suffi-
cient  milk ; if, however, the baby has been
weaned, more care will be required, as it will
not digest its ordinary  food ;  thin arrowroot
with a third of milk  may be given, or milk
and water  sweetened  according  to  taste ;
once  a  day a little  chicken broth or  veal
broth  may be given.   The bowels are  fre-
quently disordered in these cases, and at the
outset a rhubarb powder may be given with a
little soda and gray powder ; one dose will
he  enough,  and it need not be  continued.
Should there be much vomiting and inability
to retain food  on the  stomach,  lime-water
may be mixed with the food, in  the propor-
tion of one part of lime-water to four parts of
milk and  water.   It allays  vomiting  and
diarrhoea by neutralizing any acidity  in  the
stomach, which is apt to be  superabundant at
these times.  Solid food should not be given,
as it is painful to a child to eat, and therefore
it swallows its food hastily without digesting
it, and thereby adds to the intestinal derange-
ment.   In addition to the local ulceration and
affection of the gums in teething, and besides
the derangement of the digestive functions,
convulsions may be added as a not uncom-
mon occurrence, and they seem to occur  in
consequence of  the greater susceptibility  to
any irritant  cause of  the infant's nervous
system ; indigestion  and   diarrhoea  would
help to bring about a similar state of things ;
careful dieting and  a warm bath  during the
fit are the best measures.   A slight purgative
may be given if  required, and now and then
lancing the gums may be necessary.  During
dentition the  temperature of the body may
suddenly rise several degrees, and this usu-
ally occurs at bed-time while in the morning
the fever may be much less, or perhaps ab-
sent ; the very suddenness of the rise of tem-
perature would negative the idea of any fever
coming on, and  point to some reflex  source
of irritation.   Lastly, there are some skin dis-
orders which are liable to  appear during the
process of teething ; just as sometimes occurs
after vaccination, eczema may appear on the
skin from  the constitutional  irritation ; so,
during teething,  from a similar cause, eczema
and impetigo may occur.  The former may
appear  in scabs on the scalp or behind the
ears, and in the  flexures of joints ; when the
scabs come off, a  moist  red surface is left
which  will  soon  again become encrusted.
Impetigo appears on the chin and cheeks gen-
erally as angry,  red spots, with a little pustule
in the centre about as  large as a pin's point ;
these rapidly spread by scratching, and give
great annoyance to the child.   The  nature
and treatment of each will be described un-
der separate  heads.  (See Eczema and Im-
petigo.)  It is not always wise to cure these
rashes at the time  of  dentition, as serious
symptoms have  resulted ;  the local mischief
may be kept in  check,  and during the inter-
vals of dentition the  skin  disease may  be
cured.
  The second dentition consists in the replace-
ment of the " milk" or " deciduous" teeth by
others which succeed  them ;  this  important
change  takes  place  in  childhood,  and com-
mences about the  seventh or eighth year of
life ;  some  time before  this  however, the
germs  of the new teeth begin to  develop.
The sixteen teeth in each jaw are arranged  as
follows : 3  molars, 2  bicuspids,  i  canine,
I lateral incisor,  2 middle incisors,  I lat-
eral incisor, i canine,  2 bicuspids, 3 molars.
In the  replacement of the  " milk" teeth, the
development takes place with  considerable
regularity.   First the middle incisors fall out
and are renewed ;  and then a similar process
takes place with the lateral incisors ;  the an-
terior temporary molars are followed by the
anterior bicuspid teeth ;  then the posterior 
 100        DEOBSTRUENTS

 temporary molars are replaced  in a like way
 by the bicuspid teeth ; this latter change oc-
 curs about a year later than the former : the
 canine teeth  are the last to be exchanged ;
 finally in the succeeding year the second pair
 of true molars appear, while the third pair,
 or the " wisdom teeth"  may not appear for
 three or four years, or even longer ; now and
 then they cause considerable pain and distress
 during their development.
   DEOBSTRUENTS  are a class of medi-
 cines supposed to remove  obstructions from
 any part of the body, especially chronic en-
 largements,  tumors, etc.   Plasters,  iodine,
 turpentine,  and  other local  stimulants  are
 thus called, and also the stimulus of friction
 either with a brush or the hand, when applied
 to the skin.
   DEODORANTS  are  substances   which
 purify the air and remove noxious vapors  or
 gases which may be injurious to human life ;
 they also check the growth of fungoid or in-
 fusorial  organisms.   The  diffusion  of gases
 in the atmosphere, and their consequent dilu-
 tion, thr: currents of air  caused by the varia-
 tions in  the temperature, oxidation and  the
 fall of rain,  are the main processes by which
 nature is constantly carrying on a purifying
 action.  Yet,  in  the large centres of popula-
 tion, chemical agents are required to destroy
 the various poisonous elements which would
 otherwise accumulate to a dangerous extent.
 Carbonic acid, ammonia, sulphuretted  hydro-
 gen, and various organic substances,  some
 odorous, others not, are the chief impurities
 met with.  Air purifiers or  deodorants may
 be in the form of solids or liquids and  absorb
 the substances from the air, or they may be
 gaseous,  and  passing into  the atmosphere
 act on the various impurities.
   I. Solid Deodorants.  Charcoal is the most
 effectual, and  has the remarkable  power  of
 separating gases  and  vapors from the atmos-
 phere, and oxidizes rapidly a great variety of
 substances.   Animal  charcoal is better than
 any other variety.  It should be exposed to
 the air in bags or saucers ;  its effect is very
 marked with sewage gases ;  it absorbs sulphu-
 retted hydrogen and purifies the air from the
 organic emanations of disease ;  it is very use-
 ful, therefore, in the wards of a hospital or
 in a sick room ; after death some should be
 placed in the coffin, or laid  about the  room
for a few days.   Quicklime absorbs carbonic
acid and  may be employed for that purpose ;
the carbolates of lime and magnesia  and  a
mixture of lime and coal tar are useful, but not
so effectual nor so easy to obtain as charcoal.
  2. Liquid Deodorants.   Solutions  of potas-
 sium permanganate, zinc chloride, and lead ni-
trate are  often used ; they should be exposed in
thin layers  in flat  dishes, or cloths may be
dipped in the  solution  and hung about the
room.  Not being volatile they act only on the
air which comes in contact with them, but
              DEODORANTS

 even then  may do  a great deal  of good.
 Chlorides of lime and soda, and solutions of
 sulphurous acid act  chiefly by the gases
 which they evolve.
   3.  Gaseous  Deodorants.  These air purifiers
 act  as a powerful means of freeing  the air
 from impurities.   The principal are  ozone,
 chlorine, iodine, nitrous and sulphuric acids,
 carbolic  acid, tar fumes,  acetic acid, and
 ammonia.   Ozone is  supposed to be a modi-
 fied form  of  oxygen, and  may be  produced
 by the action of electricity ;  it is found in the
 air in increased quantity  after any  electric
 phenomena ;  it may be evolved by partially
 immersing a stick  of phosphorus in water in
 a wide-mouthed bottle, or by heating  a plati-
 num wire by an electric current.  It destroys
 organic matter,  and acts as  an  oxidizing
 agent.  Chlorine,  when  given  off  in large
 quantities,  is very irritating to the air pas-
 sages, but  in small quantities it is very valu-
 able. Chloride of lime or soda may be moist-
 ened with water  and placed about the room
 in shallow vessels ;  the  gas is  then  slowly
 given off ;  if a quicker effect is desired a little
 weak sulphuric acid maybe added, which will
 liberate the chlorine more rapidly.   Chlorine
 decomposes sulphuretted hydrogen and sul-
 phide of ammonium  very soon-; it  no doubt
 destroys organic matter  in the air, and its
 powerful effect may be seen by its property of
 bleaching organic colors and destroying odors;
 it abstracts hydrogen from the compound and
 indirectly oxidizes  it.   This gas has  an un-
 pleasant  odor, although  its action is very
 effectual.   Iodine  will  decompose sulphu
 retted hydrogen and arrest putrefaction, but it
 is not so diffusive as  chlorine, and  therefore
 less useful  ; it is also very irritating  ; a small
 quantity may be placed on a hot plate, when
 the gaseous fumes will be given  off.  Nitrous
 acid is made by placing clean copper in nitric
 acid and water ;  a colorless  gas (nitrogen
 dioxide) is given off, and this, combining with
the air, forms the red fumes of nitrous acid.
 It  is a powerful agent for oxidizing organic
matter,  and it has this   property  by  very
 readily parting with its oxygen and reforming
the nitrogen dioxide, which in  its  turn will
again combine with the oxygen of the air and
 make nitrous acid ; in this way  the oxidizing
action may be continued for a long time.   It
rapidly removes the smell of the dead-house,
but  is extremely  irritating and offensive;
hence the room  should be cleared of  people
 while the deodorizing  process  is going on.
 Sulphurous acid is easily  made by burning
 sulphur ; it decomposes sulphuretted  hydro-
 gen, and acts  powerfully on organic matter ;
 this gas is extremely useful; a small quantity
 burned in the morning in a hall,  or on  a stair-
 case, will  purify a house very readily  and no
 disagreeable smell will remain :  it is  thus use-
 ful  in a children's  hospital or  in a nursery
 wherever  there  is close air.   Carbolic  acid is 
DEODORANTS
DERBYSHIRE NECK      101
now much used for  deodorizing air ; when
weak its smell is rather pleasant.   It is  pre-
pared from coal tar.   The solid acid may be
placed in a saucer about the  room,  or,  still
better, some of the solution may be sprinkled
about.   It conceals all odor and arrests pu-
trefactive  changes, and  seems to  have the
power of stopping the growth of fungi.  Tar
fumes, vinegar, or acetic  acid, and ammonia,
are old  remedies for a  similar purpose, but
they are not very effectual.
  It will thus be seen that some deodorants
decompose sulphuretted hydrogen and sulphu-
phide of ammonium, as chlorine, iodine, and
sulphurous acid ; others destroy the organic
molecules which  float  about in the atmos-
phere, as ozone and carbolic acid.  It is, how-
ever, most important to remember that none
of these agents, valuable as they  are, can
take the place of ventilation and free currents
of air.   In a sick-room a small fire should be
kept up, and the door or window opened for
a short time three or four  times a day, but
not so as to place the patient in a draught ;  it
is important to  have the air thoroughly re-
newed.  Charcoal should be placed  about the
room, or some carbolic acid  should be sprin-
kled about.  Deodorants are not  only of
much service in purifying the air in the above-
mentioned cases, but they are equally valua-
ble in  destroying  the   noxious  emanations
from sewage ;  ior  this purpose numerous
measures  have  been  suggested.   Charcoal
may be employed, but it is not so useful here
as  in purifying the  air.  Dry earth has  a
good effect ; it is used  in  earth-closets and
has been found very valuable in large institu-
tions and  in camps ;  the excreta are at once
covered  over and no effluvia  escape ; in this
way diarrhoea  and typhoid fever  appear to
have been prevented.  Quicklime and water
may be added to the  sewage  until a deposit
occurs.  The lime forms insoluble  salts, and
decomposes the  sulphuretted hydrogen ;  it
delays but does not prevent  the decomposi-
tion of animal and vegetable matters.  The
salts of alumina mixed with charcoal are very
useful.   The alumina which is thrown down
forms a very bulky precipitate, which entan-
gles the suspended matters,  and this is aided
by the albumen of the blood, which coagulates
during the process.  A deposit soon forms and
an odorless fluid is left, free from any poison-
ous influences ; the deposit is valuable as a
manure, and being concentrated can be easily
removed.  Perchloride of iron is also useful  ;
it decomposes sulphuretted hydrogen and car-
bonate of  ammonia,  which  is so  often  met
with in sewage.  A solution  of chloride of
zinc (half a pound to a gallon of water) may
be used;  it will destroy ammoniacal com-
pounds and organic matter ;  it delays decom-
position  for some time.  Permanganate of
potash must be used in very large  quantities
to have much effect on sewage ; it is useful in
deodorizing excreta, and may be  poured on
the  stools of patients suffering fiom  chol-
era or typhoid fever.  The preparations from
coal tar, as creasote, carbolic acid,  and cresy-
lic acid, are very valuable agents in purifying
sewage ; they may be obtained as powders or
crystals or  liquids ; the latter are the most
useful, as  they mix readily with sewage ; one
part of the liquid  carbolic acid,  if  good; may
be mixed  with eighty or one hundred parts of
water and poured into a  cesspool,  or on a
dung-heap,  or used in  a water-closet.  In sea
sons when cholera is about, or any infectious
epidemic is raging, or in hot weather, when
the effluvia from drains is very abundant and
offensive, several  gallons of weak carbolic
acid should be  poured into  the drains ;  the
water also which sluices the water-closets may
have some of the  acid poured into it, and in
a similar way all latrines or urinals in public
places should be treated ; in  this  way much
good may be done and noxious smells in a
great measure prevented.  It does not follow
that because  air smells badly it is therefore
impure in  proportion ;  gas works  or  tan
works may be disagreeable, but they are  not
injurious  ; again, a cesspool or drain may not
smell much, but the exhalations may be most
dangerous.   A noxious smell is like a Davy
lamp to a miner, a warning of danger,  but
it is not  itself  the danger.   By keeping in
mind the  evils arising  from impure air, close
rooms, noxious  emanations, and sewage con-
taminations, and  by  using every  means to
procure ventilation and to remove the  im-
purities by chemical  means, a  vast deal of
good must result,  and many diseases may be
prevented.
  DEPILATORIES are  substances  used
for  removing superfluous hairs.  A  variety
of them is  offered in  the drug-stores,  but
they usually have either an arsenical or a caus-
tic  basis,  and are consequently highly inju-
rious to the skin.   Plucking out the hair by
the roots  is by  far the best way of removing
it.   In  cases where this will not answer,  the
following  depilatory is less objectionable than
any that  can be  bought already  prepared :
Take a half-pound of slaked lime, and  a half-
ounce cf orpiment in  powder ; mix and keep
in  a well-corked  bottle.  To apply,  mix a
small  portion with water to the consistence
of cream,  spread  it upon the objectionable
hair, and  let it remain about five minutes, or
till  it begins to  burn the skin ;  then remove
with an ivory  or bone paper-knife, wash  the
part  with water,  and apply  a  little cold
cream.
  DERBYSHIRE   NECK,  called  also
goitre, signifies a swelling in the neck,  owing
to enlargement  of the thyroid body.   It is a
common disease in some of the  cantons of
Switzerland, especially the Tyrol  and valley
of the Rhone (cretins).  Its  cause is  some-
what obscure, being assigned usually to (in 
102  DETERMINATION OF BLOOD
DIABETES
Switzerland) the use of snow water, and con-
finement in damp, close valleys, inactivities,
and want of occupation ; it is frequently as-
sociated  with idiocy.
  DETERMINATION OF  BLOOD is  a
phrase erroneously applied to the feeling of a
rush of blood  to the head  in those who are
liable to  apoplexy and  some other nervous
diseases.
  DEW-POINT is the point at  which the
mercury  stands in the  thermometer when
aqueous  vapor is deposited from the atmos-
phere on a cold object in the shape of minute
globules  of water.  The atmosphere  always
contains  aqueous  vapor in greater  or  less
quantity,   and   when  a  cold  substance is
brought into a warm room, this vapor is de-
posited on the  cold object in  the shape of
minute globules  of water ; this may be easily
shown by bringing a glass of cold water into
a warm room ; in a few minutes  the  outside
of the glass is  quite moistened  with dew,
which  will  again  become  vapor when the
glass has become warmed to the temperature
of the room.  And a similar process takes
place on  the earth's surface.  During the day
the earth is warmed by the sun's rays, at
night this heat  is given off  by radiation, but
not equally from  all objects ;   thus  metals
have very  little radiating  power, especially
when polished, while plants, grass, sand, and
the ground readily radiate  their  heat ; they
thus become much cooler than the surround-
ing atmosphere ; in consequence the aqueous
vapor  in the air is condensed on their  sur-
faces in the shape of dew or minute globules
of water.  In hot countries and  in hot  sea-
sons this is most noticed, as the earth being
so much  heated  during the day gives off the
heat very  rapidly  during   the  night.   The
state of the sky also exercises  a  marked in-
fluence on the dew-point.  If  the  sky  is
cloudless, the earth radiates heat very consid-
erably, and therefore  becoming  very much
chilled, there is  an abundant deposit  of dew.
But if  there are clouds, these radiate  toward
the earth, and so as less chilling occurs, there
is only a slight deposit of  dew.   Wind also
affects the quantity of vapor  deposited.   If
feeble, it increases it, because it  renews the
air ;  if  strong,   it diminishes it,  because  it
heats the bodies by contact.  The formation
of dew is greater in proportion to the moist-
ure present in the air.  The dew-point will
vary, therefore,  under  many conditions, and
to obviate any sources of error very  ingeni-
ous methods have at various times been in-
vented ;  instruments used for finding out the
amount of  aqueous vapor in  the air at any
given  time are called hygrometers.   (See
Hygrometer.)
  DEXTRINE is a compound of  carbon,
hydrogen,  and  oxygen, and is one  of  that
series of bodies which is called the dextrine
series. When the seeds of a plant germinate,
the starch they  contain  is  converted  into
sugar.  This is well seen in the process of
malting, in which the grain  is  made to ger-
minate, and when  the* sugar is formed, the
process of growth is arrested by roasting, and
malt is formed.  The sugar of the malt is then
fermented and made into beer.  If the process
of germination is arrested after the starch has
begun to  change,  and before the sugar is
formed,   dextrine   is  obtained.  Dextrine
differs from  starch in  that  it is soluble in
water, and not colored blue by iodine, and
from sugar in the absence of sweetness, and
the capability of fermentation.   Its name is
given by the  property it possesses of pro-
ducing  right-handed rotation upon a ray of
polarized  light. It has some of the properties
of gum, such as forming  an  adhesive  liquid
with water, and  is used  for gumming trie
backs of stamps, and other purposes.   Dex-
trine is used for making moulds,  and has been
employed as a splint in  surgery.   Dieteti-
cally, it resembles gum, and does not appear
to be absorbed into the blood,  so that it is
valueless  as an article of diet.   Gum may be
said to  be stereotyped  dextrine.  Liquorice,
or Spanish juice, is a  kind  of  dextrine ; so
also is pectine.  It is, in fact, because a num-
ber of  substances   closely  resembling dex-
trine, of which starch stands below, sugar at
the top,  and dextrine in the  middle, that
they  have been  called the  dextrine series.
To these  belong lichenin, or lichen starch—
the starch of sea-weeds and lichens—manna,
and various  kinds  of sugar, none of  which
are of any value as articles  of  diet, only as
they can  be  converted into  sugar, dissolved
in water,  and taken up into tbe blood.
   DIABETES is  a disease in which a very
large quantity of saccharine  water is passed
daily by the  patient, accompanied by great
thirst and general  debility.   It may  attack
people at any age, but it is far more fatal, and
runs  a  much more rapid course in children
and young people  than in adults, or in those
of  advanced age ;  among the latter, a small
quantity of sugar in the urine may be present
at one time and absent at another, and these
cases seldom need  cause much  anxiety.  It
is, at present, a  moot  question  whether the
liver or the blood is at fault in  this disease,
nor is it  yet settled what part  the nervous
system  may play in this affection, but it is
an ascertained fact, that  irritation in certain
parts of the brain will produce  sugar  in  the
urine.  The kidneys are not the seat of mis-
chief ; they merely allow the sugary urine to
pass, and, in doing so, suffer more or  less in
the process.
   Symptoms.—Great thirst, dryness of skin,
and passing  an immense quantity of  urine,
are the most marked features in this disease.
The thirst is  so  great, that the  patient is al-
ways wanting some liquid, and will drink as
much as four or five gallons of water a day in
M 
DIABETES
DIARRIICEA           1C3
 some cases ; two or  three gallons is a very
 common amount.   Since they pass  so much
 urine, the other tissues of the body are drier
 than usual ; the skin  feels  dry and harsh,
 and an eczematous eruption is liable to break
 out, and sometimes boils form ; the nails are
 dry,  and frequently chip in  consequence.
 The bowels are confined and the motions are
 generally firm  and dry.  The urine is light
 in color, but much heavier than usual, from
 the great quantity of  sugar present in it ; the
 usual specific gravity of urine varies from 1015
 to 1020 ; in this disease it may rise to 1030 or
 1040.   Sugar may be detected in the urine in
 several ways :  1.  Take equal  amounts  of
 urine and  liquor potassae in  a test-tube and
 boil ; the solution  will become, first yellow,
 then  orange,  and,  finally, of a deep horse-
 chestnut color.   2. On adding to the urine a
 drop or two of a strong  solution of  sulphate
 of copper (blue vitriol) and then  three or four
 drops of liquor  potassae, the  precipitate first
 formed will dissolve, and the solution will
 have a dirty  bluish-green color ; then boil,
 and an orange  precipitate will  come down.
 3. To a large test-tube  full of the urine add
 a little yeast; invert the test-tube in a dish
 which also contains urine, and let it stand in
 a warm place for twenty-four hours ; gas will
 then have formed  in  the upper part of the
 tube, which will be due to the carbonic acid
 evolved, for fermentation has taken place, and
 the sugar has been converted  into alcohol and
 carbonic-acid  gas.  4.  A more  delicate test
 is obtained  by allowing the passage of  a ray
 of polarized light to pass through  the urine :
 when sugar is  present,  the ray is  turned to
 the right.   The appetite is generally good,
 and  even  excessive,  in some cases  ;  the
 tongue  often dry and red. and the tempera-
 ture rather lower than  usual ;  the  patient
 sleeps well,  and the general health may go on
 for a  long time without being seriously im-
 paired.  In the course of time, there is more
 or less wasting of the  body, and a liability to
 disease  of the lungs.  Cataract is, also, by no
 means  an  uncommon  complication.  In
 young people and children, the disease often
 runs a  very rapid  course, and may cause a
 fatal result in six weeks from the commence-
 ment of the symptoms ; much more common-
 ly it lasts for two or three years, and, in old
 people, sugar may occasionally appear with-
 out any harm resulting.  Death  often takes
 place  by suppression  of urine, followed  by
 stupor, coma, and, perhaps, convulsions ; or,
 it  may occur, through general exhaustion, or
 from disease of the lungs.
  Treatment.—The treatment of diabetes gen-
 erally consists in placing the  patient upon a
 diet from which all starchy or saccharine arti-
 cles of food are, as far as possible, excluded.
 Brown bread, bran biscuits, meat, green veg-
etables, and  milk, etc., may be allowed, but
ordinary bread,  sugar,  rice,  potatoes,  etc.,
 are prohibited.  (See Diet.)  Persistence in
 this plan is often  followed by much relief to
 the patient, causing him to gain strength,  les-
 sening his thirst and the quantity of urine,
 but it will not avail in curing him ; nor, at
 present, is any remedy known which can erad-
 icate this disease ;  nevertheless,  much may
 be done to  alleviate  the urgent symptoms
 and prolong life in  some  cases.   Since there
 is so much thirst, a large  allowance of water
 must be given, as much, in fact, as the patient
 likes.   Raw meat has been found to be bene-
 ficial in some cases.  Various preparations,
 as diabetic' bread and diabetic biscuit, have
 been  recommended, but  few can  continue
 their use long, as they eventually tire of keep-
 ing to a restricted diet.
   There  are  certain cases in  which  persons
 pass a very large  quantity of  water without
 having any sugar in the urine : they are then
 said to be suffering from polyuria ;  this dis-
 ease is of much less importance.
   DIACHYLON is the  name given to  ad-
 hesive  plaster, both  spread and unspread ;
 though in the Pharmacopoeia the name is con-
 fined  to  the  litharge  plaster (Emplastrum
 plumbi).   (See Lead.)
   DIAPHORETICS are a class  of medi-
 cines which exercise an almot exclusive action
 on the skin, producing perspiration and there-
 by reducing  fever.  Such drugs as ipecacu-
 anha, antimony, squills, camphor, and opium
 are of this sort.
   DIAPHRAGM.—The diaphragm is  the
 chief muscle  of inspiration ;  it divides  the
 chest from the abdominal cavity, and is per-
 forated in several places so as to allow of  the
 passage of various vessels  and nerves ; above
 it, are the lungs and heart while immediately
 below it  are  the stomach, liver,  spleen, and
 intestines.  During inspiration it descends, so
 as to increase the cavity of the chest and to
 give the lungs room to expand,  while it  as-
 cends during expiration.   When there is any
 distension of the abdomen, as  from the pres-
 ence of a large tumor, pregnancy, ascites, or
 flatulence, the action of  the diaphragm is im-
 paired and respiration is made more difficult.
  DIARRHOEA  can hardly  be considered
 as a disease in  itself, but  rather as a symp-
 tom of other diseases.   It  is characterized by
 frequent loose evacuations from the bowels,
 due to functional or organic derangement of
 the small intestines, and produced  by either
 local or constitutional causes.   The evacua-
 tions 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 diarrhoea is readily pro-
 duced and is often very troublesome to cure ;
 it may be acute or chronic, and in  both foims
is dangerous to life.  Under five years of age
the mortality from this cause is greater than 
104           DIARRHtEA
DIARRIICEA
at any other period of life, and the greatest
liability is shown during the  period of teeth-
ing, from six months to eighteen months or
two years of age.  As regards  the time of
year,  diarrhoea is far  more prevalent  in  the
summer and autumn  than in spring or win-
ter.
  Causes.—The  causes may be divided into
the local and  general.  Among  the  former
may be classed indigestible food, bad air and
water, parasites in  the bowels, and  any irri-
tating  matters poured into the intestines.
Among the latter may be enumerated several
diseases which produce  cachexia,  and  in-
duce a diminution of the 'yjtal powers.   Con-
sumption, diseases of the river and  kidneys,
and many cases  of blood poisoning are  ac-
companied by diarrhoea ; it is also associated
with many fevers at their onset, and it is a
prominent  symptom in typhoid or enteric
fever.   Chronic  malarious   complaints are
often  complicated by diarrhoea,  and it may
occur in many cases where there is a degen-
eration  of tissue in any of the abdominal vis-
cera.  In these cases diarrhoea appears as a
symptom, while in  other cases the diarrhoea
appears to be produced  more directly and to
be due  to the operation of bad water or a
vitiated atmosphere acting  on  the  blood or
through the nervous system.   Diarrhoea may
be beneficial and due to an effort of the irri-
tated  bowel  to  throw 'off its noxious con-
tents, as in cases where bad meat or putrid
fish or unripe fruit is taken ;  in other cases it
aids to bring  about a fatal result by exhaust-
ing the  patient ;  hence to properly treat a
patient, it is important to  make out  thor-
oughly  the cause  ; this is sometimes difficult,
as two or three causes may be conspiring to
produce the  same  effect,   i. In  summer
diarrhoea prevails epidemically during the hot
months ; it is never absent  during that time
of the  year,  but  varies  very  much  in its
spread.   The disease is probably due  to the
heat causing a general relaxation of the tis-
sues, but its exact nature is not yet made out;
checked secretion of the skin, and miasmatic
influences generated by the  heat may aid in
producing it.   When genuine summer diar-
rhoea  is very severe, it is commonly called
English cholera, or choleraic diarrhoea, but it
is advisable  not to use such terms, as they
lead to the impression that it is either related
to cholera, or a mild form of it, whereas there
is no  proof  at all of the connection, and it
causes a panic in the  minds of timid people,
which is often very  injurious.   2. Lmpure air
is a common cause.   Those who are engaged
in any occupation which exposes them to the
influence of decaying  animal  or  vegetable
matter,  decomposing manure, or emanations
from  drains or sewers are very liable to this
complaint.  A leaky waste-pipe from a watei-
closet may allow  the  foul air to enter into a
house and cause diarrhoea among all  the in-
mates.  3. Indigestible  food will cause diar-
rhoea ; it may do so by the direct irritation on
the bowel or by producing a vitiated state of
health.   Prisoners in jails or all large collec-
tions of people suffer sometimes in this way.
The excessive mortality of infants is often due
to this cause, and it is very common just after
they have been  weaned, and when  they arc-
put too soon upon  an altered diet.   In chil-
dren  brought up by hand, and  in  those  in
foundling hospitals, this disease is often  met
with. Starvation frequently causes diarrhoea,
and in the chronic wasting which attends many
lingering diseases, the badly nourished tissues
supply the blood with materials which rapidly
decompose and  cause  colliquative diarrhoea.
4. Impure water is another  common cause  of
this  complaint.   Spring  water,  which con-
tains much saline matter, will cause a loose-
ness of the  bowels, especially in those who
are not used to it.  Any water which con-
tains decomposing animal  matter or sewage
is a fruitful  source of  diarrhoea,  and it may
cause  it either  by direct  irritation of the
bowels, or by introducing poisonous matter
into the blood.   Water from wells into which
drainage can enter is  always hurtful to life,
and  should   be  carefully avoided.   5.  Any
irritants  introduced into the stomach may
produce diarrhoea ;  eating a large quantity  of
unripe fruit  will  frequently bring on purging,
vomiting, and griping pains in the stomach ;
fruit is by many parents forbidden to their
children  during  the summer months ; this is
a mistake in the opposite direction ; a mod-
erate quantity of ripe fruit is most  beneficial
to health, and when cooked and made  into
puddings  or tarts it will do no  harm.  Fish
which is not perfectly fresh may cause con-
siderable distress with sickness and purging ;
so also will mussels and periwinkles some-
times ; in some  people oysters have a similar
effect. Tainted meat, and the preserved meat
which turns sour on keeping the tins open too
long  in which it is kept, may  produce  this
complaint.  Purgative medicines, the mineral
acids and  caustic  alkalies, many   common
berries which grow in our  hedge-rows, etc.,
will cause diarrhoea by irritation of the  mu-
cous lining of the alimentary canal.  6.  Ma-
laria, or the damp, faint-smelling emanations
from a marshy district, are very injurious ;  in
summer-time, walking along the banks of a
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.  7. 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 it.
   Symptoms.—In simple irritative diarrhoea,
the  patient  will feel, a  few hours after a
meal, some  flatulence and pain in the bowels,
A 
DIARRHCEA
DIARRHOZA
105
 followed by loose evacuations ; this purging
 may and generally  does relieve  the  pain ;
 the motions are feculent, and consist of a
 brown fluid containing small  lumps of solid
 faeces ; if the purging continues, the motions
 become  more  liquid,  and contain mucus.
 Generally the diarrhoea will cease of itself as
 the noxious cause is removed by the purging.
 The pulse does not rise, and  there is  no in-
 crease in the temperature ; the tongue may
 be  slightly  coated  with a  moist  white  fur.
 Eating too much and too rapidly, and  taking
 purgative medicines,  will  bring  on these
 symptoms.  If the cause should be diseased
 or putrid food and water, then the diarrhoea
 will be more severe  and exhausting ; there
 will be considerable  constitutional  disturb-
 ance ; the pulse may become  feeble, and  the
 surface of the body is  colder than usual : in
 some respects these cases resemble the  milder
 forms of cholera, but they are  not often fatal.
  In  children simple irritative diarrhoea  is
 common in the summer and autumn months.
 If the attack comes on in previously healthy
 children, it generally attacks, and is attended
 with vomiting of the contents of the stomach;
 at first the excreta are natural, then they as-
 sume a yellow color, which  changes to green
 on exposure to  the air, or they are slimy and
 mixed  with  mucus ; sometimes white par-
 ticles of undigested milk are found in the dis-
 charges ;  the purging often comes on  just
 when the child is suckling or taking food, and
 this gives rise to the popular notion  that  the
 "food runs through  the child as  fast as it
 takes it ;'' it is hardly necessary to say that
 this notion is quite untrue, and the excreta
 in those cases are the remains of food pre-
 viously taken, and which happen to be evac-
 uated at the same  time that fresh food is
 given.  As  the child returns  to  health  the
 faeces become less watery, and resume their
 yellow color, or they may remain for some
 time green and slimy ; the  disorder usually
 goes away in four or five days, although there
 is a tendency to diarrhoea on very slight irri-
 tation.  Such cases  are not  accompanied  by
 fever or  much  constitutional  disturbance in
 the majority of  cases ;  the appetite is  much
 impaired, and the child will  cry for water, as
 it is more or less thirsty. The tongue is moist,
 but not much coated, while the papillae may
 appear more prominent than usual, and look
 like  bright red  spots on the  surface of the
 tongue ; there is very little pain or tenderness
 over the abdomen, and if there is any it is  re-
 lieved by the purging.  Great loss of flesh
 rapidly ensues, and in two  or three days a
 fat,  healthy child will lose greatly in weight
 and its flesh become loose  and flabby ; the
 face  is pale,  and the  eyes  appear sunken,
 while the child sleeps badly and is fretful and
 languid.  In the diarrhoea produced by teeth-
 ing the symptoms do  not come on  so sud-
denly, and they are slower  in their course,
while they generally disappear when the tooth
is cut.  In whooping-cough, and after recov-
ery  from measles and   other  febrile  dis-
orders, diarrhoea may come on and assume
a chronic form, which may kill the child by
exhausting its  strength.  Diarrhoea  is very
obstinate in some children just after they are
weaned,  and is due to the altered diet; more
or less pain over the stomach, constant vom-
iting and  loss  of  flesh,  accompany the
purging.  Sometimes  this  simple  diarrhoea
passes gradually into an  inflammatory form,
and in these  cases the  symptoms are graver
and there  is much more constitutional dis-
turbance ;  vomiting and purging  come  on
with great frequency, the stools are  like green
water, and consist chiefly of mucus from the
bowel mixed with some  feculent matter ;  at
times a little blood passes, and often there is
" prolapsus ani," or a  protrusion of the lower
part of the bowel.  The skin is dry and hot,
the pulse quick, the child heavy and peevish ;
at first restless,  it soon passes into a half-
drowsy state, and likes to lie quietly on its
mother's lap ; very little suffering occurs, al-
though  there is  generally a little abdominal
pain before each  evacuation ; the tongue be-
comes red,  and  the  child  is  very thirsty ;
there is loss of appetite, and the stomach re-
jects what  is  given ;  great  loss  of flesh
ensues, and in a few hours a plump child may
become emaciated. -Yet a fatal result is not
very common, and a marked improvement
generally takes place in two or three days ; a
danger  exists   in these  cases   becoming
chronic, which they are apt to do, and wear
the child out in the course of a few weeks.
  Parasites in the bowels will bring on diar-
rhoea in  children and  adults.  In such cases
the worms may be passed, and the nature of
the case is then clear, in other cases  the breath
is foetid,  the  abdomen larger than  usual, the
appetite increased and difficult to satisfy, and
there is  often  grinding of the teeth at night
and  picking of the nose ; the  round worms
and  the  thread-worms   are most likely  to
cause this  complaint.   Inflammatory  diar-
rhoea may occur in the adult as well as in the
child, and will produce much the same symp-
toms ; in some of these cases it is difficult to
distinguish it from dysentery ; but in the latter
there is ulceration of  the large bowel, which
does  not take place in  the  former disease.
  Summer diarrhoea sets in suddenly ; there is
copious vomiting and purging, and  the stools
are copious  and liquid ; generally there  is
much pain and cramp of the abdominal mus-
cles or of the muscles of the calf of the leg.
The tongue is  dry, and the patient thirsty ;
great exhaustion will supervene,  and in very
severe cases the pulse will become feeble, the
voice not raised above  a whisper, and the
general surface of the body lowered in tem-
perature.  The majority of cases are amen-
able to treatment, and  are well in two or three 
10G          DIARRHOEA
DIARRHOEA
days ;  the mortality is very small.   Diarrhoea
appears in the course of typhoid fever, and
many  chronic wasting  disorders ; but  the
symptoms and treatment in such  cases will
come under notice in describing the separate
diseases.
  Treatment.—The treatment of  diarrhoea
must vary with the cause ; and when  that is
ascertained then only can any good be done.
In  many cases it is  not advisable to check
the purging, especially where there is some
irritant present in the bowel, which is keeping
up  the flux.   Often  a change of  diet, which
should be light and  nourishing,  is of great
benefit ;  and any food that is taken  should be
given  in small quantities at a time.   If  the
purging be due  to  unripe fruit or  indigesti-
ble food, a dose of castor-oil  at bed-time,  fol-
lowed  by greater care in the diet, will suffice
for a cure ; but if the purging  continue, and
should prove at all exhausting to  the patient,
then it should be stopped.  In the case of
infants who have been recently weaned, and
are suffering from this complaint,  cold milk
and water should be given, with a little broth
or  beef-tea,   while   solid food  should  be
avoided ; no opium should be given, as it is a
very dangerous remedy at that age ; an aro-
matic mixture of  chalk, flavored with pepper-
mint or anise, will be useful to keep the purg-
ing in  check ;  if it depend on teething, it will
probably cease as soon as the tooth has been
cut, and  a simple diet, with saline medicine,
will promote a cure.   Summer diarrhcea  is
generally curable in two  or three  days, with-
out the use of medicine ;  but if it persist, and
the tongue be clean,  a mixture of  chlorodyne
with camphor-water and tincture  of ginger
will check it ; should the tongue  be much
coated and the abdomen  distended and pain-
ful, a gentle purgative should be  first given ;
a dose of Gregory's powder or castor-oil will
be  sufficient.  If the symptoms are  severe,
and there is collapse and cramp in the legs,
then medical aid  should at once be called in ;
in the  mean time, iced water or milk may be
given,  and  mustard-plasters applied  to  the
calves  of the legs ;  stimulants are  not of
much avail, and should be given in very small
quantities.  If impure air is the cause,  re-
moval  to another place is naturally the most
efficient  remedy ; should it  break  out in a
camp,  the troops should change their posi-
tion.   If it occur from the bad air of a drain
or sewer, means  should be taken  at once to
flush the  pipe, see that there is nothing block-
ing it up, and take care that the foul  air should
be carried out into the open, and  not enter
the  house ; often  the air accumulates  in  the
waste-pipe of a  water-closet, and  when  the
pan is  raised, the  poisonous gas rushes up be-
fore the water from the cistern  can come
down ; this  can  be remedied by letting  the
waste-pipe communicate directly  with  the
open air, so as to prevent the stagnation of
the noxious air in  the pipe and each closet
should be provided with a small cistern of
water immediately above it. Should the cause
be indigestible food, or  if the latter  be in-
sufficient  in quantity as well as in quality, a
more generous diet will afford  relief;  and
this  subject is one of much  importance, as
the comfort  of many individuals  depends
upon it.   Any food which has been  found to
disagree  with  a person  should be avoided  ;
the meals should be taken at regular intervals,
and not too much should be taken at a time. If
impure water is causing diarrhcea, the remedy
clearly is to improve the supply ; the cisterns
supplying a house should be examined, to see
if they are clean and sweet ;  no cistern sup-
plying a  privy  or  water-closet should also
supply the drinking-water, although  this sim-
ple hygienic condition is  rarely observed.  If a
well receive any surface  drainage, it must be
condemned at once, and no  one should be
allowed  to  use it ;  this  is most important
when the  diarrhcea is very prevalent, as a
whole village may be attacked at once from
this cause. No stagnant water should ever be
drunk, and every care should be taken that the
source of the water should be kept free from
decomposing animal or vegetable matter.  If
the purging follow any irritant food, as putrid
fish or meat or poisonous berries, a mild pur
gative may be given, so as to remove speedily
the cause ; and this should be  followed by a
light and simple diet until  recovery take
place.  Malarious influences must be avoided
if they cause this complaint, and frequently
change of  residence  is  the  only cure.   In
short, to  cure diarrhcea, the food, the water,
and the air should be looked to, and every
means taken to insure their purity  ; and as
towns increase in size,  so, unless careful san-
itary means are  taken, the danger to human
life will be continually  on the increase.
  In chronic diarrhcea,  where the  cause is
some serious constitutional disorder, no rules
can here be laid down, as they  must  be treat-
ed according to the special requirements of the
case.  A few general rules may here be men-
tioned  lor the treatment of  diarrhoea,  and
they may be adopted in addition to removing
the cause,  i.  Diet.—This should not consist
of too much farinaceous food, as arrowroot,
tapioca, etc.   Iced  milk is most refreshing,
and can be readily borne when nothing else
can be retained on the stomach  ; where neces-
sary, a little brandy may be added.   Beef tea
and  broth carefully made  are very good ;
but the latter should contain  no vegetables,
and the former must be  made by stewing the
meat  first  and then raising it to the boiling
point ; in this  way the most  nourishment is
gained, while much is  lost if the meat be first
put into boiling water.  An egg may be beaten
up in the milk or in tea, and prove beneficial;
but hard-boiled eggs must be avoided. Sago,
rice, and such like foods often produce flatu- 
DIARRHOEA
DIET
107
lence ;  the lean of a mutton  chop or a piece
of  well-boiled mutton  may be  given,  but
potatoes and most vegetables are  inadmissi-
ble.  Chicken and veal are good  ; but pork,
bacon,  or  salt beef are  too indigestible.   In
the case of  children,  lime-water  mixed with
the milk proves of great service.  A large quan-
tity of  fluid  should not be given  at a time ;
but if the  patient be very thirsty, the mouth
may be moistened frequently with iced drinks.
Cooked fruit may be given, and  the pulp of
grapes or ripe orange-juice ; unripe fruit must
be carefully avoided.   2. Residence andcloth-
iug.—A damp, low situation is injurious,  and
removal from malarious influence is essential.
Flannel should be worn next the skin.   3.
Change of climate.—Change is of great benefit
to many who suffer from this complaint ; but
the place selected must vary with  the nature
of the  case and the  state of the patient.  A
long journey must not be recommended, un-
less the invalid is strong enough  to bear it.
4. Medicines.—In malarious cases, quinine is
of great value, or dilute nitric acid may be
given, with infusion of gentian or calumba ;
as a rule, these cases require  some tonic to
promote a cure : in addition, iron, strychnia,
and salicine may be  useful.   Opiates are
rarely, if ever, called for in the case of chil-
dren ; they are of much  value when given to
the adult in certain  cases, but, on the other
hand, they are frequently  injurious : where
they cause  flatulence and  abdominal disten-
sion, followed by discomfort, vomiting,  and
pain, they must be avoided.  They are chiefly
of use in the inflammatory forms of this com-
plaint,  and they may often be given combined
with a purgative, so that the  bowel is sooth-
ed, while the astringent action is counteracted.
Astringents may be given when the diarrhcea
is not  due  to an  irritant, or,  when arising
from that  cause,  the  purging has  gone on
without being checked.  Chalk  mixed with
mucilage is commonly given, and to this may
be added some tincture  of catechu and pep-
permint-water ; in some long-standing cases
tannin, gallic  acid, and kino are  beneficial;
in others the sulphates of iron  or  copper are
resorted to  ; ipecacuanha in certain cases is
resorted to with benefit.   No rule, however,
can be  given as to when these drugs are to be
given.   Where simple remedies fail, medical
advice must be sought.
   Rest in bed or on a sofa is advisable in all
cases of diarrhoea.  When a patient has been
suffering from diarrhoea in a chronic form, he
is very liable  to  relapses,  and any error of
diet, or exposure to an exciting cause, may be
most deleterious.  In all cases, therefore, not
only should care be taken during convales-
cence, but for some time after it ;  and this is
the more advisable in those persons who have
suffered abroad, and, after  a cure  effected by
absence, return to the place where they pre-
viously suffered.
  DIASTOLE signifies the dilatation of the
cavities of  the heart, which follows immedi-
ately after their contraction.  (See Heart.)
  DIATHESIS implies a peculiar state or
constitution of the individual, which renders
him specially liable to  a disease or group of
diseases ;   in  this country there are  well-
marked diatheses,  as the gouty, the nervous,
the tuberculous, the bilious, etc.
  DIET.—The question of  diet is one of
much importance,  and  it is  one  which is
somewhat difficult  to determine accurately, as
it must  vary much with the taste and  condi-
tion of the individual.  Men require more food
per day than  women, and those engaged in
hard manual exercise require more than those
employed   in  sedentary  work.    Different
periods  of life make a difference in  the quan-
tity as well as in the quality of the food taken,
so that this subject naturally divides itself into
the diet required  for (1) .adults, (2) children,
and (3)  infants.  But, in the first place, must
be given a short account of the different kinds
of food.  Physiologists have for a long  time
divided food into five classes, viz., the starchy
or saccharine, the oleaginous  or  fatty, the
mineral or saline, the albuminous, and the
aqueous.   1. The starchy or saccharine food
forms a large element in the composition of
wheaten  bread, rice,  arrowroot,  potatoes,
sago, etc.  Starch is a complex chemical com-
pound of carbon, hydrogen, and oxygen, and
such bodies are termed hydro-carbons ; when
burnt off  in the human  economy,  they  form
water and carbonic  acid by  entering into
combination with oxygen ; the fat or adipose
tissue in each individual is stored up in con-
sequence  of  the  amount of  starchy  food
taken ;  infants are much fatter than adults in
proportion, because  they are accustomed to
live on  so much farinaceous food, and such a
diet contains a great deal of starch.  Starch
becomes converted into sugar when it mixes
with the saliva ; in this way, when a piece of
bread or  potato  is  well masticated a large
amount of sugar is formed,  and  this new
compound is much more soluble in the stom-
ach than starch ; the secretion from the  pan-
creas which flows into the intestine has a sim-
ilar action to that  of the saliva.  It has been
said  that  starchy or saccharine  diet forms
hydrocarbons when taken into  the system ;
now these hydro-carbons build up  the  fatty
tissues, and just in the same way as a  person
who drinks much beer will get too stout,  so
one who lives on too much starchy food will
become corpulent ; hence those who go into
training avoid this  kind of  diet,   and take
more meat,  which  gives  them  muscle and
strength.   2.  The oleaginous or fatty kind of
food  is commonly known ; all  butter,  lard,
suet,  the  fat part  of meat, and  rich  greasy
foods consist of  this  variety ;  like the last
kind, they consist of carbon, hydrogen, and
oxygen, and form, when used up in the human 
108
DIET
DIET
economy, water and carbonic acid ;  they dif-
fer  in  not being acted on by the saliva  or
pancreatic juice, but they are made into  an
emulsion by the secretion from the liver, and
thus being divided into extremely minute par-
ticles or globules, they are  in  a fit state for
absorption by the  lacteals, which  are so nu-
merous in the small intestine.   This kind  of
diet tends to make persons fat, and a common
example is seen in the case of those who take
cod-liver  oil ;  those  who  naturally  are loo
corpulent should avoid taking saccharine  or
fatty substances as far  as  possible.   3. The
mineral or saline variety of food is  found in
nearly every article of diet : common salt is a
familiar  example ;   in  ordinary   drinking
water, in milk,  in bread, and, in fact, in  every
animal and vegetable product, there  is more
or less saline matter ; it is one of the most
important  constituents for the formation  of
tissues, and  during  foetal  life  the   child  is
nourished  by a fluid which contains a good
deal of common salt : wherever vital changes
go on  rapidly,  saline matters are essential ;
without them the health fails, and many dis-
eases have arisen from the want of salt during
long  sieges.   4.  The  albuminous  foods.—
These consist of hydrogen, nitrogen, carbon,
and oxygen, and are also called azotized sub-
stances from their containing azote  or  nitro-
gen.  The lean  of all kinds of meat, the white
of an egg, the  caseine of  milk, the gluten  of
bread, are common examples of this kind of
food.  While  saline  substances are readily
absorbed by the stomach without undergoing
any change, albuminous  bodies have first to
be digested in the stomach, and, when thor-
oughly acted on by the gastric juice, they are
taken up by the vessels and introduced into
the economy ;  they help to build up muscular
tissues, and hence are much required by those
who lead active lives, and who undergo  much
exertion.   5. The aqueous or watery portion
of  our food is  too  well  known  to require
notice ; no substances that we eat are so ab-
solutely dry as to contain  no water, and vve
drink  not  only to quench thirst but also to
dissolve solids and render them  more easy of
absorption.  Finally, there are certain condi-
ments, as mustard,  pepper, pickles,   etc.,
which are not  essential as foods, but which
tickle  the  palate and cause an  increased se-
cretion of saliva and gastric juice,  and by
doing so help to promote digestion.
  From this brief survey it will be seen how
valuable milk is during the growth  of chil-
dren, for it contains in a liquid and soluble
form all the elements necessary for the growth
of the  body ; the cream contains oily matter,
while  the  remaining liquid portion   consists
chiefly of  water holding in  solution saline,
saccharine, and albuminous matters.  Bread,
again, is a valuable article of diet, inasmuch
as it contains water, salt,  starchy and albu-
minous materials. Thus two cheap and com-
mon articles of diet contain all that is essen-
tial  for  human life.   An ordinary  joint of
meat contains albuminous matter, as shown
by the amount of lean, associated with more
or less of fat and aqueous material, and in
addition  a small quantity of salt.  An egg is
a good example of a mixture of the different
kinds of  food ; the yolk contains much fatty
matter, while the white of  an egg is made up
chiefly of albumen,  water, and salt.  Beer
contains  saline and saccharine matter in com-
bination  with alcohol and water ; the hops
only aid  in  giving  a bitter flavor, and  pro-
moting the appetite ,  the strength of the beer
depends  on  the malt it contains ; this fluid, it
will be seen, tends to promote the growth of
fatty tissues, but is not  of much use in the
formation of muscle.  Tea, coffee, and cocoa
contain chiefly water when taken  as bever-
ages, and,  in addition,  sedative and tonic
properties ;  cocoa contains  a good  deal of
fatty and saccharine  matter,  and  is  very
nourishing.   With this brief survey, rules
will  now be laid  down which  may be em-
ployed in the diet of infants, children, and
adults ; but  in each case circumstances must
modify the amounts given,  and various modes
of dressing  the food  by devices in cookery,
may, of course, in any case be adopted.
  Diet of Infants.—Too much  care cannot
be taken in the  bringing up of children ; a
great many of their  complaints are due to
errors in feeding, and a large mortality annu-
ally  results  from  this cause.   An immense
amount  of  ignorance still remains  on this
point : often solid food  is given at  far  too
early an age, when the delicate stomach is
unable to digest it, and flatulence,  pain, and
sickness  frequently occur.   Attention to the
following simple rules  will be  found of  the
greatest benefit ; they have lately been drawn
up by a committee of the London Obstetrical
Society :
  Suckling.—Nature  provides breast-milk as
the proper food for infants, and suckling is
by far the best way of feeding a child.   Pro-
vided the mother or wet nurse has plenty of
milk, and is in good health, the child requires
and should have no other food but the breast-
milk until about the sixth  month.  The  milk
itself, for the first few days, acts as a laxative,
and no other aperient is necessary.  Should
the formation of the milk be delayed, a little
cow's milk,  diluted with an equal quantity of
warm water, and slightly sweetened, may be
given until the mother is ready to nurse. The
child should, for the first six weeks, be put to
the breast at regular  intervals of two hours
during the day.   During the night it requires
to be fed less often.   As the child gets older,
it does not  require to be  fed so frequently.
A child soon learns regular habits as  to feed-
ing.   It  is a great mistake, and bad both for
the mother and child, to give the breast when-
ever the child cries, or to let it be  always 
DIET
DIET
109
 sucking,  particularly  at  night.   This  is  a
 common cause of wind, colics, and  indiges-
 tion.
   How a nursing mother or wet nurse should
 be fed.—A nursing woman ought to live gen-
 erously and well, but not grossly.   It  is  a
 common  mistake for wet nurses to live too
 well, and this often causes  deranged diges-
 tion in the child.  Should a nursing woman
 suffer from dizziness, dimness  of sight, much
 palpitation  and  shortness of  breath, or fre-
 quent nightsweats, it is a sign that  suckling
 disagrees with her, and that  she should cease
 to nurse.
   Mixed  feeding, when the  mother  has not
 enough milk.—When  the mother  has  not
 enough milk to nourish the child, other food
 may be  given, especially during the night.
 This should  consist of  the best milk, with
 one third the quantity of  warm water added.
 This  plan  of combining breast-feeding with
 bottle-feeding  is better than bringing up the
 child by hand alone.
    Weaning.—The child should not be weaned
 suddenly but by degrees, and, as a rule,  it
 should not be allowed to have the breast after
 the ninth month.  After the  child has cut its
 front teeth  it should have one or two meals a
 day of some light  food, such as bread and
 milk or nursery biscuits, and  these  may be
 gradually increased until the  child is weaned.
 When the child  is about from seven to ten
 months old, according to its  strength, it may
 have one meal a day of broth or beef tea,
 with crumb of bread soaked in it, or it may
 have the yolk of an egg lightly  boiled. When
 it is about a year and a half  old, it may have
 one meal a day of finely minced  meat ; but
 even then milk should form  a  large  propor-
 tion of its diet.
   The food of grown-up people bad for chil-
 dren.—Meat,  potatoes, and  food,  such as
 grownup people eat, are often given to young
 infants. This kind of food, and  all stimulants,
 are  entirely unsuitable, and  are  common
 causes of  diarrhoea and other troubles.
   Hand-feeding.—If the child must be brought
 up by  hand, the chief rule to  remember is,
 that the food  should resemble as closely as
 possible the milk provided for it by  nature.
 Milk, and milk only, should  be used  for this
 purpose.   Cow's milk is generally used, but
 ass's or goat's  milk is good.   Two thirds
 pure and fresh milk, wi'h one third the quan-
 tity of hot water added to it,  the whole being
 slightly sweetened, should be used.  A table-
 spoonful of lime-water may often, with great
 advantage, be added to the  milk, instead of
 an equal quantity of the warm water.   The
 milk should  be given from a feeding-bottle,
 which should be emptied and  rinsed out after
 every meal, and the tube and cork or teats
 kept in  water  when not in  use.   Perfect
cleanliness  is  most important ;  otherwise
the milk may turn sour and disagree with the
 child.  The child should be fed regularly, just
 as if it were suckled ; it is a bad habit to give
 it the  bottle  merely to keep  it quiet.   The
 milk diet  only should, as a rule,  be given
 until the child begins to cut its teeth, when
 other food may be gradually  commenced, as
 recommended under the head of " Suckling."
 When  milk is found to disagree, other food
 should be given under medical advice.   Most
 of  the mortality from hand-feeding  arises
 from  the use of arrowroot, corn flour,  and
 other unsuitable kinds of food, which consist
 of starch alone, contain no proper nourish-
 ment, and should not  be used  as substitutes
 for milk.
  Diet of Children.—It  is  difficult to lay
 down accurate quantities of the different kinds
 of food suitable for children in health ; some
 require and   can  digest more  than others ;
 some  take also more active  exercise  than
 others.  To  make his  subject clear, the fol-
 lowing tables are given as a guide for parents :
  i. From eighteen months to two years old.
 Breakfast  at  7.30 A.M.  A large cup of new
 milk, Avith a good slice of stale bread ; or
 half a pint of  hot bread and milk.  If break-
 fast is taken eaily, a cup of milk may be given
 in about three hours'  time.  Dinner should
 be taken about 1.30 P.M.   It may consist of
 some good beef tea or broth, in which some
 bread crumbs or a well-mashed potato may
 be mixed.  A  cup of milk and water may also
 be given.  At 6 p.m. a large cup of good milk
 may be given, with a slice of  bread and but-
 ter.  No other meal need be given, as the
 child, when healthy, ought  to sleep all night,
 and  it is bad to  accustom it to wake in the
 night and cry for food.  Yet, if it should do
 so, a  little milk and  water  may  be given.
 Farinaceous food  should not  be given at an
 early  age  to  any extent, as the stomach is
 overloaded by that means and fails to digest
 it properly.
  2.  From  two years  to  three years  old.
 Breakfast  at  7.30  A.M.  A large  cupful of
 milk, with  a  slice  of  bread and butter, and
 now and then the  lightly  boiled yolk  of an
 egg.  At 11 A.M. a cup  of milk may be given.
 For dinner, a large cup of beef tea or broth, or
 a little finely cut-up roast  mutton ;  or three
 or four  tablespoonfuls of  gravy,  in which
 bread crumbs, or a "mashed potato may be
 mixed.  A small  quantity  of  rice pudding,
 with plenty of milk,  or  a piece  of  custard
 pudding. At 6 p.m. some milk may be given,
 or a little  tea with plenty of  milk in it, to-
gether with some bread and butter or some
 toast and  butter.   Now and then a little
stewed fruit may be  given, or occasionally  a
little jam.  Rich  things should be "avoided,
and no child should be allowed to eat too
much.   A diet can always  be  modified from
day to  day to  please  the  palate, but  milk
should form a main ingredient in the morn-
ing and evening meals. 
110
DIET
DIET
   3. From  three to ten years of age.  The
amount of food given will vary with  the  age
and appetite of the child.  Breakfast at 7.30
A.M.   A basin of bread and milk, with some
thick slices of bread and  butter.   Occasion-
ally a lightly  boiled egg  may be given.  At
11 o'clock a.m.,  a small  slice of bread  and
butter may be given, if required, with a little
water  or milk and water.   Dinner  at 1.30
r.M.  Some lightly boiled  mutton, or a slice
of roast beef or mutton with plenty of gravy ;
bread should  be eaten with it, or  a  mashed
potato.  Occasionally some  other vegetable
may be  given, as well-boiled cauliflower, or
asparagus heads or some turnip and carrots
well done.   A  light pudding may be given,
as rice, custard, ground rice,  etc.   At times
a fruit pudding,  well  cooked, may be tried,
or  well stewed fruit is beneficial.  Consider-
able variety may be adopted at this age, pro-
vided that too much is not given, and that it
is digested well.   Broth or soup may be sub-
stituted once or twice a  week for the meat.
Boiled  salt beef,  pork, and veal  are not so
easily  digested as  fresh  beef and  mutton.
Cheese is  not advisable.  Prunes,  figs,  al-
monds, and raisins, and such like fruits, may
be given  now and  then with advantage ; but
any excess should be avoided carefully.  Bis-
cuits,  nuts, preserved foreign fruit,  walnuts,
and dates  are less digestible.   A   roasted
apple, well sugared, or stewed pears  are very
nice, and suitable for children ; and occasion-
ally some jam, as  raspberry, strawberry, or
currant preserve, may be given with  bread at
tea-time.   At 6 p.m.  milk and water, or tea
with plenty of milk, may be given ;  also
bread and butter.   Plain  seed cake, or a slice
of an  ordinary home-made plum  cake, may
occasionally be substituted, or a sponge cake.
No stimulants need be given at all at this age.
There is seldom any occasion for supper ;  if
required, a thin slice of bread and butter may
be given.
  4. From ten to fifteen years old.  The same
•diet as No. 3, only now more may be given
in proportion to the age ;  boys, too, often re-
quire more than girls, as they undergo more
active  exercise.  A good meat meal should
be given at mid-day,  but, it  is not required
oftener.   For  breakfast,  cocoa and milk is
very nutritious,  or a basin  of oatmeal por-
ridge with fresh milk may be substituted for
the bread and milk.  These diets presuppose
that the  child is  in  good health, and  that
active exercise is taken ; but if disease be pres-
ent some modification may be required,and for
this medical advice should be  sought.  In the
treatment  of  children's diseases more than
half the success is due to the careful arrange-
ment of the diet.  Many diseases  are simply
due to the engorgement of the stomach pro-
duced by over-eating, and it is owing  often to
the fond but  foolish  mother, who, to please
the child, gives  it anything which  it fancies,
without considering whether or not it is hurt-
ful.  A little firmness in refusing a child too
much food, and a little more knowledge on
the part of the parents of  the chief articles of
diet which a child should  have,  would  save
their  offspring  from  many an  illness and
much discomfort.
  Diet of Adults.—It is difficult to lay down
any strict rule as to the amount of food to be
taken in twenty-four hours for grown-up peo-
ple :  men require more animal food  than
women, and  those engaged in active exercise
require much more than those who live a sed-
entary life.   Laborers can get  through much
more work in a day when well fed than when
living on a meagre diet.   The different kinds
of  food  should be well apportioned ; it is
equally bad to live on a purely farinaceous
diet, as it would be to take  only fat or meat;
what is required for a state of health is to take
a  fair proportion of  each.  Hunger  is  the
best test as to when a man should eat ;  but it
is often very unwise  to go on eating  until a
feeling of fulness and engorgement ensues ;
it is important  also that meals should be taken
with regularity, as it a is very bad plan to allow
intervals of  varying length between  meals.
A great  many  people  eat too much, and this
has its evils, just as much as excess of drink-
ing.  It has been estimated that the food re-
quired every twenty-four hours by a man in
full health,  and taking free exercise,  is, of
meat 16 oz., bread 19 oz., fat 3^ oz.,  and of
water  52 fluid ounces ; that is, about i\ lb of
solid food and about 3 pints of fluid.  The
amount  of fluid taken varies with  the work
and with the season  of  the year ;  those per-
spiring a great deal require the most,  and in
summer time many take more than three pints
in  the twenty-four hours ; rhe fluid here in-
cludes any  liquid  taken.  Of the different
kinds of meat,  mutton and roast  beef are the
most digestible ; salt beef, bacon, pork, and
veal would rank next in order ; some sorts of
Jish are  digestible, but there is not so much
nutriment  in  them as  in  a corresponding
quantity of meat.  Bread  is  taken at most
meals, either as bread or toast ; or the same
elements of food are taken, as biscuit, cake,
etc., and it forms an important element of
diet ; not only  is it cheap, but it contains four
out of the five kinds of food ; life can be sus-
tained for a long time on bread and  water.
Pastry is an abomination, and is very rarely
well made ; it  is heavy, greasy, and indiges-
tible. Fruits or preserves made into puddings
or  tarts are very excellent articles of diet, and
so  are light  puddings made of rice, arrow-
root, tapioca, etc.  Salt should be taken with
food, and generally it  is present  in a greater
or less degree in most kinds of food.  Sugar
seems  necessary in early  life, but the desire
for it is lessened as we grow older.  Both the
saccharine and  fatty foods  should be avoided
by those who are too corpulent, as they both 
DIGESTION
DIGESTION           111
 help to build up fatty tissues.  The system of
 Banting rested  on this principle, and there
 is no manner of doubt that fat people can be-
 come  greatly reduced in weight, and keep
 themselves down, by attending to this rule ;
 the change should not be made too suddenly,
 but no danger need be feared  on that score.
 The following substances should be avoided
 by a fat man, or at least taken only in mod-
 eration :  Fat of  meat,  bacon,  pork,  etc. ;
 white bread, potatoes ; starchy food,  as tapi-
 oca, rice, arrowroot,  sugar, beer, and heavy
 wines or spirits.   The following articles may
 be taken without  fear of forming too much
 fat:  Brown bread, toast, biscuits, rusks, lean
 of any kind of meat, fish, fowl or game, green
 vegetables,   as  cauliflower,  asparagus,  and
 lettuce, celery, fruit, either  cooked or fresh,
 jams  in moderation,  and light  wines.  Of
 course, no one can strictly adhere  to this plan,
 but  attention to its  leading  principles will
 soon make  a vast improvement  in the ease
 and condition of the individual.   For people
 who are thin, a converse plan may be in part
 adopted.  Climate makes a great difference
 in the appetite, as has been  shown by  the
 large  amount  eaten by sailors who have
 served in arctic expeditions.   Some people
 have  been known to eat 8 lb. of  meat a day,
 and others from 12 lb. to 20 lb.  per day, in
 those  northern regions.   (See Bantingism,
 Composition of Body, and Food.)
   DIGESTION.—The alimentary canal is
 the great channel whereby new material is
 introduced into  the  blood, and  it is in this
 canal that the important function  of digestion
 takes place.   A  man swallows daily a certain
 amount  of meat, bread, butter, water, vege-
 tables,  etc.,  and it has been computed  that
 the amount of  chemically dry solid  matter
 taken  daily  by  a man of average size and
 weight amounts  to about 8000  grains ; he
 also absorbs by  his lungs about 10,000 grains
 of oxygen every twenty-four hours, making
 a  total of 18,000 grains (or nearlv  two  pounds
 and three quarters avoirdupois) of daily gain
 of dry solid  and gaseous matter.  Of  this
 quantity about 800 grains, or one tenth part
 of solid matter, leaves  the body  daily as ex-
 creta, and as no solid matter in any quantity
 leaves the body in any other way, it follows
 that  in addition to the quantity of  oxygen
 absorbed by the  lungs, about 7200 grains of
 solid  matter  must pass out of the body in
 gaseous  or liquid  secretions, supposing the
 man to keep the same weight.   The urine,
 the perspiration, and the expired air from the
 lungs,  carry  off  nearly all this quantity in
 their secretions.   All the substances  used as
 food are classified and discussed in the articles
 on Diet and  Food.   When these different
 foods  are swallowed various  changes  take
place.  Starchy compounds are very  insolu-
ble, but  the  saliva  converts these  during
mastication into sugar, and this passing down
 into  the  stomach  is  easily soluble ;  hence
 arises the  necessity  for  well  masticating
 bread,  biscuits,  potatoes,  toast,  rice,  and
 arrowroot, etc., so that all the starch may be
 thoroughly converted, or else indigestion may
 ensue.  Albuminous compounds, as the lean
 of meat, etc., should be well masticated so as
 to tear up each portion into minute pieces and
 enable it to be easily acted upon by the gas-
 tric juice when it gets into the stomach ;  no
 chemical  change takes  place  in the mouth
 with regard to this group, nor with the next
 two groups either ; the only change is  a me-
 chanical one, and  by this means the food is
 well mixed together and finely divided.  The
 oesophagus  is  merely  a tube to convey  the
 food  from the mouth  to the stomach, and
 takes no part in  digestion.   The stomach is
 a dilated  chamber  where the  food remains
 for a time to be digested and to be acted upon
 by the gastric  juice.   This  important  secre-
 tion,  poured  out from the walls of  the  stom-
 ach  in  great quantity  during  digestion, ren-
 ders soluble  all the proteids or albuminous
 compounds ; and the more finely divided these
 bodies are, the easier does the process go  on.
 When meat is swallowed hurriedly, or when
 tough, fibrous, and indigestible food is taken,
 the action of the gastric juice is lessened and
 indigestion  results. Thus, in the course of
 three or four hours after a meal, the stomach
 contains all the proteids, amyloids,  and min-
 erals, in a state of solution, for water in some
 form is always taken  with food :  only  the
 fatty  matters as yet are unaffected.  Passing
 down into the small intestine the food is now
 called chyme, but it does not go far when it
 meets with the bile and  the pancreatic  juice,
 which,  acting on the fatty  matters, form an
 emulsion, whereby the oily particles are so
 minutely  divided as to render them capable
 of being absorbed by the lacteals and vessels
 of the small intestines.   Thus, either in the
 mouth, stomach,  or intestinal canal, the vari-
 ous  kinds  of food are so  acted upon as to
 render them capable of absorption, and this
 process goes  on not only in  the stomach but
 all the way down the  intestines, so that the
 blood is supplied after every meal with a fresh
 stock of food to make up  for the losses which
 are continually going on in other parts of the
 body.  There is, however,  always  a residue
 of indigestible matters in the food, so that all
 the chyme is  not absorbed, but the remainder
 is excreted daily  and known  as faeces.  As
 the coat of the intestines is in part made of
 muscle, it is constantly contracting in  waves
 and gently pushing the  chyme forward so as
 to bring it in contact with different parts of
 the canal, and finally to expel the indigestible
 remainder. If this process from any cause go
on too rapidly then  diarrhcea will result, and
if it continue the patient will lose flesh, because
those substances  escape  which ought  to be
absorbed by the blood ; or again, if there be 
112            DIGITALIS
DIPHTHERIA
disease of the mesenteric glands or walls  of
the intestines,  as in  some  cases of wasting
disease in children, in cancer of the bowels,
etc., then absorption will not go on properly
and  emaciation  will  be the  consequence.
Foods vary much in their degree of solubility,
and  hence arises the importance of careful
diet in those who have  a weak  digestion,  or
in those who are convalescing  from an ill-
ness.  By bearing in mind the importance
of mastication  and  digestion in early  life,
much suffering may be avoided in after years,
and  many of those who are confirmed in-
valids and martyrs to indigestion might have
been  free from  disease had they paid  more
attention to diet.  Not  only should  the food
be easily digestible, but it should not be swal-
lowed too hastily ; it should always be taken
at regular intervals, and rest after a meal for
a  short time is  advisable ;  also too  much
should not be taken  at once, so as to make
the individual feel distended and uncomfort-
able.   (See Diet, Food, and Indigestion.)
  DIGITALIS, or Foxglove,  though a com-
mon plant, is one of  our most valuable rem-
edies.   The leaves of the plant are used, and
from them may be extracted an active prin-
ciple, not an alkaloid, called digitaline.  Its
two officinal preparations are an infusion and
a tincture. The leaves are taken when about
two thirds of the flowers are expanded, and,
as a  rule, the second year's leaves are the
best.   Digitalis  acts as a sedative on certain
important organs, especially on the heart, and
that, too, through one special nerve called the
pneumogastric or vagus.  This nerve serves as
a kind of fly-wheel to the heart. Stimulation of
it  in any shape diminishes the rapidity, while  j
it  increases  the  force of  the heart's action.
Paralysis of it, on the other hand, increases the
rapidity, leaving the  iorcepari passu.  Now
digitalis  stimulates this  nerve, and therefore
steadies  the  heart.   Under its  influence the
heart no longer  beats frequently and imper-
fectly expels  its contents,  it  acts more slowly
and more perfectly. Hence, had dropsy arisen
from the heart's imperfect pumping, the fluid
is again taken up by the vessels,  and carried
through  the kidneys,  whose  functions  of
course in this fashion increased, so that the
medicine acts as a diuretic.   Of course, if the
use of the drug be carried  too far, a totally
opposite result will follow—the heart's action
will be reduced too far, and  may even cease.
When digitalis has   been  too freely  given,
therefore,  there  is  considerable danger  of
paralysis  of  the  heart—it may  stop, and so
death ensue.  This is most likely to be  the
case if the patient attempts any unusual ex-
ertion, or even sits up in bed.  It is, however,
to be  noted  that in  patients the subject  of
heart disease, this remedy may  be given for
months with  only good effects.   It is chiefly  j
used as a remedy in heart disease, where it is  I
most valuable if the proper cases are selected.
It has also been used in delirium tremens in
large doses, but this treatment has not been
generally accepted.  A more valuable appli-
cation perhaps  is  to the  treatment of acute
mania.   Digitaline is sometimes used in the
same malady, being injected under the skin if
there is any difficulty  in  getting the maniac
to  take it.   At all times digitalis should be
used with caution, and is one  of  those rem-
edies  which  in  appropriate cases do much
good, but  in  badly selected cases  may kill.
The infusion of it will keep as the best prep-
aration  ; the dose should always be less than
one tablespoonful.
  DILATATION occurs in various organs
of  the body.   i. In the heart, in  many cases
in  which there is  disease of the valves,  or
where  the  wall of that organ  is fatty  and
weak.   2. In the air-cells of the lung, forming
the condition known as emphysema.  3. In
the bronchial tubes, in persons who have long
been  subject  to winter-cough.   4.  In  the
bladder, when the patient has suffered from
stricture for some time.  5.  In the kidney, if
ihe ureter be blocked  up by a stone, so that
this organ may be distended into a large cyst
and become quite  useless.   6.  In  the ven-
tricles of the brain, as  in some cases of men-
ingitis.   Thus there is hardly any cavity in
the body which may not become dilated as a
result of some form or other of  disease, but
the treatment  will consist in removing the
cause for the dilatation, if possible, as little
or nothing can be done for the organ when it
has once been well dilated.
  DILL is the fruit of Anethum graveolens, a
plant  belonging to the hemlock  family.  It
contains an oil which may be distilled from
it.   To this oil it owes its property, and from
it,  or  from  the  fruit, is prepared dill-water,
the form in which the substance is commonly
used.   It is almost entirely employed in the
maladies of children,  accompanied by flatu-
lences.   It is much used as  a domestic rem-
edy, and is the more to be commended for
this, inasmuch  as  though useful  it is harm-
less.  A teaspoonful   of  the water  may be
given for a dose, or a drop of the oil  let fall
on sugar.
  DILUENTS are a class of remedies made
use of to quench thirst, or to make the blood,
heated and  thickened  by fever,  thinner and
cooler.   Toast and water, barley-water, lem-
onade,  and such like  beverages, are of this
class.
  DIORESIS  implies  an excessive  flow of
urine.
  DIPHTHERIA is  a  specific contagious
disease, occurring generally  in  an  epidemic
form,  and characterized by a peculiar inflam-
mation of the mucous or lining membrane of
the fauces,  pharynx, and upper  part  of  the
air-passages ; sometimes the  disease  spreads
to  other parts of the  mucous membranes ;
there is also generally  some affection of the 
DIPHTHERIA
DIPHTHERIA         113
 spleen and kidney, together with much gen-
 eral prostration.  This disease seems to have
 been known for the last two thousand years,
 and under various names it has prevailed with
 great severity in  different countries.   It has
 often been confounded with croup and scarlet
 fever, and it  was  not until recent epidemics
 that this disease has been clearly and gener-
 ally recognized.  Children and young people
 are  more liable to it than adults, and more
 girls suffer from it than boys ;  in like manner
 women are  more liable than men, and the
 weakly of either sex are more prone to the
 disease than the strong and healthy.  Climate
 and season do not seem to exercise any influ-
 ence on the disorder ; it occurs with equal
 severity in   the  winter as in  the summer
 months, and  in its  symptoms and  mortality
 it is the same in hot as in cold  countries ; yet
 various epidemics differ in severity and in ex-
 tent.  It is quite  clear that this  complaint is
 contagious, but in what way is not so mani-
 fest ; at one time an isolated case will appear
 in a country  village and not  spread widely,
 while on another occasion a whole district will
 suffer severely  ; if one inmate of a house be
 attacked, most of  the other members of the
 family  will suffer, too, if they come  in con-
 tact with the  patient.   The infectious matter
 is capable of  diffusion into the  air and carried
 to distant parts, but it  is more common for
 people who inhale the patient's breath or who
 come in close contact with  the sufferer to
 suffer  most.   No  atmospheric  condition  is
 known  which tends to favor  the spread or
 check the progress  of the disease ; it  is very
 doubtful if the disease can be taken  from one
 house to another by an unaffected person, but
 the presence of one sick person in a house is
 sufficient for  its communication to  another,
 although the  two  may be kept as separate as
 possible. As in most epidemics the mortality is
 greatest at the outset, and this is probably due
 to the  most weakly and  most  susceptible
 being attacked first.  Although every care be
 taken to cleanse and purify an apartment in
 which  a patient has suffered  from  this dis-
 order, yet the infection  will sometimes cling
 to it with remarkable tenacity.   "In a coun-
 try  house in Scotland a visitor suffered from
 this  disease  while occupying  a chamber in
 which a case of diphtheria had occurred eleven
 months before." The time between exposure
 to the disease and the  first appearance  of the
 disorder varies very much ; in  some  cases
 the   period  has only been thirty  hours,  in I
 others  several  days elapse.   The  infection
 may be disseminated for some time after con-
 valescence has been established ; thus in one
case, a little boy, who  had  been absent from
his family for three weeks, went to see  his
sisters who were recovering from the disorder,
and caught it; other instances are  recorded
where, five or six weeks after the commence-
ment of the illness other persons have been
 attacked. There seems to be a predisposition
 on the part of some people to take this disease
 more readily than others ;  those  who  are
 highly nervous or have undergone much men-
 tal activity, and those who have suffered from
 exhaustion or bodily fatigue are more liable
 than others.   The disease seems  to attack in-
 differently all classes of society.
  Symptoms.—The onset of an attack is mark-
 ed by lassitude and prostration, aching in the
 back  and legs, pallor of the skin, and pain in
 the throat ; in children there may be diarrhcea
 headache,  giddiness, and a stupid  condition.
 The pulse becomes quick and may beat 120 or
 140 times a minute, but the respirations  are
 not particularly increased .  The  tongue  is
 moist and  slightly coated ; the appetite is im-
 paired, and there is more or less thirst.  The
 urine is pale and  generally contains a little
 albumen ; this  may be known on  heating a
 small quantity in a test-tube ;  if  a hazy cloud
 appear, which does not go away on adding a
 little nitric acid, it shows that albumen is pres-
 ent.  More marked are  the local symptoms.
 The throat is sore, and it is difficult and even
 painful to swallow, and this pain extends often
 to the ears, and there  is a  feeling of stiffness
 in the muscles of  the neck.  On looking in-
 side the mouth there will be found some swell-
 ing and redness of the soft palate and tonsils
 and the back part of the throat ; if the inflam-
 mation extend upward into the nasal passages
 there may be a glairy discharge from the nose,
 or, if  it spread downward into  the larynx,
 symtoms similar to those met  with in croup
 will appear. There will then be hoarseness and
 weakness of  the voice, with cough  and crow-
 ing inspiration, and if the obstruction be very
 great there will be imperfect expansion of the
 chest,  pallor of the face, and  lividity of the
 lips.
   When the inflammation extends  into the
 larynx the mortality, especially in children, is
 very  great, and it has  been  estimated that
 one half of the fatal cases die from this cause ;
 in adults this extension of the disease proves
 less dangerous, and they are often able to ex-
 pectorate large pieces of the false membrane.
 Sometimes the mischief  is confined entirely
 to the larynx, but  more  generally the fauces
 will be found affected also.   The most char-
 acteristic appearance in diphtheria is the pres-
 ence of a  membrane which covers  more or
 less the parts about the upper and back part of
 the mouth ; this membrane is soft and of an
 ashy-gray color, and  when removed  leaves
 behind  a red and  raw surface,  and then it
 rapidly  reforms again ;  the swelling of the
 mucous membrane  and the amount of false
membrane may be so great as to prevent swal-
lowing, and so endanger life  by preventing
enough air from entering the lungs.  This
membrane, too, may appear on any abraded
surface, on a  mucous  membxane, or on the
skin ;  if there be an open  wound anywhere 
114          DIPHTHERIA
DIPHTHERIA
the surface will cease to heal and become cov-
ered with this unhealthy membrane.  Hemor-
rhage occasionally takes place on attempting
to remove  the deposit  from any affected sur-
face, so that much care must be taken when-
ever  this  is  attempted.  The inability  to
swallow  is sometimes  very great, and when
fluids are taken they are often apt  to  come
back  through the  nose ;  at  the same  time
there is a loss of sensibility in the fauces and
soft palate ;  complete inability  to  swallow
seldom comes on  before the third  or fourth
week of the  disease, and  it arises from par-
alysis of the muscles of deglutition ;  this con-
dition is a very serious one and adds much to
the danger of  the  case ; the pulse  may be-
come weak and slow,  and death may  occur
suddenly from fainting on any undue exertion.
The paralysis may extend to other parts of
the body, and these become affected at a later
period ;  in  this way the legs or arms become
useless for a time, and the  muscles of the
neck may be  so paralyzed that the patient is
unable to move his head.  Loss of power and
irregular action of the muscles of the pharynx
is the earliest and most common form of ner-
vous affection in this disease, and it may dis-
appear rapidly and leave no mischief behind,
but sometimes  it  lasts for many weeks or
months  and retards convalescence.  The pa-
tient is often  unable to articulate clearly from
imperfect movement of the tongue,  and ting-
ling sensations are often  felt in the tongue j
and lips.  Every case  of  diphtheria must be I
regarded with anxiety, as it is attended with
considerable  danger ;  any extension of the I
deposit in  the fauces,  the  onset of a hoarse j
voice,  or croupy  breathing, and the occur- |
rence of  hemorrhages,  are serious symptoms.
The mortality varies in different epidemics,
and some of  them have been marked by an
immense percentage of deaths ; occasionally
all the members of a family have been rapidly
carried off  in succession, but  the average of
deaths ranges from one in three at the height
of the epidemic to one  in seven or ten  at its
close.
  Treatment.—This   consists  in  general
means and  local measures.  There is no drug
which  can  be looked upon as a specific, nor
are there any means in our power  to elimi-
nate the  disease when once it has attacked an
individual,  yet a great deal may be done at the
outset if the disease is  recognized sufficiently
early.   As a  local  remedy   a  solution of
nitrate of silver should be thoroughly applied
to the  diseased surface of the throat, but not
forcibly so  as to rub off the membrane and |
cause bleeding to follow.   Hydrochloric acid
and honey  have been used for a similar pur-
pose, but in  all these  cases  medical advice
must at once  be sought, as it is dangerous to
employ merely popular remedies.  The pa-
t  ent  must  be put in a well ventilated room,
but free from draughts, and  if the  weather
be  cold  there should be a  fire in the room ;
the air should be between 6o°  and 650 Fahr-
enheit, and it may be kept moist  by boiling
water  in a kettle on the fire and letting the
steam pass into the room occasionally. Com-
plete rest must be obtained, as there is always
great prostration, and any exercise or move-
ment on the part of he patient  should be
avoided  so as to store  up all his strength.
Milk may be given to the extent of three or
four pints  a day, and brandy can be mixed
with it, if it is necessary.  Beef-tea, chicken-
broth,  and eggs  may "also be given ; it is of
no  use giving solid food as the patient will
not  care for  it,  and it will  create pain in
swallowing.  The general treatment in  fact
is similar to that which has been laid down
in the article on Fevers ; in this disease, how-
ever, great care  must be taken that the food
is given in small quantities at a time,  and
slowly, because in consequence of the paraly-
sis of the muscles of deglutition which olten
ensues,  the act  of swallowing is  rendered
dangerous.  Where there is much obstruction
in the  larynx the operation of tracheotomy
may be  resorted  to,  but this proceeding is
attended with a very small amount of suc-
cess, and is nearly always followed by a fatal
result in  very young children.  When conva-
lescence  begins, the return to solid diet must
be slow  and gradual ; for many  weeks the
nutriment  should be light  and wholesome,
and not too much should be taken at a time.
As  soon as the patient can be removed with
safety,  and without  carrying infection  to
others, removal to country air or the seaside
is most beneficial, and it is the more needful
in these cases as there is so much prostration
and  anaemia  for many  weeks afterward ;
yet, even in bad cases, the health will in time
be thoroughly restored.   Cold bathing, tonic
medicines, moderate exercise,  or even a sea
voyage, are very  valuable aids in restoring
the health.  In  cold  weather a bath is not
advisable unless  the  chill is taken off  the
water, but in summer time it is most refresh-
ing and strengthening ; carriage exercise may
at first be taken, or a short walk during the
fine  part of a day, but  no great  exertion
should be  made, and the patient should rest
as soon  as a tired feeling comes on.   Al-
though this disease  is not so  communicable
by the  clothes  as scarlet fever  and  some
other disorders,  yet  it  is always  advisable
that any articles of  clothing should be thor-
oughly disinfected before being worn again,
and for this purpose they may be placed in
an oven and exposed  to a high temperature ;
a similar remark will apply to the bedding,
curtains, sheets,  etc, of the room in which
the patient has   lain.   When possible, the
house in which the disease  has broken out
should be  well cleansed  and fumigated ;  it
may be  kept  empty for this  purpose, for a
week or ten days,  and chloride  of  lime 
DIPHTHERITIC  PARALYSIS
DISINFECTANTS        115
 may be  sprink'ed about the rooms on  the
 floors.
   The  great  danger in diphtheria seems to
 be from  inhaling the breath of an affected
 person, therefore communication with other
 people  should be avoided as far as possible,
 and this  is most important in  the case  of
 children,  who are very susceptible to this com-
 plaint.   Nothing  is  more  foolish than  for
 friends to come and see those who are affect-
 ed with  some contagious or infectious dis-
 order, unless  they are either doctors or nurs-
 es, or are of some use to the patient; by giv-
 ing way to  a  morbid sympathy or curiosity,
 they run the risk of  catching the  disease
 itself or  of communicating  it to others, and
 in this case, as in  many others,  prevention is
 better than cure.
   DBPHTHERITIC  PARALYSIS.  (See
 Paralysis.)
   DIPSOMANIA is the name given to that
 horrid craving for drink which is either devel-
 oped or is innate in some men—more rarely in
 women.  Whatever be  its  cause, whether
 brought on by a man's own doings, or, as
 some would have  us  believe, hereditary, the
 man who b*ecomes the subject of dipsomania
 is no longer a free agent, and he ought to be
 dealt with as  such.  Undoubtedly such can
 be reclaimed, but only by stopping all supplies
 of liquor until they have regained their power
 of self-government, which they have utterly
 lost.  It  is terrible to see   a man who has
 been brought  up well, and  whom  you have
 known  as a true gentleman, become  from
 whatever cause a  dipsomaniac.  The  man
 who was once the soul of honor becomes a
 liar, whose  word you cannot for a moment
 trust.   He was honorable in his dealings, he
 becomes everything that is  the  reverse, and
 will not hesitate to steal to gratify his horrid
 appetite.   This, indeed, is  a consummation
 much to be desired, for if he does he can be
 locked  up and  cured, for if  he is not locked
 up he  will not be  cured.   If  you take his
 money from him he will pawn his clothes, if
 you search the house every night  his cunning
 will defy  you  ; he will get drink unless you
 lock him up, and if you do so you do  it at
 your  peril.  An  action for  false imprison-
 ment would lie, and  you  might  be mulcted
 in ruinous damages.   Yet, while  you  talk to
 them and are with them these  people are
 manageable ;  it is  only when they  escape
 from  your sight that  they   straightway go
 wrong.
  DISINFECTANTS are substances which
 are used to purify  the air of those noxious
 products which emanate from persons in cer-
 tain  states of  disease.  It is supposed that
when persons are suffering from various con-
tagious disorders, as small-pox, scarlet fever,
measles, typhus fever, diphtheria, certain par-
ticles emanate from them, and  passing into the
air, carry the disease to other people.  These
 germs, which are floating about in the atmos-
 phere, maybe easily carried to  other locali-
 ties, and set up fresh centres of disease. It is
 therefore very important to use such measures
 as may be possible  to destroy these  germs,
 and so diminish  the propagation of the dis-
 order.  In small-pox and the above-mentioned
 fevers it  seems likely that  the morbid prod-
 ucts are given off from  the skin  or in the ex-
 pired air, while in cholera and typhoid fever
 the evacuations from the bowels  are looked
 upbn as the chief source  of danger.  Patients,
 as a  rule,  are  more   dangerous to others
 when the malady is subsiding, or during the
 convalescent  period ; thus  in scarlet fever
 when a child's skin is peeling the disease  is
 very liable to be propagated.    Chlorine   is
 one of the best disinfectants, and if the air of
 the room could be  thoroughly charged  with
 this  gas, all  the  poisonous particles would
 most likely be destroyed ; this cannot be well
 done because the  gas is  so irritating, and the
 same remark  will apply  to the use of nitrous
 and sulphurous acids ; nevertheless, when the
 room is empty and requires fumigating, these
 gases can be  used freely and with great ben-
 efit.   In  any case of fever chloride of  lime
 can be laid in saucers or shallow dishes about
 the room, and then enough chlorine will be
 given off to produce  a faint smell of the gas
 in the apartment.   Carbolic acid is perhaps as
 effectual, and is  not so  disagreeable ; solu-
 tions of it diluted with  water  may be sprin-
 kled about the room, or  cloths dipped in the
 fluid may be hung up  ; in other cases the
 powdered carbolale of lime may be placed
 near the  patient.   All   these disinfectants
 should be also placed outside the apartment
 in the hall or on the staircase, and the hands
 of the attendants  should be washed in weak
 carbolic acid  (one part  to  two  hundred of
 water) before they leave  the sick-room.
  Dr.  Elisha  Harris gives  (in  one of the
 " Hampton Tracts for the  People") the fol-
 lowing " Simple Rules for Disinfection :"
  (i.) Quicklime.— To  absorb moisture and
 putrid fluids,  use  fresh stone lime  finely
 broken ; sprinkle  it  on the place  to be dried,
 and in damp rooms place a number of plates
 or  pans filled  with the lime powder ;  white-
 wash with pure quicklime, freshly slacked in
 water, and  of a  creamy thickness.   If the
 apartment has been contaminated  by foul
 gases or by contagious  disease,   add a pint.
 of the best fluid  carbolic acid to  every  gal-
 lon of fluid whitewash.
  (2.) Charcoal  Powder.—To absorb  the
 putrid gases, the coal must be dry and fresh,
 and should be combined with Lime;  this
 compound is  the  Calx  Powder,  as sold in
 shops.  Any person  can  prepare it.
  (3.) Chloride of Lime.—To give off chlo-
 rine, to destroy putrid  effluvia and to stop
putrefaction, use it as lime is used, and if in
cellars or  closets  the chlorine gas is  wanted, 
116          DISLOCATION
DISLOCATION
pour strong vinegar or diluted  sulphuric acid
upon plates of Chloride of Lime occasionally,
and add more of the Chloride.
  (4.)  Carbolic Acid.—This may be  diluted
at the rate of from ten to forty  parts of water
to oneol the best fluid acid. Use this solution
for the  same purpose  as copperas is used ;
also to sprinkle upon any kind of garbage or
decaying matter, and on foul surfaces of any
kind.    For  sprinkling  foul  or  unhealthy
streets and alleys, gutters and  foul  places,
mix I  to 3 parts  of this  crude carbolic acid
with 100 parts of  the copperas solution, and
sprinkle the entire surface every four or five
days during the summer  and autumn.  It is
chiefly valuable to prevent putrefaction.
  (5.)  Sulphate of Iron (Copperas) and Car-
bolic  Acid.—To disinfect  privies,  cess-
pools, drains, and sewers, and especially the
vessels,  grounds, or places in  which the dis-
charge from the sick with any  fever or diar-
rhceal diseases  are  evacuated  or cast away:
Dissolve eight or ten pounds of sulphate of
iron in  three or  four gallons  of water, and
add a pint of best fluid carbolic acid (if it is
desired,  and a  good quality is at hand), stir
or agitate it briskly to make a complete solu-
tion.   Use this  disinfectant as  follows :
   To keep privies and water-closets from becom-
ing infected or  offensive,  pour a pint of this
solution into every water-closet pan or privy
seat, every evening.
   To disinfect masses of filth, privies,  servers,
or drains, gradually pour in the solution, hour
by hour, until every part  of the mass  or foul
surface has been thoroughly disinfected.
   To disinfect the discharges from the sick,  let
a small quantity of this solution be constantly
kept in all vessels into which the discharges
are voided from the body, and let every privy
and every place  where the discharges are cast
away  be thoroughly saturated  with the dis-
infecting solution.    Wherever cholera  or
dysentery, and  any of the fevers  are pres-
ent in a house or neighborhood, and wher-
ever  persons   are  arriving  from  infected
places, the daily use of this disinfecting fluid
should be  maintained.  Bedpans and cham-
ber-vessels are disinfected with this strong so-
lution, using a gill or more  at a time, and
emptying and thoroughly cleansing as soon
as used by the patient.
  (6.)  Sulphate of Zinc and Common Salt.
—Dissolved together in water  in the propor-
tions  of 4 ounces of the zinc  sulphate to 2
ounces of salt to  the gallon of  water, is one
of the best disinfectants for clothmg as soon
as taken from the  sick, or their beds.   All in-
fected  clothing  should  be packed  in  such a
disinfecting fluid until it is boiled in the wash.
This is the disinfectant for clothing  recom-
mended  by the  National Board of Health.
(See Deodorants and Fumigation.)
  DISLOCATION means the displacement
of one or more  bones,  and  a separation,
cither partial or wide and complete, of those
surfaces which  are  covered by cartilage or
gristle,  and in their natural condition remain
in close contact forming a joint or articula-
tion ; thus, when the shoulder or elbow is
said to  have been  " put out," there is a dis-
location or separation of the upper extremity
of the humerus from  the shoulder-blade, and
of the bones of the fore-arm from the lower
end of the humerus or long single bone of the
arm.  Dislocation  is in most instances caused
by external violence, generally a fall.  Now
and then a joint which had previously been
severely injured,  undergoes What is called
spontaneous dislocation, the bones being sud-
denly displaced  by rapid  or excessive use of
their  muscles.   This form of  dislocation is
occasionally met  with  in  the  shoulder and
lower-jaw.  In  most  cases of  dislocation
caused by external violence, the ligaments or
sinews  which  fasten together the ends of
bones forming joints are torn and stretched,
and  in  many instances the skin is  bruised
and  the soft parts about the joint are swol-
len and very painful.   The most severe form
of injury is that called  by  surgeons a com-
pound dislocation ;  here  a deep  wound is
present, which extends  from the surface of
the injured region to  the dislocated bone and
leads directly into the joint.  Simple disloca-
tion  at  one of  the  joints  of the arm or leg
when promptly and properly treated, is by no
means so serious  an accident as fracture in
a similar situation, but when overlooked and
not reduced shortly  after  the accident,  be-
comes a source  of great and long-continued
annoyance to the  patient.   If surgical assist-
ance  be put off for  three  or four days,  the
nature of the injury will be obscured by swell-
ing of the soft parts about the joint, and any
attempt to move the damaged limb will then
cause great pain.   The  difficulty and pain
attending the reduction of a dislocation, bears
a direct proportion to the  duration of the in-
jury.   In the great majority of cases of dis-
location at a large joint, it is impossible after
an interval of twelve hours to replace the sep-
arated  bones  without  administering some
anaesthetic.  Dislocation  is  by no means so
frequent an accident as fracture.  According
to the statistics  of the  French surgeon Mal-
gaigne,   the proportion is  as one to eight.
The joint which is most prone to  dislocation
is the shoulder ; next in  frequency  are  the
hip, elbow, and  ankle.  The number of cases
of dislocated shoulder  far exceeds those of
dislocations of all  other joints put together.
  The signs which indicate  a recent disloca-
tion  are: inability to move that part of the
limb  immediately below  the seat of injury,
the displaced  extremity of  the  bone being
fixed in its unnatural position ;  pain in the in-
jured joint; this, though usually not so acute
as the pain attending a broken  bone, varies
in intensity in  different  cases ;  sometimes 
DISLOCATION
DISLOCATION         117
the displaced bone presses upon one or more
large nerves and then causes much suffering.
Inability to move the  joint,  and pain, are in
most cases associated  with some  swelling of
the soft  parts near the seat of dislocation,
and with bruising of the skin ;  the latter how-
ever, are not constant  symptoms.  Finally,
but more important than any other sign, there
is deformity in the joint; this  can usually be
recognized at the first glance  ; sometimes there
is flattening as in dislocation at the shoulder,
and at  other times well-marked  unnatural
prominence of one or  more bones, as in the
elbow and ankle.  It should be borne in mind
that all  these symptoms are common to dis-
location and  to fracture near the joint-end of
a bone.   It  is very often an extremely diffi-
cult point with surgeons to decide whether
a certain injury in the region  of a joint be a
fracture, a dislocation, or a combination of
these two kinds  of injury.   In fracture the
segment of bone below the injury is generally
very movable, and one  may generally detect
on moving the broken parts a peculiar grat-
ing noise, called by surgeons  crepitus, which
is felt rather than heard both  by patient and
medical attendant.  In pure dislocation, this
crepitus  is absent.  Another  distinction be-
tween dislocation and fracture consists  in
this ; when once the deformity attending the
former injury has been removed by surgical
manipulation, or setting of  the joint  as it is
called, it does not return, as the head of the
displaced bone when brought back into  its
socket remains there  ; with fracture,  on  the
other hand, there is a constant tendency for
the fragments of bone to become displaced,
until they are joined together by young bone
in the  course of the  treatment.   In  conse-
quence of the resistance of the  muscles which
move the dislocated bone, the treatment of
this injury, even when quite recent, is by no
means easy, and necessitates,  particularly in
large joints like the shoulder and hip,  the ap-
plication of a considerable amount of force.
If the dislocation has been left unreduced for
a week  or ten days,  this difficulty is much
increased, and it becomes necessary to place
the patient thoroughly under the influence of
chloroform, for the purpose of relaxing  the
tense muscles which prevent  the return of the
displaced bone.  In dislocation of six  weeks'
or two  months' standing,  the chances of a
reduction will depend upon the situation of
the injury.  If the shoulder be affected, well
directed attempts under the influence of an
anaesthetic will probably replace the head of
the  bone. With the hip, however, the chances
of recovery are not so  good at the end of a
month after the receipt of the  injury.  After
an interval of six months the case is gener-
ally  hopeless ; the limb, however, does not
remain  immovable  and quite  useless ;  the
head of  the  dislocated  bone by its pressure
forms for itself a fresh socket in that portion
of the adjacent bone on which it was thrown
at the time of the accident ; fresh  sinews are
formed, the muscles adapt themselves to the
altered  state of things, and  a new joint  is
formed which allows the patient considerable,
though  far  from perfect, use of his arm or
leg.  This favorable  process is carried on
only in  strong and healthy individuals.
  The surgical treatment of dislocation  con-
sists : in pulling at  the part below the in-
jured joint—extension ;  in keeping the parts
immediately above  the joint fixed—counter-
extension ; and in endeavoring with the hand
to elevate or replace the  dislocated bone—
manipulation.  In recent cases of dislocation
of the shoulder and elbow and of most small-
er joints, a sufficient  amount of  extension
may be obtained by  the unaided  efforts  of
the surgeon  and one or two assistants ; but
in recent displacement of the upper extremity
of the thigh bone, and in most old dislocations
of other  joints, the pulleys are  required.
Counter-extension  is  generally kept up by
means of a napkin, jack-towel or folded table
cloth.   The reduction of the bone is indicated
by a sudden snap,  the form of  the joint and
its functions are at once restored, and the pain
is very  much relieved, the whole limb  also
recovers its natural length and position in re-
lation to the rest of the body.   The subse-
quent treatment consists  in  confining the
limb for  a period varying with the size and
situation of the injured joint.  In  dislocation
of the shoulder, the arm is bandaged to the
side of the body for about  two weeks, and in
dislocation  of the hip it is necessary for the
patient  to remain in bed for some time.   By
keeping the joint at rest, the  pain  and irrita-
tion  caused  by  the  injury are removed, and
the torn sinews  are repaired.  The muscular
power and  general  tone of  the limb are re-
stored  by shampooing and friction, affusion
of cold water, and the use of liniments.   Pre-
mature  use of an injured limb prevents the
complete  repair of the structures of the joint,
and favors a return of the  dislocation on the
application of slight violence.   Recovery can
never be complete, as the dislocated joint al-
ways remains weaker than any of the other
sound joints.  In a  healthy  and young or
middle-aged subject, whose injury has been
properly  treated, this difference is scarcely
appreciable,  but in old people and those who
are rheumatic or  gouty the  joint  remains
more or less stiff and  painful,  and is much
affected during climatic changes  and after ex-
posure to cold and wet.   The immediate and
provisional  treatment of a patient who has
received a severe injury producing dislocation
of some important joint—the hip, for instance
—should  be the  same as  that carried out in
a recent case of fracture.  (See Fracture.) In
the following paragraphs a short  sketch will
be given of the symptoms and  management
of the most common forms of dislocation : 
118          DISLOCATION
DISLOCATION
  Lower-Jaw.—This  bone when dislocated
is carried forward, and its front part  is de-
pressed so that the lower row of teeth pro-
jects  beyond  the  middle teeth  of  the jaw
above.  The jaw is fixed in this position, and
the mouth cannot  be closed,  the  cheeks, are
flattened, the tongue  is slightly protruded,
and  the  saliva flows over the lower lip and
chin.  There is generally  severe  pain  below
the ears.  This dislocation may be produced
by  opening the mouth very  widely,  as  in
yawning or  attempting to  masticate large
pieces of food,  or by a blow or fall upon the
chin when the mouth  is open.   So  long as
the jaw is in this  unnatural position the pa-
tient is unable to speak plainly or  to swallow.
Sometimes only one head of the bone is put
out of place, and then the  teeth are displaced
laterally away from the seat of dislocation.
This accident, as has been stated above, may
in many cases  be  easily produced by  slight
causes.   When  surgical aid cannot be ob-
tained, an  attempt may be  made to reduce
this dislocation by placing the thumbs, pro-
tected by pieces of linen, over the last teeth
on  either side  of  the  lower jaw, and, while
depressing these teeth by raising the chin
with the  fingers, the jaw will then probably
return with a sudden  snap.  When  the dis-
location occurs only on one side, one thumb
only  is to be placed on  the  corresponding
molar teeth.  The jaw  should then  be kept
in its place by a  handkerchief or bandage,
and the patient must for many weeks restrict
as far as possible the movements of the bone,
for the sake of avoiding a recurrence of the
dislocation.
  Shculder-Joint.—Dislocation  occurs more
frequently in this than  in  any other  joint of
the body.  The hemispherical head of  the
arm-bone moves on a very shallow socket on
the outer  margin of the shoulder-blade, and
is retained there by a loose membranous sac
called the  capsular ligament ; this arrange-
ment admits of great mobility and free lati-
tude of motion to  the  arm-bone, which on
the application  of  great force, either directly
upon the shoulder or indirectly  through the
arm,  may be readily displaced.   The usual
causes of dislocation in this region are blows
upon the shoulder  or falls upon the elbow or
hand.  Dislocations of the  shoulder vary very
much in the direction  taken  by the head of
the displaced arm-bone. It is most frequently
forced downward  into the arm pit, but may
be carried inward,  forward,  or  backward.
The following are  the signs of  a downward
dislocation of  the  arm-bone : pain and loss
of motion in the  joint, slight elongation of
the upper extremity and  tilting  outward of
the elbow, which  cannot be brought in con-
tact with the side of the body without causing
the patient great pain ;  the patient leans over
to the side of the dislocation, and supports the
elbow of  this  extremity with the  opposite
hand ; the hollow of the arm-pit is occupied
by  a hard swelling which moves with the
rest of the arm, and can be felt distinctly to
be the displaced extremity of the bone.  In the
absence of surgical aid, an attempt may be
made to reduce this dislocation by raising the
injured arm  from  the  side of  the body, the
patient being seated in a chair, and placing
the knee in the arm-pit, and then gently de-
pressing the arm over this, which should serve
as a fulcrum.  Another method, which how-
ever, is not  so safe, is to place the heel, the
boot  having  been removed, in the arm-pit
and  to pull down the whole arm, the grasp
being taken either at the wrist or just  above
the elbow.   The patient must lie at  full
length on a mattress.   If any grating should
be felt or  heard on  moving the injured limb,
these attempts ought  not to be continued.
Dislocation at the shoulder-joint is very liable
to return, unless care be taken to confine the
injured arm in bandages for some weeks after
the reduction.
  Elbow.—Dislocations at this joint are com-
mon in children.  The most frequent form
is the displacement of the  bones of the fore-
arm  backward  ;  they  are sometimes  dis-
placed to one  or other side,  and,  in  some
rare instances, forward.  The backward  dis
location  is usually  caused by  a fall on  the
palm of  the  hand.   The  following are  the
symptoms of this injury :  The whole of  the
upper extremity appears to be  shorter than
its fellow ; the  fore-arm is half  bent and the
thumb and outer  surface of the wrist is turn-
ed forward ;  at the back  of the elbow there
is a considerable  hard projection formed by
the dislocated upper extremity of the cubit;
in front of the  elbow the lower extremity of
the  arm-bone  is  unnaturally prominent.
Every attempt to bend or straigthen the fore-
arm  causes acute pain.  In lateral disloca-
tion, which is always  partial, the nature of
the injury is indicated  by increased width of
the elbow, particularly in front, and by un-
natural prominence  of one or other of the lat-
eral  projections at the lower extremity  of the
arm-bone.  The lateral dislocation more  fre-
quently occurs outward.   The  reduction of
a recent  dislocation at  the elbow can gener-
ally  be effected without much difficulty ; the
patient having been  placed in  a  chair,  the
surgeon, resting his foot on the seat, applies
his knee  to  the  front of the elbow, he then
grasps the wrist and bends the forearm around
his knee, taking  care at  the  same  time to
press backward the upper  extremities  of the
bones of the fore-arm,  in order  to free them
from the lower part of the single bone of the
arm.  If this method  should not succeed, an
attempt may be made to reduce the bones by
forcibly  extending the fore-arm, while an
assistant   keeps  up  counter-extension  by
grasping the  arm firmly above the elbow and
holding it in  position. 
DISLOCATION
DISLOCATION          119
  Thumb.—The  first, or metacarpal bone,
 which  extends from the wrist toward  the
 web of the digits, is  sometimes dislocated
 either  backward or  forward  at its upper
 extremity ; this, however, is a rare accident.
 The second and  third bones are frequently
 dislocated backward over the heads of  the
 bones above, in consequence of falls upon the
 end or  contracted  surface  of the  thumb.
 Forward dislocations also occur, though very
 rarely.   In  dislocation of the  second  from
 the head of the  first bone,  the  reduction in
 many  instances may be  readily performed,
 either  by pulling out the end of the thumb,
 or by forcibly bending the displaced  portion
 backward,  and pressing  forward the  dislo-
 cated extremity of the second bone.   When
 the injured thumb is  short, or a firm grasp
 it cannot be obtained for  the fingers,  a finger
 bandage  or  piece of broad tape may be tied
 round the thumb in a clove-hitch, and extension
 made with this.   In some cases of  the above
 dislocation, and in almost all cases of disloca-
 tion of the third bone of the t humb, reduction
is extremely difficult,  and before  it can be
 effected it is often necessary to administer
 chloroform, and  even to perform  a cutting
 operation.   Dislocations  of  the fingers  are
 not so frequent as those  of the thumb, and
 are treated in same manner.
   Hip-Joint.—Dislocation occurs more fre-
 quently at this than at any other joint of the
 lower extremity,  although the rounded head
 of the thigh bone  works in a  deep  socket, is
 retained  there by strong ligaments, and is
 protected in all directions  by thick and power-
 ful  muscles.  There  are  several varieties of
 dislocation at the  hip-joint.   The most com-
 mon form is displacement of the head of the
 thigh   bone, backward  and  upward,  upon
 the back of the large hip-bone.   This injury
 is usually caused by the individual falling
 while bearing on his  shoulders a heavy load,
 or by a fall of some  large and  heavy  mass
 upon  his shoulders  while the  body is bent
 forward.   The following  are the symptoms :
 The injured limb  is shortened to the extent
of one  inch and a half or two  inches ;  the
knee is turned inward and bent forward ; the
foot is also inverted and the toes rest upon the
surface of the sound foot : the head of the
thigh-bone forms an unnatural projection
above and behind the situation of  the hip-
joint, and the natural roundness of  this joint
has disappeared ;  the lower extremity cannot
be moved by the patient without suffering.
The reduction of this, as of all other disloca-
tions of the hip, whether they be old or quite
recent, requires  the  application  of  much
force, and it is necessary in most cases to put
the patient under the influence of chloroform.
There are two methods of restoring the head
of the thigh-bone to  its  socket; it may be
done by forcible traction or by what is called
manipulation.  If  the former method is to be
practised, the patient is laid on his back upon
a mattress, and a  jack-towel is passed be-
tween the dislocated hip and the perineum,
and fixed behind the patient's head, either to
a bed-post or to a hook  firmly screwed into
the wall ; while counter-extension is kept up
by this,  traction  is made on the thigh-bone
by cords and pulleys fixed at one end to a
staple in the wall in front of the patient, and
the other  to a padded  leather  belt or long
towel fastened around the lower part of the
thigh, the knee being turned inward and the
whole thigh brought over the opposite limb.
The surgeon sometimes endeavors to raise
the displaced head of the thigh-bone by means
of a second jack-towel passed under the up-
per part  of the thigh, and around the back of
his neck  and  shoulders.  In reduction by
manipulation no pulleys  or apparatus of any
kind  are required.  The patient having been
put under the  influence  of chloroform, the
surgeon bends the knee and hip of the injured
extremity to the utmost extent, then rolls the
thigh-bone outward, and  finally abducts the
thigh or  forces it directly  outward and away
from  the median line.   During these man-
oeuvres the head of  the thigh-bone generally
slips  with an audible noise into its  socket.
 When no  surgical  assistance is  at hand, the
patient  should  be  laid  on his back, and his
legs be fastened together above  the knees by
a broad bandage.   In cases where reduction
has not  been effected, there is  much lame-
ness  and pain in the injured joint when the
patient  gets  up for the first time, but in the
course of a few months a new joint is formed,
and the range of movement is much increas-
ed.  The limb is of course shortened and the
patient  must always limp, but with  the aid
of a thick sole  to  the  boot worn on the in-
jured side, these inconveniences  may be very
much diminished.   The next in frequency to
the above is dislocation forward and down-
ward.   Here the limb is  lengthened  to  the
extent of two inches or  more ; the knee is
bent  forward and  the whole limb is  widely
separated from its  fellow ; the body  is bent
forward  and  slightly directed to the injured
side ; the foot is pointed forward and down-
ward.  This dislocation may be reduced by
the pulleys, counter-extension being made as
in the former injury by a jack-towel passed
around  the crutch.   Extension  of the limb
having been made  downward and outward,
the head of the bone should  be pulled out-
ward  by  means of a towel applied round the
upper part of the  thigh.  Dislocation for-
ward  and  upward  is  a  very rare  injury.
According to Sir A. Cooper, " it  happens
when a  person while walking puts his foot
into some unexpected hollow on  the ground  ;
and his body, being  at the moment bent back-
ward, the head of  the  bone is  thrown for-
ward  upon the pubic bone.   In this  injury
the, foot  is turned  outward and the  whole 
120         DISLOCATION
DISLOCATION
limb  separated  from its  fellow, rolled out-
ward and shortened.  In the groin can be felt a
large hard mass which is the displaced head
of the thigh-bone.   In the reduction  of this
dislocation the  surgeon  makes extension of
the limb downward and  in a line behind  the
axis of the body, so that the thigh-bone may
be dragged backwards ; to effect this the sur-
geon places the patient  near the edge of  the
bed or couch,  so that the injured  limb can
hang down."
  Knee-joint.—The leg may be displaced for-
ward,  backward, or   to  either side.  The
dislocation is nearly always partial,  as  might
be expected from the  extent of the opposed
surfaces of  the thigh-bone and the tibia, or
larger bone of  the leg.   In  lateral displace-
ment the  nature of the injury  is apparent at
first sight, in  consequence of  the unnatural
projection of the inner or outer condyle of  the
thigh-bone.   The leg is  generally twisted
upon its  axis.    These injuries are usually
caused by violent and sudden  twists of  the
knee or by  heavy blows.  Dislocations  for-
ward or backward are most serious injuries,
and are associated with much tearing  of  the
ligaments and soft parts  around the articula-
tion ;  in the backward dislocation, the lower
end of the thigh-bone projects in  front and
the hollow at the back of the joint is occu-
pied by the displaced head of  the  leg-bone.
The dislocation forward, which is a rare in-
jury, is associated with rupture of all the  im-
portant ligaments of the knee and of some of
the hamstring  tendons.   Reduction may be
effected by extending the leg while  the thigh
is fixed by counter-extension.   After  reduc-
tion, cold should be applied to the injured
knee, and the patient be kept in bed for about
three weeks.
  Knee-cap.—This bone may  be  displaced
inward,   outward,  or  upward.   In  some
cases,  it is half twisted upon its axis, so that
its outer or inner edge rests upon the front of
the lower extremity of the thigh-bone.  The
most frequent injury is dislocation outward ;
this, like the other varieties of dislocation, is
generally  caused either by a blow on the side
of the knee, or by a sudden  lateral  move-
ment of the  body made by the patient, in
order  to avoid being knocked  down by any
passing object, or being run over. The bone
may be either partially   or completely dis-
placed.   In  the dislocation edgeways,   the
knee-cap  forms  a  very distinct unnatural
prominence in front of  the knee ; and  its
sharp edge, in most cases the outer one, can
be felt immediately under the tense  skin.   A
laterally displaced knee-cap  may generally
be restored  to  its proper position without
difficulty by raising the limb high above  the
level of the  body, and then  depressing  the
prominent edge of  the  dislocated   bone.
Sometimes the  bone may be taken between
the  thumb and finger, and lifted into its prop-
er place.   A twisted knee-cap cannot be re-
placed so easily, and sometimes remains im-
movably fixed.   Reduction of this  form of
dislocation may be produced by bending the
knee forcibly and  suddenly ; or, if this does
not  succeed,  by  making  the  whole  limb
straight, and then  pressing down  the promi-
nent edge of the bone.  The subsequent pain
and  inflammation  in  the joint  should  be
treated by keeping  the knee at rest, and by
applying ice or frequently renewed cold com-
presses.  A person while walking  sometimes
strikes the everted foot against some hard pro-
jecting object, and immediately feels an acute
pain in the knee, which  prevents him from
walking. The leg,though stiff and painful when
the patient is erect, can be readily moved when
he lies down.  After  the  accident the knee
begins to swell.  Similar symptoms are some-
times  produced  through  a sudden  inward
twist of the leg upon  the thigh.  In cases of
this  kind, there is dislocation  of  the semi-
lunar cartilages, two flat gristly structures of
a horse-shoe  shape, which are fixed to  the
margins of the upper surface of the leg-bone.
One or both  of these become  detached and
slip  between  the opposed surfaces of the
bones of the thigh and leg, and so give rise
to the severe sickening pain which is so char-
acteristic of this  injury.   Reduction may  be
readily effected by  first  extending  the  leg
upon the thigh, and then suddenly  bending it
backward  until  the  heel  touches  the  corre-
sponding buttock ; the other hand  of the sur-
geon being placed at the same time upon the
front of the knee.  This  dislocation is very
apt to return, and for this  reason the patient
should, when  he takes exercise, wear a ban-
dage or tight knee-cap.
  Ankle-joint.—Dislocation at this  joint  is
generally  associated  with  fracture of one or
both  bones of the leg.  The uncomplicated
dislocations are those in  which the foot is
moved forward, or its upper part  driven up-
ward,  between  the  two bones of  the leg.
Both these  injuries  are extremely rare.   In
those dislocations which are complicated with
fracture, the  foot  may be  dislocated out-
ward,  inward,  or backward.   In  the first
and  third class  of cases, .the slender outer
bone of the leg is generally broken ; and  in
the second class  both bones across their
lower ends.  In simple dislocation  of the foot
forward or upward  an  attempt  may   be
made to bring about  reduction by grasping
the instep of the  injured foot with one hand
and the heel with the other,  and making exten-
sion, while the leg is kept steady  by an as-
sistant. In the complicated dislocations, the
chief  object of treatment  will  be  to reduce
the fracture, and to retain the foot in its prop-
er position  by splints until the bones are set.
The  astragalus,  an irregularly  shaped bone
which  articulates with the  lower surfaces of
the bones  of  the  leg, is sometimes thrown 
             DISPENSARIES

forward upon the upper surface of the foot,
and  forms there a  hard  prominent  tumor.
This, if it cannot be reduced by forcibly ex-
tending the foot while the patient is under
chloroform, may give rise to much local mis-
chief, and the formation of abscesses, which
will  necessitate its  removal by a surgical
operation.
  DISPENSARD3S are institutions founded
and  kept  up by charitable people  for the re-
lief of the poor. They differ from hospitals
in not having beds for in-patients,  and in the
fact that out-patients are visited at their homes
by the physicians  and surgeons, or  by the
resident medical officer.   Out-patients attend
also  for advice at  the dispensary  at  certain
fixed times,  and for this they must, in  the
first  place, obtain a letter of admission from
a governor or subscriber.
  DISSECTION WOUNDS.—Under  this
heading we may conveniently class  not only
such poisoned wounds as are encountered by
those professionally engaged in the examina-
tion  of dead bodies, but such as are fre-
quently met with in individuals, who may be
in any way exposed to contact of decaying or
putrescent animal matter introduced into the
system by some local wound  or  abrasion.
During the decomposition of animal matter,
substances are formed which  have a most
deleterious effect if introduced into the blood
of a  living animal.   When the patient suffers
from the effects of inhalation of such  poison
only, he exhibits symptoms of sickness, di-
arrhoea, or dyspepsia, and the poison is quickly
eliminated  by change of air, stimulants, or
aperients.   But in the case of  such  poison
being inoculated,  the symptoms are  severe
and are frequently  fatal.   The most danger-
ous cases are  those where the body dissected
has  died  recently  of erysipelas,  puerperal
fever, or pyaemia ;  much more so than from
the body in a mere state of advanced putre-
faction ; and the more recently after death
the greater the danger,  as it seems that the
virus has a tendency to neutralize itself after
a short time.   In dissecting-rooms,  after  a
puncture or scratch, there is rarely  any great
danger of  more than a local  sore,  as the
modern antiseptic processes of  injecting the
vessels for preserving the subjects for the
lengthened period necessary for dissection,
have rendered  them all but innocuous, un-
less,  of course, the  operator is in a low state
of general health (in which instance the atmos-
phere of dissecting-rooms and hospital wards
should be most studiously avoided).   It is not
usually the severe wound which infects, as the
individual recognizes it at once, and sucking
it, or the immediate application of  a caustic,
or poulticing,  generally reduces  the effects to
mere locality, but it  is from some insidious
scratch or abrasion,  which has existed per-
haps  some time, and has been so small as to
pass  unheeded,  that the more  serious cases
          DISTILLED  SPIRITS      121

arise,  and at some period, perhaps  six  or
eighteen hours  later,  the patient  begins  to
feel  unwell,  depressed,  sick,  shivery,  with
severe headache,  and a  sharp, rapid pulse.
Supposing a finger to be the seat of inocula-
tion  ; pain and  tenderness in  the  shoulder,
perhaps, at first directs his attention to his
case ;  afterward there is severe  pain and
swelling in  the  arm-pit, and upon examina-
tion  there will  be seen  red,  regular  lines.
along  the fore  and upper arms, proceeding
from the seat of inoculation  toward the arm-
pit, indicating the course of the lymphatics.
Abscess forms after a while,  perhaps, accom-
panied with diffuse  suppuration of the sur-
rounding areolar tissue.   There is always in-
tense constitutional disturbance.  Sometimes
the influence of  the morbid poison is so viru-
lent  that the patient dies of the precursory
fever before sufficient time has elapsed for
any  local disease to appear, and  there are
cases on  record  of  patients  dying  within
forty-eight  hours  after  the receipt  of the
wound. Sometimes diffuse cellular abscesses
occur in remote parts,  such as the knee  or
hip.   Sometimes  diffuse  inflammation com-
mences at the seat of injury and extends up
the arm, accompanied by cutaneous erysipe-
las.
  Treatment.—With regard to the treatment,
the indications  are to endeavor to eliminate
the  poison from the blood, to support the
strength and relieve  pain, and promote the
discharge  of pus.  In the first instance, by
purging, diaphoretics, and diuretics, these  to
be maintained  till elimination seems to be
complete ;  afterward tonics, fresh  air, and
exercise.  In more urgent cases, calomel and
opium are  frequently beneficial, and after
suppuration has been freely established, iron,
bark and ammonia are indicated—all abscess-
es should  be opened at once.  Thirst  should
be quenched by effervescent drinks ; beef-
tea, wine, or brandy should be given to sup-
port  the pulse.   In very severe cases doses
of quinine and mineral acids are of great ser-
vice.   Locally,  hot  fomentations,   poultices
to the inflamed and swollen axilla, or  elbow,
and  free incision as soon as  any decided
swelling with softening be detected,  and it is
mainly upon prompt attention  to the  evacu-
ation of pus or serum  that  success in treat-
ment depends.
  DISTILLED SPmiTS are made by dis-
tilling alcohol from some of the various forms
of fermented liquor in which it exists.   Dis-
tilled spirit  is not, however, pure  alcohol ;
but contains varying quantities of water.   A
spirit having a  density of 920, water being
1000, is called proof spirit in this country, and
when distilled spirits  contain more or less
alcohol than this, they are said to be under  or
above proof.  The most  common  forms  of
distilled spirits which are used in this country
are brandy,  gin, rum, and whisky.  Brandy 
122      DISTILLED  WATER
DRAIN-FEVER
is distilled from wine, and  its peculiar flavor
is produced by the addition of peach  kernels
to  the liquid  while  distilling.   It  also con-
tains cenanthic and acetic ethers.  Gin is ob-
tained  from fermented grain,  to which the
berries of the juniper  are added  to give a
flavor.  Other flavoring substances are used,
such as  cinnamon,  cloves, etc.,  and also
sugar for making what is called  "  Cordial
Gin."  Rum  is  procured  from  fermented
sugar and molasses  in the West Indies.   Its
peculiar odor  depends on butyric ether, and
a flavor is  sometimes given  by adding pine-
apples.   Whisky is distilled  from fermented
grain.  Many  other distilled spirits are drunk
in  various parts of the world. Arrack  is made
in  the East from  rice or from  betel nuts, or
the sap of various species of palm.  Liqueurs
are also  alcohol  distilled  with  various sub-
stances to give it  a flavor, and large quantities
of sugar are also  added.  The favorite liquor
of the French is Absinthe, which is  a spirit
distilled from  wormwood.   Spirits are made
from all  fruits containing  sugar, as  apples,
oranges,  pears, artichokes, maize, and other
things.   Honey is capable  of vinous  fermen-
tation, and a  beverage called Mead is made
from it.  Proof-spirit is used  for making tinc-
tures.  These consist principally of solutions
of vegetable substances directly in the proof-
spirit.  Sometimes vegetable substances  are
added to proof-spirit and then distilled. Such
preparations are  called  Spirits in  the Phar-
macopoeias.
  DISTILLED  WATER.   (See Water.)
  DIURETICS are medicines  which  in-
crease the flow of urine, whether directly or
indirectly ; as a class, it is an  extremely un-.
satisfactory one,  though doubtless many sub-
stances have  the power of increasing this
secretion.  The  flow of urine may  be  in-
creased in various ways ; thus,  in disease of
the heart, by strengthening the action of that
organ, as is done by digitalis.   But there are
certain substances which seem  to act directly
on the kidney, and  to stimulate it in such a
way as to give  rise to  a free flow of urine.
Such  are cantharides and  turpentine.  But
they must be given  cautiously, or they will
create irritation and really diminish the flow.
Juniper,  too, acts in this way.   We may also
foster the flow of urine by  introducing cer-
tain salts into the system  ; these have to be
got rid of somehow, and are usually  expelled
by the kidney, notably increasing the flow of
water along with them.  Such  are citrate and
acetate of potassa, cream of tartar,  etc.  One
of the most efficient and most readily obtain-
able diuretics  is broom.  The tops are boiled
and  the  fluid  used.   This, combined  with
cream of  tartar  and juniper or gin,  which is
flavored  by juniper,  will often  be found to be
an efficient and  harmless remedy in  cases of
dropsy, for it is in that disease that diuretics
are mostly required.  Alcohol  itself is diu-
retic, and a glass of beer will often produce a
copious flow of urine.   Alkaline diuretics are
frequently of use in getting rid of refuse ma-
terial  which, if not expelled, would give rise
to maladies such as gout.
  DIZZINESS.   (See Vertigo.)
  DONOVAN'S   SOLUTION  was  the
name given   to a valuable combination of
arsenic, iodine, and mercury.  It  was found
to be of special value in the treatment of skin
diseases connected with syphilis, but not lim-
ited  to  these.  It has fallen greatly out of
practice, and is not  now contained in the
Pharmacopoeia.  Ten  to twenty drops  were
given for a dose, but it had to be given with
all the precautions attaching to other prepar-
ations of arsenic.
  DOUCHE signifies  a stream  cf  hot  or
cold water which is poured over the body ; it
is used in  the  ordinary process of sham-
pooing, and sometimes it  is ordered  as a
remedial agent, as in  cases  of chorea and
hysteria.
  DOVER'S POWDER, so called from its
inventor, is known in  the Pharmacopoeia as
Compound  Ipecacuanha Powder.  It con-
tains  ipecacuanha and  opium, a grain  of
each in  ten of the  compound powder, and so
it must  be prescribed  with a due regard to
the  quantity  of  opium it   contains.  Ten
grains is the usual full  dose.   It was origin-
ally a secret preparation, and then contained
some saltpetre along with the two other in-
gredients ; now instead it contains  sulphate
of potass.  It is a powerful diaphoretic—that
is to say, it  promotes  free perspiration, and
is consequently of great use  in many mala-
dies.   It does not agree with everybody, and
at all times it is advisable to take precautions
against cold after its  use.   In the feverish
stage of a common cold, this remedy is par-
ticularly valuable, and  frequently  cuts  short
the malady.   When the patient is cold and
shiveiy, but the skin hot and the nose stuffed,
ten grains of the powder at bed-time, putting
the feet in  hot water at the same time, and
promptly getting  covered over with the bed-
clothes, will commonly induce  a profuse
sweat, and will probably greatly benefit the
patient. A  cold sponge  is  advisable next
morning, and the bowels must be seen to if
confined.  In the  dropsy which follows scar-
let fever this remedy is frequently used, but
must be used with great caution ; other dia-
phoretics, especially those which  contain no
opium,should have the preference.
  DRAGON'S BLOOD is the common name
of an Indian  plant (Pterocarpus draco), from
which exudes a red-colored resin—once used
in medicine as an astringent—but now only
employed  to  color   tooth-powder,  or  by
French polishers to give a deep color to their
wood.
   DRAINAGE.   (See House.)
   DRAIN-FEVER. (See Typhoid Fever.) 
DRASTICS
DROWNING          123
  DRASTICS is  a name given  to purga-
tives whose action  is somewhat violent; such
are elaterium,  gamboge,  jalap,  scammony
and the like.  Put it down as a broad rule that
they should never be used except  by medical
advice.   More  constipation is caused by the
use of such remedies than perhaps  arises from
any other cause whatever.
  DRESS.   (See Clothing.)
  DROPPED WRIST  is an affection met
with among  painters, and others who  work
much with lead ;  it consists in  a paralysis
and wasting of the muscles of the arm ;  the
right arm is generally more affected than the
left, and the muscles on the outside of,  more
than those on the inside of the  arm ; the re-
sult of the wasting is that the patient cannot
raise  the hand when  the  palm  is turned
downward.  (See Lead-poisoning.)
  DROPSY  is a term  applied  to any  accu-
mulation or effusion of fluid  under the skin
or in  a cavity of the body, occurring in dis-
eases  of the  heart, liver, lungs, or kidneys.
Sometimes the legs only are swollen, and this
may proceed simply from enlarged veins in
the upper part of  the  leg without any other
'serious disorder.  At other times the abdo-
men becomes swollen  to a very  great size,
and when the  breathing becomes impaired
the operation of tapping and drawing off the
fluid may be had recourse to.  Dropsy affects
the most dependent parts, and hence the legs
are more swollen at night after walking about.
When the dropsy is all over the body, as in
some  diseases  of  the  kidney, it. is  called
Anasarca ; when limited to one  part, it is
spoken  of as CEdema of that  part ; when in
the abdominal  cavity it is called Ascites ; in
the cavity of the chest, Hydrothorax ; when
in the cranial cavity the name Hydrocephalus
is applied.   Under these headings more de-
tailed accounts are  given.
  DROWNING is a frequent form of violent
death.  In a case of  pure drowning the indi-
vidual at first sinks to a certain depth and
then ascends to the surface  of  the water,
where,  if he be not a good  swimmer,  he
struggles to  clear his lungs and mouth, and
to obtain fresh air.  As water is generally
taken  in with the inspired air the patient sinks
again  for a short distance, and then by  his
exertions again succeeds in reaching the sur-
face.  These  struggles  are repeated until  the
lungs  and stomach are  filled with  water, and
the general specific gravity of the  body is in-
creased.  The body then sinks to the bottom
of the water.  The duration  of this contest
for life will vary according to the sex, age,
strength, and general condition of  the indi-
vidual.  Fat persons float more readily than
those who have large bones without any  un-
usual amount of adipose tissue.  Women and
children float longer than adult males, their
skeletons being smaller and the fat more abun-
dant.  The loose flowing clothes of the female
tend to buoy up the body, in consequence of
their spreading out and floating upon the sur-
face of the water ;  the tight-fitting dress of
the male on the other hand, when thoroughly
saturated with  water, has a  tendency to sink
the body more deeply.   After the final sub-
mersion the dying individual still  endeavors
to breathe,  and the  remaining portion of air
is forced out from the lungs by the entrance
of more water, and  rises in  bubbles.  Death
is preceded by convulsive movements of the
extremities, the patient  having by this  time
become unconscious and  insensible.  Accord-
ing to Dr. Taylor,  who  accidentally experi-
enced all the phenomena of drowning up to
this  point,  " there is not the least sensation
of pain, and as in other cases  of asphyxia, if
the individual recover, there is a total uncon-
sciousness of suffering during the period when
the access of air was cut off  from the lungs."
The question as to  how long a human being
may be submerged, and  yet be recoverable,
has not yet been  clearly settled.  According
to the officers of  the Humane Society, per-
sons who have been under water for  more
than four or five minutes do not generally
recover.  But on the other hand  cases have
been reported  in  which  recovery took place
after  submersion  lasting for  fourteen min-
utes,  and even half an  hour.   According to
Dr. Taylor, however, the recorded cases of
restoration  after submersion of half an hour
and upward are to be regarded as " extrava-
gant fables."   Dr. George  Harley, who was
a member  of a committee appointed by the
Royal Medical and Chirurgical  Society  to
consider the subject of apncea, believes " that
if a person be completely  submerged, and
the entrance of water to, and the exit of air
from, the  lungs  not  prevented,  recovery
would be impossible after two minutes.  On
the other hand if the air passages were closed
against the entrance of water, and the chest
kept full of air, we see no reason for thinking
that a human beinguvould perish either more
slowly or more quickly  than a dog placed
under similar circumstances—namely, in from
four to five minutes."   (Holmes's System of
Surgery, article  Apncea.)  It is  held  by
many that  those  individuals who  fell  into a
state of syncope  or fainting at the  time  of
submersion may  survive for a longer period
under water than  those  in whom the heart's
action is maintained until the last, and who
die from pure apnoea. The  following are the
appearances generally  presented by a body
which has been recovered shortly after  death
by drowning :  The  surface of  the  body cold
and of a white color, mottled  here and there
by  large patches of lividity,  the  face also
pallid ; the jaws closed and  the lips and nos-
trils covered by a frothy foam ;  the tongue
swollen,  but not protruded ;  the eyes half
open and the upper lids  livid and  somewhat
swollen ; the  knees and elbows bent ;  the 
124
DROWNING
DROWNING
hand clinched, and mud, or sand, and  some-
times portions  of weed,  found included in
their grasp, the skin of the fingers is  some-
times excoriated, and mud or sand is  found
underneath the nails.  The stomach and air-
passages and sometimes  the  lungs  contain
much water.  The vessels of the lungs are
engorged with black fluid blood.  All the im-
portant internal organs are much congested.
The blood on  the left side of the heart has
been found  to  contain more water  than the
blood left in the  cavities of the right side.
The right side of the heart  contains  much
more blood than the  left s.ide.  In a body that
has been in the water for along time, general
putrefaction has taken place.  The skin  where
not  covered  by clothes  is of green or blue
color, and the face much swollen and distort-
ed.  The gases formed by putrefaction  and
decomposition  of the tissues  collect and ren-
der the body lighter than its bulk of water, so
that it rises  to  the  surface and floats there.
The period at which the drowned  body rises
varies  according to the depth of the  water,
the character of the water—whether it be salt
or fresh, and its temperature.   In inquiries
as to how a body found in water  came to its
death ; whether in the  first place  it  was due
or not to drowning,  and next whether in the
former  case  the drowning was  accidental,
suicidal,  or  homicidal,  great  importance is
attached to  the presence or  absence  of the
following post-mortem appearances : excori-
ations  of the fingers ;  sand  or mud  under
the nails ; portions of water-plants, or mud
grasped  in the hand ; a rough or contracted
skin—the so-called goose-skin ; water in the
stomach, especially when this contains plants,
duckweed, and other substances  resembling
those which exist in the water from which the
body has been taken ; froth  on  the  mouth
and  nostrils ; mucous froth containing mud
or sand in   the air-passages ; water  in the
lungs.  On no one of these signs ought a posi-
tive  assertion to be based, but in the presence
of all or of  several  of them the probability
that death occurred  from drowning is very
great.   The  circumstauces   attending the
death cannot very readily be determined, and
the questions as to whether it was accidental
or intentional, and whether it was the result
of suicide or  homicide, are extremely difficult
to answer.   When  there  are no marks of
violence upon  the surface of the body, this
point cannot be considered by a medical man,
and  must be decided  upon other evidence.
When marks of injury are present, it  has to
be considered whether these might not have
been caused by the fall of  the individual
against  some hard substance at  the time of
immersion,  or  by the  rubbing of the body
against sharp and  hard obstacles after  death,
or if the  marks be such as to indicate inten-
tional infliction before immersion,  whether
these were such as would be inflicted by one
intending suicide.
  Treatment of the apparently Drowned.
—The following very useful directions have
been  published by  the Royal National Life-
boat  Institution.   The leading principles of
these are founded  on  those of the late Dr.
Marshall  Hall, combined with those of Dr.
II. R. Silvester, and are  the result of exten-
sive  inquiries which were  made by the in-
stitution in  1863-64 among medical men,
medical  bodies,  and  coroners  throughout
Great Britain.  These  directions  are in use
in Her  Majesty's  fleet, in  the Coast-guard
service, and at all the stations of the British
army at home and abroad:
  "I. Send immediately for medical assist-
ance, blankets, and dry clothing, but proceed
to treat the patient instantly on the spot, in
the open air, with  the face downward, whether
on shore or afloat, exposing the face, neck,
and  chest  to  the  wind, except  in severe
weather, and removing all tight clothing from
the  neck and  chest, especially the  braces.
The  points to be  aimed  at are—first and im-
mediately, the restoration of breathing ;  and
secondly, after breathing is restored, the pro-
motion of  warmth and circulation.  The
efforts  to  restore breathing must  be com-
menced immediately and energetically,  and
persevered in for one or two hours, or until
a medical man has pronounced  that life is ex-
tinct.  Efforts to  promote warmth and circu-
lation, beyond removing, the wet clothes and
drying the skin,  must not be made until the
first  appearance of  natural  breathing ; for if
circulation  of the blood be induced before
breathing has recommenced, the  restoration
to life will be endangered.
  " II. To Restore Breathing.— To clear the
throat.  Place  the  patient  on  the  floor or
ground with  the face downward, and one of
the arms under the forehead, in which posi-
tion  all fluids will more readily escape by the
mouth, and the tongue itself will fall forward,
leaving the entrance into the windpipe free.
Assist this operation by wiping  and cleansing
the  mouth.  If satisfactory breathing  com-
mences,  use the treatment described below
to promote  warmth.  If there  be only slight
breathing, or no  breathing, or if the breath-
ing fail, then turn the patient well and in-
stantly on the side, supporting  the head, and
excite the nostrils with snuff, hartshorn, and
smelling  salts, or  tickle the throat with  a
feather, etc., if they are at hand.   Rub the
chest and face warm,  and  dash  cold water,
or cold and hot  water alternately on them.
If there be no success,  lose not a moment,
but  instantly  imitate breathing.  To imitate
breathing, replace the patient on the face,rais-
ing and supporting the chest well on a folded
coat or other article of dress. Turn the body
very gently on the side, and a little beyond,
and  then briskly on the face, back  again,
repeating  these  measures   cautiously, effi-
ciently, and perseveringly, about fifteen times
in the minute, or once every four or five sec. 
DROWNING
DRUNKENNESS         123
onds, occasionally  varying the  side.   (By
placing the patient on the chest, the weight of
the body forces the  air out; when turned on
the side  this pressure is removed, and air enters
the chest.)  On each occasion that- the body
is replaced on its face make uniform but  effi-
cient pressure with brisk movement on the
back between and below the shoulder-blades
or bones  on each side,  removing the press-
ure immediately before turning the body on
the side.  During the whole of the operations
let one person attend solely to the movements
of the head and of the arm placed under it.
The result is respiration or natural breathing,
and if not too  late, life.  While the   above
operations are being proceeded with, dry the
hands and feet, and as soon as dry blankets
or clothing can be procured, strip the body,
and cover or gradually reclothe it, but taking
care not to interfere with the efforts to  restore
breathing.
   "III. Should  these efforts not prove suc-
cessful in  the course of from two to five min-
utes,  proceed to imitate breathing by  Dr.
Silvester's method, as follows :  Place  the
body on the back on  a flat surface inclined a
little  upward from  the feet ; raise  and sup-
port the head and shoulders on a small firm
cushion or folded article of dress placed under
the shoulder-blades.  Draw forward the  pa-
tient's tongue, and keep it projecting beyond
the lips—an elastic band over the tongue  and
under the  chin will answer the purpose, or a
piece of string or tape may be tied  around
them, or by raising the lower  jaw the teeth
may  be made to retain  the  tongue  in that
position—and remove all tight clothing from
about the neck  and chest,' especially  the
braces.  To imitate the movements of breath-
ing :  Standing at the patient's head, grasp
the arms just above  the elbows, and draw the
arms gently and  steadily upward above  the
head, and  keep them  stretched upward for two
seconds.  (By this  means air  is drawn into
the lungs.)  Then  turn  down  the  patient's
arms, and press them gently and firmly for
two seconds against the  sides  of ihe  chest.
(By  this  means air is  pressed out  of  the
lungs.)  Repeat  these measures alternately,
deliberately, and perseveringly, about fifteen
times in a minute, until a spontaneous effort
to respire is perceived,   immediately upon
which cease  to  imitate  the  movements  of
breathing, and proceed to induce circulation
and warmth.
  '' IV. Treatment  after Natural Breathing
has been Restored.— To promote warmth and
circulation, commence rubbing the limbs up-
ward, with  firm  grasping   pressure  and
energy,  using handkerchiefs,  flannels, etc.
(By this measure the blood is propelled along
the veins  toward the heart).   The friction
must be continued under  the blanket or over
the dry clothing.  Promote the  warmth of the
body by the application of hot flannels, bot-
tles, or bladders of hot water, heated  bricks,
etc., to the pit of the stomach, the armpits,
between  the thighs, and to the soles of the
feet.   If the patient has been carried to  a
house after respiration has been restored, be
careful to  let the air play freely  about the
room.  On the restoration of life,  a tea-
spoonful of warm water should be given, and
then, if the  power of swallowing have re-
turned, small quantities of wine, warm brandy -
and-water,  or coffee should be  administered.
The patient should be kept in bed,  and a dis-
position to sleep encouraged.
   " General  Observations.—The   above
treatment should  be persevered in for some
hours,  as it is an erroneous opinion that per-
sons are irrecoverable because life does not
soon make its appearance, persons  having
been  restored  after persevering for  many
hours.
  " Cautions.—Prevent  unnecessary crowd-
ing of  persons round the body, especially  if
in an  apartment.   Avoid rough usage, and
do not allow the body to remain on the back
unless  the tongue is secured.   Under no cir-
cumstances hold the body  up by  the feet.
On no account place the body  in a warm bath
unless under medical direction, and even then
it should only be employed as  a momentary
excitant."
  Dr.  Bain's Method of Performing Arti-
ficial  Respiration.—This method has been
thus described by Dr. Bain himself:  " The
patient being laid on his back on a table,  if
convenient, the mouth and nostrils are to be
wiped  dry, the clothes from the upper part cf
the body,  at. least, having  been removed.
The operator stands at the head  of  the pa-
tient, placing the fingers of  each hand in the
armpits, in their front aspect, with the thumbs
on  the collar-bones, and pulls the shoulders
horizontally  toward him with  a certain de-
gree of power.   Upon  relaxing his pull the
shoulders  and chest return  to their original
state."
  DROWSINESS is a symptom which nat-
urally  precedes sleep ;  it is often the fore-
runner of serious  mischief in  those who are
the subjects of Bright's disease, and it is then
accompanied by a scanty flow of  urine, and
such persons may afterward pass into a fatal
state of coma or insensibility.   It occurs also
as a result of living in an  overcrowded or
badly-ventilated room, in  consequence of an
accumulation of  carbonic acid gas.   It pre-
cedes the fatal stupor of those  who are frozen
to death in the snow.
  DRUNKENNESS.—Alcohol, when swal-
lowed, is speedily absorbed by the veins of
the stomach  and mixed with  the blood, and
then, by  its  poisonous action  on  the  brain,
spinal  cord, and nerve trunks, produces the
symptoms  of acute alcoholism  or drunken-
ness.   In mild cases the pulse becomes rapid,
the face hot and flushed, and the eyes  blood- 
126         DRUNKENNESS

shot ; if more drink be taken, there is confu-
sion of intellect and partial paralysis of the
voluntary  muscles,  and  the  drinker feels
giddy, reels, and experiences more or less dif-
ficulty in articulating properly, as the muscles
of the tongue become paralyzed ;  he becomes
maudlin and afterward noisy and delirious,
and finally sinks  gradually in a state  of deep
stupor.   On  the following day there  is gen-
eral prostration, with  nausea and occasional
vomiting.   In fatal cases  of  poisoning by
alcohol, the state of stupor passes into one of
true coma  ; the drinker becomes quite uncon-
scious and  insensible, and cannot move ; res-
piration ceases, and finally the action of  the
heart is arrested.   Some few instances have
been recorded, in  which speedy  death  had
been caused by a very large quantity of spirit.
Orfila mentioned an instance in which a sol-
dier died instantly after drinking for a wager
eight pints of brandy ; and Professor Chris-
tison,  in his work  on Poisons,  refers to a
case of  a London cabman, who for a bribe of
five shillings drank at a draught a  whole
bottle of gin, and in a few  minutes dropped
down  dead.   In  cases of death from large
quantities  of  alcohol, the  patient speedily
passes into a state of marked coma, which is
sometimes accompanied with convulsions.
The intensity and character of the symptoms
of alcoholic poisoning, and  the rapidity with
which  they come on, vary much in different
persons, even when about the same quantity
of  alcohol  has been taken  by  each.  The
more concentrated the spirit, the more rapidly
is drunkenness produced.  The  speedy  ab-
sorption of alcohol into the blood is favored
by  an absence of  food from  the stomach.
When much alcohol  is taken on a full stom-
ach the ordinary symptoms of drunkenness
are associated with excessive vomiting.   The
mental  symptoms, such as noisy talk, senti-
mental and maudlin utterances, and delirium,
vary according to the  character  of the indi-
vidual.   When excessive drinking is  com-
bined with  the consumption of strong tobacco
or cigars, drunkenness comes on quickly, and
is indicated by much reeling, much  mental
confusion,  and vomiting.  During the state
of drunkenness, alcohol is present in the urine
and sweat,  and the odor of the spirit or wine
which has been taken  is very perceptible in
the breath.  It has  been stated that about
one fourth  of the quantity of alcohol is elim-
inated unchanged in the  course of  forty-
eight hours.   The  action of alcohol on the
nervous  system is  indicated by the  double
vision, the  difficulty of articulation, the par-
tial palsy of the muscles of the lower extrem-
ities, and the mental condition of the individ-
ual.  Drunkenness  may be  produced by in-
spiring  the concentrated  vapor  of alcohol.
Persons employed in large  wine-cellars, and
who have been occupied for many hours in
bottling  spirits, and also  anatomists, who
             DRUNKENNESS

have been engaged in the dissection of speci-
mens preserved  in  strong  alcohol, may be
readily intoxicated by the spirituous vapor.
  Consideration  of the predisposing causes
of alcoholism will render evident  the hope-
lessness of all attempts  by  mild or  ordinary
legislative means to prevent the consumption
of stimulants so widely prevalent  in  this
country.   General  education  and  increased
wages to the  laboring classes, with an ame-
lioration in  their moral and  hygienic condi-
tions, will  no doubt produce vast improve-
ment in this portion of the community, in re-
spect to the diminution of drunkenness ; but
still  the occupations, both mental and bodily,
of those who are the typical  representatives
of a  highly civilized  and commercial nation,
necessitating, as they do,  excessive energy
and  intense  mental excitement and mental
tension,  which are  invariably followed  by
nervous exhaustion and depression, must in-
duce, in many instances, a craving for stimu-
lants.  Poverty,  serious disappointments in
life,  and pecuniary  embarrassments, are all
predisposing  causes of alcoholism.   Monot-
ony  of occupation is  also  another frequent
predisposing  cause.  Dr. Anstie, in an article
on Alcoholism in Dr. Reynolds's System of
Medicine, states that " amongst monotonous
occupations,  especially when  combined with
much confinement  in close rooms, there arc
none which have  furnished him with so many
and  such  serious cases of  alcoholism as the
trades of shoemaker and barber.  The want
of active out-door exercise, of course, repress-
es elimination and much  increases the evil."
Dr.  Anstie has seen " few more desperate
cases than some which have occurred in bar-
bers, who have been habitually  confined in
miserably small shops, and  at the  same time
have received enough money to  pay for a
great deal of  drink."  Finally, we meet with
those unfortunate persons  whose  tendency
to indulge in alcohol has been caused by an
inherited morbid condition of the  nervous
system.
  The diagnosis of advanced alcoholic intoxi-
cation is a question of great  difficulty and im-
portance,  and has been much discussed of
late in consequence of the increasing number
of those unfortunate instances in which per-
sons have been confined in  police-cells while
in a  state  of  insensibility due to some other
and  perhaps  fatal condition.   A person  is
found lying in the  streets in  a state of com-
plete insensibility, and it is then at once as-
sumed by those who find him  that he is dead
drunk, whereas it is just  as  probable that his
unfortunate condition may  be due to one of
the following causes : cerebral apoplexy, con-
cussion from  an injury to the head, compres-
sion  of the brain from fracture of cranium or
traumatic  intra-cranial hemorrhage, opium -
poisoning, or uraemic poisoning from disease
of the kidney.  A medical man, when asked 
DRY CUPPING
DYSENTERY          127.
 to give an opinion on a case of this kind, has
 to pass over  in his mind the characteristic
 symptoms  of  each of  the above  affections.
 If the face  be flushed, and the conjunctivae
 red and swollen, if the breath smell strongly
 of liquor, and  if the man, when aroused, sup-
 posing it is possible to do so, talks maudlin
 or sentimental nonsense, the  case  is clearly
 one of drunkenness.  If the face be pale, the
 surface of the  body cold, the pupils contract-
 ed, and if the  patient, when aroused, speaks
 but a few  words, and then  relapses into a
 state  of unconsciousness,  the  case is  consid-
 ered to be one of concussion.   If the  breath-
 ing be stertorous, the face drawn on one side,
 the pupils dilated,  one or more limbs para-
 lyzed, and the patient  in a state of confirmed
 coma, perfectly unconscious  and insensible,
 the case will probably be regarded as one of
 cerebral compression, due either to apoplexy
 or to  injury.  In a doubtful case the medical
 man would  endeavor to draw off some urine
 from  the bladder by means of  a catheter, and
 then  if he  found, on  boiling this  urine, or
 on adding  to it a  few  drops  of strong nitric
 acid,  that there was a dense white and cloudy
 deposit, he would probably assume, in the
 absence of  any other  cause for the state of
 insensibility,  that the patient was suffering
 from  the  effects  of uraemic  poisoning.  It
 should be remembered, however, and this is
 the chief cause of all the difficulty and annoy-
 ance atlending these cases, that although the
 insensible person  may have  been  drinking
 freely, and  that a strong  odor of  alcohol in
 the breath  is  most unmistakable,  the insen-
 sibility may not be the direct effect  of  the
 drunkenness.  He may have  had a fall and
 injured his  head ; fatal injuries to the brain
 may occur without any external signs, save a
 slight graze or bruise of the scalp.  Apoplexy
 may  have occurred  while the man was in a
 state  of intoxication.  Again,  a person not
 very intoxicated may be rendered insensible
 by  exposure to cold  and wet.   And  then
 again, it must  be remembered  that the symp-
 toms  of cerebral concussion or compression
 may be marked by the  peculiar symptoms of
 alcoholic intoxication.   So great is the  diffi-
 culty  attending the diagnosis of one of these
 so called police  cases.  Indeed, it may be
 said to be impossible,  in a large majority of
 instances ; and therefore it ought,  we think,
 to be  laid down as a rule, that every  person
 found lying insensible in the streets, or  in
 any place where  he is alone  and away from
 his own residence, should at once be placed
 under medical  treatment—if  possible,  in a
 hospital—until the  real nature  of his case has
 been cleared up by the further course of the
symptoms.   (See   Delirium   Tremens and
 Dipsomania.)
  DRY CUPPING.   (See Cupping.)
  DULCAMARA, better known perhaps as
bitter-sweet (Solarium Dulcamara) is a remedy
 of very doubtful value.   It has a certain  rep-
 utation in family practice,  but when tested
 in public practice  it has been found wanting.
 It has been commended  for certain forms of
 skin disease, especially those of a scaly na-
 ture,  but most probably it has no real influ-
 ence over them.
   DULCAMARINE is an  extract, not a
 true proximate  principle obtained  from  the
 twigs of bitter-sweet.
   DUMB  AGUE.   (See  Intermittent
 Fever.)
   DUMBNESS  is usually associated with
 deafness,  and but few instances are met with
 where it is not  so.  Occasionally, however,
 there is some congenital  malformation of the
 organs of  speech, which  prevents the power
 of articulation, and in  rare instances  it is re-
 corded as  arising from the entire neglect in
 childhood of exercising the function.   There
 has  recently been a  system  introduced by
 which the dumbness consequent on deafness
 is overcome, and  the deaf person is made to
 articulate sounds  by aid of sight—that is to
 say,  after seeing a  word  formed and  pro-
 nounced by the  lips of another person many
 times, the  power of imitation enables him to
 do the  same,  and produce   an  articulate
 sound, so that he can no longer be said to be
 dumb.
   DURA  MATER,  a  thick  fibrous mem-
 brane, which lines the skull and spinal  col-
 umn, and forms a covering for the brain and
 spinal cord.
   DYSENTERY, which is an inflammatory
 affection of the great gut, giving rise to ulcer-
 ation, mucous,  and blood  stools,  straining
 and much pain,  is well known and very fatal.
 The causes of dysentery are not quite clear,
 but it generally appears among soldiers after
 long exposure to wet in low districts with in-
 sufficient food.   It always tends to make its
 appearance in marshy  districts where  malaria
 prevails.  It generally begins with some un-
 easiness and griping  pains in the abdomen,
 and there is  much desire to go to stool.   At
 first this gives relief, but  by and by no relief
 follows, so then the patient seems to desire
 to sit on the stool constantly.   What comes
 away consists at  first of badly formed  mo-
 tions,  but  by  and by  they  become more
 scanty, then mucous and even bloody, some-
 times mixed up with small hard masses called
 scybahc.  The desire continues  to  increase,
 trie attempt to gratify the desire increases the
 pain,  the stools alter more and more,  becom-
 ing bloody, foetid, and with shreds of mem-
 brane in them sometimes too ; there is puru-
 lent matter.  The urine is frequently voided
 and  is generally high  colored and scalding.
 There is at the same time more or less fever,
 and there is great restlessness and sometimes
 cramps.   The  tongue is furred and  dry.
 The pulse small and quick.  Great thirst and
1 complete loss of  appetite.   Perhaps these 
128          DYSENTERY
DYSMENORRHEA
gradually abate,  the  purging  and straining
become  less frequent,  and  the  rest in the
intervals is more complete, gradually the pa-
tient gets better, but his bowels  remain in a
troubled state for a long time to come. Some-
times, on the other hand, and this  is especially
the case where  the malady is epidemic, the
patient  gets  worse,  the bowels  become in-
flated and the abdomen  tender, the tongue
becomes dry and glazed or aphthae  form on
it, and the insides of the cheeks.  The evacu-
ations are exceedingly  offensive  and passed
under the  patient, the whole body has  a
corpse-like odor, coma comes on, and death
soon  follows.    Very  frequently in  warm
countries or in epidemics, dysentery is  com-
plicated  by  ulcers of  the liver.  Sometimes
the ulcerations  perforate the gut and set up
peritonitis, or the gut may mortify.  In warm
countries,  too,   the  disease  may  become
chronic,  and the nutrition of the body is so
sadly interfered  with that the patient withers
away.   The bowels continue during this time
very irregular, and the discharges most offen-
sive.
  Treatment.—Very  much may  be  done by
treatment, especially when the disease is not
epidemic.   The  diet should  be  scanty but
nutritious, hot 'poultices or cold  compresses
applied  to the abdomen, and strict rest en-
joined.  It is  desirable to remove all hardened
faeces which may set up  irritation,  and for
this purpose nothing suits  so well,  or gives
the bowels so much  relief, as copious injec-
tions  of  warm  and very thin gruel.  These
having been removed, a totally different plan
must be adopted : no more copious injections,
but injections of an ounce or two of starch,
containing 30 drops  of the liquid extract of
opium.   This may be repeated if necessary.
At the same time it  is desirable to give in-
ternally full  doses of ipecacuanha, consisting
of not less than from  30 to Co grains, in any
form  which  may  be  deemed desirable.  It
may be repeated in 6 hours if necessary.  If
the patient gets over this,  another  kind of
treatment must begin.   Tonics must be given
carefully, the bowels attended to, and every
sign  of  relapse closely  watched.    The diet
must  then be nourishing,  but  not bulky.
Remedies may be given to prevent the con-
tents  of the  bowels  from  putrefying, which
often  causes much discomfort.  Sulphate or
hyposulphate of soda, or sulphocarbolate of
soda,  or  carbolic acid, may be given for this
purpose. If dysentery become chronic, change
of climate is  important, a mild and agreeable
atmosphere doing great good.
  Dysentery in  Children.—This  is much
more  frequent in this country than the dysen-
tery of adults, and is caused  by  indigestible
food,  unripe or decayed fruit or  vegetables,
the breathing of impure air, exposure to cold,
strong cathartic medicines, and bad or impure
water.  Its symptoms are a constant desire to
go  to  stool,  resulting in small discharges of
bloody mucus ;  there is considerable fever,
griping pain usually  near the lower portion
of the  intestines, causing the child to scream
at times as if in fright, with cold shivers, and
more or less delirium.   Treatment.— Domestic
treatment of dysentery cannot be relied on,
but in  the absence of a  physician proceed
thus :  If there has been any constipation dur-
ing the previous day or two, give a moderate
dose of castor oil ;  when  the bowels have
moved, as a  result  of  this, dissolve a tea-
spoonful  of  gum  arabic   in  an  ounce of
peppermint water, and give a  teaspoonful
every half hour.   A better mode of treatment,
however,  is this ;  Make a little thin starch,
and to one tablespoonful of this add one drop
of laudanum ; inject it into the child's bowels
with a  small syringe, and  keep it  there as
long as possible.  This  should be  repeated
every four hours until the disease is arrested.
Increase the quantity of laudanum  by one
drop for each year up to five.  From the first
the  child should be kept as quiet as possible,
as rest and warmth and a recumbent posture
are  essential to comfort and recovery.
  Dysentery is infectious by evacuations, and
therefore all  bed-pans or other vessels used
by the patient should be scalded each time
with boiling  water.    The  privy-vaults and
water-closets should also be disinfected with
sulphate of iron or carbolic acid.
  D5TSMENORRHCSA,  or difficult  men-
struation,  is a disease  which is very harassing
to the  patient, and often  very obstinate to
cure.   It affects more especially women who
are  nervous, or of a rheumatic and gouty ten-
dency.   It may occur at  any time in the
child-bearing period  of life, and affects both
the  married and the single.   The pain is felt
in the  lower part of the  abdomen on each
side, just above  the groin and in the region
of the ovaries ;  pain  is also felt in  the back
and in the womb itself ; it  is generally most
severe  a day  or two before the " period"
comes on, and is relieved when the flow takes
place.   Between  the  different  times the  pa-
tient may  enjoy good health.  In some the
pain is due  to  neuralgia  of  the  ovaries or
uterus, and in such cases medicines  contain-
ing quinine are useful, and bromide  of potas-
sium  is a valuable sedative.   In others  the
pain is due  to the vessels of the part being
too full of blood, and when the congestion is
relieved great benefit ensues ; a hot hip bath
and leeches applied to the neck of the womb
or  to  the abdomen over the seat of the pain
will give relief.  In all cases belladonna may
be applied locally with much benefit in allay-
ing the pain. During the interval the general
health  should be  looked to: . if able to bear
it, moderate  exercise every day in the open
air  should be ordered ; if  too feeble,  a car-
riage drive may  be  taken.  Avoidance of
late hours, of overwork in  close and confined 
DYSPEPSIA
EAR
129
rooms, a generous and wholesome diet, with
an occasional aperient, will aid in curing this
disease.
  DYSPEPSIA.  (See Indigestion.)
  DYSPNCEA,  or  shortness of breath, is  a
symptom often met  with in many  diseases.
It occurs naturally after running fast, and  it
is due to the alteration, for  the  time being,
in the quantity of blood passing through the
lungs,  and the amount  of  air entering the
chest.   In emphysema,  chronic bronchitis,
and in almost all diseases of  the lungs, lar-
ynx and trachea, difficulty  of breathing oc-
curs as a symptom ; in many cases of kidney
and heart  disease it is almost  always met
with, and such invalids are thereby prevented
from  running  up-stairs or hurrying them-
selves ;  in fact, any condition which alters the
amount of the blood which  usually flows
through the lungs per  minute,  as  in affec-
tions of the heart, or  which alters the amount
of air entering the lungs, as in affections of
the air-passages, will result in  producing this
symptom.   It comes on  when  the  patient
makes any exertion,  or on  exposure to cold
air, as going out on a raw foggy morning,
and sometimes it will make  the patient wake
suddenly from his sleep, and  forms then what
is commonly  called  an  asthmatic  attack.
Rest in bed,  in a room with moist air  of
the temperature  of 65° to 700  Fahrenheit, is
to be recommended when the  patient is very
much  troubled  in this  way ;  avoidance  of
cold air must be  insured ;  in.some cases  a
respirator  is advisable.    During an attack
much  relief may ensue from taking an expec-
torant mixture containing ether and ammonia
and squills. Generally by  these means an
attack may pass off, but at times, and during
the last few days of life, in those  who are dy-
ing of heart disease or bronchitis or dropsy,
the dyspnoea  is  very distressing ;  the face
then shows'great distress, the lips are blue or
livid, the veins of the neck stand  out like
blue cords, and there is but  little movement
of the chest.   In some  cases  bleeding from
  EAR—The  structure of  the  ear is  ex-
plained  in the articles on  Deafness  and
Hearing.  The diseases or affections of  the
ear may be referred to those three chief por-
tions of which  it  consists,  thus—(1) The af-
fections of the External Ear, or Auricle.  (2)
Those of the Middle Ear, or Tympanum.  (3)
Those of  the Internal Ear, or  Labyrinth.
  (1) Affections of the Auricle.—The auri-
cle is subject to severe cutaneous  affections,
the most important being—chronic erysipelas
and chronic eczema.  In chronic erysipelas  the
ear becomes greatly swollen,  its skin is dry,
red, and covered with epithelial scales, with
derangement of general  health.   The treat-
the veins of the arm will for a time relieve
the congestion : in others, pricking the legs
with a needle, when they are  very dropsical,
will give much ease by withdrawing some of
the excess of fluid.  When  there  is hydro-
thorax or oedema of the lung, brought about
either by kidney or heart disease, less air can
enter the lungs and dyspnoea must be more
or less present, and the space  in the chest is
further encroached upon by the increased size
of the heart  usually found  in these  cases.
When the dyspnoea comes on in consequence
of a foreign body, as a marble  or a coin get-
ting  into the larynx or  windpipe, surgical
means must at once be resorted to, and when
it  is due to inflammation of that tube, as in
cases of croup or diphtheria, special remedies
must  be used, which will be detailed  when
treating of those diseases.   Finally, an an-
eurism of the aorta may cause dyspnoea by
pressing on  the windpipe or setting  up a
spasm of the epiglottis by  pressing on the
nerve supplying  that part of the windpipe ;
however,  but  little can be  done in such
cases.
  DYSURIA, pain or difficulty in passing
urine,  may arise from  a great variety  of
causes.   Some connected with disease of the
organs concerned, others arising from altered
conditions  of  the fluid  itself ; stone ;  stric-
ture ; inflammation of the bladder and urinary
passages,  are all  important  causes,  and  to
these the reader is referred.   Alterations in
the urine giving rise to dysuria, are common-
ly excessive acidity or  the presence of cal-
culi, either of which may give rise to  great
irritation, and a tendency to pass water with-
out, however,  bringing any away.   Albumi-
nuria also gives rise  to something of  the
same kind, the  patient  frequently  emptying
his bladder.   Sometimes there is a kind  of
neuralgic  pain  connected  with  urination,
which gives rise to much  discomfort.  If the
pain arises from acidity, alkalies will speedily
relieve it; if due to spasms, a pipe of tobacco
is  perhaps the best remedy.
ment consists in cleanliness and free exposure
to the air.   If the inflammation is consider-
able,  poultices are of use,  and an astringent
lotion should be  applied.    Glycerine  is  a
valuable application.  In  chronic eczema the
auricle is considerably swollen, and covered
with yellow crusts, exuding fluid.   The  itch-
ing and irritation are  considerable.   The
meatus,  or passage,  must be well syringed
out with warm water, to prevent the accumu-
lation of discharge, and  the ear itself bathed
with some  astringent  solution, or with glyce-
rine.  The  scabs are   to  be removed by
poulticing.   Excoriations of  the  auricle  in
children  are readily  cured by  attention  to
E. 
130               EAR                                        EAR
cleanliness, or by  the use  of  astringent lo-
tions.
  Gout affects the external ear, and is a com-
mon cause of deafness.  The burning  heat
and  gnawing  pain  commence  about mid-
night,  gouty deposits are found in the auri-
cle, and  there  is congestion of the cartilage.
The treatment is the same as that for gout in
other parts of the body.   (See Gout.)
  Tumors are frequently  met with.  For ex-
ample, enlargement  or  hypertrophy  of the
lobes,  frequently met with in women  who
wear heavy earrings,  cystic, fibrous, and ma-
lignant tumors, all requiring surgical inter-
ference.
  The external meatus, or passage, is liable to
accumulation of the cerumen or the natural wax,
and deafness is frequently due to this condi-
tion.  This is one of the most frequent affec-
tions of  the external ear-passage, and when
detected  should be removed  by syringing.
The syringe  should  be  fitted with  a very
small nozzle, and the instrument  itself capa-
ble  of affording a  strong and   continuous
stream.  The water injected should be  warm,
and a small ear-spout placed beneath the ear
to catch the return current and its additions.
The ear should be plugged with cotton wool
after the operation  is complete, for  a day or
two.  If the wax be very  hard  and firm, a
few drops of oil introduced  for a  few  nights
will facilitate its dislodgement.  In syringing
the  ear, the error is  commonly made of in-
troducing the nozzle of the syringe obliquely
to the side of  the head, instead of placing it
at right angles  and pressing the  tragus (the
eminence  over the opening)  forward.   As
excessive sensitiveness is the after-result, it
is best to  fill the ear with some fine cotton-
wool.
  Some abscesses or boils often form  in the
meatus, causing intense pain.   Hot poultices
and fomentations applied to the ear give great
relief, and  in  severe  cases, free  purges and
leeching  may be advisable.   The constitu-
tional treatment consists in the  administra-
tion  of  tonics, of which  iron is of the most
value.   This  external meatus is very  fre-
quently the seat of inflammation,  which  may
be either acute or chronic.  In acute inflam-
mation there is at first a dull aching pain, en-
largement of the glands of the neck, and im-
pairment of hearing,  followed perhaps  by a
discharge of mucus  or muco-pus,  and consid-
erable derangement of the health.   Syringing
the passage with warm water gives great re-
lief, hot  fomentations and poultices and the
internal  administration  of morphia, all ex-
posure to draughts carefully avoided, and the
general health  attended  to.   The chronic
form is generally a sequel to the foregoing,
and is often caused  by prolonged bathing and
neglect in  drying the hair ; weak astringent
lotions, such as a weak solution of acetate of
lead or of nitrate of silver, are of great  use.
 In children this complaint is invariably asso-
 ciated with derangement  of the health, and
 quinine, cod-liver oil, and iron are indicated.
  Polypi may form anywhere in the passage,
 and not unfrequently on the membrane ; one
 form  soft, pulpy, and vascular, and the other
 firm and fleshy.  These growths cause deaf-
 ness,  and set up an offensive discharge.  The
 treatment consists in their removal.
  Foreign bodies in the meatus have been sep-
 arately treated of.   (See Foreign  Bodies
 in Ear.)
  2.   Affections of the  Tympanum.— The
 Membrane of the Ear (see  Hearing) is liable
 to both injury and disease.  Rupture may oc-
 cur from a variety of causes, such as  the in-
 troduction of foreign bodies, a blow, sudden
 deafening noises, violent syringing,  with im-
 proper  introduction  of  the  syringe  (see
 above), violent blowing of the nose,  vomit-
 ing, coughing,  etc.   The symptoms are slight
 pain,  generally a little bleeding, and perhaps
 impairment of hearing, although this condi-
 tion  is  not  necessary.  Inflammation of the
 membrana tympani, like  all other forms of
 inflammation,  may be  acute  or chronic, a
consequence of cold, gout, scrofula, or syph-
 ilis.   The symptoms are pain, itching, and
slight deafness.  Ulceration may take place,
and perforation of the membrane ensue.  It
is to  be treated according  to circumstances,
dependent on  its  causes;  beyond  this the
treatment is the same as that for inflamma-
tion of the  external meatus.   Perforation of
this membrane occurs after  certain  condi-
tions, such as ulceration of its substance from
internal inflammation ; the diagnosis of this
perforation is easy.  In the first place it can
 be detected by a speculum ; again, the patient,
by closing the  mouth and nostrils, can blow
air (if the Eustachian tube be not obstructed)
through it, and the patient is moreover some-
 what  deaf.   If possible, attempts  must  be
made to close the orifice by the application,
 in slight cases, of lunar caustic to the edges
 of the wound, or by the  introduction  of cot-
 ton wool, or by the  artificial membrana tym-
 pani.   This artificial membrana tympani con-
 sists of a thin circular plate of vulcanized In-
 dia-rubber, to which a silver wire is attached
 obliquely as a handle.   At first this apparatus
 should only be worn for an hour or two, and
 always removed on retiring to rest.  Occa-
 sionally the  hearing becomes re-established
 after  it has been worn  for  some time.   The
 Eustachian  tube, or passage of communica-
 tion between the middle ear and the pharynx
 is liable to several forms  of disease, obstruc-
 tion,  and  a- permanently  open  condition.
 The  cavity  of  the  tympanum  is liable to se-
 vere inflammation, arising  from cold, scrof-
 ula, or a  sequence of  scarlet fever.   The
 usual symptoms of this condition are discom-
 fort in swallowing or blowing the nose, head-
 ache,  and intense pain in the ear,  and more 
EARTH CLOSETS
ECTHYMA
131
or less deafness.   The  constitutional symp-
toms  are  severe, and in  adults delirium is
present, and convulsions in children.  These
conditions  terminate either in resolution or
by the formation of abscesses, the matter by
bursting through the membrane,  or by in-
flammation of the mastoid cells and mastoid
bone.  Salines should  be given,  if  due to
gout or rheumatism, colchicum, or iodide of
potass.  Locally, steam, poppy-head  fomen-
tations, linseed, onion, or garlic poultice,  and
small blisters on the mastoid process of the
temporal bone—just behind the ear in fact.
  (3) Affections of the Internal Ear.—The
function  of hearing may be  impaired,  or
completely destroyed by  the results of the
severer diseases of the middle ear,  when sup-
puration has followed  either of them.  The
auditory nerve, which  is  found lying within
the labyrinth, is subject to functional diseases,
causing what  is   termed  nervous  deafness.
True  neuralgia has been described as occur-
ring occasionally.
  Earache.—The earache, or otalgia,  is  a
neuralgic   affection,  occurring  in   fits  of
excruciating pain, darting over the head and
face, generally caused by  bad teeth.   It may
be partly  relieved  by  syringing the ear out
with warm water, to which a little laudanum
has been added—say, twenty drops to a wine-
glass of water.   Hot fomentations should be
applied  to the ear, or tincture of aconite or
belladonna, painted behind the auricle.  The
state of the bowels is to be carefully attended
to, and free action obtained by purgatives.
  EARTH CLOSETS are  contrivances re-
cently  introduced  for  superseding  water-
closets,  particularly in  country places.   In
them, instead of pulling  the handle and al-
lowing a  flood of water to  sweep away all
matter from the pan into the sewer, the same
handle allows, from a  hopper, a quantity of
dry earth to fall and cover the evacuations.
The dry earth completely prevents any smell
from arising from them, and  apparently pre-
vents all  further  decomposition.    After a
time the accumulated  matters may  be re-
moved,  and constitute  a  valuable  manure.
No doubt in cities the general application of
such a plan would not be easy, but in the
country the plan is valuable.   In cities drain-
age is carefully  looked after by the  proper
authorities, and it is a man's  own fault if his
drains in his  own house are bad ;  but in the
country  drainage is hardly possible, except
into  a cesspool, which  is a perpetual source
of risk to  all  in  the neighborhood.   In the
country there is no sufficient  water power to
rinse out the drains—they get  choked up, and
typhoid fever breaks out.   All this is avoided
by the use  of earth closets.  As soon as they
get filled they can be emptied  ; they give rise
to no smells, and, as far as we know, to no
fevers.  Only one  or  two precautions  are
necessary  to make  them work well.   Fluid
excretions should, as far as possible, be kept
apart from solid excreta, and  the earth used
should  be well  dried  before use.  Imper-
fectly burned wood ashes, mixed  with ordi-
nary  loam  dried, makes  the best kind  of
earth to use.  Sand does not suit well.
  EAU DE COLOGNE, a  much esteemed
perfume, which derives its name from the city
where it is so largely manufactured.  It is a
distillation in alcohol of various sweet-scented
substances,  and is most refreshing and grate-
ful as an application in cases of headache and
exhaustion.   A bad nervous  headache  may
often be relieved by diffusing eau de Cologne
over the part affected by means of a vaporizer
or even by dipping  a  handkerchief into  it
mixed with water and then gently fanning the
patient  till  the eau de Cologne evaporates,
and removes the heated condition of the head.
  ECCHYMOSIS.  (See Bruises.)
  ECHINOCOCCUS is the name given to
the parasite found in hydatid cysts,  and when
occurring in man, the echinococci  are  de-
veloped from the tapeworm of the dog.   (See
Hydatids.)
  ECLAMPSIA.   (See Puerperal  Con-
vulsions.)
  ECRASEUR is  an instrument that has
been  devised  for the purpose  of  removing
tumors  by a combined process of crushing
and tearing.  Its use is attended with much
less bleeding than that of the surgeon's knife,
and  for this reason it has been applied  with
success to  cancer of the  tongue,  internal
piles, and other vascular growths.
  ECSTASY,  a peculiar  form of  intense
nervous and  emotional  excitement.    (See
Catalepsy.)
  ECTHYMA  is the  name  given to a skin
disease.  It consists of large,  circular, raised
pustules, surrounded by a  livid purplish zone.
They occur generally on the extremities, and
are always isolated ; the fingers and legs are
very common  seats of the  eruption.  If the
pustule  is pricked, an  unhealthy,  greenish-
colored fluid exudes, and a scab forms ; then
in about three  weeks this  scab  falls off, and
leaves  no ulcer  beneath,  but simply a red
scar.  As soon as one heals another appears,
and so they  may  be  seen  in all  stages at the
same time.  It  mostly occurs in children, and
especially when from  any cause they are in a
debilitated condition, as after recovery from
measles or scarlet fever, or from bad living.
Plain but wholesome  diet, with fresh air and
exercise, will improve the general condition ;
while steel wine taken internally,  and  zinc
ointment applied to the spots, will  generally
complete  a  cure.  An occasional aperient
may  be  required.  There  is no pain attend-
ing this eruption ; if there should be, or if
the  scabs require removing,  a hot linseed-
meal  poultice may be applied at  bed-time.
Care should be  taken that the child does not
knock the pustules or scratch the head off. 
132
ECTOZOA
ECZEMA
  ECTOZOA are  animal  parasites which
have  their " habitat" on the surface of the
human  body.   The  following  are  the  most
common varieties which are met with :
  i. The acartts, or itch-insect.  There are
two kinds, male and female ; the latter bur-
rows in the epidermis and there deposits the
ova.  They are generally found among very
dirty and poor people, and  occur on the out-
side of  the arms  and very often between the
fingers, also on the  trunk ; but rarely above
the shoulders or below the knees.  By means
of the suckers or ambulacria, they have pow-
ers of locomotion, while with their mandibles
they are enabled to cut through the epider-
mis, and extract fluid from the tissues.  The
female  seldom leaves her burrow  except at
night ;  when  disturbed by  scratching,  they
crawl with great rapidity over the  skin, and
readily  pass from one person to another ;  so
that the complaint is easily caught.  Great
itching  accompanies the presence of these in-
sects, so that the skin may often be  seen cov-
ered with scratch  marks, and  in some parts
bleeding from the friction used.  The acarus
likes tender skin, and hence is more common
in youth than in old people.   The disease,
although  extremely  troublesome,  is  easily
cured.  An  ointment, composed of sulphur
and lard well mixed together, should  be
thoroughly rubbed  in every night until the
skin which is rubbed feels a warm glow, and
the next morning the patient should be well
washed in hot water with coarse soap and a
flesh-brush.   This method, if repeated three
or four  mornings properly,  will generally ef-
fectually cure. Every night the person should
be wrapped in an old shirt which can be de-
stroyed as soon as the disease is cured.
  2. Pediculi, or lice.  Of these there are dif-
ferent kinds.  Some are found on the hair of
the head, and chiefly at  the  back part ; they
are of  a  pale drab  color, and much longer
than they are broad ;  they crawl about in the
hair, and deposit their ova on the hair  by
means of a gummy kind of substance.   At
first these ova are close to the root of the
hair ;  but as the hair  grows  they may  be
found an inch or two off the skin ; but by
that time the ova have escaped, and only left
the empty sac in which  they lay attached to
the hair ; these sacs with  their contents are
commonly called " nits."   In  dirty children
they may be seen in abundance,  when the
back hair is separated, as little shining parti-
cles arranged along the hairs.  Great itching
is produced by the presence  of these parasites
and even eczema may be  produced  by the
scratching ; the hair then becomes matted to-
gether,  and  the head gets  into a very filthy
state.   The  best  treatment  is  to cut off the
hair as close  as  possible, and rub in every
night for three or four nights some white pre-
cipitate  ointment ; this should be done, how-
ever, with care.  A  solution of carbolic acid
(one part of the acid to sixty parts of water)
will kill all the lice, but not the ova.   Others
are found in the hair of the genitals, to which
the names of crab-louse, or  " crabs"  have
been given.  (See Crabs.)
  3.  The harvest-bug,  which often   attacks
people when walking through a stubble-field
in the autumn ;  it is a small red insect which
causes intolerable  itching.
  4.  In the West Indies a most  troublesome
creature is the chigoe, or Pulex penetrans.  It
penetrates the skin,  and there  lay its eggs,
producing, in consequence, an irritable sore.
  ECTROPION.  (See Eye.)
  ECZEMA is a skin eruption of very com-
mon occurrence.   It is a non-contagious dis-
ease and is characterized by the presence of
minute  vesicles  hardly  seen  without  a lens.
These spots may terminate by the fluid in the
vesicles being  reabsorbed,  or  excoriations
may form which leave a raw red surface from
which  a watery liquid oozes ; as the liquid
dries, it forms dirty scabs  on the affected part
which present a  very loathsome  appearance.
This common disease may be  produced  in a
great many ways.  Heat may cause  it, and
then it  is  called eczema solace or heat spot ;
thus it may be produced when a fair or tender
skin  is exposed to the sun on a hot summer's
day.   Contact with irritating substances will
produce it, and so it is found among grocers,
affecting the hands of those who deal much in
sugar ;  potboys are, from a similar cause,
very liable to it.   It sometimes occurs  in
those engaged in  working with quicksilver,
or in those who have taken an undue amount
of mercury ; this  is, however, very unusual,
and probably depends on  some peculiar state
of the constitution on the  part of the individ-
ual affected.   The eruption begins usually on
the groins and  thighs ;  it is commonly pro-
duced  in  the  flexures or  folds of the  skin in
fat and dropsical people, and when the folds
are raised, a raw, moist,  and red surface is
seen.  The skin at first is red, and is  accom-
panied by heat  and tingling ; it is apt to ex-
tend very  rapidly, but although  the  surface
affected may  be large, yet the disease  does
not go  below the skin itself.  On this red
angry-looking skin, numbers  of minute glit-
tering  vesicles soon  appear, and  these vesi-
cles  are  due to a very small portion of the
epidermis being raised up  by a little serum or
watery fluid beneath ;  at first they are clear
and almost pellucid, but the contents  become
opaque, and under favorable circumstnnces
dry up ; more often these  little vesicles burst,
and the fluid escapes and dries up into gum
my masses on the surface ; in doing this it
entangles any dust or dirt that may be present,
and thus forms large ugly-looking scabs ; this
takes place when  the part is neglected, for
with proper care  such  scabs  should  not  be
allowed to form.   This  disease  is a moist
skin  eruption, and hence,  when the scabs are 
ECZEMA
ECZEMA
133
 taken away, the skin looks raw and moist ;
 great discomfort from this cause is felt by the
 patient also ; the clothes which he wears next
 the  skin  become stiffened and dirty with the
 discharge, a foetid smell is often present ; the
 rash spreads, the vesicles  increase in size
 from the irritation and the acrid juice which is
 being poured out, the skin swells up, feels
 hot  and uncomfortable, and the poor sufferer
 is in a state of great  worry and  distress.
 The constant irritation makes him feverish ;
 he sleeps badly  at night and is always want-
 ing  to scratch himself, and  this only tends to
 make him worse.  In children it runs a sim-
 ilar  course to  what it does in  the adult.
 Owing to  their  delicate condition,  any dis
 turbance of the  constitution is liable to cause
 the appearance of this rash, especially in those
 who are at all  strumous.   In infants, after
 birth, a red rash often  appears, merely from
 the  irritation of  the air or clothes on the ten-
 der  skin ;  this is well known under  the com-
 mon name of red gum ;  it is easily cured by
 washing the surface with warm water and
 using zinc ointment.   After vaccination,
 eczema often appears, and it is owing to this
 in a great  measure, that so much prejudice is
 felt  against vaccination : now this operation,
 simple as it is, and valuable as it is in its re-
 sults in preserving humanity from small-pox,
 cannot be done  without  some  slight disturb-
 ance of the constitution, and then this disease
 often  appears ;  among  the  ignorant and
 the  filthy, the   rash soon spreads and forms
 dirty, foetid scabs, which lead people to im-
 agine that their children are  suffering from
 some  horrible and dangerous disorder ; no
 popular prejudice can be more unfounded, as
 eczema is in nearly all cases curable by a little
 care and cleanliness, and  it is in no degree
■ attended  by danger.  Teething is another
 cause, and here  again the irritation and febrile
 disturbance brought  about  by that  process,
 acts in a similar way  to the  above.   Fat chil-
 dren often have  this  eruption  in the folds of
 the  chin, beneath  the knees, in the bend of
 the  elbow, and very often in the  nates or
 round the  buttocks ;  this is generally due to
 the  irritation caused by the passage of the ex-
 cretions, and to a want of due cleanliness
 and  proper changing of  linen.  The head in
 children is a very common seat of eczema ; it
 begins on the   scalp  in the usual way, and
 comes behind the ears, leaving angry  red
 places from which  oozes   moisture ; often j
 there is a running from  the ears, and  lumps
 appear beneath the chin or at  the back of the
 neck, and these are  due to  the lymphatic
 glands becoming enlarged from the affection
 of the skin in the neighborhood.   This dis-
 ease often  comes on  after a child is recover-
 ing  from  measles or scarlet fever ; it  is met
 with after an attack of chicken-pock or glass-
 pock, and is often due to the child scratching
 the  vesicles and so irritating  them.  In  the
disease known as itch, eczema appears some-
times ; it  is here produced artificially by the
scratching of the skin.
  Treatment.—In most cases the following
treatment will  suffice.  Smear  on the part
some simple olive oil, so as  to  soften the
crusts, and then lay on at bed-time a hot lin-
seed meal poultice,  so as to cover the part
well.   In  the morning most of the scabs will
be removed and a great deal of the dirt, while
a moist red surface  will  be left,  and if the
process be not repeated, it will soon scab over
again ; washing with soap is of no use, as it
only further irritates the skin ;  let cleanliness
be kept up carefully by oiling and washing.
If the rash should be in a part where  it is
difficult to keep  on  a poultice, it is just as
good to wash  the  part with oatmeal and hot
water instead of poulticing.   When the sur-
face is in  this way cleaned, let zinc ointment
be  applied all over the sore, and in a short
time much improvement will ensue.  A child
in a filthy state and  covered with  scabs may
thus in a day or  two with great care, make
great progress.  When  itch is present, the
remedy for that must be used, both diseases
cause itching,  but the itch does not affect the
head, but comes on  the  body and arms and
between  the  fingers,  and is  moreover very
catching.   Children are often much benefited
by taking steel wine  for  a few weeks.  It is
important to  know that while  the great ma-
jority of  cases are thus easily cured, yet the
disease is very liable to recur, and  in a few
obstinate  cases seems to defy all  treatment.
In some  scrofulous children  the disease will
break out in  some part or other, the skin at
first looking  rough,  dry, and shiny, as if  it
were too tight over the part;  then  it becomes
moist and goes through the usual stages.  Re-
lief may be afforded  for a time, and the child
may grow out of it, but  such cases are very
troublesome.  It is singular that such children
very often look well and are playful, and in
good condition.   The hair  should be kept
away from the skin  where this eruption has
broken out.    Mere  wrapping  the  part in
rags kept  constantly wet with cold water will
bring about a cure.  Fuller's earth is useful ;
most of the powders  in common  use are of
no value,  as they irritate the  skin.
  Eczema  of the leg is  often met with in aged
people, and in those who suffer from varicose
veins and ulcers.   There  are two typical
forms of  eczema  in  this situation, viz., the
acute and the chronic.   In  the former, the
affection comes on quickly and  is very pain-
ful.  The  skin is  of  a bright red color and
very tense.   Upon this  inflamed  portion of
skin minute blebs are formed, which contain
a transparent  fluid.   As  the  inflammation
subsides,  these blebs  either dry up and form
thin scales, or their contained fluid increases
in amount and  becomes thick and milky-like
pus, causing much irritation to the skin, and 
134  EFFERVESCING DRAUGHTS
ELATERIUM
finally drying and forming  thick yellow or
brown scabs.  The severe symptoms of acute
eczema subside  in the course of  five or six
days, and then the affection either disappears
altogether, or, as most frequently happens, it
passes into the chronic form.   Here the skin
is less painful and inflamed, and there is less
" weeping,"  or  discharge  of thin fluid from
the  affected  surface.   The  skin,  however,
and  also the parts immediately beneath  are
swollen and  inflamed.  Large white and  ad-
herent scabs  are formed by the drying up of
the frequently renewed crops of blebs or ves-
icles. The chronic form of eczema is a trouble-
some and obstinate affection, and is generally
attended with much itching.  Eczema occa-
sionally attacks the nipples. Very small blebs
are formed, which break and leave raw sur-
faces from which there is profuse weeping of
thin  clear fluid.  Like  other forms of acute
eczema, this  is attended with much pain.  It
attacks women  at  all periods of life, most
frequently girls  who have just reached  the
age  of puberty.  The chronic form is very
troublesome  and obstinate.  Eczema  in  the
lower extremities of persons troubled with
varicose veins may be prevented by the use
of bandages or an'elastic stocking, cold bath-
ing,  and by their avoiding  as far as possible
much standing or walking.   The treatment of
acute and severe eczema, whether in the legs
or on the nipples, consists in administering
saline purgatives,  and by  applying some
warmed  goulard water mixed with a small
quantity of laudanum.  For  chronic  eczema
tonic medicine  is  generally  indicated,  and
also  warm baths.  The inflamed parts should
be frequently washed with simple water or
with  bran-water.  Soap should not be used.
The  skin around the inflamed patch should
also  be well  washed  with  weak spirits of
wine, and then carefully wiped.  The follow-
ing are some of  the lotions most  frequently
applied to chronic eczema :  bicarbonate  of
soda dissolved in water ; nitrate of silver dis-
solved in water, with the  addition of some
sweet spirits of nitre ; a mixture of  tannin
and glycerine ; bichloride  of  mercury, proof
spirit, and water ; lime-water ;   borax  and
glycerine.
  EFFERVESCING  DRAUGHTS   are
often very useiul  and pleasant in febrile at-
tacks.  They can be made from  any of  the
vegetable acids and an alkali.  To a tumbler
of water the following proportions are suffi-
cient : Bicarbonate of potash, 2  scruples ;
tartaric acid, 25 grains ;   or,  carbonate of
soda, \  drachm ; tartaric  acid, \  drachm.
Adda teaspoonful of capillaire, or any syrup,
and you have a pleasant draught.
  EFFUSION  is  the  pouring out  of  any
fluid either into a cavity or the cellular tissue
of the body.   An effusion may be of blood
or serum, which  is called  water.   Thus, we
have  in the first case apoplexy, if the effusion
  be of blood  on the brain ; or water on  the
  brain, if of serum.   Likewise on  the chest,
  effusion causes either congestion  or  water,
  as the case may be.   Effusion  also may take
  place  in the joints, or between the skin and
  muscles.
   EGGS are very nutritious articles of food,
  they  contain as much oil and flesh-forming
  matter as butcher's meat.  The white, how-
  ever,  is not so digestible as meat.   They
  enter into the composition of puddings, cakes,
  buns, and'other forms of diet.  They are also
  eaten alone, boiled or fried, and are most di-
  gestible when  least done.  The egg  of  the
  domestic fowl is usually eaten, but those of
  other birds are frequently used.  The eggs of
  the crocodile and other oviparous reptiles  arc
  eaten in some  parts of the world.  The eggs
  of the  woodcock,  plover, and other  small
  birds are esteemed a luxury.   Those of  the
  duck and  goose have a strong flavor, and
  those of the seafowl are fishy.  The eggs of
.  the turkey are rich  in flavor, while those of
  the guinea-hen have a  delicate  flavor.  All
  birds'  eggs  may be eaten with  impunity.
  Eggs are most useful and nutritious as articles
  of diet in the sick-room.  They are used  for
  mixing with castor-oil, turpentine, and  other
  strong medicines, to render them more pala-
  table ; also for making  mulled  brandy and
  wine.  A most nutritious and agreeable drink
  may  be made  for invalids,   consisting  of
  sherry or brandy beaten  up with raw eggs and
  sweetened with sugar.  Eggs may also  be
  given mixed with Liebig's extract of meat.
   ELATERIUM is the sediment which falls
  from the expressed  juice of  the  squirting
  gourd, or wild cucumber. When ripe it ejects
  its  seeds, hence its name.  The juice is set
  aside  after expression,  and the sediment is
  allowed to strain on a linen cloth, after  which
I  it is dried on a porous  brick.  For this rea-
  son the thin scales in which elaterium is seen
  are marked on one side  by the impression of
  the cloth.  The drug is an exceedingly power-
  ful one—one eighth of  a  grain  acting as a
  strong  drastic  purgative, carrying off  much
  fluid.   It  accordingly requires  to  be cau-
  tiously given, and should never be employed
  if there is a tendency  to irritation  of  the
  bowels.  It often causes  nausea and sickness,
  and sometimes gives  rise to considerable
  pain.   Its great value is in dropsical accumu-
  lations of fluid,  as in heart disease. In such
  cases the fluid may  accumulate to an  extent
  that diuretics  are  unable to  cope with it.
  When that is the case elaterium given  in the
  above-mentioned dose, combined with  a  few
  grains  of  compound extract  of  colocynth,
  often does great good,  causing an  immense
  drain  of  water.  It  should, however, not be
  used for too  long  a   period continuously.
  Belladonna  is  a good  thing  to give  along
  with it.  Elaterium is often bad—it spoils by
  keeping, and is frequently adulterated, hence 
ELATER1NE
ELECTRICITY          135
it should be procured direct from some reli-
able druggist.
  ELATERINE  is  the  active  principle
found  in  elaterium.  Its dose  is  about a
quarter that of elaterium.
  ELDER  FLOWERS.—The water  dis-
tilled from  off these flowers  is sometimes
used as a vehicle for more powerful medi-
cines.  It has  no specific properties  of  its
own, but the inner bark of the tree  acts as a
hydragogue   cathartic, and has been  used
with success in the  treatment of dropsies in
the form of decoction.   Four ounces of this
bark may be  boiled  in  a pint of water, and
two or three ounces taken as a dose.
  ELECTRICITY, or Galvanism, is an  ex-
ceedingly powerful remedial agent, the exact
value of which we are only now beginning to
appreciate.  There  are three kinds of elec-
tricity  in  use—first,  the  so-called  static  va-
riety, which is obtained by  rubbing a glass
plate or cylinder, and which may be  stored
up in Leyden jars.  This is also called Frank-
lin's electricity, from its discoverer, Frank-
lin,  and is  not  greatly  used  in medicine.
The most important variety of electricity is
that called dynamic, or  current electricity,
and of this there are two kinds—namely, that
which  passes  in  a  continuous current from
one pole of the battery to the other,  and that
which is called interrupted, which is a kind of
to-andfro current ;  the last is also  called an
induced currer.t,  and as its properties were
first investigated by Faraday, it has  received
his name.   It is to these last we must con-
fine  our attention,  as it  is these which  are
chiefly used in medicine.   It  would be im-
possible  to  enter into full  details  as to  the
mode in  which these forces are developed ;
briefly, the main points  are these :  Suppose
a plate of copper  and a plate of zinc are in-
troduced into a vessel containing diluted  oil
of vitriol ; if now a copper wire be so placed
as to touch both of  these, active change will
be set up in the fluid, and an electric or gal-
vanic current will be set up in the fluid from
the zinc to the copper, and out of the fluid by
means  of the wire from the copper  to  the
zinc.  This is  the continuous  current, and if
the pair of  plates be multiplied, so will  the
force increase.  Moreover, if  two  wires  are
used instead of one, and any portion of  the
body be introduced between the two, the cur-
rent will pass thiough the body so  as to go
from one wire to  another, and its effects  on
the body will be made manifest. There  are
many varieties  of continuous current batter-
ies, but they are all constructed nearly on  the
same principle, though  the material varies.
It is to  be  noted that  the effects are only
noticeable when the  circuit, as it is called, be-
tween the metals which gives rises to the cur-
rent is complete ;  when the circuit is broken,
that  is to say, when the two  wires neither
touch directly nor indirectly, there is no cur-
rent.   But suppose the current to be made to
pass through a piece of soft iron, this will be
affected like the wires, readily conducting the
electricity from one wire to another.  If now,
however, a coil of thin wire be made to sur-
round the soft metal so as not to touch either
it or itself, through the coil of wire  will pass
a stream of  electric  force  whenever the cir-
cuit is opened or  shut ; that is to say, when-
ever either  of the wires  is made to remove
from or to touch the iron centre piece.  When
the wires touch, the circuit is closed, and the
current passes from  the copper to the zinc,
as usual,  but if  removed it can no longer
pass, and the iron remains unelectrified.  The
wire coil  does not touch the centre, and so
the current  is said  to be induced ; it  only
passes on opening and closing the circuit,
that  is, interrupting  the current, hence it is
also  called  an interrupted current, but it is
plain these  interruptions  occur in both the
original  circuit and  the induced current, so
that  in reality both  are interrupted, though
only one  is  induced.   It would not be possi-
ble to  give  in this short space full details of
the kind of cases in which the several forms
of electricity may prove  or have proved use-
ful.  In the first place they may be either ap-
plied locally or  generally—that is  to say, to
some one spot or part of the body, or to the
whole body.   If applied  to one definite part,
the influence  would  naturally be to a great
extent  limited to that part, but if to the whole
body, a kind of tonic rather than any distinct
or specific effect would be anticipated. Briefly
we shall point to  two most important sets of
cases where electricity does  good.   First in
neuralgia, especially of the face.  This most
intractable and   painful  malady  sometimes
yields in a most surprising manner  to the use
of electricity, and especially to the continu-
ous current, though cures sometimes do bet-
ter with the  interrupted one.  In facial palsy,
too, where the muscles are so wasted as to be
unable to respond to  the interrupted current,
prompt contraction follows the application of
the continuous one.   In  ordinary cases of
paralysis one great object, at all events,  is to
keep the muscles properly nourished until the
nervous system of what has suffered damage
has had time  to  be  repaired.   For this  pur-
pose, as a  rule,  the  induced current is best,
each separate muscle of a limb can be duly
exercised  and prevented  from undergoing
degeneration  by  applying the force to appro-
priate points.   At the same time if the exact
nerve  centre  affected can be  made out, the
continuous current may perhaps be of service
in aiding  its recovery.   One form  of loss of
voice connected  with hysteria is  promptly
cured by the interrupted current.   In certain
forms  of paralysis connected with  syphilis
the continuous current is most useful.  These
instances might be  multiplied indefinitely.
but the main principles affecting  the use of 
13G       ELECTRO-BIOLOGY
EMBROCATIONS
electricity are above indicated.   Of  course
the kind  of electricity to be used, and its
mode of application, must be left to a physi-
cian.
  ELECTRO-BIOLOGY.   (See Mesmer-
ism.)
  ELECTUARIES  are certain  forms of
remedies into which sugar or  honey largely
enters.  They are of the consistence of a thick
paste,  and  readily admit of  being made up
into pill-like masses which may be covered
over with  sugar or any  tasteless material.
They are much the same  as confections, and
two of them at least are very valuable reme-
dies.   These are confection  of sulphur and
confection of senna,  both sometimes called
electuraies ; both are valuable laxatives, the
former  especially  useful  to those troubled
with piles, the latter as a means of adminis-
tering a good  but nauseous remedy to chil-
dren.
  ELEMI is a kind of resin, with properties
allied  to turpentine, which is imported from
the East.   Its ointment is  sometimes em-
ployed  in sluggish sores.   It is  not given in-
ternally
  ELEPHANTIASIS is the name given to
a condition where limbs swell to enormous
proportions  from  no  very definite  cause
and remain permanently  in that elephantine
condition.   In it the skin and subjacent tis-
sues are greatly thickened and increased in
density, but the muscles are destroyed  or
altered for the worse rather than increased in
strength.    Most  frequently  it  attacks the
lower extremities,  sometimes the upper ; less
frequently other parts of the body.  The skin
is the part most  affected ;  it becomes of a
brawny thickness.    All  kinds of remedies
have been tried, even to ligatizing  the vessel
which supplies the limb,  but success has not
been great.  Some of the cases ligatured have
done well, some badly ; bandaging has done
good  to some.  In India such a growth fre-
quently attacks the  scrotum, causing  it  to
assume the most portentous proportions. For
this, as for the other, removal seems the best
remedy, and should not be too long deferred,
or  the  health may suffer irretrievable dam-
age.
  ELIXIR  is  an Arabic  word,  signifying
strength.  At one time it was a favorite name
for medicines  supposed  to  be  particularly
efficacious,  and where the ingredients were
almost entirely dissolved  in the  menstruum,
making it  thicker than  a tincture.  There
were all sorts of elixirs sold, but we now only
find in the shops elixir of  vitriol and paregoric
elixir.
  ELM BARK is a remedy of very uncer-
tain value ; some thinking it  very valuable,
and others useless. It is given in the form of
decoction  as an   alterative—whatever that
may mean.   Certainly we possess far more
powerful remedies.
  EMACIATION or loss of flesh occurs in
many cases, as in  cancer,  consumption, and
starvation, etc., and is due to the tissues not
receiving a due supply of nutrition.
  EMBALMING is the  process of prepar-
ing any animal body  to resist the decay nat-
ural to  it.  The art of embalming was  prac-
tised by the Egyptians in perfection, and we
have their mummies now to prove their skill.
The chief ingredient in all embalming prepar-
ations  is  benzoin, a resin existing  in friars'
balsam.   This, combined  with naphtha, is
freely used, and  bandages soaked in it are
bound round the body, after elaborate  prep-
arations of  spices  and  resins have  been
placed within the body itself. At the present
day embalming is seldom required even by
the rich for their dead, excepting when a long
time must necessarily  elapse  before  inter-
ment ; and, as in  the  case of royal person-
ages, where lying in state is practised.
  EMBOLISM  is a term applied to a con-
dition in which a piece of fibrine in the  heart
or in a large vessel has become dislodged and
carried  by the  current of  the circulation into
some distant   part.   This occurs in  some
cases of heart disease, and more especially
after  rheumatic fever has caused disease of
that organ ; a  clot of fibrine carried  into an
artery of the extremities would  do very little
harm, but if carried into an artery supplying
the brain,  an attack of hemiplegia or paralysis
will ensue, and the patient  will pass into a
state of coma or insensibility.  This is a very
serious  condition and nearly always fatal ; it
may be suspected in those  who, suffering
from heart disease after rheumatic fever, have
daily variations of temperature with weak-
ness and pallor, and other well-defined symp-
toms of fever.  An embolon, or plug of fibrine,
may be carried from a vein into the heart and
cause sudden  death  by blocking up the pul-
monary artery.  Such cases are very rare and
may come on after  a confinement.   Death
will take place in an hour  or two, or may be
still more prolonged  ; the patient will  suffer
intense agony and  distress from a  feeling of
impending suffocation ; she will toss herself
about calling  for air  although there  is plenty
entering  the  chest,  and  a  fatal  result will
shortly ensue, not because there is not enough
air to aerate the blood, but because the blood
cannot  get to the air  to be oxygenated.   The
symptoms are  the same as those met with in
death  by apnoea, although  the cause  is re-
versed in this case.   It is doubtful if recovery
ever takes place, when once the above symp-
toms have come on.
   EMBRYO  is the  name given  to the ear-
liest appearance of the foetus when it begins to
be developed in the womb.
   EMBROCATIONS are forms of remedies
intended to be rubbed into a part, whereas a
liniment is strictly intended only to be smear-
ed on  to. it.  Nevertheless,  the word lini- 
EMETICS
EMPHYSEMA          137
ment is now generally  used in the widest
sense so as to embrace embrocations.  (See
Liniments.)
  EMETICS are medicines or other agents
which  produce vomiting ; the simplest,  and
in many cases the most effectual,  being a
tickling of the back of the throat, especially
at the  part  called the soft  palate, with a
feather.   In  medicine  several classes  of
emetics are used ;  some cause  sickness and
faintness ;  some by  irritating  the  stomach
cause it to get rid of its contents without any
great degree of faintness such as  accompanies
the other.  Vomiting  itself is  a  complex act,
partly the result of the powerful muscles con-
stituting the walls of the belly, partly the re-
sult of contraction of  the muscular  walls of
the stomach itself,  that is to say, of the cavity
into which the food is received.  Of ordinary
emetics, ipecacuanha  is that most frequently
employed ; antimony  is also used in the form
of antimony wine or tartar emetic, the latter
in small doses.  These remedies cause much
sickness and  prostration,  and consequently
are used chiefly in  cases where it is desirable
that such a condition should  beinduced  for
the arrest or suppression of certain diseases.
Thus, in the case  of  children attacked with
croup, or in whom the croupy cough has been
brought on by exposure to wet,  an emetic of
this  class is  of  the greatest  possible value,
and often succeeds in arresting  the  disease,
especially if accompanied with a warm  bath
and fostered with  lukewarm  drinks.  Then,
again, it must never  be  forgotten that little
children, especially infants, if attacked  with
cold,  cough, and  thereby expel from  their
lungs the matter which  has collected there,
but this in all probability only reaches the air
tubes and gets no farther.  The material may
it is true, reach the  throat and be swallowed,
but infants cannot expectorate, and so the
tendency is  to accumulate phlegm in the chest,
whence the  rattling noises heard when they
have colds.   Now it is of vital importance to
get rid of this substance, and of  all remedies
an emetic is the most  efficient.   Ipecacuanha
wine had best be used, and that may be given
in repeated teaspoonful doses until the child
is sick and the whole is brought  up.   This
may seem harsh practice, but in  the end it is
safest.   In  olden times  it was  the common
practice to begin a course of physic as it was
called by a vomit and a purge, and it was held
that these would often arrest a fever ;  now
our beliefs are somewhat altered, but we are
also inclined to think that the value of emet-
ics is too frequently overlooked.   In poison-
ing, by whatever agent, it is of  vital impor-
tance  to get  it expelled  from the stomach  ;
frequently the  substance  is of  a character to
induce vomiting itself ; if so, all that requires
to be done is to foster  this tendency by copi-
ous draughts of lukewarm water, or  some
bland drink ; if  not,  the  stomach  must  be
emptied, and to this end it must never be for-
gotten that the readiest  means  is  the best.
In most situations common salt,  mustard, or
smelling-salts are  obtainable, and these may
be given in the respective doses of a handful
of salt, a tablespoonful of mustard,  or a tea-
spoonful of smelling-salts, all freely diluted
with water, and to be followed up by copious
draughts of  lukewarm  water.   These  are
especially useful in poisoning with  opium or
other narcotic agent.   For this purpose, too,
sulphate of zinc (white vitriol) and sulphate of
copper  (blue vitriol)  are  particularly  well
adapted,  but  as a rule less readily obtainable.
Sulphate of zinc is a very safe emetic, empty-
ing the stomach without giving rise to much
nausea.  Perhaps the best is a combination
of this with  ipecacuanha—15 grains of sul-
phate of zinc and  5 of ipecacuanha, given as
usual with  much lukewarm water. There are
many cases where an ind vidual has  partaken
of  indigestible or unsuitable  food,  that an
emetic, by  getting rid of it, does great good,
as during  the process of vomiting, the liver
and gall bladder  are compressed,  and bile
finds its way back into the  stomach, thence
to be expelled by the mouth.  An  emetic is
often one of the very best plans  for getting
rid of an accumulation of bile in  the liver or
its appendages.   The  process of  vomiting
commonly  also causes a  certain amount of
perspiration.
  EMMENAGOGUESare remedies which
are  supposed to  foster the  menstrual flow.
They are a most diversified and unsatisfactory
group.  Very often  deficiencies   or absence
of the flow are due to no local cause, but to
bad  health  generally, especially to the condi-
tion known  as anaemia.  When this is  the
case it is  useless to  attempt to  restore  the
local functions until  the general  mischief is
set right.  For this reason  salts of  iron are
among  the  most useful emmenagogues, es-
pecially in  large towns, and  as in these  pa-
tients the bowels are usually more or less slug-
gish, especially the lower bowel, it is well to
give aloes at  the same time.   Sometimes the
arrest or non-appearance  of the  flow is due
to mechanical obstruction,  in which case
operative procedure becomes necessary. This
is comparatively rare.
  EMOLLIENTS are remedies which, when
applied locally, soothe the part and  diminish
irritation.  Heat and  moisture are perhaps
the most important agents ; but these may be
used in  a variety of ways.   Bathing with
warm water ; the application of hot poultices,
however compounded ;  the  application  of
oily or greasy substances, so as  to  keep the
skin lissome  and  supple, all  come within the
definition.
  EMPHYSEMA is a disease of the lungs,
which is attended  very often by shortness of
breath,  cough, and  inability to  expand  the
chest thoroughly.  It very frequently comes 
13S          EMPHYSEMA
EMPHYSEMA
on  as  a sequel to a winter  cough.  When a
person has been suffering every winter with a
recurrence of bronchitis, the air-cells of the
lungs become unduly distended, and cannot
so well expel their contents  ; it thus happens
that the lungs become larger and holds  more
air than usual, but as the air is stagnant in
the lungs in a great measure respiration is
carried  on imperfectly,  as  the products of
combustion  are  not removed fast enough.
For the same reason an emphysematous per-
son cannot take a deep  breath,  because his
lungs being already full of air, he is in a sim-
ilar state to a man who has taken  a  deep in-
spiration, and  therefore the further expan-
sion can  only  be very slight.   Such people
are generally stout, and have too much fat
deposited about them ; this arises from the
fact that they are not able, or are indisposed,
to take violent exercise, and that the ordinary
processes of combustion  in  the lungs are
somewhat impaired.  In  old people also em-
physema  occurs,  in  consequence  of the
changes which naturally take place in the tis-
sues in old age  ;  the lungs, like other organs
in the body, are less nourished  then  than
usual, and so they are unable to bear the ex-
ternal  pressure of  the   atmosphere ;  hence
the air-cells  dilate,  and this  is most observed
in the upper and front  parts of  the lungs.
This disease is met with also in children, and
appears in some  cases to be hereditary ; in
many cases,  however, it follows  whooping-
cough or some bronchial affection of child-
hood, and the little patient  may be seen with
high shoulders,  prominent  chest, quick but
shallow expansion of chest, and  rather con-
gested appearance in veins of face.  This dis-
ease in itself is not dangerous, but it is so often
accompanied by  bronchitis, and  in a  great
measure induces  that  disorder,  that  grave
evils may ensue.   Besides the shortness of
breath and the inability to take fast exercise,
there is often palpitation of the heart and pain
at the  pit of the stomach,  because the right
side of the heart is  full and cannot properly
force  its contents through the altered lungs.
Sometimes the neck and face are  swollen,
and even the legs may  become so too, and
then when the finger is pressed on the skin a
little  pit of  depression  is formed,  and the
patient  is said to  be dropsical.   But  these
results do not occur except in bad cases, and
only when the person has been  suffering for
some years.  Bronchitis  is the most common
affection which  coexists with emphysema,
and often it is extremely troublesome.  Year
after year, when  the cold weather sets in, the
emphysematous  person  will fear  his winter
cough, which is almost sure to come on if he
is at  all exposed in his trade or calling to
atmospheric  changes.  Thus it will be seen
that while bronchitis often causes emphysema,
the latter is  also in its  turn a cause for the
former, and as each aids in  making the  other
worse,  such  a person  generally becomes
worse after each fresh attack.   When a cold
comes on the breath is shorter than  before,
and there is difficulty in breathing ; the pa-
tient is wheezy, and feels as if there were a
weight lying on  his  chest ; in a day or two
under proper treatment the cough will be-
come looser, and he will find relief by expec-
torating a good deal of phlegm from the chest.
The cough is generally very troublesome first
thing in  the morning,  because the phlegm
has been accumulating during  the night ; the
patient  is unable to lie down comfortably,
and feels  better when propped up in bed. By
coughing  so much, pain is frequently felt in
the lower part of  the chest on  each side, and
this  is due to the  muscles there being tried
with the violent exertion.  At times the eyes
may be bloodshot, and the veins  of the neck
stand out during the cough because they are
congested.  Frequently the patient breathes
better when he leans forward, resting on his
hands, because then, the shoulders  being
fixed, expansion of the chest takes place more
freely.  After many  attacks the  lips,  ears,
and nose  often are of a livid or purplish tint,
owing to long-jcontinued congestion of the
vessels  of the  part.  This disease affects all
classes,  more especially those whose work
exposes them  to all kinds of weather.  A
very common cause is  indulgence in eating
and  drinking ; when old gentlemen are seen
with large stomachs, shortness of breath, and
a wheezy condition of the chest, emphysema
is  pretty  sure  to be present.   Women, by
leading a more domestic life, are less subject
to  this disease than men.
  Treatment.—If a person  is predisposed to
emphysema by one of his parents having suf-
fered from it, he should avoid exposure to in-
clement weather as far as possible, and when
he has a  cold  or an attack of bronchitis he
should try and  get it cured as soon as possi-
ble.  Avoid excess of eating and drinking,  if
at  all inclined to obesity  ; take  lean  meat
rather than fat ;  do not eat much bread, or
butter, or pastry, or potatoes, but have dry
toast, biscuits, or brown bread,  and  green
vegetables ; a little claret or sherry is prefer-
able to beer.  Exercise should betaken every
day in fine weather, and night air should be
avoided.  But it generally happens that  a
person takes no  heed of himself until he  is
actually emphysematous, but even then the
observance of the above rules may somewhat
prevent  further  mischief.    Removal to  a
warmer and equable climate is of the greatest
service, but this is  often beyond  the means
of most people.   When an  emphysematous
person has taken cold,  or has an attack  of
bronchitis, he  should at once to go 1o bed
and keep the room at a moderate temperature
of 650 Fahr. or 700 Fahr. ; if too  hot, the air
is  oppressive ;  the  atmosphere  should  be
moistened by boiling water in a kettle, so that 
EMPYEMA
EMPYEMA
139
the steam  shall  pass into the apartment ;
moist hot air is  what is most  grateful to the
patient.  Avoid  any draught of cold air into
the room.   Place on the  chest hot linseed-
meal poultices, but care should be taken that
they are really hot, and not allowed to lie on
until they become a cold damp lump  on the
chest ; or flannels, wrung out of hot water,
may be sprinkled over with a teaspoonful  of
turpentine, and then placed over the chest  or
back ;  a piece of oiled calico  should  be laid
over the flannel—it not only keeps in the heat,
but prevents the clothes becoming wet.   The
patient should not lie too  low in  bed,  as he
will breathe freer if propped up by pillows.
Careful attention should be given to the diet;
solid food should be avoided at first, and hot
milk or bread and milk may be given, with a
lightly boiled  egg and beef-tea at  intervals.
Beer should not  be given,  and if any stimu-
lant be needed, some  port  wine negus or a
glass  of warm  whiskey-and water may be
given ; any excess in this  direction is bad.
Any light farinaceous pudding or some mut-
ton may be tried in a few days, when  the ap-
petite returns, but the stomach should not be
loaded with food  so  as to  cause distension.
The bowels are often confined,  and  so purga-
tives may be given occasionally.  By adopt-
ing these means  an attack of bronchitis may
disappear in three or  four days, but in old
people who are in a feeble  state it  is a very
serious complication, and often carries  them
off very rapidly  ; this  may be  noticed every
year at the  onset of cold weather.   Between
the attacks, and during the warm summer
weather,  the object is to improve the general
health, as far as  possible by careful diet and
tonic medicine.  Flannel should be worn next
the skin, and warm  socks and thick boots.
A respirator often gives great relief, as the
inspired air is by that  means warmer, but it
is not so pure.  Persons affected in this way
should breathe through the nose rather than
through the mouth, and they should not talk
when out walking in  the  night air.   Great
relief is afforded by staying in the house all
the winter, so as to  avoid  being exposed  to
cold or wet  ; but this is a plan which can only
be adopted  by the few.
  EMPYEMA  is  a disease  of the pleura
associated  with  the effusion of pus into the
pleural cavity.   In many  respects this dis-
ease presents symptoms closely resembling
those met  with in pleurisy, but differing  in
being more intense, and  attended with more
danger to the patient ; in  simple  inflamma-
tion of the  pleura, the products effused have
a tendency  to become absorbed, and to leave
only adhesion of  the two surfaces  of the
membrane,  while  in  empyema  adhesions
rarely occur, and  the matter must be  let out
by surgical  interference ; there is,  in fact,  in
these  cases a large abscess  in  the  chest,
which,  by compressing the lung on  that side,
causes great distress and  much difficulty in
breathing.   Persons who suffer from this dis-
ease  are generally in a bad state  of  health
previously, and are often of a scrofulous con-
stitution.   Scarlet fever in  children may set
up  empyema, and it is more common from
this cause in early life than among adults.   In
some who have diseased joints  or  sinuses in
the limbs, with diseased and bare  bone, and
after amputation of a limb when  pyaemia has
been set up, secondary  deposits in the lungs
and empyema are very liable to recur.  Those
also whose  lungs  are in a diseased state,  as
in cases of  phthisis and  some forms of pneu-
monia,  are liable  to this complaint.  The
bursting of an hydatid cyst into the pleura,
the rupture of a  tuberculous cavity of the
lungs, and  the extension of a similar disease
in  the  pericardium,  will set up empyema.
And,  finally, it may come on insidiously with-
out any distinct cause being made out.
  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 without increasing this pain.   In
a few days, when the fluid is poured out into
the pleura,  the pain may diminish consider-
ably ; but  there is more or less distress of
breathing,  because, from the pressure of the
fluid, air cannot enter the lung 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 toward 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 nicht and perhaps
two or three degrees lower in the  morning.
When  disease  is  well  established, the dis-
eased side of the  chest is larger  in circumfer-
ence than the other, and there  is bulging  of
the intercostal spaces ;  the veins also are ob-
structed over  the part, and appear as blue
lines running over the  chest.   The dyspnoea
is great, and increased on exertion ;  each res-
piration is hurried and  shallow ; the counte-
nance is anxious, and sometimes pale or livid.
Generally 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 afterward.   The  rigors, the
hectic flush, the daily oscillations of tempera-
ture, the increase at night in the intensity of
the symptoms, the  bulging of the chest-wall,
and the distress and prostration of the patient
are the  indications  which  show that  the
case is one  of empyema, and not  of  simple
pleurisy ; yet in some cases these  symptoms 
140
EMPYEMA
ENEMA
 even may be absent,  or at least  not  well
 marked ;  and, again, a  person may be at-
 tacked with ordinary pleurisy first, and after-
 ward the  effused fluid may turn to pus.
   Treatment.—The patient  must be kept in
 bed in a warm and well-ventilated room ; the
 air  should  be moist, and of a  temperature
 from 6o°  to 650 Fahr.  When there is much
 pain a few leeches will often give great relief,
 and then a hot poultice can be applied, or else
 flannels wrung out of hot water, and covered
 over with some oiled calico  or  oiled silk, so
 as to keep in the heat, and  prevent  the  bed-
 clothes becoming wet.   Care should always
 be taken  that, in applying either poultices or
 hot flannels, the bleeding from the leech-bites
 (if any have been applied) should have quite
 stopped,  because,  if this  precaution  be not
 tiken, the warmth  will encourage the bleed-
 ing, which will trickle into the poultice with-
 out being seen, and so the patient may lose
 much more blood than is advisable.  Food of
 a  light and nourishing  description  must be
 given ; milk, beef-tea, broth, and a moderate
 amount of stimulant are best  borne ;  the diet,
 in fact, is such as may be given  in  all cases
 of fever,  and will be more  fully described
 under the  general  head  of fever.    (See
 Fevers.)  When there can be no doubt in the
 mind of the medical man that pus is present,
 it  is certainly  advisable to open the  chest by
 a small incision, so as to let it out ;  no good
 can  come by delay, as  the  patient's  health
 will become worse, and no benefit can be ex-
 pected from leaving the case alone.    Yet,
 should any doubt exist as to (he nature of the
 disease,  an  exploratory puncture  may  be
 made ; this is done by means of a fine trocar
 and canula,  or,  in  other words,  a  needle
 which just fits  into a silver tube, and after both
 have been inserted into the chest-wall,  the
 needle or  trocar is withdrawn, while the fluid
 will escape through the canula or tube ; this
 is  a very simple and harmless operation, and
 of great use in making sure of  the nature of
 the effused  fluid.   If pus escape, then there
 can  be no hesitation  in tapping the  chest, or
 in performing the operation which is techni-
 cally known as "paracentecis thoracis."  For
 this purpose an  incision, about an inch long,
 or  rather less,  is  made through  the skin,
 about the sixth or seventh intercostal 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.
 Sometimes enormous quantities are  removed
 in this way, and the relief given to the patient
 is very great  in proportion, as now  the com-
pressed lung may  begin to expand again if
the disease has  not lasted too long, and the
pressure  on the other internal organs is re-
moved.  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 accumu-
late 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  produced
daily gradually diminishes until at length it
ceases.   All this while  the  patient will be
easier ; he  can breathe more comfortably ;
there is less fever and hectic ;  he will recover
his appetite, and rest better at night ;  but in
all cases that recover convalescence 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 afterward. In time the healthy lung
becomes much increased in size, and does in a
great measure the work of both. The mortal-
ity from  this disease is considerable, and it is
nearly  always  fatal  when  arising  from py-
aemia, 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.
   EMULSIONS are soft,  smooth liquids,
usually prescribed for coughs, though purga-
tives can be made into  emulsions, as when
castor  oil  is rubbed down with yolk of egg,
or milk,  or  mucilage and syrup.  A pleasant
cough emulsion is made from  almonds, gum-
arabic, sugar, water, and a little tolu, pare-
goric, and sweet spirits  of nitre.
   ENCEPHALITIS is a technical term for
inflammation of the brain.
  ENCEPHALOID    CANCER.   (See
Cancer.)
   ENDEMIC diseases are  those which are
peculiar  to localities or  situations, as  goitre
to Switzerland, and plica polonica to Poland.
Diseases  may be endemic and epidemic at
the same time.
   ENDOCARDITIS  means  inflammation
of the  lining membrane of the  heart,  and is
common after an attack of rheumatic  fever,
and in  course of Bright's disease ; it gener-
ally is met with in the left ventricle, and sets
up a serious affection  of  the valves.  (Sec
Heart.)
   ENEMA.—Where, from whatever reason,
it  is considered not to be advisble to adminis-
ter food  or medicine by the mouth, it is pos-
sible, by means of a specially prepared ap-
paratus,  to introduce them in a fluid form into
the lower bowel.   Whatever is so introduced
is termed  an  enema ;  formerly  a clyster.
First, then, an enema may be  employed with
advantage in cases of prolonged constipation,
when it  is better and easier  to act upon the 
              ENERVATION

 hardened mass from below than from above.
 Many substances may be employed, but there
 is none better than  plain soap and water.   If
 that do  not succeed, half an ounce of  castor
 oil and  half  an ounce of  turpentine may be
 beaten  up  with an  egg,  and a  pint  of hot
 water added.  Usually this will suffice, espe-
 cially if repeated more  than once ;  if not,
 other means must be taken.  It is to be noted
 that in  making use of enemata for this pur-
 pose not less than a pint should be used ;  for
 the  normal stimulus to the bowel to act is
 distension.   If, on  the other hand, it is  de-
 sired that the enema should be retained  in-
 stead of being expelled, the smaller the quan-
 tity used the better.  This is the case when
 from disease of the  stomach it is  impossible
 or unadvisable to give food that way,  and
 small quantities  of beef-tea, etc.,  may  be
 thrown  up  the bowel.   Then not  more than
 a couple of ounces  should be used at a time.
 This too is the case when opium enemata  are
 prescribed, as they sometimes are for disease
 of the lower bowel or neighborhood.
   ENERVATION is a term applied to  the
 weak state met with in cases of nervous  de-
 bility, and  in those  who  suffer from hysteria
 and allied nervous disorders.
   ENTERIC FEVER.   (See Typhoid
 Fever.)
   ENTERITIS, or Inflammation of the
 Bowels, particularly that portion called  the
 small intestine, is rare as a disease arising of
 its own accord.  Usually it is the result of
 irritants, or comes on in  typhoid  fever, or is
 produced by scrofula.  The term, moreover,
 is applied only to inflammations beginning in
 the  inner coat, though  it may extend out-
 ward and affect all.   Inflammation  begin-
 ning  in the outer coat  is called  peritonitis.
 When inflamed, the mucous membrane  be-
 comes of a deep red color, almost  black, and
 very frequently ulcers form on it correspond-
 ing  with certain glands  on its  inner wall,
 called Peyer's glands and  patches.  Some-
 times these ulcers eat  so deep into the gut
 that their outer wall is  perforated, the con-
 tents escape, and peritonitis, a much more
 fatal malady, is set  up.   If the inflammation
 be only of a subacute character,  the bowel
 may be  thickened. This sadly interferes with
 i.s function, and gives  rise to constantly  re-
 curring  attacks of diarrhoea.   The symptoms
 of enteritis  vary exceedingly in gravity.   In
 typhoid  fever  there  are often no'signs of it
 beyond   diarrhoea  until  fatal  perforation
 occurs, and peritonitis  is  set up.   If all the
 coats are affected at once,  this is different.
 The symptoms then  resemble those of  stran-
 gulation, as it called, there  being more  the
 signs of enteritis.   There is intense pain, a
 hot skin,  quick hard  pulse ;  the legs  are
drawn up to relieve the tenseness of the belly,
and  there  is nausea and  vomiting.   The
bowels too, in this form, are obstinately con-
                ENTOZOA            141

fined, and there may be faecal vomiting.  The
slightest pressure  increases the pain, so that
the patient can hardly bear  the bed-clothes.
The pulse soon  becomes excessively  small
and hard,  wiry,  and imperceptible.   If  the
mucous  membrane  alone be  affected,  the
symptoms are quite different.   There is diar-
rhoea instead of costiveness,  and no  faecal
vomiting ;  but there is  great fever,  thirst,
and pain, and the bowels  swell with flatus.
  Treatment.—In dealing with  such a case
we must rely on opium, given both  by the
mouth and bowel.   If it cannot be retained,
morphia must  be  given  in the anus or over
the bowels.   Small doses frequently repeated
are best.  Hot fomentations  or  turpentine
stripes  applied to  the  abdomen  give  great
relief.   Ice to such is both grateful and valu-
able.   Strict  quiet is to be maintained in bed,
and no  attempt  made to open the bowels
until  such time as  that  is urgently needed.
Premature attempts of this  kind  may  cost
the patient his life.   The food,  too, should be
given in the smallest possible bulk ; as there
is little or no appetite and the body is under-
going no exertion, little food suffices, and so
the bowels may  remain  locked  for  a long
time  without  inconvenience.  When  it  is
judged safe to open them, if  they do  not act
of  their own accord, enemata of  soap and
water  had  better be  used.   With children
opium  must  be  given  with great caution
Lime-water suits them well.
  ENTOPHYTA  are  vegetable parasites
which dwell within the body ; they are found
in some diseases of the mucous membrane of
the mouth  and alimentary  canal.  In  the
complaint called  thrush,  so common  in in-
fants, spores  of the fungus known as Oidium
albicans may  be found, also in the false mem-
brane formed in the throat in cases of diph-
theria.   In certain cases of enlargement and
dilatation of  the stomach, fungi are found in
the vomited  matters ; the name of Sarcina
ventriculi has been given to them ;  they form
little  square  packets of  a greenish yellow
color, and are marked  by vertical and trans-
verse lines.   The  yeast plant,  or  Tortula
cerevisia, which is made use of in fermenting
beer or spirituous liquors, is also occasion-
ally found in  the stomach and  bladder.   All
these parasites are of very low organization,
and generally consist merely of bright, round
particles or sporules, or of threads formed by
the union of   these  spores ; they are only
seen under high powers  of the microscope.
They  are probably  conveyed  into the body
from  the external atmosphere, and develop
wherever they find  a convenient nidus.   No
particular treatment need be adopted, as they
are an  accompaniment of the disease, and
not the disease itself.
  ENTOZOA are animal parasites which are
met with or have  their " habitat"  within the
human body.   They have been  divided by 
142            ENTOZOA

biologists into three classes :  I. Coclelmintha,
or hollow worms ; 2. Sterelmintha, or solid
worms ;  3.  Accidental parasites,  or those
having the habits,  but not referable to the
class, of entozoa.
  1.  The following  are the most  common
worms met  with in the class Ccelelmintha :
a.  Ascaris lumbricoides, or round worm, which
is met with in the small intestine, and often
passes upward into the stomach.   The male
measures from four  to six inches long ;  the
female from ten  to  fourteen.  In  shape  it
much resembles  the ordinary  earth-worm ;
it is of a reddish color, round, smooth, and
fusiform,tapering gradually at each extremity.
They are most common in  children between
the ages of three and ten years.  Their num-
ber varies from two or three  to twenty  or
thirty, and  they are  seldom  solitary.    b.
Ascaris or Oxyuris vermicularis,  commonly
known as thread-worms ;  they are  found in
the rectum  or lower  bowel, and are more
frequently met  with  in children than  any
other worm.   The male measures one-sixth
of an inch in length ; the female is from one
third to half an inch long.   They are not seen
when a child is suckling, unless other food be
given.  (See  Ascarides.)  c.  Tricocephalus
dispar, or the long  thread-worm ;  it is  not
very common in this country ; the  male meas-
ures an inch and a half in length, the female
two inches.  It is found in the large intestine.
These three varieties are sometimes spoken
of as nematoid  worms, because they belong
to  the  order  Nematoda.  d.  Trichina spi-
ralis.  A worm rare in this  country, but com-
mon in Germany.  It gets into the system  by
eating sausages not thoroughly cooked.  It
is attended by symptoms not unlike  those of
typhoid fever, in some respects.   They are
met with in the muscles, where they lie coiled
up  in little oval  cases, which are  just visible
to the naked eye.
  2. The following are included under the
class Sterelmintha. a. Tcenia Solium, or tape-
worm.  Its length is great, varying from six
to ten or twenty feet or more.  It is a flat,
ribbon-like worm, of a white color, about one
third of  an inch broad, and made up of seg-
ments about an inch long near the tail end,
and each fits  into the segment preceding.
The body is pretty uniform in width, but to-
ward the head,  the  neck  tapers  very much,
not exceeding often one  eighth  of  an inch,
and the segments also are very much shorter.
The head is known by four black spots upon
it, and these are the suckers by which it clings
to the walls of the bowels ; the head is about
the size of a pin's head, and is rather wider
than the neck.   On the front part of the head
is a small proboscis, on which is arranged a
double row of hooks in a circle. A tape-worm
may  have several hundred segments ;  the
ones near the neck are  at first immature. The
worm increases in length  by fresh  segments
                ENTOZOA

 being produced  at  the neck, while the  fully
 developed segments near the tail drop off ;
 each fully matured segment is called a " pro-
 glottis ;" when these pass away with the ex-
 creta, the patient.is known  to  be suffering
 from  tape-worm.   No good is  done unless
 the head  is  expelled, as yards  may  come
 away, but if the head remain fresh growth will
 take place.  This worm is usually solitary, is
 found in the small intestine, and rarely arlects
 children under three years of age.  b. Tcenia
 mediocanellata is another kind of  tapeworm,
 and the more common of the two. It resem-
 bles  the preceding in every respect,  except
 that there is no proboscis on the  head and no
 hooklets.  c. Boihriocephalus latus, or broad
 tape-worm ; it  is the largest  of all,  and is
 often  twenty or thirty feet in length and an
 inch in breadth.  The head is blunt and flat-
 tened from  behind forward; there are no
 hooklets ; the anterior segments are narrow
 at first, but  widen  gradually, so  as to attain
 their greatest width toward the centre of the
 body ; toward the tail   end, the segments
 diminish in width, but increase  in depth, so
 that the worm is much thicker in the posterior
 than in the anterior part, where it is flattened,
 The total number of joints  has  been said to
1 be four thousand.   These three  varieties are
 the most common, and they are called by
 some cestoid worms, because they belong to
 the natural order Cestoda.   The mature seg-
 ment or " proglottis" of  these worms contains
 both male and  female  orders  of reproduc-
 tion ; when one mature  segment has become
 impregnated with another mature segment by
 contact  with it, eggs  are  formed.  These
 eggs  remain  in the " proglottis" until it
 escapes  from the  bowel, when the  " pro-
 glottis" itself bursts from the growth of the
 eggs within ; when the  ova escape in this
 way, they may be  eaten by  some  animal, or
 even taken into the stomach by drinking water
 into which they have got.  When the embryo
 in this  way enters into a  pig  or rabbit, it
 breaks its shell, and,  boring through the in-
 testinal wall, lodges in the  tissues ; here it
 forms a cyst, where it may attain a  large
 size, and develops an animal consisting only
 of a  head and  neck.   Thus it  will be seen
 that the eggs of a tape-worm in  man will not
 produce a tape-worm in another animal, but
 a body known as a cysticercus, or an anmial
 in an intermediate stage ; now  when a cysti-
 cercus is swallowed by man, the  fully devel-
 oped taenia or tape-worm will be produced.
 The two stages cannot take place in the same
 animal.  There are a great many tape-worms
 of different kinds, and many animals, as the
 dog, cat, and rabbit, are liable  to them as
 well as man.  We  may chance to swallow the
 ova of the  tape-worm  in the  dog by eating
 water-cresses, or drinking water in which the
 embryo has happened to be ; and if  this be
 done, we shall not suffer from tape-worm, but 
ENTROPION
EPILEPSY
143
from  the intermediate variety,  and  thus  a
cyst may form in some organ, and grow so as
to cause some inconvenience, and even danger
to life. These cysts are often called hydatids,
and the liver is the most  common seat ;  they
rarely heal of themselves, but generally form
rounded tumors which cause very little  pain
or disturbance ;  they generally contain fluid,
and attached to the inner wall of the cyst are
those curious  bodies known as cysticerci, or
the worm in the intermediate stage.  These
cysticerci, when removed from  a cyst alive,
may be swallowed by man with impunity, but
if given to a dog again, they will develop in
its intestine into a mature worm. Tape-worm
in man is not caused by swallowing  the ova,
but by eating meat in which the cysticerci are
lying.   Pigs and rabbits  provide us  with the
 Tenia Solium,  while  oxen may give us the
 Tenia  mediocanellata.  When   the   mature
worm  is  developed in  us, the ova which
escape may in their turn supply these animals
with fresh material for  forming  cysticerci.
Hence  it is an  important thing to  burn all
portions of worms that are voided.  There are
some other  unimportant  varieties ;  the first
two are the only common ones in  this coun-
try ; the  development of  hydatids  is  very
rare.   Tape-worm  itself  is  attended  with
much inconvenience,  but very little  danger.
  3. There are a few accidental parasites, as
the larva' of the gad-fly,  and a few less well
known.   These resemble  the entozoa  in
dwelling within  the body, but  they  have no
anatomical relation to those  nematoid and
cestoid  worms which  form the class known
under the name of  Entozoa.   For treatment
of all these varieties, see  Parasites.
  ENTROPION.   (See  Eye.)
  ENURESIS, a technical term for incon-
tinence  of urine.   (See  Incontinence of
Urine.)
  EPHEMERA.   (See  Milk Fever.)
  EPIDEMIC  diseases  are such as  are uni-
versally prevalent in a district or country at
the same time,  and which, having  endured
for a  period, at last  disappear  or die  out.
Influenza and cholera  are instances  of epdi-
demic diseases.
   EPIDERMIS is the  name given to the
epithelial covering  of  the skin ;  the  number
of layers of epithelial cells or scales varies in
different parts of the body, being thinnest on
the inside of the arms and legs and on the
fingers and toes, while it is  very  thick on the
external surfaces of the  body,  on the palm
and heel,  etc.   When a blister is applied, it
is the epdidermis or scarf-skin which is raised
above the true skin, and separated from it by
the effused fluid ; so also after an attack of
scarlet fever, or some other febrile  disorders,
it is the epidermis  which is shed in  various-
sized patches.
  EPIGLOTTIS,   a  valve-like membrane
which fits accurately over the glottis or upper
part of the air-passages, so as to prevent any
food going down that way.
  EPILEPSY is a diseased condition, the
exact cause of which is undetermined, but of
which the main features are sudden and total
loss of consciousness, and convulsions lasting
a longer or  shorter period.   These  attacks
have a tendency to recur and ultimately affect
the  mental  powers.  Frequently these fits
are preceded by  a kind  of warning  (see
Aura) ; and if this can be stopped, the attack
may be arrested.  The attack begins with a
sudden  pallor of the countenance and a fixed
expression  of  face.  Sometimes there is  a
shriek, and the indiviudal falls to the ground
violently  convulsed (hence the name falling
sickness).   There is usually  foaming at the
mouth ; the  tongue is thrust forward,  and
sometimes  fearfully lacerated by the teeth.
The eyes are often fixed, sometimes rolling
and quite insensible.   The countenance is
diffused, sometimes purple, and the breathing
is frequently suspended  for a  time.  The
bowels and bladder may discharge their con-
tents.  The  convulsions may  affect  any or
all  parts  of the body ; usually one  side is
worst.  Gradually they pass off, and the pa-
tient remains quiet and apparently sensible ;
this may pass into  sound sleep, from which
he may recover knowing nothing of what has
passed,  except from the pain from straining
his muscles and  the pain from his lacerated
tongue.  Generally, too,  there is headache.
The fit may last from a  few minutes to  half
an hour, and may  recur sometimes once or
twice in one day,  often  not for  very long
intervals.   There is always some risk to the
epileptic from being seized in a situation of
danger.  They  may  fall  on the face  and
bruise themselves,  or they  may  fall in the
water and  drown themselves in a pool a few
inches deep.  Such are  the  characters of a
severe and well marked fit of  what the French
call the grand mat.   The petit mat may only
mean a slight  momentary unconsciousness,
instantaneously7 recovered from, or there may
be a faint  for a few seconds  without any fall
or dizziness ; or there maybe some twitching
of the face or one limb, followed by an absent
feeling for a few minutes or  moments.  The
appearance  of confirmed  epileptics  is strik-
ing ; they have  a stolid, immobile look, are
usually  very stupid ;  and  very likely also
their  moral  faculties are obtuse.   Epileptic
maniacs are an extremely  dangerous  set.
Often, in them, a fit of violence will  take the
place of a true  epileptic paroxysm, and they
are always  dangerous before  and after the
onset of a paroxysm ; it is at these times the
homicidal impulse  is greatest.   Epilepsy is
often hereditary, but it may be induced by a
variety of causes.   Epileptiform convulsions
are not, however, to be confounded with true
epilepsy.  Such  often occur  as the result of
over-mental  strain, indigestion,  etc.,  but 
144
EPIPHORA
EPISTAXIS
when  the cause is removed  they  have no
tendency to recur ;  not so with epilepsy.
  Treatment.—The  treatment  of  epilepsy
resolves itself practically into what is  best
done in the intervals of the  fits.  During the
paroxysm, the patient should be let alone,
care being taken that he  does  not hurt him-
self.  The great remedy  for epilepsy at  the
present day  is bromide of potassium in  full
doses.  To begin, the patient  ought to have
at least 10 or 15 grains,  three times a day,
going up to 30, 40, or even 60 for  a dose, if
necessary.  This does  good in a great ma-
jority of cases, but in  some it does  not.  In
these strycnhine or nux vomica is sometimes
given with advantage, but  it must  be used
cautiously, and ought never to be given with-
out a physician's prescription.   At  the same
time every effort must be made to  improve
the general health.
  EPIPHORA means an overflow  of tears.
(See Eye.)
  EPBPHYTA are vegetable parasites met
with on the  skin or external surface of the
human  body.  There are several  varieties,
and they form in many cases a very trouble-
some form of skin affection.  They  are con-
tagious,  because the. spores  may  be taken
from one  body to another by contact, and
they are most frequently met with in  children.
  I. Pityriasis versicolor,  or chloasma, is due
to a parasitic fungus ; the  disease  is a very
common one, and often seen on the  chests of
poor people, especially  of those who wear
flannel next to the skin, and who are not very
clean.    It occurs  in  fawn-colored  or buff-
colored patches,  so that  the  surface of  the
skin is mottled with these discolorations.   If
a  few of the epithelial cells  so affected be
scraped off, soaked in a solution of potash or
soda, and  placed under  the  microscope, a
number of small round globules are  seen ad-
hering to  the  scales, and  besides  may be
found  filaments  formed  by the long cells
being placed  end to end.  A solution of sul-
phurous acid or hyposulphite of soda, applied
to the skin after it has been  well washed, will
often cure this disease ; acetic acid or strong
vinegar and  iodine paint are effectual,  but
they are more painful applications.  Liver-
spots is a  name sometimes  applied to  this
affection,  while Microsporon furfur  is  the
technical name given to the  parasite.
  2. Tinea tonsurans is the name given to the
common affection known as ringworm.  It oc-
curs in circular patches on the scalp or back of
the neck, or on the arms,  but it may  be found
anywhere on the  skin.   Commencing as a
small red patch, it spreads in a circular man-
ner,  so  that while the centre may be healed,
there is an outer ring of  a red tint,  and cov-
ered with a little scurf ;  this scurf  is due to
the scales of epithelium which are being shed ;
when these scales are examined, as mentioned
above, the spores of the fungus may be seen.
Trycophyton tonsurans  is the technical name
for the fungus.   Although  very catching, it
may readily be healed by painting the surface
affected with a solution of sulphurous acid or
vinegar, iodine paint, or solutions of corrosive
sublimate ; the first-named is the best, as it is
harmless and causes no pain, while fatal re-
sults  have occurred  from the incautious use
of the latter.   Ink is a domestic remedy, and
it  may  do good sometimes from containing
iron and tannin, but it is a dirty application.
  3. Favus  is  a  troublesome disease  of
the scalp,  which  now and  then occurs in
children.   It  is   due  to  the  presence  of a
parasitic fungus, Achorion schonleinii, which
attacks  the  hair-follicles and  the   bulbs c f
the  hair   itself;  hence  the  hair  becomes
brittle  and  breaks  off  short.   Scales are
formed  in  abundance, and  these constitute
yellow  crusts,  whose  surface  is  concave ;
they are generally circular in shape, and have
a disagreeable mousy odor.  The only cure is
to shave the  head as close  as possible,  and
pull out the  hairs at the spot affected, then
apply a solution of corrosive sublimate ; this
must  be done  constantly, and  whenever a
fresh  crop appears, but with every care it is
very difficult  to eradicate.
  4. Microsporon mentagraphytes is a parasitic
fungus  met  with  in the hair-follicles in the
disease  known as sycosis or mentagra.   It
occurs in man,  and affects the mustachios
chiefly,  or the hair  close around;  the hairs
become brittle and  break off,  while at the
roots  are little pustules, which break and dis-
charge  matter.   The hair should, be pulled
out, and treated in a similar way to cases of
favus.
  5. Microsporon Audouini is another fungus
affecting the  scalp in cases of Tinea decaloxus.
This disease  may be known by bald, circular
patches occurring on  the  head.  While the
centre is devoid  of hair, the disease spreads
at the circumference, and here  short broken
hairs  may  be seen.   It may be cured by the
free application  of acetic acid or sulphurous
acid.    Every bald  patch is not due to this
parasite ; it is only when the broken-off hairs
are found that this is the case.
  The spores or sporules  in each of  these
diseases are  almost indistinguishable  from
one another ; they are all contagious, because
the fungi  may  be pretty readily  conveyed
from  one to another.   The remedies act by
killing the parasites,  hence the name parasiti-
cides has been given to them.
  EPISPASTICS,  that is to say, things that
draw, is the term commonly applied to blister-
ing agents,  of  which  the chief are Spanish
flies—Cantharides (which see,/.
   EPISTAXIS  signifies  a  bleeding  from
the nose.  The  blood supply of the nose is
important.   The  arterial supply is derived
from  the ethmoidal, spheno-palatine, posterior
palatine, and facial, and, as a rule,  the veins 
EPITHELIUM
ERGOT
145
accompany these arteries ; but some of them,
the emissary, have no analogy with the above-
mentioned arteries, and establish  an intricate
communication between the nostrils and the
cranial  veins—a circumstance of some im-
portance, as accounting for the bleeding from
the nose in cases of  obstinate cephalalgia or
headache,  and for the " efficacy of derivative
abstractions of blood from  the nostrils under
such circumstances."  The causes of  epis-
taxis are idiopathic or traumatic, spontaneous
or accidental.   Accidental or traumatic is the
result of a blow, or by any unusual exertion,
sneezing,  or  violent blowing  of the nose.
Spontaneous  or idiopathic epistaxis has as its
causes several different circumstances :  thus,
capillary haemorrhage dependent on active or
passive congestion, renal and hepatic disease,
ulceration, or the presence of polyp.  (See
Polypus.)  In  young persons  of  nervous
temperament, such  symptoms as flushing of
the face,  buzzing in  the  ears,  and severe
headache, are generally relieved  by bleeding
from the nose.  Spontaneous bleeding may
also occur in vicarious menstruation,  scurvy,
fever, or in the hremorrhagic diathesis.  (See
Hemorrhage.)   Epistaxis  is frequently a
concomitant of declining  and advanced life,
in which instance it is usually venous.
   Treatment.—Simple forms of hemorrhage
from  the nose, whether accidental or spon-
taneous, can  be readily arrested.  Cold ap-
plications to the nose and forehead, or snuff-
ing cold water up the nose, a cold  key slipped
clown  the back,  or   cold  water  dashed to
the nape of the neck, or the elevation of the
arms as high  as possible  above the head, are
all of great practical  use.  In some instances
the bleeding  may be stopped by pressing
upon the nostrils with the thumb and finger
for some short space of  time.  The  head
should be maintained in the erect position, as
it is naturally.  If  these  simple methods
prove  unavailing, a  stream of  cold water,
containing a little perchloride of iron, tannin,
or alum, directed through the nostrils, will
stop the bleeding. The ultimate resort is the
plugging of the nares ; but this must be done
by a physician, with  an instrument made for
the purpose.   The plugs should  not be kept
 in for more than forty-eight hours or so, as
the confined  discharges become  very offen-
sive,  and indeed dangerous.  On  removal,
the cavities  should  be thoroughly cleansed
with warm-water douches.   By  the  prompt
 plugging  of  the  nostrils, in severe  hemor-
rhage, manv  lives have been saved.
   EPITHELIUM  is a delicate  cell mem-
brane, which  invests  the internal and external
surfaces of the body, and which is found lin-
ing  the  various cavities.   Over  the  skin,
where there are several superimposed layers,
it is known  as epidermis ;  but  it is much
thinner over the mouth, nose, lips, and  fau-
ces ; it is very thin  all the way down the ali-
mentary canal,  which  it  lines throughout.
The ureter, bladder, and urethra, the perito-
neum, or  lining membrane of  the abdomen,
the pleura, or lining membrane of the thorax,
and the ventricles of the brain, all have a thin
coating of epithelium.  It is found in arteries
and veins, and forms a large portion of the
liver  and  kidney ; it occurs  in the heart and
lungs, and in the various follicles and glands
of the skin and mucous membranes.  It not
only  serves  as a layer  to preserve delicate
vessels  and nerves from  injury, but it  takes
an  active  part in the functions of secretion
and excretion.
  EPSOM SALTS,  or  Sulphate  of  Mag-
nesia, are one of our most useful  and most
simple remedies.   These  salts are  now com-
monly got by acting  on dolomite  limestone
by sulphuric acid.  Formerly they were  got
from  wells or sea-water.    They occur as fine
needles, which  are  almost  identical   with
those of sulphate of zinc—a somewhat danger-
ous resemblance.  In ordinary doses Epsom
salts  act  as a saline purgative, giving rise to
a speedy  and free watery evacuation of the
bowels.    Two  drachms  or  half  an ounce
would commonly be required.  As, however,
constipation for a time sometimes follows its
use this way, it is perhaps better to give the
salt in smaller doses, daily repeated for a time.
The  addition of a few  drops of dilute  sul-
phuric  acid renders the salt more  palatable.
In  this way it is best given  in the morning,
and is  an exceedingly valuable remedy for
those whose livers are  habitually what is
called torpid—that is, where  there is a ten-
dency to biliousness, with irregular bowels and
high-colored urine,  such  as occurs  in  men
who habitually live too highly.
  EPULIS.  (See Gums,  Diseases of.)
  ERGOT  is the product of a peculiar fun-
gus which attacks the grains of rye, especially
in bad years, and gives rise to a black-look-
ing protuberance from the ear of rye. Hence
the  name it commonly  gets,  viz.,  speared
rye.  It  contains a  quantity of oil,  and a
principle  called  ergotine.   Its best prepara-
tion is the liquid extract, but it  may also be
used as  an  infusion,  if  freshly  prepared.
Ergot exercises its powers, whether directly
or indirectly, mainly on  unstriped muscular
fibre.   Hence it  acts specially  on  the mi-
nuter blood-vessels, and still more markedly
on the womb, especially  during pregnancy
and at the period of childbirth.  Its main use,
indeed, in medicine is to stimulate the womb
and  cause it to  contract during  delivery.
But it must  always be used with care,  for if
given in unsuitable  cases  it may prove fatal
to both mother and child.   Of the  powder of
ergot 20 or 30 grains are given after infusing
in water for 20 minutes, grounds and all ; of
the  liquid  extract the corresponding  dose
would be about  30 drops.   This having been
given to a woman in childbed—and the case 
146          ERUCTATION
ERYSIPELAS
being in every way  suitable—in  no long time
contractions of the womb,  previously sus-
pended from whatever cause, begin ; having
begun,  they continue almost without  inter-
mission until the child is born.  These con-
tinuous and powerful contractions constitute,
indeed, the great danger of ergot, for thereby
the child maybe destroyed, and  if the way be
not clear for its expulsion  the mother also
may be injured.  Ergot is frequently of great
value in  flooding after  labor,  especially if
this arises from imperfect contraction of  the
womb and the retention of blood-clots.  From
its effects in the smaller arteries,  ergot, if
long taken, may prove dangerous.  It causes
such contraction of their calibre that blood is
prevented from reaching the extremities in
sufficient quantity to keep them  alive, and so
a kind of mortification,  such as sometimes
occurs  in  old  men,  follows.   This  only
occurs from eating rye bread  made of  badly
prepared grain,   containing   consequently
much ergot.
  ERUCTATION is a term applied to  the
rising of gases  into the mouth from the stom-
ach ;  it is often a sign of indigestion.
  ERYNGO,the Sea Holly (Eryngium mar-
itimum).  It grows abundantly on  almost
every sea-coasf.  A decoction  of  the  root,
when made  of sufficient strength, is said to
act on the kidneys and liver, and is useful in
cases of congestion.   A confection is  made
of slices of the  root steeped  in boiling syrup,
which  is  agreeable and  useful  in  coughs or
hoarseness.
  ERYSIPELAS  of the face is a  disease of
pretty frequent occurrence,  and  although
causing  much  discomfort  to  the  patient, is
not often attended with much danger.   It
seems to affect  persons of a nervous and  ex-
citable temperament, and some seem  much
more liable  to  it than others.   It  is  rarely
seen in children, but it attacks adults of both
sexes, and women are more subject to it than
men.   It comes on without apparent  cause
in many causes, but sometimes a blow or ex-
posure to a cold and cutting wind sets up  the
inflammation.  It usually begins  at the  ear
or one side of the nose, and then the redness
and  swelling extend over  that side of  the
face ; more  rarely it crosses over the  median
line and affects the whole of the upper part
the face.  Pain and tingling precede the in-
flammation, and when the latter has reached
its height, the eyelid is so swollen that it can-
not be  opened ; the  ear is  large, red, and
flabby, while the skin adjacent is swollen,
red,  and  painful.   Erysipelas is, in fact, an
inflammation of  the  skin, and  it  is  severe,
according to the depth to which  this tissue is
implicated.   Sometimes only the upper layer
is affected, and then  the appearance is like
that seen in  erythema.  There  is  but  slight
swelling, and the constitutional symptoms are
not severe ;  but if the whole thickness of  the
skin be attacked, and, in addition, the  loose
cellular tissue beneath,  then  the inflamma-
tion is of graver import, and may spread over
a large area.  There is, from the first, a high
temperature, quick pulse, thirst, often a sore
throat, loss of appetite, and a thickly coated
tongue.  The patient feels very  restless, and
sleeps badly at. night ; in many cases delirium
comes on toward  evening, and this is mostly
observed in those  previously addicted to  in-
temperate habits.   The bowels are often con-
stipated, and the urine high-colored and con-
taining a little albumen.  The mucous mem-
brane of the throat is of a dusky purple color,
and swollen in some cases, and when erysip-
elas attacks this  part  alsb, it adds to the
danger of the patient by preventing swallow-
ing, and even by  causing suffocation.  Ery-
sipelas of the face, without any other compli-
cation, usually_runs a course of  six or seven
days, when  the  temperature  rapidly  runs
down, the tongue begins to clean, and all the
febrile symptoms  disappear, leaving the pa-
tient weak and anaemic. But, if the inflamma-
tion has affected the deeper layers of the skin,
or if the patient has been previously in bad
health, matter or pus may form beneath the
scalp from extension  of  the disease upward ;
when this occurs, the pus soon burrows about
under  the scalp, and  therefore,  when  this
takes place, an opening  must be  made to let
the matter  out  at once.  The formation of
pus may be known by the temperature keep-
ing high,  and by  the patient  having rigors,
accompanied at  the same time by a doughy,
soft swelling on the  scalp above  where the
matter has formed. Large blisters often  form
over the inflamed skin  of the face, and  very
frequently the hair comes  off in large quan-
tities during convalescence, and  especially
where there has been any inflammation of the
scalp.
  Treatment.—The patient must be kept in
bed, and fed on a light and nourishing diet, in
the same way as is described under the  gen-
eral treatment of  fevers (see Fevers).  The
light should be kept off the patient's eyes,
either by placing the person with  the back to
the window or by having curtains round the
bed.  The greatest relief is obtained by pre-
venting the access of  air  to  the  inflamed
skin, and for this purpose flour is commonly
dusted over the surface ; a much better plan
is  to brush or  smear the part gently with a
mixture of equal parts of castor oil and collo-
dion, or  castor  oil alone may be  used.  It
effectually keeps off the air and relieves the
tightly stretched skin.   Some  opening medi-
cine may be given at first, if the bowels are
confined and the tongue much coated.  As a
rule, the disease will  get  well  with careful
nursing in  a  few days ; but if the throat be
much affected, the case must be watched and
means taken to  subdue the swelling.  Stim-
ulants are not wanted, except  where there is 
        ERYSIPELAS  (SURGICAL)

 much prostration and delirium, and in those
 cases where matter has  formed  under the
 scalp.   During convalescence,  tonics, con-
 taining iron and quinine,  may be  given, and
 for some time any exposure to cold winds,
 etc., should be avoided  ; great moderation in
 the use of  intoxicating liquors should also be
 exercised.
  ERYSIPELAS (SURGICAL).—In the
 great majority of cases  of erysipelas,  and
 especially of the more severe forms, the  dis-
 ease has its starting point in a wound, open
 sore, or large ulcer  on  the  surface of the
 body.   Given a recent contused or lacerated
 wound on the scalp or the skin of  the leg in
 a badly nourished  and debilitated  individual
 living under faulty hygienic conditions, ery-
 sipelas will most probably show itself in  one
 of the two following forms :  simple or cutane-
 ous erysipelas, resembling in all respects the
 affection which frequently attacks  the face in
 the absence of  any wound or local irritation,
 and the characters and  treatment of  which
 have been described.  In  some cases of con-
 tused wound of the scalp, the redness, swell-
 ing, and blistering of the  skin  of the face are
 associated  with much  pain  and  tenderness
 over  the   whole  of the  head,  and a  hard
 brawny condition of the scalp.   The patient,
 after an attack of intense  shivering, becomes
 very  hot and feverish, and often  loses his
 senses and raves violently.  The tongue be-
 comes brown, and the pulse very  rapid.   In
 the course of thirty-six or forty-eight hours,
 the  condition  of  the  scalp  undergoes  a
 change ; it is no longer hard  and tense, but
 now very puffy and raised from the surface
 of the  skull by a collection of fluid, which
 subsequently,  if not let out by the surgeon,
 breaks through at  one  or more points,  and
 shows  itself as thick yellow pus or matter.
 Along with the profuse discharge from these
 openings there is a throwing off of foul shreds
 of a white  or  yellowish-white  color, formed
 by the death of the soft  and tendinous struc-
 tures between the skin and the surface of the
 bone.   Occasionally considerable portions of
 the skin are destroyed, and bone is very often
 laid bare.   If  the patient  should survive the
 acute stage of  this dangerous  affection, the
 erysipelatous redness and  swelling  disappear,
 the  fever  and  delirium  subside, and  the
 sloughing wounds on the head are replaced
 by ruddy ulcers,  which heal  rapidly as  the
 general health  improves.    In many cases,
 however, death occurs from  one or more of
 the following  causes : the  intense  general
 action  of the  erysipelatous  affection which
 seems  to poison the  whole mass  of blood  ;
 pain and  cerebral  excitement ;  a  general
 affection resembling typhoid fever, which is
 associated with formation of abscesses in the
 liver, lungs, and some of the joints ; purging
and hectic  fever ; exposure  and death of a
portion  of  skull, and formation of abscess
         ERYSIPELAS (SURGICAL)   147

j between the inner surface of skull and the
 upper surface of brain.  This, which is called
 the phlegmonous  form of  erysipelas, may
 occur after an external injury at any part of
| the surface of  the body or limbs.  It is often
j seen after  severe  contused  wounds or com-
 pound fractures  of  the lower  extremities.
[ There  is yet  another  variety of erysipelas,
! called diffuse  cellular  inflammation,  which
 may present itself in  connection with local
 irritation or an open and discharging surface,
 but which is generally due to the introduction
 into the system of some animal  poison, as in
 dissection-wounds, the bite of a horse, or in
 snake-bites.  Here there is much  swelling
 and hardness of the affected part, intense pain,
 and  rapid  sloughing,  with  formation of
 spreading abscesses.   The skin, however, is
 not primarily affected, but the cellular tissue
 beneath, large portions of which are destroyed
 and become gangrenous.   This  disease  is
 generally  diffused over a wide surface, and
 spreads rapidly.  It does not in all cases ap-
 pear in the neighborhood  of the  wound or
 sore ; but is separated from it by a tolerably
 wide  extent of  perfectly sound skin,  The
 constitutional  symptoms are very severe, and
 death generally takes place on the seventh or
 eighth day, and  sometimes earlier.   The
 essential cause of erysipelas, though  as  yet
 not well determined,  seems  to be  a poison
 engendered from putrid animal matter.  The
 predisposing causes arc to  be sought for in
 the affected individual, and  in the condition
 as to ventilation,  living, and the like, under
 which he is placed.  The general state of dis-
 order produced by habitual intemperance and
 irregular living,  disease of the liver  and kid-
 neys,  indigestion,  exhaustion from fever and
 from  profuse  discharges,  render  patients
 with wounds liable to an attack  of erysipelas.
 Exposure to cold, fatigue, and indiscretion in
 diet are also predisposing causes.  There are
 some individuals who seem to have a peculiar
 constitutional  predisposition to the disease.
 It has been asserted  that women  are more
 liable to contract it than men. Of all the pre-
 disposing causes of erysipelas, deficient ven-
 tilation is probably the  chief.
   Treatment.—In the treatment of wounded
 individuals, great  care should be taken  re-
 move all sources of foul and unwholesome
 exhalations, and to keep up a constantly re-
 newed supply  of fresh  air.   Unremitting at-
 tention should also be paid to the cleanliness
 of the patient and everything about him.  The
 bed-linen ought to be  frequently changed,
 and not be  allowed to remain when soiled by
 discharge.   The motions should be at once
 removed,  and  a solution  of carbolic acid,
 chloride of  lime, or some other  antiseptic be
 poured into the bed-pan. The wound or raw
 surface should not be  wiped with a sponge,
 but with tow  or  cotton-wool,  which must
 immediately be  thrown away or destroyed. 
 148            ERYTHEMA

 The patient's bedroom should be emptied of
 all but indispensable articles of  furniture,
 and bed-curtains be at once  removed.   The
 treatment of phlegmonous  eryispelas  and
 diffuse  cellular  inflammation  consists in  sup-
 porting the  strength  of  the  patient by alco-
 holic stimulants  and  by  tonics, the most
 effectual of which are quinine and the tincture
 of  perchloride of iron.   In no other disease
 is brandy or wine more  needed than in  ery-
 sipelas.  The bowels should be freely relieved
 from time to time.  Bleeding and the  appli-
 cation of leeches are now but rarely resorted
 to, and then only in cases of  threatening in-
 flammation of the brain in strong and  full-
 blooded patients.  Ammonia is  a valuable
 medicinal agent in bad cases of diffuse cellu-
 lar inflammation from snake-bites and animal
 poisoning.   In the local treatment of  the
 severe  forms of erysipelas   various  agents
 have been  used.   Of these  perchloride of
 iron, sulphate of iron, tincture of  iodine,  and
 nitrate of silver, or lunar caustic, have proved
 the most  useful.  When the swelling is  soft
 and boggy, incisions must be made in  order
 t,o  let out the purulent  fluid  and shreds of
 gangrenous subcutaneous tissue.   In the ab-
 sence of  medical aid  the simplest and  best
 local treatment  would  be  the  application
 around  the inflamed parts of flannels dipped
 into boiling water,  and then well wrung, or
 of  linseed-meal  poultices,  to  which  when
 there is a profuse and ill-smelling discharge
 of  pus, charcoal, carbolic  acid powder, or
 chloralum should be added.
  ERYTHEMA is the name given  to an
 eruption of  the skin which is attended by a
 diffuse redness over a larger or smaller tract
of skin.   When the finger is pressed upon an
affected  portion, it  becomes  pale  for  a
moment,  paler  as the blood  is pressed from
the vessels, but  the redness  almost  directly
returns.   This  disease is something like 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.  This  disease, unlike erysip-
elas, is not confined to the face and head  par-
ticularly ; it is  not attended with  inflamma-
tion 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 erythema-
tous ; the face and  neck may become in  this
condition from walking out in a cold north  east
wind ; the friction  of  clothes will  also do it,
and it may be produced by colored articles of
wearing apparel, from which the dye comes off
and irritates the skin.  These  simple cases
may be treated  by resting the affected part,
keeping it covered up from the air, and bath-
ing it with tepid water several times a day.
Another kind which is more  important, but
still very curable, has  been styled " erythema
nodosum."  It is generally seen in children,
                   ETHER

  and is found on the shins and arms ;lhc ex-
  tremities are affected more readily than the
  body.  Dirty purplish patches are to be seen
  in  front  of  the shins, and these  are raised
  above the surface, and are painful on pres-
  sure ; they  are worse after walking about.
  This state is due to blood and serum  being
  effused under the skin, and it is thus differ-
  ent from  the other variety.  The child is gen-
  erally pale  and in  bad  health at the time.
  Rest in bed is  a good thing, and let the pa-
  tient be fed  well with plenty of  nourishing
  diet,  viz., milk, meat,  or strong beef-tea or
  broth.  With the aid of a little medicine of a
  tonic 'character,  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 then
  come out in a few days, nearly always on the
  legs,  and they are  generally situated along
  the length of the limb or  in  a vertical direc-
  tion.   The  patches are  oval, and may be
  several  inches in length ; they  generally as-
  sume a more or less rounded appearance.
  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.
   ESCHAROTICS  are   such   powerful
[  chemical  substances as when applied to the
|  surface  of the body destroy the vitality of a
I  portion of it, this subsequently coming away
  as a slough  or eschar.  The most important
  escharotics are the  red-hot  iron, the strong
  mineral acids and  alkalies, chloride of zinc,
  and  the strongest acetic acid ; acting in a
  milder degree they arc called caustics. Their
  chief use is to remove unhealthy growths, or
  such  as by their own malignancy  would de-
  stroy life, and  so  to obtain a clean  surface
  after the  slough has  separated, whereby
  wholesome  growth is promoted.   They are
  also used to completely destroy a part  that
  has been bitten by a mad  dog or such animal,
  to prevent infection from putrid  sores  and
  the like.
   ESSENCES in  the  Pharmacopoeia are
  preparations in which the volatile oil extract-
  ed from the plant by distillation is dissolved
  in spirit.  The only two essences of this kind
  are essence of  aniseseed  and essence of  pep-
  permint.  Essence of aimonds is a totally dif-
  erent kind of preparation.   The term is fre-
  quently employed for a more or less  concen-
  trated preparation  of the  substance whose
  name is attached to  the title.
   ETHER, more strictly sulphuric ether, is
  a liquid obtained from alcohol by  abstracting
  water from the latter.  It is a volatile color-
  less liquid, with a peculiar smell and pungent 
ETHER SPRAY
EXERCISE
149
 taste.   It is very inflammable, and so vola-
 tile as to produce  a sensation of cold if ap-
 plied to the hand.  It is most frequently given
 internally,  mixed  with  spirit.   When so
 taken, or by itself, it is a powerful stimulant,
 acting more  rapidly and passing away more
 speedily than alcohol. Hence it is useful to dis-
 pel wind from the stomach, to relieve asthma,
 spasms,  and pains about the heart.   It  may
 be used locally, so as to freeze the part and
 so give rise to complete loss of  sensation.
 This  is sometimes  taken  advantage  of in
 surgery ; and as it  also produces insensibil-
 ity when inhaled into the lungs, it  is occa-
 sionally used as an  anaesthetic.   It is gener-
 ally considered safer than chloroform, but is
 less manageable, takes longer  time, and is
 more bulky.  Given internally the  dose of
 ether should not exceed half a drachm.
   ETHER SPRAY.—Of late  years an in-
 genious method of producing  " local  anaes-
 thesia" by freezing, has been introduced  with
 a view of rendering painless certain  minor
 and superficial operations  in surgery, such
 as removing small cysts, opening abscesses,
 extracting  teeth,  toe and  finger  nails,  etc.
 The apparatus is precisely  similar to  that
 adopted by the chemists for dispersing  per-
 fumes, thus  one  tube  dips  perpendicularly
 into a bottle of ether ; another tube  is^so
 arranged that a current of air blown  through
 it  shall  cross the orifice of the first.   This
 creates an upward-suction current in the  first
 tube sufficient to lift the ether,  and  blows it
 away in the form  of  a fine  mist or spray.
 There are various  mechanical appliances for
 providing the air-current, such as  working a
 hollow india-rubber ball or foot  bellows, but
 the apparatus is sold complete by any instru-
 ment maker.
  EUSTACHIAN TUBE.  (See Ear.)
  EVAPORATION is the slow production of
 vapor at the surface of a liquid.  It is through
 evaporation from the earth's surface that wet
 clothes dry when exposed to the air, and  that
 open  vessels containing water become emp-
 tied.  Aqueous vapor  rises  in  the atmos-
 phere from the evaporation constantly going
 on from seas, lakes, rivers, and the moist soil.
 These vapors condense in the upper regions
 and form clouds, and finally return to the earth
 as rain, snow,  or  sleet.   Evaporation is
 much increased by raising the temperature,
 which acts by increasing the  elastic  tension
 of the vapor ; its rate is also  affected by the
 quantity of the same vapor in the surround-
 ing atmosphere ; no evaporation  could  take
 place at all in a space already saturated with
 vapor of the same liquid, while it would take
 place  very  rapidly in   air  free  from  those
vapors.  Hence on a damp day evaporation
takes place  very slowly, while on  a fine dry
day it occurs readily.   It  is evident,  also,
that a breeze, by renewing  the  air,  will in-
crease evaporation, for if the air which sur-
 rounds the liquid  be not renewed it would
 soon  become  saturated  and  evaporation
 cease ; the more frequently the air is renewed,
 the more evaporation goes  on.   The extent
 of surface exposed makes an important dif-
 ference in the rate of evaporation  ; the greater
 the surface the more rapidly  this process goes
 on.   It is  obvious that a great deal more
 evaporation goes on in summer than winter.
 It is possible for 15,000 gallons of water to
 be evaporated in twenty-four hours from the
 surface of a lake equal in extent to an acre,
 on a hot summer's  day during a breeze ; in
 winter, during  the same  time and  from  a
 corresponding area between three and four
 thousand  gallons would pass into vapor.
  EVOLUTION is a term variously applied
 to different changes  going on in  the body.
 The enlarged uterus  in a case of pregnancy
 is said to be  evolved  from its simple  ele-
 ments,  and an  embryo  is also  said  to  pass
 through different stages of  evolution on its
 way from the cell-elements  of which it is at
 first composed to the complex structures met
 with in the infant.  The term is also used by
 biologists to signify the development of  man
 at different periods of the world's history.
  EXANTHEMATA, a name  applied to
 several febrile and contagious disorders which
 are  accompanied  by  a   rash or  eruption
 on  the skin ;  the  group  includes measles,
 scarlet  fever,   small-pox, chicken-pox,  and
 erysipelas ; some also include under this head
 typhus and typhoid fevers, but these are gene-
 rally spoken of as continued  fevers.
  EXCISION  means the removal by opera-
 tion of a  part of the body ; in surgery the
 term does not, however, include  amputation.
 The great advancement made in  modern sur-
 gery has  in  many  instances substituted an
 intermediate excision or  resection in  lieu of
 amputation :  thus,  the   knee joint, elbow
 joint, hip joint, etc., being the seat of scrofu-
 lous disease (white swelling), is excised instead
 of amputating  the  limb,  whereby  in many
 instances a useful member is  preserved.   The
 term  is  also applied to  tumors or morbid
 growths requiring removal, or to any part in
 which such a growth exists, such as the upper
 or lower jaws, eyeball,  tongue, etc.  The re-
 marks made in the article on incision are of
 course mechanically  applicable to excision,
 the instruments for  such  proceedings being
 knives, saws, cutting forceps, scissors, chis-
 els, gouges, elevators, etc.   (See Incision.)
  EXCRETIONS.—Whatever is no longer
 serviceable to the system is an excretion, and
 is thrown off  by one  or other of the organs
 of the body.   Secretions are the  healthy
juices of the body, which enter into its com-
position, while excretions  are the waste and
useless parts which pass away either by the
bowels, or bladder,  or perspiration.
  EXERCISE as  a remedial agent  is  too
frequently disregarded  so  far as preventing 
150   EXFOLIATION  OF  BONE

is  concerned.  Its degree and kind  is  too
often left to the patient himself.  The vari-
ous kinds of exercise used to  be classified as
sailing.carriage, horseback, and foot, but prac-
tically may be  limited to the last three.   But
these do not include the exercise of  all  the
muscles.  To do  that  gymnastics  must be
employed.   (See  Gymnastics.)  The grand
rule  in  prescribing  exercise  is  this :  the
patient should never  feel actually  tired  or
fatigued, but rest should be grateful after it.
Exercise carried to an extent  so as  to  induce
much fatigue is worse than useless.
  EXFOLIATION  OF BONE.—When a
superficial  layer .of bone  (such  as  from the
shin, for instance) dies and  detaches itself,
after an iniury or disease, and  comes away
as a scale, the bone is said to exfoliate.  It is
frequently  noticed in the jaws after clumsy
tooth-extraction,  or in the  shins after blows
or kicks.  A lotion of weak nitric acid is the
best application, and when  the she'll of bone
is thoroughly loose it should be gently  pulled
away with forceps.
  EXOPHTHALMOS  is a name given to
the condition in which there is  great  promi-
nence of the eyes, so that the individual  has
a marked and peculiar stare.
  EXOSTOSIS,  a tumor connected  with a
bone,  and composed of true bony substance,
which is sometimes very  hard and compact,
and at other times light and porous. In most
instances the unnatural growth is  made  up
entirely of bone, but occasionally is  met with
composed partly of bone and partly of carti-
lage or gristle.  The former is called a true
and the latter a false exostosis. These tumors
usually occur  singly,  but sometimes affect
simultaneously several bones in different parts
of the body.   The  bones most frequently
diseased in this manner are the  arm-bone at
its upper end, the thigh-bone  at its inner  sur-
face and close above the knee, the tibia or
larger bone of  the leg at its inner surface  and
upper extremity,   the  collar-bone,  and  the
bones  of  the  skull.   Exostoses   take  the
forms of flattened discs, large lumps with
broad bases, and oval  tumors mounted on a
short bony stalk or pedicle.   In the first  two
the structure is generally of ivory hardness ;
the  growths of this  character are seated on
 the jaws and the bones of the skull ; the
oval and  stalked  varieties  are  most  fre-
quently  met  with in  the bones of  the ex-
tremities, and  their tissue is  more  open  and
spongy.  The  causes of exostosis  are  very
obscure.  The growths are  sometimes pro-
duced through blows or long-continued pres-
sure.  Some individuals show a remarkable
tendency to the multiple  development of  ex-
ostosis.  In patients  suffering from  advanced
venereal disease,  and in scrofulous  children,
hard painful tumors resembling  exostoses in
form and composition  are  often met  with in
different parts  of the skeleton.   These, how-
               EXT'ACTS

ever, differ from true exostoses in the rapid-
ity  of  their  growth, in  the pain attending
them—very acute in venereal disease, dull and
gnawing in  scrofula—and  in  their submis-
sion to medicinal treatment.  True exostosis
grows  slowly,  and is  amenable  to no treat-
ment  save a surgical  operation  undertaken
for  its  complete removal.  At first it is pain-
less, and often  reaches considerable propor-
tions   before  its  existence  is  discovered.
When  very  large, however,  it  may  be at-
tended with pain in consequence of its pres-
sure on adjacent  nerves.   Exostoses, when
seated  on the bones of the trunk or the skull,
may cause  serious  and  even  fatal conse-
quences through their pressure on important
organs.
  EXPECTORANTS  are  medicines  or
other remedies  which promote the expulsion
of fluids from  the air-passages.  This is the
strict  meaning of the word,  though  some-
times it is used in a wider sense.  The sub-
stances included in  the group  are of a most
diverse character,  some  soothing,  some
stimulating, some acting directly in altering
the  kind of the secretion,  others in altering
its quantity.  It is hardly possible, therefore,
to give any  extended account of the group.
(See Ipecacuanha.)
  EXPECTORATION is the term applied
to the  fluid  or  phlegm which is  coughed up
from the air-passages ; it varies much  in dif-
ferent  diseases  ; in pneumonia it is viscid, te-
nacious, sticks  to the sides  of the vessel, and
of  a rusty  appearance ; in  bronchitis it is
frothy, abundant,  and  often  marked  with
black streaks, or it is thicker, and of a green-
ish-yellow color  from the  presence  of pus  ;
in catarrh, the  phlegm is often coughed up in
pellets, which are black or  iron-gray or  yel-
lowish in color, and generally  most trouble-
some on awaking, as the secretion  has been
accumulating during sleep ; the color  is due
to particles  of  dirt  or smoke in the inhaled
air. In consumption the expectoration varies
from   a  small  quantity of  frothy  fluid to
abundant greenish-yellow purulent phlegm.
  EXTRACTS are forms of remedies in
which  some  fluid preparation, infusion, de-
coction, or tincture has been gradually evap-
orated until a thick  paste  is formed.  Some
substances lose a good deal of their efficacy
in the  process ; others do not.   Remedies so
prepared  are  usually given  in  the form of
pill, the extract serving as the  basis of  the
pill, and having,  perhaps, other remedies in
the form of powder conjoined with it.  A few
extracts are  kept quite dry, and only mois-
tened  as required. This is the case with com-
pound extract of colocynth.  Occasionally an
extract is rubbed up with some other prepar-
ation,  to  add  to  its strength.   In this way
extract of  belladonna  is  not  unfrequently
added to  the liniment or  tincture, or itself
reduced with  glycerine.   There are a  few 
EXTRAVASATION OF URINE
EYE
151
 liquid extracts which are less dense than  the  j
 ordinary ones ;  these are prescribed in min-  i
 ims instead  of  grains—sugar of squill, bal-  j
 sam  of Peru and tolu,  ammonia,  ammoni-  j
 acum, copaiva, tartar  emetic, oxide of anti-
 mony, creasote, etc.   Perhaps  the best and
 most useful of all in most cases  is the  vapor
 of  water  to which other volatile substances
 may or  may not  be  added.  (See Meat,
 Extract of.)
  EXTRAVASATION   OF   URINE—
 By extravasation of the urine is meant itsun-  i
 natural escape from either  the kidney, where
 it is secreted ; the ureter, the duct by which  !
 it passes  to the bladder, its receptacle :  or
 from the urethra, the channel  by which it is
 conveyed from the system.   The  causes of
 extravasation in each case are either the re-
 sult of local injury, or the giving way of any
 one of these structures from special reasons.
 Usually, however,  the  term  " extravasation
 of urine"  is meant to convey the idea  of the
 giving way of the urethra, and the infiltration  |
 of the urine into surrounding tissues ; as the  I
 result of a blow, a kick, or a fall on the peri-  j
 naeurh, thereby rupturing the  tube, or from
 the  pre-existence  of stricture, and  a conse-
 quent preternatural distension of the  blad-
 der.  This case,  then, will  be described  in
 the  first  instance.   When  the urine  is  re-
 tained in  the bladder and cannot escape per
 urethram, from  whatever   cause,  ulcerative
 absorption, as it is termed,  takes place just
 above the point of obstruction, and its  most
 frequent  locality  is  in the membranous
 urethra,  just behind  the  bulbous  portion.
 The  train of symptoms  occurring from the
 escape of the urine is in  general as fol-  j
 lows : The  sense of fulness of  the bladder
 and inability to make  water induce violent
 attempts  at  micturition, a  sudden  yielding
 takes place,  followed by  a  great  sense of
 relief, much to the  patient's pleasure, but to
 his surprise no water flows from the expected
 channel, owing to the giving way of the ure-
 thra, and the escape  of the urine  into the
 tissues. Now, the urine may be extravasated
 in all directions, upward, when it  gets between
 the bladder  and pubes or by the side of the
 prostate, or  downward  into the  scrotum ; it
 does not advance down  the  thighs, owing  to
 the deep  layer of  superficial  perineal fascia
 being bound  to the rami of the pubes, and
 thus  limiting its effusion,  at all  events  at
 first, to  the  scrotal tissues, supposing the
 giving way to have  occurred at a point ante-
 rior to the deep perineal fascia.   The effused
 urine soon excites  great local irritation and
 inflammation, and  most alarming constitu-
 tional symptoms.   The scrotum,  which  is
 rapidly distended, becomes dark-colored and
 quaggy  to  the  touch ; the  constitutional
 symptoms are those attendant on  asthenic
suppuration and gangrene, rapidly becoming
more and more typhoid, and ending in fatal
 collapse if unrelieved.  Cases  of scrotal ex-
 travasation are those in which best hopes are
 to be held out of the patient's recovery ;  al-
 though there are cases on record of intrapel-
 vic extravasation, which have  got well, after
 efficient openings have been made, and plenty
 of  nourishment  and  stimuli  administered.
 But such cases  are hopeless if t the urine be
 extensively insinuated into the pelvic cellular
 tissue.   All relief must be prompt and active
 — a free incision is to be made into the peri-
 naeum, through  the tissues, into the  infil-
 trated structures,  hot fomentations applied,
 and the patient's strength supported by wine
 or  brandy, etc.   It  must be borne in mind
 that the scrotum is not necessarily involved
 in  these cases ;  thus, if  the extravasation
 take place  behind  the  bulb, the urine, being
 temporarily confined by the deep fascia, bur-
 rows,  and thus the local signs  are obscured ;
 in  these  cases  the glans penis is frequently
 found to be hard,  swelled, and black, indicat-
 ing infiltration  into  the corpus  spongiosum
 urethrae, and this is a most alarming symptom,
 and in such instances free  and complete in-
 cisions, such as would lay bare the source of
 extravasation,  must be made at once.  In
 cases  of  extravasation from local  injury to
 the  perinaeum, as  in  kicks or  blows, etc.,
 scrotal distension  is usually very sudden.  A
 full-sized catheter  should be passed into the
 bladder to  allow of the escape of urine.  In
 extravasation from rupture of the kidney, the
 different  symptoms will be in proportion to
 the  severity of the injury.  The symptoms
 of such an  accident are in general collapse,
 vomiting,  pain  in the loins  and along the
 course of the ureter, retraction of the testicle,
 and numbness of the upper part of the thigh.
 Such urine  as would come through a catheter
 introduced  into the bladder will be scanty,
 high-colored, and contain a large quantity of
 blood ; this blood is often stringy and worm-
 like, owing to the  form given it by the  ureter.
 If urine escape anteriorly, acute peritonitis is
 set up  almost immediately ;  if  posteriorly,
 the symptoms of peritonitis, perhaps, will not
 be so early marked ;  but  rigors,  high fever,
 and a general typhoid  condition  soon make
 their appearance.   Slight cases  of  ruptured
 kidney, doubtless, frequently recover ;  severe
 ones, never.
  Treatment.—Absolute   rest is  the  first
 thing,  and the free administration of opium,
 and the urine drawn  from the bladder daily
 until it becomes clear.  In cases where the
 extravasation is posterior, on the possibility
 of suppuration,  careful  examination  should
 be  made  with a view of  giving exit  to the
 pus.    Extravasation  from  rupture  of the
 ureter has been recorded, but the  cases seem
somewhat obscure.
  EYE.—For an explanation of the  structure
of the eye,  see the article  on  Vision.  The
diseases and injuries to which the eye is svbject 
152
EYE
EYE
 may be most conveniently classified thus :  i.
 Injuries and diseases of the  appendages  of
 the eye—i.e., of the eyelids and tear-secreting
 apparatus.   2. Injuries and diseases of tne
 eye itself—i.e., of the  eye-ball and its con-
 tents.
   1. Eyelids.—The  eyelids  are two thin
 movable folds placed in front of the eye, pro-
 tecting it  from  injury.  The upper  is the
 larger, and  has  the most  power of  action,
 being  provided with a special elevating mus-
 cle,  the levator palpebrce, which is absent  in
 the  lower  one.   The angles  of junction  of
 the upper and lower lids are called the can/hi.
 At the margin of each  eyelid  at  the inner
 canthus are seen two small conical elevations,
 the  apices of which are pierced  by a small
 orifice  called the punctum  lachrymale j it  is
 through this orifice that the tears pass into the
 nose.   The eyelids are composed of the fol-
 lowing structures taken in order,  as in mak-
 ing a section from  the surface  : Integument,
 areolar tissue,  fibres  of a  muscle  called
 orbicularis, tarsal  cartilages,  fibrous mem-
 brane, Meibomian  glands, and  conjunctiva ;
 and in the  upper lid is the tendon of the  mus-
 cle before  mentioned, the levator  palpebrae.
 The integument is very thin, and  continuous
 at the  margin of the lids with the mucous
 membrane covering the inner surface of the
 lids.   The  subcutaneous areolar tissue  is very
 loose and delicate.   The tarsal cartilages give
 the shape and support to  the lid.   The  Mei-
 bomian glands, about thirty in number in the
 upper  eyelid, and  somewhat  fewer  in the
 lower,   are situated between  the  afore-men-
 tioned  tarsal cartilages and the conjunctiva,
 and  on everting the lid look like  parallel
 strings of  beads ; they are a  variety of the
 sebaceous glands of  the  skin, and  open by
 ducts upon the free margin  of the lids by a
 number of  small  orifices ;  they  secrete  a
 sebaceous matter,  which  is intended  to pre-
 vent adhesion of the lids.   The eyelashes, or
 cilia, are thick, short, curved hairs, attached
 to the  free margins of the lids ; those of the
 upper lid curving upward,  and those of the
 lower  downward, so that normally there  is
 no interlacement of them.
  Diseases  of  the  Eyelids.—Owing  to  the
 number of structures which  enter into the
 formation of the eyelids, there  is  necessari-
 ly a  great number  of diseases to  which they
 are liable ;  but in a  work like the present,
 we must content  ourselves with  describing
 the most frequent,  or  at all events such as
come most frequently under observation.
  Ptosis.—Ptosis signifies a drooping of the
upper lid, owing to  paralysis of the nerve (the
 third)  which supplies the levator palpebrae
muscle.  The disease is sometimes congeni-
tal, but in such cases it is probable that this
muscle is absent.
  Entropion.—Entropion  signifies  an inver-
 sion of the eyelids, and in  its simplest  form
 is  sometimes  met  with  in  children, who
 suffer from ophthalmia, owing to  spasm  of
 the orbicular muscle.  Collodion, painted on  .
 the skin of the lower lid, contracts  the part
 into its proper position, while suitable reme-
 dies are to be used for  quelling the existing
 ophthalmia.   Occasionally  old  persons are
 afflicted with a spasmodic contraction of the
 orbicular muscle ;  and in some severe forms,
 resulting  from chronic  inflammation of the
 conjunctiva,  the  upper  tarsal  cartilage be-
 comes so contracted upon itself, that the eye-
 lashes are turned inward and sweep the globe,
 setting up the most intolerable irritation.
 The cicatrization  following  burns, acids,
 caustics,  or severe and ill-dressed  wounds
 are the  frequent  causes  of entropion.  In
 such cases, the means of cure lies in opera-
 tive proceedings,  a variety  of which have
 been devised,  and which, of course, must be
 modified to suit the exigencies of the case.
  Ectropion.—Ectropion,  the reverse of the
 foregoing  condition, signifies an eversion of
 the lids.   As was  before mentioned in the
 case of entropion, a spasmodic form exists,
 which is seen  after purulent ophthalmia in
 infants,  and  from the  peculiarly  unsightly
 aspect it presents, causes great alarm in those
 who have the care of the child ; but, as the
 inflammation  subsides,  the  deformity will
 cease.  In adults a chronic form of ectropion
 occurs, as  a result of thickening of the con-
 junctiva after  purulent  ophthalmia,  or after
 burns, exfoliation  of bone, etc., and which
 may be remedied by operation.   By far the
 worst examples we have of ectropion are the
 result  of  burns or scalds, or of the ravages
 of  syphilitic ulceration,  and for the remedy
 of which a variety of operative proceedings,
 forming a branch  of surgery termed "plas-
 tic," is needful.
   Trichiasis.—By trichiasis is  meant an ir-
 regular growth of the eyelashes, such that in
 some instances three or four lashes will grow
 inward against the globe of the eye, setting
 up  a sense of pricking, and a constant irrita-
 tion and weeping of the eye.   These lashes
 should be plucked out from time to time.  It
 must be borne in mind, that considerable
 care, and  no  little dexterity is requisite  in
 plucking out these hairs, for if it be broken
 short off and  not  completely  removed,  the
 broken stump  causes more irritation and pain
 than the hitherto perfect hair.   A good well-
 made pair of forceps, not too fine at the points,
 should be used, and  the hair should not be
jerked or twisted out, but gradually withdrawn
 by  a slow  steady pull.
  Styes.—(See Hordeolum.)
  Ophthalmia  tarsi is an eczematous inflam-
 mation of  the  edge  of the  lids, associated
 with a disordered secretion of the Meibomian
 glands already mentioned, whereby the lids
 stick together, and become encrusted  with
 the dried  secretion during sleep.   Daily at- 
EYE
EYE
153
 tention to the washing off of the  accumula-
 tion, night and  morning,  is of the  utmost
 necessity, as without this, no remedies are of
 any avail.  As very minute sores exist at the
 roots of the hairs, they should be kept closely
 cut with scissors ;  by this means the forma-
 tion of crusts is diminished.  The edges of
 the lids  should  be neatly  smeared with the
 diluted nitrate of mercury ointment, or the red
 mercurial ointment, or the oxide of zinc oint-
 ment, diluted with spermaceti or fresh lard.
 If a lotion be used, the acetate of lead forms
 the  best, in the proportion  of two to four
 grains to the ounce of distilled water.
   Crab lice.—A  species  of louse (ththirius)
 nuite  distinct from that  infesting the  scalp
 (pediculus), sets  up an irritable condition of
 the  eyelids frcm its presence.  This  rarely-
 met with insect  gives  rise  to  a condition
 termed phthiriasis. The parasites are readily
 destroyed by smearing the roots of the lashes
 thoroughly with the white precipitate  oint-
 ment.
   Epiphora and  Stillicidium Lachrymarum
 both signify  an  overflow of the tears,  but
 from different causes.  In the first case it is
 owing to an over-secretion of the tears, and
 in the second  it is owing to an obstruction of
 the little channels  situated on the margin of
 the upper and  lower lids (puncta lachrymalia),
 and which naturally  conduct the tears into
 the lachrymal canal.   An ordinary epiphora
 is usually due to some irritability of the eye,
 or the presence of  some  foreign body.  As-
 tringent lotions, aperients, tonics, and ant-
 acids appear to be the best treatment.  In the
 case where the overflow is dependent  on ob-
 struction  of  the  puncta,  an  operation  is
 necessary.
   Obstruction of the Arasal Duct, i.e., of the
 tube which conveys the tears from the eye to
 the nose, generally occurs in strumous per-
 sons, and it commences with an overflow  of
 tears in one eye, and a dryness  of the corre-
 sponding side of the nose.  This is usually the
 first stage of inflammation  of the lachrymal
 sac,  resulting in abscess, causing  lachrymal
 fistula, which requires  special surgical inter-
 ference for its  cure.
  Injuries.—Ecchymosis,  commonly called a
 black eye, is the result of an effusion of blood
 into  the  areolar tissue, immediately  below
 the skin, generally caused  by  a  blow on the
 eye, though not necessarily, as, owing to the
 continuity of this areolar tissue over the scalp,
 a blow on the back of the head may lead to
 the effusion of  blood which will gravitate into
 the lax tissue in the upper lid.  The best and
 readiest way of  getting rid of the disfigure-
 ment is the application of a poultice formed
of the  freshly-scraped  root of  the   black
bryony mixed with linseed meal or  bread-
crumbs.  The  immediate application of tinc-
ture of arnica is generally  of use.
  The eyelids are of course subject, as  other
parts of the body, to growths of various kinds,
which require the assistance of the surgeon,
such as cysts, warts, naevi  (mother's marks),
carcinoma, and epithelial cancer.
   Wounds.—In the instance of wounds of the
eyelids, the neatest adaptation of  the divided
surface must of course be  obtained, and  the
greatest care taken to avoid  irregularity  or
puckering of the edges. Very fine needles,arm-
ed with fine silver wire, should be used, and the
stitches withdrawn directly  any inflammation
or redness appears around them.  Cold water
dressings  should be  lightly applied ; and
attention to the bowels and diet are of impor-
tance.
   Substances in  the  lids or on the surface of
the eye, see Foreign Bodies.
   2. Diseases of  the Eyeball and its Con-
tents.—Diseases  of  the  Conjunctiva.—The
conjunctiva, the  mucous membrane   which
lines the eyelids and covers the anterior sur-
face of the  eyeball, is subject  to  several  se-
vere forms of disease, namely, conjunctivitis
or common ophthalmia.   The several forms of
ophthalmia and their treatment are described
in article on  Ophthalmia.
   Granular Conjunctiva.—That portion of the
conjunctiva which lines the lids,and which is re-
flected on to the globe, is very often the seat of
a rough, thickened-looking red papillae, aeon-
sequence of old  standing ophthalmia, causing
great  pain, and disturbing the proper motions
of the eye.  This has been described as " the
complaint of the poor  Irish"—perhaps  as
good  a way of describing the malady as any
amount of technicality.  It  is best treated by
counter-irritation  outside the  lids, such as a
small blister behind the ear, and by endeav-
oring to improve  the general health by iron,
quinine, and, if possible, change of air.
  Diseases of the Cornea.—The cornea  is the
transparent portion  of the globe  of the eye,
through which  the rays  of  light  pass  to the
interior , it  occupies about  the anterior sixth
part of the  eyeball, and as seen  from  the
front is somewhat flattened  above and below,
owing to the overlapping of the sclerotic.   In
the healthy eye it is perfectly clear and highly
polished in appearance, sharply and minutely
reflecting any object upon its surface. In acute
corneitis the originally clear and polished ap-
pearance of  the cornea becomes hazy, dim,
and rough, red,  or opaque.   The margins ad-
jacent to the sclerotic coat are vascular, and
the sclerotic itself at  the point of junction is
pink,   cwing  to  its   increased  vascularity.
There is an  abundant secretion of tears, and
intolerance of light ;  it most commonly affects
strumous  children, or it may be the result  of
injury.  It is sometimes followed by suppura-
tion between the layers of the corneal tissues,
and in some instances ulceration of either the
posterior or  anterior wall  may  take  place,
giving rise in the first instance to a deposition
of pus in the anterior chamber  (hypopyon^ 
154
EYE
EYE
shown by a  crescentic yellowish  fold at  its
lower part, and  in the former  case an open-
ing ensues,  by means  of the  perforation,
through which the iris protrudes, termed staph-
yloma iridis.   Other consequences of corneitis
are opacities of the cornea, owing to an effusion
of fibrin into the  corneal  substance,  or be-
tween it and  its  covering membrane, the con-
junctiva, or from  a cicatrix after ulceration.
In the first case  it  has received the name of
nebula ; in the latter, albugo or leucoma. The
treatment of  inflammation  of the cornea con-
sists in subduing the inflammation by small
doses of mercury, given with a tonic, such as
quinine and ammonia ; in  very acute  cases a
leech or two  to the temple, or a small blister
behind the ear, and warm fomentations.  All
stimulating lotions are hurtful.
   Ulcers of Cornea.—The cornea  is  very fre-
quently the seat of ulceration, which has sev-
eral varieties, and may result from  injury,
scrofula, inflammation of the conjunctiva, or
conjunctivitis, and  from insufficient  or non-
azotized food. Three conditions are described.
Healthy, with a slight opacity from the adhe-
sive effusion  necessary  to healing ;   the in-
flamed, with  a vascular  hazy circumference,
requiring leeches and  counter-irritants ; and
a third, clear, transparent, cleanly  cut, and
indolent, requiring  slightly stimulating appli-
cations.  In  very irritable  ulcers, where there
is  great pain and intolerance  of  light, they
may be greatly relieved by being touched with
solid nitrate of silver from time to time.
  Staphyloma is  a condition following perfo-
ration or disorganization of the cornea after
ulceration, when any of the contents of the
eyeball protrude through it toward the surface.
(See Staphyloma.)
  Conical Cornea  is  a rare form of  disease
wherein the cornea is exceedingly convex, in
some cases almost  approaching  to  a point,
with the apex central.
  Diseases of the Sclerotic.—The sclerotic coat
of the eye is that which  constitutes  the ap-
parent body of  the eyeball ; a small  portion
only of it is seen from  the front, the  central
portion of the visible  eyeball  being that  al-
ready described, the cornea. It is proportion-
ally, with regard to the eyeball, about five
sixths of its entire surface, and contains the
whole optic   mechanism.    It  consists  of
white fibrous tissue, and  into  it are  inserted
the muscles controlling the movements of the
eyeball ; it is pierced behind by the  optic
nerve, and covered in front by the conjunctiva
already described.   It is  subject to  several
forms of  disease, and the most  frequent is
acute sclerotitis,  or acute inflammation  of the
sclerotic, a disease difficult  to distinguish from
corneitis,   frequently  of  rheumatic  origin,
though  not necessarily.   It is known by  a
pinky redness of the white of the eye, gen-
erally  great  intolerance   of light,  a  sharp,
stinging  pain, general malaise, and  severe
supra-orbital pain.  With regard to treatment,
iodide of potass in small doses, with bark or
tincture of colchicum, seem the best constitu-
tional remedies, and perhaps a small blister
to the temple or  eyebrow.  There should be
attention  to diet; and  beer, port wine, and •
sugar avoided.
  Diseases of the Choroid.—The choroid is the
vascular coat of the eyeball, containing pig-
ment ; it extends over the whole of the pos-
terior portion of the eye, and is continuous
in front with the iris. It is pierced by the op-
tic  nerve.  The coat is subject  to  an acute
inflammation  (choroiditis).  It is,  however,
rarely seen alone, and is very  rapid  in  its
course.   Its  detection  is  a matter of some
difficulty to the most skilful.
  Diseases of the Retina.—The retina is  the
nervous coat of the eye, and lines the choroid.
It is the  most  essential part  of the eye, re-
ceiving  the impression of light, and is very
complex in its  structure.  Retinitis, an  in-
flammation of this coat, is very rare, idiopath-
ically, and  is caused  by exposure  to vivid
light, the glare of snow, or of burning sands.
It is  sometimes  met in connection with the
various forms of ophthalmia.
  (The diseases of the lens and iris are sepa-
rately considered,  under  the  articles Cata-
ract and Iritis.)
   Squinting, or strabismus, is a want of par-
allelism in the position  and motion of the two
eyeballs.   The usual forms are  the conver-
gent and divergent.  The convergent is most
common in young  persons, and is that  in
which the eye is turned inward.   The diver-
gent  is more uncommon, and  is  most fre-
quently met with  in elderly persons, the  eye
being turned  outward,  generally from partial
paralysis of the inner rectus muscle.   Various
methods have been adopted for mitigating the
deformity, and  very frequently, if  it be  of
only a few weeks' duration, may be removed
by judicious  medical treatment ; but  if the
squint be of long standing and habitual, and
if there be inequality of vision, the operation
of dividing  the  internal rectus muscle must
be performed.
   Short Sight, or  myopia, is  where  the par-
allel  rays of  light are  brought to a focus be-
fore they reach the retina, caused  either  by
the  refracting power  of  the eye  being  too
great, or  its  antero-posterior  axis  too long.
With regard  to  treating  it, all minute work
must be avoided, and carefully adjusted spec-
tacles should be worn.
   Long Sight, or  presbyopia, is  a failure of
vision for near  objects.  " In pure presby-
opia the far point is  at a normal distance
from the eye, parallel rays are united upon
the retina,  and neither concave  nor convex
glasses (even after the instillation of atropine)
at all improve distant vision.  The eye is
neither myopic or hypermetropic. There is. in
fact, no anomaly  of refraction,  but only a 
FACE-ACHE
F.ECES
155
narrowing  of  the range of  accommodation.
The near point  is removed  too  far from the
eye, and hence the difficulty  of distinguishing
small objects."  Spectacles  should be used,
the lenses of which cause the type of a book
to appear bright .and distinct, but not larger
than natural, when held ten  or twelve inches
from the eye.
  Hypermetropia.—In this case  the  parallel
rays are brought to a focus behind the retina,
and not upon it,  and after some  time of em-
ployment, print  becomes dim, the lines run
into  each other, and the eye feels  hot and
dull.  It can be remedied by the use of well-
chosen  convex spectacles, which relieve the
strain upon the  power  of  accommodation.
This affection is frequently associated with
convergent strabismus.
  Astigmatism  is  " irregular refraction, in
which different  meridians of  the same eye
have different power of refraction."   Thus
certain  lines, for instance, appear clear and
well defined, while near ones are indistinct
and blurry.  (See Amaurosis, and for lotions
for inflamed eyes or weak eyes, see Colly-
rium.)
F.
  FACE-ACHE is a  form  of  neuralgia,
 sometimes depending on unsound  teeth, and
 at other times on an  anaemic  and debilitated
 state of the system ;  it is not uncommon dur-
 ing pregnancy, or during the period  of  nurs-
 ing ; it is then associated with general pallor
 and weakness. A liberal diet and tonic medi-
 cines, especially quinine, give the greatest re-
 lief.  In the case of unsound teeth, the den-
 tist may  be consulted ; if  the  cheek be  much
 swollen,  hot fomentations or poultices will
 relieve, and in some  cases leeches  maybe ap-
 plied to the gum.  (See Pain and  Tic.)
  FACIAL PALSY.  (See Paralysis.)
  F.JECAL ACCUMULATION is a not
 unfrequent consequence of the habitual use
 of strong purgatives, especially in elderly fe-
 males.  The proper  stimulus to  the gut  is
 distension ; when it  is full at  one particular
 part, it has a  tendency to evacuate its  con-
 tents.  Habit has much to do with this.   But
 if the stimulus is unheeded or resisted, then
 as time goes by the fluid from the faeces is ab-
 sorbed by the gut and they become hard, and
 wedged into the bowel apparently; what  is
 technically termed impacted.   Many people,
 the subjects of constipation, only  have their
 bowels opened after they use purgative medi-
 cines, and they too often have recourse to the
 more  powerful  remedies  for  this  purpose.
 And it is plain that if the bowel is only called
 on  to  respond to such a  stimulus  as  these
 afford it will not to such a simple one as dis-
 tension, and so the  evil  perpetuates  itself.
 Elderly females are  particularly prone to this
 mischief ; their abdomen is capacious  from
 frequent child-bearing, and it is wonderful  to
 what an extent the faeces may accumulate  in
 such subjects.   The part of the bowel where
 these  most frequently accumulate  are the
 beginning and end   cf  the great  gut, the
 caecum and the rectum, though frequently the
 whole of  the large intestine is blocked  up  in
 this manner.   The principles of dealing with
 such accumulations are plain.  Powerful dras-
tic  remedies   are to be  avoided.    Gentler
remedies, like  castor  oil and  Glauber's  salts,
are to be used  ; the principle is to  soften the
mass of faeces, and  if remedies  given by the
mouth fail to do this, injections must be used.
(See Constipation.)
  F2ECAL VOMITING, or the vomiting
of substances already converted into ordure,
is one of the most  disgusting symptoms pa-
tients can be subjected to, or their friends be
called  on to endure.   It  may arise  from va-
rious causes, but the essence of them all is ar-
rest of the passage of the refuse food down-
ward, so that it passes upward again when
converted into faeces, all  downward passage
being denied.  Hence it is a symptom of va-
rious import; in perhaps the majority of cases
it indicates  strangulated  hernia (which see).
But it may also arise from other forms of ob-
struction, such as twists of  the  gut,  catching
in a loop such  as  may occur when there is
much internal  motion  in  the abdomen  and
any string-like body is adherent to  the walls
of the abdomen  or to the gut itself; in fact, all
the various causes of  intestinal obstruction
(which see).    Even  great accumulation of
faeces,  from the bowels having been  long un-
moved,  may give  rise  to this symptom.
Another cause, though a less frequent one, is
a communication between  the great  gut  and
the stomach, which does  sometimes occur,
and then a mingling of the contents of the two
takes place.   In this way faecal  vomiting oc-
curs from passage of the faeces into the stom-
ach, and undigested food  is passed by the
rectum.  As to treatment, that resolves itself
into removing the case  of  the obstruction  if
possible. Each must be dealt with on its  own
basis. That  form most amenable to treatment
is the one due to faecal accumulation without
any distinct cause.  (See Ftecal Accumula-
tion.)
  F.SICES, the excrementitious contents of
the bowels,  on the proper  nature of  which
health very generally  depends.   The color of
this excretion depends  on the  admixture of
bile with the mass of refuse which passes from
the stomach into the bowels.  When healthy
it should be  of a light  brown color, and mod-
erate consistence : the presence  of too much
or to little  bile is indicated by the dark or 
15G
FAINTING
FAINTNESS
light color of the motions, as  the  faeces are
called in common language.
  FAINTING.  (See Syncope.)
  FAINTNESS, though produced Dy many
different causes, may be said to depend in all
cases on  impaired circulation in the brain,
however brought about.   In itself it  consti-
tutes  a  peculiar sensation,  and people are
often accustomed to speak  of being  faint,
when faintness, as we here use  the word, is
very far from being present.    Thus  many
healthy people  use  the word  to signify the
feeling  of  emptiness  which   accompanies
hunger.    This of  course  is  appeased  by
food, but true faintness is accompanied  by
nausea, which renders the idea of food intoler-
able.   Such faintness as we now speak  of is
commonly accompanied by other signs of the
condition ;  the countenance,  including the
lips, becomes deadly pale, the  muscles relax
so that the individual  can no longer  stand
erect and would fall, or does fall, if he does
not lie down ; the skin  too is  relaxed and is
covered with a cold perspiration, and there is
an uncomfortable beating of the heart indicat-
ing imperfect contraction of  that organ ; and
if the pulse be felt at the wrist it will be found
to be either extremely quick and feeble or else
imperceptible.  All  these  symptoms may be
brought about in various ways.  Thus pain,
alarm, dread, and a great variety  of mental
emotions acting on a  delicate system  may
give  rise  to  it. A   great number  of  af-
fections  connected   with   the bowels  and
other abdominal organs, especially  the stom-
ach,  give rise to it.  Interference with the
heart's action, from whatever  cause, is, per-
haps, the most potent cause of  all, and it is in
this way these mental emotions act, affecting
one special nerve, called the vagus, which in
its turn affects the heart.  This  same  nerve
is distributed to the stomach, and it is  proba-
bly through it that any irritation of  the  stom-
ach causes faintness,  not directly, but in a way
we term reflex.   Thus  the irritant, whatever
it may be,  affects the nerve in the walls of
the stomach ;  by the nerve this  irritation or
stimulus is conveyed to the brain, and from
the brain a fresh stimulus is sent forth which
affects the heart.    The  stimulus  conveyed
from the stomach to the brain is  called a sen-
sory stimulus or sensation,that from the brain
to the heart is called a motor stimulus, as in-
terfering with the heart's motion.  For the
conversion of a sensory into  a  motor stimulus
some nerve-centre, like  the brain, is requisite.
Accordingly in this case the stomach, though
very near the heart,  cannot act on it directly,
but only through a nerve-centre.  Sometimes,
however,  when the stomach  is very  much
distended by air, giving rise to flatulence, its
distension  may interfere with  the heart's ac-
tion and so give rise to  a feeling of faintness.
One  of the most powerful, if not the  most
powerful, cause of faintness is loss of blood,
from whatever cause.  If there is not enough
blood in the body to enable it to carry on all
its functions, and the brain requiring a good
supply to carry on its  work, these  must be
more or less interfered with.   All this, how
ever,  must be  but little  apparent  while the
individual is lying quite flat and at absolute
rest, but if he attempts  to rise or  to  sit up,
the extra exertion on the muscles of the body
and the extra work of the heart in driving the
blood to the head may be too much,  failure is
the consequence and so faintness, which may
be deadly.   Such an occurrence is, unfortu-
nately, by no  means  unknown in midwifery
practice after childbirth  where there  has been
great loss  of blood.   Faintness -is  by no
means,  however, without certain concurrent
advantages.  Thus,  where an individual is
bleeding from wounds,  received it matters
not how, except the  bleeding be artificially
arrested  he is likely to perish.  Should, how-
ever, faintness supervene, the lessened force
of the circulation,  due to  interference  with
the heart, may give the blood time to coagu-
late and  so prevent further hemorrhage, as it
is called.  This  natural  coagulation may be
simulated in various ways without inducing
faintness, but the same  process had  recourse
to by nature is sometimes had recourse to ar-
tificially.
  Treatment.—For the cure of  faintness the
first thing is to secure as favorable blood sup-
ply to the head  as possible, and accordingly
the patient  should be laid down flat on the
ground  with  nothing under the head.   It is
better too  to  place  him  on the face lest the
faintness bring  on vomiting, and  if the pa-
tient was lying  on  his back  and unable to
eject  the vomited matters from  his  throat
some of it might be drawn by the breath into
the windpipe  and  suffocate the individual.
We have known death  caused in this way.
Accordingly it is best to lay the patient flat on
the chest, with the face  turned a little to one
side.  Restoratives may be given, but not till
the patient can fairly swallow ; before these,
smelling-salts, burnt feathers, or any ordinary
preparation of ammonia  may be held to the
nose, but  too  violent  remedies  sometimes
leave bad  effects, as far as the nose  is con-'
cerned.   We have seen  it badly burned, for
instance, by the irritants applied to it.   If the
patient can swallow, it is better to give some
stimulant internally, spirit of some kind, or
ammonia, especially its aromatic spirit,  com-
monly called spirit of sal volatile. Thirty drops
of this on a piece of  sugar do well.  A small
quantity of brandy  diluted with warm water
may be given if this is not to be had.   Spirit
of chloroform also,  called chloric ether,  is
another useful remedy.   Thirty drops should
be given.  But  it is far  more  important to let
the patient lie  quietly at absolute rest, without
interference, than to bother him or her with a
lot of remedies.   Of course there  are  cases 
FALLING SICKNESS
FALSE JOINT          157
where another rule prevails, where the patient
would die if something were not done, but
these are not ordinary cases.
  FALLING SICKNESS.  (See Epilepsy.)
  FALLOPIAN TUBES are hollow canals
forming appendages to the womb ; they con-
nect the ovaries  with  that organ and convey
the ovum from the ovaries into the uterus or
womb.
  FALSE  JOINTS.—There  are   certain
bones in man  which after fracture rarely be-
come whole  again, and the broken pieces of
which do not usually unite  in  the ordinary
manner by the deposit around and between
them of new bone.  The two fragments of  a
transversely fractured knee-cap, and the de-
tached process of bone at the  back of  the el-
bow  called  the  olecranon retain a  certain
amount of freedom during the lifetime of the
individual, and are joined  by a thick and flex-
ible structure resembling and  indeed  closely
analogous  to normal  ligament or  sinew.
This  failure of true osseous union, which is
the rule  in the knee-cap, the neck  of the
thigh-bone, the olecranon, and the back part
of  the heel-bone,  occasionally  follows the
fracture of  a long bone  where the surgeon
usually expects  at  the end of six weeks or
two months to find a hard mass of callous or
bony deposit at the seat of injury and restored
cbntinuity of the limb.   In  these cases the
ends  of the  fragments remain movable, and
the limb  painful and useless.   In most in-
stances, after a perseverance in the treatment
for another month or more, the usual and ex-
pected result takes place,  and  there is endur-
ing recovery.    Occasionally, however, the
continuity of the bone  remains  broken and
the fragments glide freely upon each other
whenever an attempt is  made to use the in-
jured limb.  In the former case surgeons say
that there is  delayed or retarded union, in the
latter that there  is  non-union  due to the for-
mation of a false joint.  The opposed  ends of
the two long  fragments  of broken bone are
reduced in thickness, and  are  connected like
the fragments of a broken  knee-cap by strong
ligamentous bands, or are inclosed  in a sac
or capsule of similar tissue, the inner  surface
of which is lined by a smooth and moist mem-
brane resembling the synovial layer found in
healthy joints.  In this latter case the ends of
the fragments of bone  are  tipped with gristle
of cartilage, and glide  upon each other when
moved by the muscles of the injured limb.
Here  there is a close analogy to the conforma-
tion of a sound and normal articulation, and
hence the name of false joint  which has been
given more especially to this condition. Non-
union of broken bones except in those men-
tioned above is  an uncommon  event.  The
bones in which union after fracture most fre-
quently fails or is retarded are the humerus
or arm-bone, the thigh-bone,  and the bones
of the fore-arm.   So far as it  may be learned
from  statistics, the occurrence of non-union
does not seem to be influenced by conditions
of sex or age.   The principal constitutional
causes are the presence of .diseases such  as
syphilis,  cancer, and  scurvy,  which cause
poorness  of blood and general debility,  pro-
fuse discharges,  fevers  of a low  type, exces-
sive bleeding, and  senility.  The withholding
of an  habitual  stimulus is often a cause of de-
layed union : one  case  has been reported in
which a fractured thigh  did  not unite until
the patient was allowed  some  whiskey,  to
which spirit he had  previously been accus-
tomed, and another in which union was re-
tarded until the patient had  returned to his
former habit of smoking tobacco.  Two cases
were  observed  by Sir Benjamin Brodie  in
which false joint was formed in patients who
had  attempted,  by placing themselves  on a
spare diet, to  prevent  increasing corpulence.
The following are some of the local causes to
which the failure or delay of union has been
attributed : diminished  supply of  arterial
blood  in   consequence  of tight bandaging,
wound  and division of the nerves of the in-
jured limb, much  displacement  and overlap-
ping of the ends of the  fragments, interposi-
tion between the fragments ol a small piece of
bone  and of a piece of tendon or muscle.   In
the great  majority of cases the condition is
due to  debility and  premature lemoval  of
splints from the injured limb.
   Treatment.—For delayed unicn of  a  frac-
tured bone the most effectual treatment is that
which consists  in  improvirg   the  general
health of  the  patient  by allowing him a full
and nutritious diet and in keeping the limb at
absolute  rest  and evenly and  firmly com-
pressed by splints and bandages, or by an ap-
paratus  of plaster of  Paris.   In obstinate
cases, where  some kind of  false joint has
been  formed, a surgical operation is generally
necessary, the object to te attained  by which
is to  set  up inflammation about the ends  of
the fragments.   Inflammatory processes  of
bone  generally result in the deposit of irregu-
lar masses of new osseous tissue.  In some
cases union may be b ought about by violently
rubbing the ends together. In those cases that
are less  amenable  to  bloodless proceedings,
the introduction of a seton, or of ivory pegs,
or the simple  puncture of  the false joint with
a long needle, are often resorted to by sur-
geons.    Occasionally it is thought necessary
to have  recourse to more severe operations
and to cut down  upon  the rest of  the  false
joint, and to saw off the ends of the fragments,
and then,  afler  drilling  the bone above and
below the breach,  to secure the upper to the
lower  fragment by  means  of   ligatures  or
metallic pins.   False  joint sometimes,  and
especially  in children  under  the  age  of ten
years, obstinately  resists every  treatment.
and finally necessitates amputation of  the
limb. 
158        FAMINE  FEVER
FEVER
  FAMINE FEVER. (See Relapsing Fe-
ver.)
  FARCY.  (See Glanders.)
  FARRIS is a name given  to a skin dis-
ease,  usually  occurring  on the  scalp, and
sometimes met with in children ;  it is  due to
a vegetable parasite  called Achoiron  Schon-
leinii.  (See Epiphyta and Parasites.)
  FAT.   (See Adipose.)
  FATTY DEGENERATION.   (See De-
generation.)
  FATTY HEART. (See Degeneration.)
  FAUCES, the back of the mouth and the
commencement  of  the  pharynx, extending
from the tonsils, and  uvula to the root of the
tongue and  the epiglottis,  and  sometimes
called the  gorge.   The  fauces is often  the
seat of inflammation,  causing sore throat.
  FEBRIFUGE—A  medicine  to  dispel
fever, such as quinine, bark, and arsenic.
  FEBRILE DISORDERS are complaints
in which fever or a  rise in temperature forms
a prominent symptom.  (See Fevers.)
  FEEDING BOTTLE.—There are many
kinds of bottles used for the feeding of in-
fants.  The best kind is  that which, having
an elastic tube connected with the inside  of
the bottle, causes the infant to draw  up the
last drop of food in the bottle without imbib-
ing air, and  thus  incurring  all the evils  of
fruitless sucking, which are great.   The one
point to  be observed where a bottle is used
by  an infant is its  scrupulous  cleanliness.
Much disorder of the bowels is caused in in-
fants by the neglect of this ;  for a very small
portion of the curd of sour milk which may
have  been carelessly left  in the  bottle will
taint the whole of  the fresh  food, and give a
fit of illness to the child.
  FENNEL or Sweet Fennel, the fruit  of
Fceniculum dulce, grows all over the  United
States.   It belongs to a group of  plants of
which hemlock is the  type, but  it  has none of
the properties of that plant.  Its properties
rather approximate  to those of anise,  corian-
der, caraway,  and dill, all of which belong to
the same  group.   These are described  as
being stimulant, aromatic,  and carminative.
Briefly, they are given mainly  for flatulence
and for gripes casued by it, especially  in chil-
dren.  Fennel water is the preparation com-
monly made use of, or its oil may be given on
sugar like oil of anise, and in the same quan-
tity.
  FERN  or  MALE FERN   (Asplenium
Filix mas) is a remedy of very great value in the
treatment of intestinal  worms.   The  part of
the plant  used is  what is commonly called
the root, but is in reality the underground
stem with portions  of the stalks of the leaves
and of the roots adhering.   It grows  in  this
country, and should be collected in the sum-
mer.  The powder of the  root may be  em-
ployed, but the preparation commonly used is
made by steeping  tne powered  rhizome or
stem in ether, and then allowing the ether to
percolate through  it.   Partial evaporation of
this  leaves behind  it  a  thick  dark-colored
liquid commonly called oil of male fern, tech-
nically it is termed a liquid extract.  The ordi-
nary dose  of this fluid is thirty drops, which
should  be  taken in any convenient vehicle,
such as an aromatic water, the  first thing in
the morning. Some time thereafter—about an
hour or so—a small dose of castor oil should
be given, just as  much as will  gently move
the bowels, for  the male fern has no effect
that way.   This  will generally bring away the
worm quite dead, or if the whole  is not re-
moved the  greater portion  will be, though if
the head or  smallest portion of the body be
not removed there is a great chance  of the
whole body forming again.  This dose  may
be repeated  on more than one occasion if
necessary.   The worms against which male
fern is most useful are of the tape or flat kind.
It is  useless  for small round worms.   Male
fern is undoubtedly the most useful remedy
we possess for the treatment of tapeworm.
  FEVER is an abstract term signifying a
condition in which there is increased heat or"
the body  accompanied by a  quick  pulse,
furred tongue, headache, and a general  feel-
ing of languor. There may be also loss of appe-
tite, thirst,  and restlessness.  All these symp-
toms are met with in inflammatory disorders,
as pneumonia,  pleurisy,  and peritonitis, as
well  as in  those  cases which are  classified
under   the  head  of  " zymotic  disease."
Under the  different special headings will be
given a detailed account of each variety of
fever ; it will therefore suffice for us here to
give (i) a classification of the various kinds of
fevers,  (2)  an account of  the exciting   and
predisposing  causes,  and  (3)  the general
treatment to be  adopted.
  Classification  of Fevers.—For this  pur-
pose a  simple arrangement may be  made.
Under the  head of each fever will be given its
history, mortality, causes, resuits, and de-
gree of contagion  and infection.   The follow-
ing are usually enumerated as fevers :
Continued fever.
Exanthemata.  \
Rheumatic fever.
Puerperal fever.
Pyaemia.
Diphtheria.
Cerebro-spinal fever.
Typhus fever.
Typhoid, or enteric fever.
Relapsing fever.
Small-pox, or Variola.
Chicken-pox, or Varicella.
Scarlet fever, or Scarlatina.
Measles, or Morbilli.
Erysipelas.
   Febricula.
   Yellow fever.
   Intermittent fever.
   Remittent fever.
   Milk fever, or weed.
These fevers are spoken of as " zymotic dis-
eases ;" the term " zymosis" means a " fer-
ment," and in these  cases  the poison  from
without is supposed to enter  the  constitution
and cause certain changes in the blood where
it may develop indefinitely ;  this can be but 
                  FEVER

 noticed in  the case of  small-pox, where  a
 minute quantity of the poison entering the
 blood will  multiply  enormously,  as  seen
 by the numerous  pustules  over the surface
 of the body from each of which fresh quanti-
 ties of poison may be taken.  (See Zymosis.)
 The seven  principal  zymotic  diseases  are :
 Small-pox,   measles,   scarlet   fever,  diph-
 theria,  whooping-cough,   fever  (including
 those mentioned above as continued  fevers),
 and diarrhcea.  Cholera also  comes under
 this division, and other diseases which are less
 common.
   Causes.—There  is  hardly any subject of
 more importance than the proper understand-
 ing of the causes of fever , every year the re-
 turns of mortality  show the enormous num-
 ber of lives lost to the country by epidemic
 disorders   which in  many  cases might be
 stamped out, or their  ravages at  least much
 lessened by simple sanitary arrangements.
 Yet it  may be hoped  that with the general
 diffusion of knowledge a  time may  come
 when the community will take a more active
 interest in  the subject of public health, and
 that they  will bear in mind the  old adage
 that "prevention  is better than cure."  In
 treating of the causes of fevers we shall here
 speak of those only in which a morbid poison
 is  assumed or shown to exist—of  those in
 fact which may attack various individuals at
 the same  time, and be transmitted  more or
 less rapidly from one to another. Of such dis-
 eases some are said to  be  contagious, some
 infectious, and some partake of both qualities.
 When a fever is said to be  contagious it is
 meant that another person in close  contact
 with the one attacked is very liable  to catch
 it ; thus measles and scarlet  fever are  very
 contagious affections,  and often the  disease
 will run through  a whole  family one after
 another.   When a  fever is said to be infec-
 tious it is meant that although persons in the
 house are liable to catch the fever, yet actual
 contact is not essential ;  thus typhoid fever is
 an  example ;  but in truth the value of these
 distinctions is of very little use, as  most of
 these  disorders are contagious and  infectious,
 and so no hard and fast line  can  be  drawn.
 A more practical arrangement might be made,
 as follows :  a person is liable to catch a fever
 from  another person by the poison  entering
 his stomach  or lungs, or being taken up by
 the skin. In all cases we have to assume that
 particles  are given off  from the  person at-
 tacked, and that such particles are conveyed
 into the system of another individual through
 the medium  of his stomach, lungs,  or skin.
 Now,  bearing this  in mind, care  should be
 taken  to prevent,  as  far as  possible, such
 poisonous particles from entering.  Typhoid
 or  enteric  fever  is  not what is  commonly
called  contagious,  yet it may  infect a very
large  section of a community ; the  way it
spreads is pretty clearly made out ; the stools
                  FEVER              159

of a person so affected may be thrown into a
sewer or cesspool.  Now supposing that the
fluid portion percolates through the soil and
drains into a well from which several families
draw  their daily supply of water,  it  is quite
clear  that in this way persons drink  in the
poison and that therefore it must be absorbed
by  the stomach or intestines ; it  has  been
shown over and over again that cholera  may
be  communicated in  this way.  But  again,
the stools may be thrown into an open drain,
such an one, for instance,as may be sometimes
seen running the whole  length of  a country
village, and in this case when there is a dry
season and the drain is not well flushed, de-
composition goes on and noxious exhalations
are given off and may give rise to the disease.
Nor does it seem needful in all cases that the
poison should have got into a drain or sewer ;
it is most probable that decomposition of or-
ganic matter itself is a sufficient cause for the
disease, and thus sewer gases which leak  from
a worn-out pipe into a house may give origin
to the attack.   In these  cases we breathe in
the poisonous  particles, and  thus the virus
enters by the lungs.   In  typhus, on the other
hand, the poisonous particles are exhaled  from
the skin  and breath of the patient, so that a
person in daily contact with him is very liable
to catch the fever  by inhaling the virus.   In
yet other cases we may ourselves convey the
poisonous elements in our  clothes,  letters,
etc., to a third person, and this is often the
case in  scarlet  fever,  and also in  puerperal
fever.  In discussing the treatment of  each
fever  will be mentioned the various means at
our disposal of preventing the spread  of the
disease.   Causes  are generally divided into
predisposing and exciting causes.  Under the
first class may be enumerated age, sex, oc-
cupation, and country.  Children  are  very
liable to measles and scarlet fever, and hence
it  is not often met with in adults.  Typhus
affects people in middle life, and the majority
are attacked  after thirty years of age.  Ty-
phoid, on the  contrary, is met with in the
young, and  the  majority are  attacked under
thirty years of age.   Relapsing fever is met
with at all ages  pretty equally, but it is  very
rarely fatal.   Small-pox may attack people at
any time of life if not guarded by vaccination.
Sex has very little, if any, influence, although
some are by their  occupation  more liable to
catch some diseases than others. The exciting
causes are poverty,  overcrowding, destitu-
tion, bad air, bad food,  and  bad water.  It
may be stated as a rule  that typhus  and re-
lapsing fevers are met with  in overcrowded
courts and alleys, and originate  in a  badly-
fed family ; but when once the disease  has
been started in a town or village it  may  soon
spread rapidly among the better class of in-
habitants.  Typhoid fever has been already
mentioned as propagated  by bad  sewerage
which taints  the air, or by bad water.   The 
ICO
FEVER
FEVER
other fevers are not so much affected by these
conditions, but they seem to be caught from
one to another, and people of all classes  are
liable to the disease.
  Treatment.—This is a subject of the great-
est  importance ;  in this  class  of diseases
more than in any other the greatest benefit
may be derived from careful attention to a few
ordinary  sanitary rules.    With  regard  to
ventilation a distinction must be made between
this and a draught. It is often very injurious
for a patient to lie exposed to a draught  of
cold air,  although this is often  done under
the erroneous idea that this is the way to ven-
tilate.  It  is very essential that all foul air
should be removed from  the apartment,  but
for this purpose the window may be opened
three or  four times a day while the patient is
partially  covered over, or  if the  weather be
very warm the window may be open all day.
A small fire is of great use in  airing a room,
as it aids  the entrance of  fresh air through
the crevices  of the door and window.   The
smaller the room  the oftener  the air requires
renewal ;  it is therefore wise to make use of
a  room  as -large as possible, and discon-
nected from the  other rooms in the house
where practicable.  All useless furniture should
be taken  away—such  as bed-curtains, orna-
mental hangings, carpets, etc., as these tend
to retain noxious emanations, and may cause
the spread of the disease  afterward to other
people.  The bed on which the  patient  lies
should not be placed in a direct line between
the door and  window, as he  is exposed to a
draught every time any one enters  the room.
When the room smells  close let  the window
be opened a little way so  as to  allow  the
heated, stuffy air  to  escape.  The light from
the window is sometimes very disagreeable
to a patient,  as  in  measles, typhus, etc.,
hence the blind should be  drawn, or the  bed
be so situated  as  to prevent any annoyance
in this respect.  The temperature of  the room
should be about 650 F., or even a little higher
when there is any lung complication.  When
the air is too hot,  it makes one feel oppressed
and  restless ;  when too cold, bronchitis is apt
to come on.  An  ordinary  thermometer may
be kept in the room, and  it ought to  stand
between 65° F. and 7o0F.   In some cases the
air may be too dry ; it is easy to rectify  this
by keeping a kettle full  of boiling hot water
on the fire ; the steam then evolved will soon
moisten the air.
   Cleanliness  is also very  needful  ; for  this
purpose a mattress is preferable to  a feather
bed, as the soiled  sheets can be more readily
taken away, and the patient does not sink so
low in the bed.  All excreta should be taken
away as soon as possible, and after being disin-
fected by pouring some carbolic acid over them
they should be thrown  away.  The patient's
body may be sponged with warm water every
morning unless he is very ill, and much com-
fort is experienced by having the hands, feet,
head and neck washed daily.  In  every case at
the commencement of an illness a warm bath
is very beneficial, as it opens the pores of the
skin  and may aid  afterward in  throwing off
the poison ; among the poor, who are often
begrimed with  dirt, it is  most necessary.
Another thing of great importance is the sub-
ject of diet.  When a person is  attacked with
a high fever and has a furred tongue, the ap-
petite for solid food is gone, and therefore all
food must be given  in  a liquid  state, as it is
then more easily absorbed, and just as much,
nay  more,  nourishment  may  be  given  in
twenty-four hours  in  the  way  of  milk and
beef-tea  than  if three or four  hearty meals
were taken.    In  all  fevers, and  until the
tongue begins to clean and  the temperature
begins  to go down, milk is the main support
we ought to give to the patient. To a child
two and even three pints  may be given dur-
ing the day and night,  and to an adult three
or four pints in the same time.   If good fresh
milk cannot be obtained, the preserved milk
sold  in tins is  equally efficacious ; one tin will
make three pints  of good sweetened milk.
Cold milk is often  more agreeable than hot.
Let the patient have something  every two or
three hours,  and in  very bad  cases, where
they can take very little at a time, it  may be
needful  to give  it  every hour.   Tea may be
given, when desired, or a  rice  pudding with
plenty of milk.  It is bad to drink large quan-
tities of cold liquids ; a little at a time should
be given so as to quench the thirst.   In sum-
mer time lumps of ice may be put in the milk.
Beef-tea is a very  useful  article of food ; to
obtain the most nourishment take coarse beef,
cut it in small pieces, place them in cold water
in a jar,  and let them simmer in the oven for
a few hours ; then, when  cold, remove the
fat, and warm up half a pint for the patient to
drink.   It  is  a mistake to suppose that be-
cause beef-tea is solid when cold therefore it
is very strong and  nutritious ;  the  solidifica-
tion  depends on the amount of  gelatine pres-
ent,  and this has very  slight nutrient  proper-
ties.  When the appetite returns and a desire
for solid food is felt, much care should be taken
for the first few days ; a small piece of boiled
mutton  may be given  with a  little bread or
dry toast ;  vegetables are not good to take ;
jelly, blanc-mange, light puddings made of
tapioca, arrowroot, or rice may  be given, and
an egg for breakfast or tea.  As a rule, for mild
cases of  fever no  stimulants at all need be
given until the stage of convalescence, when
two or three glasses of sherry  may be given
daily.   In some cases, where the disease as-
sumes a very grave  form, brandy must be
given freely, but no rules can be laid down in
individual cases, and such treatment must be
left to  the  medical man.   Stimulants should
be  given with  much  caution  in  the early
stages ;  they  frequently tend to congest  the 
FIBRIN
FILTERS
161
stomach and make the patient  restless  and
oppressed, and  prevent him absorbing  the
nutrient food which is so essential for his well-
being.   If attention be properly paid to all
these points  much good will  arise,  and any
one who aspires to be a good nurse will make
such her careful  study ; and let it always be
borne in mind that in fever cases good nurs-
ing will do more  than  anything else  to  ex-
pedite recovery.    Quiet is always advisable ;
it is of no use for persons to be admitted into
the sick-room, however anxious they may be ;
when a patient is  delirious the  hum of con-
versation is very annoying, and  in most cases
they feel quite unable and  unwilling to  talk
much ;  a quiet nurse is  very valuable.  When
food is given only a little should be brought
at a  time, and that in a tempting  form ; a
large basin of beef-tea  or bread and milk is
often refused when a small quantity would be
taken. The patient's strength should be saved
as far as possible by avoidance of exertion or
excitement, at least in the severe cases ; they
should not be allowed to sit up, and when the
sheets,  etc., have  to be removed the patient
should be shifted from one side of the  bed to
the other without being taken  out of the bed.
Charcoal may be placed in a  pan under  the
bed, as  it has the power of absorbing noxious
gases, or saucers containing solutions of  car-
bolic acid may be placed about the room.
  FIBRIN is a constituent of healthy blood ;
when blood is drawn from  the body it sepa-
rates into  a  clot  and an opalescent  straw-
colored  fluid ; the clot is mainly formed of
fibrin, holding in  its meshes  the red  blood-
corpuscles, which give it the  dark color.  It
is composed chemically of carbon, hydrogen,
oxygen,  and nitrogen.   It is sometimes found
during life in  the veins or arteries of the body,
and may then give rise to clots in the vessels,
forming emboli or thrombi.   Later researches
seem to show that fibrin is composed of two
bodies,   called  respectively fibrinogen  and
fibrino-plastic globulin,  or  simply globulin ;
coagulation of the  blood will not occur unless
both these bodies are  present.   (See Blood.)
  FD3ROUS DEGENERATION.   (See
Degeneration.)
  FIGS are the ripe fruit, or  rather inflores-
cences of the  fig-tree.   In medicine they are
not much employed.   They are supposed to
have  a  slight laxative effect,  and ate con-
tained in the confection  of senna.  Split open
and  heated they have been used from time
immemorial as a poultice to  boils .and such
like sores. Now they are rarely used  for such
purposes.
  FILTERS are  used  for  purifying  water
for  drinking  purposes.  The water of  our
rivers and ponds contains a varying amount
of inorganic and organic matter, and since
the  presence  of  the latter is often  attended
with most  injurious  effects,  it is necessary
that careful measures should be taken to rid
the water of these  impurities.  Rai-r  water
and melted snow are very pure, and may be
collected in clean vessels and  drank with im-
punity. Spring water often contains lime salts
which render it " hard," and it will not then
form  a lather with soap, and is  therefore not
useful for domestic purposes ;  such  water
may,  however, be  taken  without  injurious
effects, although, if  the lime  salts are very
abundant, a form of goitre or large neck may
come on.   But the case is different when the
surface drainage manages to find its way into
a well, for then organic matters enter and may
give rise to typhoid fever and other diseases.
The water supply from  wells  is by no means
adequate  to the  quantity required daily in
large  towns, and therefore  it is usual to col-
lect water from  an adjacent  river into large
reservoirs, and then pass it through filters for
the sake of purification.  Various kinds have
been  proposed.   On a  large scale water may
be received into  large  reservoirs, and then
the heavy substances  will  settle,  while  the
rest may pass through gravel  or sand.   Pure
animal charcoal is now considered the best
filtering material.  It should be deprived of all
the lime salts by washing it  in hydrochloric
acid.   The particles of the charcoal should
be well pressed together, and the water must
not pass  through too  quickly.    This sub-
stance removes in a great measure dissolved
organic and mineral matter,  as well as the
suspended particles ; it  also takes away the
color, so as even to make a muddy water quite
clear  and  bright.   It is said  that the  power
which charcoal has of removing organic mat-
ter is  lost after a time,  but this power is re-
stored by washing the filter with a little  potas-
sium  permanganate.   Charcoal also appears
to exert an oxidizing change on organic mat-
ter, and converts it partially  into  nitrites.
Vegetable and peat charcoal are both inferior
to animal charcoal.    Magnetic  carbide of
iron, manganic oxide, silica and charcoal may
all  be used  with  much benefit.  The  filters
used  at the present time for domestic pur-
poses are  generally made of animal charcoal
or  magnetic  carbide of  iron  pressed into
blocks, and these can be relied on.  As there
is a limit to all purifying power, the action of
all  filters  is only temporary.   The various
substances which have  been  removed, accu-
mulate and block up the filter, and therefore
the filters should be taken  to pieces  and
cleaned every two or three months,or a dilute
solution of potassium permanganate may be
passed through to get rid of the organic mat-
ter, and then a little  weak hydrochloric acid
to  remove the lime salts, then pass  through
two or three gallons of distilled water, and the
filter will be quite fit for use again.   When a
new charcoal filter is used, the water which
first passes through should be  rejected, as the
substance  of which  the filter is   composed
gives  off  some substances  to the water ;  a 
1G2
FINGERS
FINGERS
preliminary washing is therefore needed.  A
pocket filter is useful for soldiers, or for those
who are travelling in  a country where fresh
pure water is not easily obtained.   These are
usually of the siphon kind, and made of hol-
low blocks of charcoal, the water filters from
without into the central cavity,  into which  a
tube  opens and the  purified water may be
drawn off.   In hot countries it is often  very
rash for people to drink from the stream ;  a
common plan for purifying the water is to have
two barrels of different sizes, one within the
other ; the outer one is pierced  with holes at
the bottom, and the inner one at the top ; the
space between is filled  with charcoal and sand,
through  which the water percolates into the
inner cask.  Water should be boiled first, and
then allowed to cool, or tea may be made and
the cold tea saved for  the next day ; this is a
very refreshing drink.   When the water sup-
ply is very short, advantage  should be taken
of every rainfall ; salt or brackish water should
be  distilled, as is  done at Iquique and other
tropical  places on  the west  coast of South
America. In a running stream, men and cattle
should  be  watered at different places,  the
former above the latter ; all washing should be
done lower down the stream, and the excreta
must  not  be   allowed to contaminate  the
drinking water.  By adopting ordinary pre-
cautions, and making use of  charcoal niters,
much disease may be prevented ; such filters
should be used on board ships, unless there is
an efficient apparatus for distilling the water.
  FINGERS. — Supernumerary Fingers. —
This congenital malformation which is called
polydactylism is often  hereditary and in most
instances affects, to an equal  degree, both
hands.  The most common form  consists in
a small though well-formed and unmistakable
digit springing from the root  of  the fourth or
little finger at the inner side of the hand, and
attached by a fold of skin.   An additional
digit is sometimes met with  springing from
the outer side of the thumb.  The presence of
a supernumerary finger furnished with a long
metacarpal bone is a very rare  event.  Two
cases are on record in which a double hand
existed. These  irregular fingers are most fre-
quently useless  deformities,  and  cannot be
moved at the will of  the individual, though
sometimes they are furnished with a distinct
tendon, and  tolerable use may be  made of
them.  The adjacent normal digit  is almost
always  reduced in size.  As supernumerary
fingers form unpleasant objects, and are gen-
erally in the way when the  child grows up
and  begins  to  use the hands,  the surgeon
usually advises their removal during the pe-
riod of  infancy,  and  while  the   abnormal
growths are still small.
  Absence or Defective  Development of one or
more  fingers is sometimes met with, though
much less frequently than the previous condi-
tion.   It will be obvious that in cases of this
 kind nothing in the way of treatment can be
 done.
   Webbed Fingers.—In this condition  the
 fingers, instead of being free and isolated, are
 bound together.  This is a congenital deform-
 ity which usually affects  both  hands sym-
 metrically, and in the same patient the toes
 almost always are similarly affected.   This
 deformity is due to persistence of a foetal con-
 dition  of the digits which  is  present at the
 second month of  intra-uterine life.   A con-
 dition somewhat similar is sometimes observed
 as a result of severe burns  or scalds of the
 hands, but in  cases of this kind  the affected
 fingers are surrounded by scar-tissue and not
 by true and sound skin.  In congenital web-
 bing of the fingers the extent of the deformity
 varies  greatly in different cases.  The fingers
 may be bound together alcng their  whole
 length, or only as far as the first or second
 joint.   The union between  the fingers may
 be very close, or they may be with intervals
 occupied  by true  webs, which cause the de-
 formed hand to resemble the extremity of an
 aquatic animal. The operative treatment of
 this  deformity though  not  dangerous is at-
 tended with much  difficulty.  Simple division
 of the web is  quite useless, as the fingers al-
 ways grow together again.   This result may
 be obviated by passing some foreign body
 into the cleft  while the wounds  are  closing
 by granulation, or  by passing a piece of metal
 or an elastic band through  a small  perfora-
 tion made at the upper and narrowest part of
 the web, and then  after three or four weeks,
 when the margins of  this orifice have cica-
 trized,  along the whole length of the web.
   Congenital   Contraction.—This  deformity
 rarely implicates more than one finger.  It is
 due  to deficiency  of  integument, in conse-
quence  of which  the finger is bent forward
 toward the palm.   When an  attempt is made
to straighten the finger, a tight ridge of skin
starts up along its  concavity.   It is important
to distinguish  this  congenital deformity from
the following similar condition which is pro-
duced in adults in  consequence of contraction
of the fibrous structure in the palm of the
hand.  The  congenital  affection may gen-
erally  be treated  successfully  by prolonged
and continuous extension of the abnormally
placed  digit.
  Acquired Contraction of the Fingers is often
met with in adult males as a consequence of
increasing rigidity and shrinking of the palmar
fascia and other fibrous tissues that intervene
 between the muscles of  the  palm and the in-
 tegument.  These changes in the tissues of
 the palm are supposed to be due either to vio-
 lent blows or to long-continued pressure ; and
 this  view is  supported by  the fact that the
 affection in question is often observed in navi-
 gators,  gardeners, carpenters,  and  those
 whose  employment  necessitates much com-
 pression of the palm.   The  finger mostTre- 
FISH, AS FOOD
FISSURE OF THE ANUS   163
 quently contracted is the ring finger, and next
 the little  finger.   When  the ring finger is
 affected the middle and  little fingers become
 implicated sooner or later, though  not to the
 same  extent.  The thumb and  index finger
 are never affected.  The  contraction comes
 on gradually, the patient at first experiencing
 some  stiffness in  the knuckle-joint.  The
 finger is then  turned  forward and cannot be
 raised, and after a time the adjoining fingers
 also become stiff and bent.   When the affec-
 tion is well marked the finger is bent forward
 at the  knuckle-joint, while at the second and
 third joints  it is free  and  movable.   The
 flexure of the distorted finger is  occupied by
 a prominent and curved  fold of skin under
 which can  be felt a tense hard band of the
 contracted fibrous tissue.  This band is tense
 and rigid, and  prevents the finger from being
 straightened.   In  a case observed by Dupuy-
 tren a weight  of  150 lbs.  did  not  bring the
 bent finger into a straight line with its meta-
 carpal bone.   The patient is unable to grasp
 large bodies, and experiences much pain when
 he attempts to move the fingers.   This de-
 formity cannot be relieved save by a surgical
 operation.  This consists in dividing the skin
 longitudinally along the summit of the fold in
 front of the bent finger, in dissecting this back,
 and then in cutting across the exposed fibrous
 cord.
   Broken Fingers.   (See Fractures.)
   Tumors.—The bones of the fingers are the
 most frequent seat  of  cartilaginous tumors.
 These form  hard rounded growths  which
 commence in childhood or youth,  and con-
 tinue to grow slowly for  twenty-five or thirty
 years.   Several of these tumors are  often col-
 lected on one hand, and thus cause  much de-
 formity and render the extremity quite  use-
 less.  For descriptions of other Affections and
 of Injuries of the Fingers, the  reader  is  re-
 ferred to articles on Nails, Whitlow,  Frac-
 tures, and Dislocations.
  FISH, AS FOOD.—The  class  of  fishes
 yields a larger number of species used as food
 by man than either birds or quadrupeds. • In
 some countries the  only animal food known
 is fish.   The flesh of fish contains less  nitro-
 genous  matter than that of birds and  mam-
 mals.  It usually contains less oil or fat, and
 a larger quantity of mineral matters. Fish is
 not so digestible as butchers' meat, and  there-
 fore not so  nutritious.  The muscles of  fish
 contain  in larger quantities than other  ani-
 mals a principle called creatin, which also ex-
 ists in  human muscles, and which  seems to
 act favorably on the human system. It  is un-
 doubtedly a valuable as well as  an agreeable
 article of diet, and should, where possible, be
 introduced into all dietaries.  Fish, when unfit
 for  human  food, acts as a valuable manure.
 The skins of eels, soles, etc., may be converted
 into gelatine  Many are used for obtaining the
oil which they possess, and this is especially
 the case with the menhaden and the cod.  The
 livers of the latter yield  the  well-known cod-
 liver oil.
   FISH,  POISONOUS.—That   a certain
 number of fishes are poisonous  is not to be
 denied, but  the exact causes of their giving
 rise  to  symptoms  of poisoning  are  by  no
 means clear.   Various  tropical  fishes are
 poisonous at all times,  but in this  country
 shell-fish,  as they are called, which at one
 time are undoubtedly wholesome, at others
 have  given rise  to  poisonous  symptoms.
 Chief among these  are  mussels, and  it has
 been assumed by some that, those which have
 given rise  to the  poisonous symptoms have
 been fed on or otherwise absorbed poisonous
 materials,  as from the copper on  ships' bot-
 toms, but of this there is no proof.  The symp-
 toms produced  are  the  same in  almost  all
 cases ; they  are the symptoms of slight irri-
 tant poisoning. Sickness and vomiting, some-
 times with purging and marks of prostration,
 are  those  commonly observed.  These  it is
 not desirable to interfere with, but rather  to
 promote until all the irritant matters have
 been expelled.   After this a  slight  cordial or
 carminative draught, with a little iced  water,
 a little brandy and  soda water, or such like.
 to  compose  the stomach,  when  the patient
 will probably go  to sleep and awake  well.
 Luke-warm  water  or  mustard  and  water
 should be  given to  aid the vomiting.  Oc-
 casionally  rashes  on the skin are observed,
 but these require no  treatment.
  FISSURE OF  THE  ANUS is gener-
 ally a long and  shallow ulcer situated either
 within or on  the verge of the anus.  In most
 cases it is  met with on the posterior wall of
 the anus in the median line of the body, oc-
 casionally on one  side, very rarely in front.
 In about nine tenths of the cases it is seated
 at the posterior verge of  the anus.  It occurs
 much more  frequently  in  women  than  in
 men. The  symptoms caused by this affection
 are considerable  irritation  about  the anus,
 and  severe scalding pain  with a throbbing
 sensation which comes on  immediately after
 an evacuation, and gradually increases in in-
 tensity, and continues for some two or three
hours.  The  suffering in most cases is very
acute, and  cases have been known in  which
patients  had nearly  starved  themselves  to
render the  occasions  for emptying the rectum
less  frequent.  After the pain  has lasted for
about three hours  it gradually subsides,  and
the  patient  remains quite free from pain until.
the  next evacuation.  The general health  at
last becomes .affected by the repeated attacks
of pain, and the patient becomes weak, indo-
lent, and sallow. There are often dull, heavy
pains in the loins and groin. On local exami-
 nation a small red  fissure  will generally be
found just on the verge of the anus ; this ex-
tends upward along the mucous  membrane
of the rectum and measures from the sixth  of 
164            FISTULA
FLATULENCE.
an inch to half an inch in length.  The ulcera-
tion  but seldom implicates the whole thick-
ness of the mucous membrane.  The edges of
the ulcer are generally smooth  and level, but
in advanced and  very bad cases  they are
thickened and elevated. The outer extremity
of the fissure is often covered by a small lump
of thickened skin, or by an external pile. The
causes of anal fissure are constipation and di-
rect irritation of the mucous membrane of the
return by purulent discharges, or by the con-
tact of foreign bodies.  It has been stated that
the unskilful administration of injections,espe-
cially with pointed rough  pipes, is  often  the
cause.   It remains doubtful whether the vio-
lent  spasms of the sphincter or  constricting
muscle of the anus which gives  rise to the in-
tense suffering after evacuation of the bowels,
be the cause or the effect of the  ulcer.
  Treatment.—The  palliative  treatment of
this affection consists in the administration of
sedative injections, and rest in the recumbent
position.  The  patient  should  take a  small
dose of castor oil every morning, and pass the
evacuations over hot water.  The application
of solid nitrate of silver (lunar caustic) or sul-
phate of copper will often produce a perma-
nent cure.   In most cases, however, the sur-
geon finds it necessary to advise an operation
in which the base of the ulcer with more or
less of the muscle below is divided bv the knife.
  FISTULA is a narrow channel or tube lead-
ing to  a cavity  containing matter or  dead
bone, and lined with a membrane which se-
cretes  a puriform fluid.   The  fundamental
cause of fistula is abscess, and  the  reason of
the  unhealed tract is  an  unhealed  abscess,
where proper outlets to the discharge have
not  been  made, or  where some  " foreign
body" intervenes, such as  a piece of dead
bone.  They usually exist in connection with
the rectum,  urethra,  salivary  glands,  and
bladder.  With regard to treatment, all sources
of irritation must  be  removed.   If matter
forms, it must be let out by what is termed a
" counter opening," and the " fistulous tract"
stimulated to healthy action by  some such an
injection as a strong solution of nitrate  of sil-
ver,  or nitric acid.  The operation of slitting
up fistulae must be left to the physician.
  FITS.—A person  may have  a fit from sev-
eral  causes ;  thus,  he may fall  down and
struggle violently, as in  an epileptic  attack
(see  Epilepsy) ;  or he may fall down in a
state of  intoxication (see  Drunkenness) ; or
he may become insensible and have an apo-
plectic stroke (see Apoplexy).  An hysterical
woman may have  a  fit  and be  for a time un-
conscious (see Hysteria) ;  or a fit may occur
in the course of Bright's  disease, or in some
disorders of childhood.   A " fit" is  a term
popularly applied to any condition in which a
person suddenly falls  down insensible,  and
has convulsions or not; but as so  many dis-
eases are associated with the so-called " fits,"
the reader must  refer  to  the  above-named
articles, and also to Coma, Convulsions,
and Syncope,
  FLANKS, a term corresponding to the
lumbar  regions, on either  side of the abdo-
men.  (See Abdomen.)
  FLANNEL, though  not strictly speaking
a remedy, is one of the most valuable means
for preserving health  we possess.  Its  great
virtue consists in  that  it prevents  the  body
from being  too rapidly cooled  after being
greatly heated.  Flannel  is a non conductor of
heat, even when saturated  with perspiration,
and  so  prevents the  heat  of the body from
being wasted in evaporating the fluid after
the body  ceases to generate excessive  heat.
For similar reasons, an  individual clothed in
flannel will be able to resist exposure to cold
and wet better than one clothed in a better
conducting material.  Such exposure, as we
well know, is a frequent cause of rheumatism,
and one attack of  rheumatism almost invari-
ably predisposes the individual to a second
attack.  It is, therefore, a good rule for indi-
viduals  who have once suffered from  this
malady, never  to  go  about without flannels
in future.  This is true, even in  summer, for
it is better to  risk a little  extra perspiration
than to  run the risk of a sudden and excessive
cooling, which would be apt to bring back the
disorder with  all  its  attendant  evils  and
dangers.  Those, too, in whom the  chest is
weak  should invariably wear  flannels, espe-
cially when they go abroad in winter.
  FLAT-FOOT is said to exist when a per-
son treads on the inner margin of the foot, the
toes are turned out and the arch of the foot
destroyed, and its  cause is  a general want of
tone in  the fibrous structures.  In a slight de-
gree it is common  in young children, particu-
larly females, in the upper  classes, and can be
greatly remedied by reducing their  standing
and walking, the avoidance of fast walking in
the company of adults, tonics, attention to di-
gestion, embrocations,  and manipulation of
the feet,  so that  inversion and contraction
may be prevented.  Laced boots,  or  boots
with stiff leather  sides, a  cork, india-rubber
or felt pad under the inner  margin of the foot,
greatly  assists in preserving the arch.  It will
be  noticed  that opera and ballet dancers are
frequently  the  subjects  of this deformity,
owing to the practice, easily taught, of stand-
ing upon  the toes, so that the calcaneo-cuboid
ligaments, or  the plantar fascia,   naturally
designed  for the preservation of the arch, be-
come preternaturally stretched and give way.
Relief is  more easily attained  in  the child
than in the adult.
   FLATULENCE, or the undue collection
of gas or air in the stomach or bowels, is an
exceedingly troublesome symptom.  Its accu-
mulation  may be brought about in various
ways.  It  maybe swallowed, it maybe formed
from the food, or it may  be apparently se- 
              FLATULENCE

 /reted from the  wall  of  the stomach  and
 bowels.  It is a common and exceedingly un-
 pleasant symptom of indigestion (see Indi-
 gestion), sometimes very hard to get rid of.
 It is  also a very troublesome symptom in
 other diseases  affecting the bowels and ab-
 dominal cavity.   In  a very great number of
 instances  flatulence is due to improper food,
 or the abuse  of certain articles of food, es-
 pecially tea.  Certain substances have a com-
 mon  reputation of being windy, and doubt-
 less in certain instances, not without reason,
 though in others the  accusation  is altogether
 unfounded.    The symptoms  produced  by
 flatulence are often  exceedingly unpleasant.
 There may be a feeling  of faintness, of giddi-
 ness,  or  of  choking,  accompanied by most
 troublesome belching.    The gases thus ex-
 pelled are most frequently tasteless and odor-
 less, and if so, are most probably due either
 to swallowing of air, or to  the formation of
 such simple gases as carbonic acid, or car-
 buretted  hydrogen,  at  the   expense  of  the
 food.   Such forms of flatulence, i.e., flatu-
 lence accompanied by tasteless belching, are
 best treated by dieting.mainly solid food with
 stale bread, a little dry sherry or weak brandy
 and water, but no vegetables, tea,  beer, or
 pastry.   Flatulence may often be the  only
 symptom of such  dyspepsia, and it  is often
 capable of relief by a slight stimulant, as aro-
 matic  spirits  of  ammonia, but  spirituous
 liquors should be avoided.   A little acid, or
 alkali with a bitter, is often of very great ser-
 vice, and nux vomica is an exceedingly  val-
 uable remedy in such cases.  Occasionally the
 patient is the subject of horribly nauseous
 flatulences.  He belches up gas of the most
 horrid odors,  disagreeable  to  himself   and
 every one round him.  These gases  indicate
 putrefactive changes in the  food, and com-
 monly occur in individuals  who have some
 obstruction  preventing  the  passage  of  food
 from  the stomach, especially if  the obstruc-
 tion be cancerous in its  nature.   In cases
 where there is such obstruction the stomach
 sometimes expands to an enormous size, and
 vomiting after  food  is  not  unfrequent.   In
 these  vomited matters are minute organisms
 called  Sarcincv,  and  these are supposed to
 have much to do with the development of the
 gas, just as the yeast fungus has in the for-
 mation of alcohol from starch and sugar with
 the evolution of carbonic acid.
  Treatment.—In  all such cases the  use of
 antiseptic remedies to prevent the putrefaction
 of the food is indicated,  and  they almost .in-
 variably do good.  The  two most important
 forms  of antiseptic remedies are carbolic acid
 and sulphurous acid.  Carbolic acid may be
given  in the dose of one or  two  drops  in a
wine-glass of water, half  an  hour after food.
 Its taste is sonjewhat disagreeable, but  it. is
exceedingly efficacious. Sulphurous acid may
be given in the same way, thirty drops of  the
        FLOWERS OF SULPHUR   165

 diluted acid in  a wine glass  of  water, or  it
 may be given as sulphite or bisulphate of soda,
 To the former of these most people will give
 the preference,  as  its taste is that of a pure
 acid ;  the taste of the other is  far more bitter.
 Flatulent accumulation in  the intestines may
 be due to any of the foregoing causes, but es-
 pecially to putrefaction of  the food, and ap
 parently in certain  cases to secretion of gases
 from the  vessels in the walls  of  the gut.   In
 children the  other  variety  is not uncommon,
 especially if  they have been  allowed to suck
 empty bottles or breasts, their thumbs, or the
 like, and  they are  fruitful  sources of gripes.
 (See Colic.)  Flatus  in the  intestines often
 gives rise to very great pain, and the patient
 urgently demands  relief.   This  can only  be
 cbtained  by  dispersing the  wind,  as  it  is
 called, which is  not always an easy task.   In
 most cases  it is vain to expect  to do so up-
 ward,  and so we  must try to do  so down-
 ward.    Perhaps the best remedy for  this
 purpose,  if it can  be  borne, is turpentine.
 It tends, however,  to upset the stomach, and
 so it is better given as an injection.   If given
 by the mouth,  about a drachm should be
 given  for a  dose,  if  as an injection half  an
 ounce or so, beaten up with an egg  in a pint
 of hot water.  At  the same  time, turpentine
 applied in the form of stupe  to the  abdomen
 is likely to give  great relief to the suffering.
   FLOATING TUMORS   is a  term  ap-
 plied to the singular, hard  and very movable
 lump which is sometimes observed in the ab-
 domen, generally on the right side.   In most
 instances the patients are  women.   No pain
 is complained of, but only an uncomfortable
 sensation due to the movements of the lump.
 Sometimes there is obstinate indigestion. On
 examination of  the floating tumor it will be
 found  to be smooth, very firm, and generally
 of the size  and shape of a  healthy human
 kidney.   It is very loosely attached, and can
 be moved over a  considerable  extent, both
 between the ribs  and the  haunch bone, and
 from side to side.  The nature of this tumor
 has never yet been clearly made out.  From
 its shape and consistence.it has been supposed
 to be a kidney, which in consequence  of  its
 loose  attachment  to  the  spine  by  fat and
 membrane, and  of  elongation of  its- vesselSj
 has  become freely movable.   It is probable
 that in some cases  it is an ovarian cyst.  It is
 held by some authorities  that the  so-called
 floating tumor  is nothing more  than a harT
 dened  mass  of  faeces, or some firm body in
 the intestinal canal, or, in some rare instances^
 a large concretion  lying loose in the abdom-
 inal cavitv.
  FLOODING. (See Labor and Ergot.)
  FLOWERS  OF SULPHUR  is  a  well-
known form of  that substance  obtained by
heating the  crude  substance, converting  it
into  vapor,  and afterward  condensing  the
vapor in a cool  chamber.   This  resembles a 
166         FLUCTUATION                                 FLUX
very fine powder, but minutely examined it is
crystalline.  (See Sulphur.)
  FLUCTUATION implies  the  wave-like
movement imparted to  the hand when there
is any accumulation of fluid  in  a part ; it is
often very  marked in cases  of ascites, and
when an abscess is forming.
  FLUDDS, ATOMIZED, though recently
introduced  into  practice,  have  already be-
come one of the standard and most frequently
employed means of treating  certain diseases
at our disposal.   They  are commonly em-
ployed in the  treatment  of  diseases  of the
nose, mouth,  throat, larynx,  and windpipe.
Occasionally,  too,  for those  of the  lungs.
They are of course  all the more valuable, the
more difficult the spot is to reach in any other
fashion, and there is hardly any other way in
which we can reach the larynx and windpipe.
The principle on which the fluids  are atom-
ized, as it is called, is tolerably familiar to all,
in the shape of a toy for dispersing perfume
in a room ;  one end of a glass tube is intro-
duced into  a  bottle containing perfume, the
other end being drawn to a very fine point.
Another and similar tube is arranged and fas-
tened at right angles to the former, so that its
fine point terminates  close to  arid just above
the level of the fine point of the  tube ending
in the perfume.  If now, one  blows through
the tube at right angles to the bottle, the force
with  which  the air is driven from the fine
point across the fine extremity of the other,
creates  a partial  vacuum,  in which  it draws
the fluid to  the top.  Thence it is  dispersed
in spray in the line of the current of air
driven from the mouth.   Of course this plan
of driving by the mouth would be objection-
able in practice, and so two kinds of appara-
tus  have been invented :  one, in which steam
is driven through a narrow orifice instead of
air, the fluid being drawn up from  the bottle
containing it  as before.   Another is  em-
ployed where the air is driven by means of a
hand ball made of india-rubber.  This, which
is attached to the transverse tube by an elas-
tic  tube  of  convenient length, has  at either
extremity a valve which prevents the air from
flowing except in one direction.  When com-
pressed by the hand, the air is driven through
the tube and atomizes the fluid ; when the
hand ceases to contract, the elasticity of the
ball causes it to expand again, drawing in the
air  by its open extremity.  The fluids best
adapted for  use in this way are nitrate of sil-
ver in good strong solution, from  3 to 5 or
more grains to the ounce  of  distilled water.
This  must be kept in a stock bottle, covered
over with paper, and only a little poured into
the bottle for use  as required, otherwise  it
speedily  decomposes and becomes useless.
Sulphurous acid of pharmacopceial strength is
a most valuable remedy,  administered in this
way.   Tannic acid, 20 grains to the ounce, is
also very valuable.  Lime-water  of pharma-
copceial strength or saturated liquor, or liquor
ferri perchloridi of pharmacopceial strength
are excellent in their several ways.  The dis-
eases best treated by means of the spray pro-
ducer are, 1st, those of the cavity of the nose ;
frequently, for instance, after scarlet fever,
there remains a tendency to the formation of
purulent matter in the  upper part  of the nasal
cavity.  This may go on to destruction of the
bones of the nose,  and the matter discharged
has got a terribly foetid odor.  Smell is often
completely and irretrievably lost if the process
goes on  too long  unarrested.  For this and
all  similar  disorders  of  the nose,  a good
strong spray is the best remedy ; it softens and
breaks down the hardened masses, which form
troublesome  crusts,  and after a time brings
them away.  This done, a bare surface is ex-
posed to  the spray, and healing follows. The
best fluids for this condition are  sulphurous
acid and  nitrate of silver.   If the mouth can
be opened widely, it is often better to make
use of stronger appliances than the spray, but
where  the  mouth cannot  be opened, and its
cavity is  diseased,  it is  invaluable.  The dis-
eases it is mainly used  in are tonsillitis and
diphtheria, and  syphilitic  affections  of  the
throat beyond the fauces.  For these sulphur-
ous acid  or nitrate of silver is best, but lime-
water tends  to soften  the  patches of false
membrane in diphtheria. For regions beyond
these, there is hardly any means of treatment
equal to the spray.  Inflammation of the lar-
ynx, whether of a common kind or  due to
tubercular or syphilitic states of the constitu-
tion, can hardly be treated  in any other way.
It is true that the skilled physician, with  the
help of the laryngoscope can reach them,  but
the spray ball anybody can use.   When there
is ulceration, chloride of silver solution is per-
haps the  best remedy ; if only inflamed, sul-
phurous acid may be tried ;  if cedematous,
perchloride of iron will do  good. The gen-
eral symptom, hoarseness and loss of  voice,
may often be relieved by  using hot  vapor
spray  (see Vapors).   In certain  diseases of
the  lungs the same  apparatus may be em-
ployed, with this additional precaution, that
the patient must be made to inhale or inspire
deeply, that is, take a long  breath at the mo-
ment the spray is  playing into  the  throat.
But as this would cause violent  coughing or
spasm of the entrance  to the windpipe, were
the spray  very irritating, only mild applica-
tions must be used. The diseases most likely
to benefit in this way are croup,  as it affects
the windpipe, bronchitis, and phthisis, if the
lungs are  affected.   The preparations thus
made use  of must be  carefully  adapted for
each case.   Plain  hot water will,  however,
very rarely do harm.
  FLUX implies a flow of fluid ; thus, when
the stools are very liquid,  in some cases vi 
FOZTICIDE
FOOD
167
 diarrhoea, the patient is said to have a watery
 flux ; or a bloody flux when blood flows from
 any cavity of the body.
   FOETICIDE  signifies  killing the  fcetus
 while yet in the mother's womb.
   FCETUS  is the name  given to the child
 when in the womb.
   FOMENTATIONS are warm lotions ap-
 plied to diseased parts, by means of flannels.
 The pieces of flannel or blanket should first
 be cut  to the required size, and then soaked
 thoroughly in water just hot enough  to  be
 grateful to the patient ;  repeating  the pro-
 cess as often as may be required.
   FOOD is the term applied to all those ma-
 terials consumed by man, and  which are em-
 ployed  by the body to build up  its  fabric
 during  growth, and renew the tissues which
 are lost during the performance of the func-
 tions of life.   What fuel is to a fire, food is to
 the body. As fire transforms the fuel into
 other compounds which it throws off, so the
 body transforms  food into other substances
 during  its vital activity.  In the same manner
 as a fire diminishes as the fuel  is diminished,
 and goes  out without fresh fuel, so the human
 body wastes  with insufficient food, and dies
 from its absence.  If a man is weighed  with-
 out taking food, it will be found that he grad-
 ually weighs lighter.   The  muscles which
 enable  him to sit or stand, the heart which
 circulates the blood, the brain that enables him
 to think and  become conscious, are all con-
 suming the materials which he has taken  as
 food.  Just in proportion to the  work a man
 has to do  is the amount of food he consumes.
 The laborer  who digs all  day on a  railway
 consumes more food than the  tailcr  or  shoe-
 maker.  The  housemaid who  is on  foot all
 day eats  more food than her  mistress, who
 sits in the drawing-room all day.  Not only do
 those who work  hardest  require most food,
 but just in proportion to the extent of the ap-
 petite and the  vigor of the digestion will be
 the ability to  perform hard work.  As it  is
 with muscle-work, so  it is with brain-work.
 The hard  student consumes more food than
 the idle man who lounges about all day with-
 out troubling  himself to  think.  Food is,  in
 fact, taken in order that we may live, and all
 the great results of our lives depend upon the
 conversion of the materials taken as food into
 the forces which  make our muscles to con-
 tract, and our brains  to conceive, think, and
 will.  The ultimate elements of the food we
 take are precisely similar to the ultimate ele-
 ments of the human body.  (See Composition
 of the Body.)    The  principal  elements
 which enter into the composition of the human
 body are  carbon, hydrogen,  nitrogen, and
 oxygen.   These  elements are sometimes
 called organic elements, because they  enter
into the composition of all the growing tissues
of the animal body.  It is principally through
 the chemical relations of these  elements that
 we find the functions of the body carried on.
 A human body  weighing 154 lbs. is found to
 contain
                                lbs. oz.
     Oxygen.........,................. m o
     Hydrogen................ ........  14 o
     Carbon..........................   21 o
     Nitrogen..........................  3 10

   The other elements which enter into the
 composition of the body are called inorganic
 elements.   They  consist  of   phosphorus,
 sulphur,  chlorine, fluorine, calcium,  sodium,
 iron,  potassium, magnesium, silicon.   The
 compounds containing these elements weigh
 about 5  lbs. 10 oz.   Although in such  small
 quantities,  they are none  the less important.
 They are wasted during the processes of life,
 and unless  supplied, disease is produced. For
 example, one of these  compounds is phos-
 phate of  lime, and it is  well known  that un-
 less food containing phosphate  of lime is
 supplied, rickets and softening of  the bones,
 which contain phosphate  of lime, comes on.
 Many of these  compounds contain the or-
 ganic elements ; thus, in  the ashes of  a hu-
 man body weighing  154 lbs. there is found 7
 lbs. 9 oz., of ashes, which contain mineral com-
 pounds.  These compounds consist of phos-
 phates,  sulphates, carbonates,  chlorides and
 fluorides of lime, potash, soda, magnesia, and
 iron.
  The compounds of the body in which the
 organic elements exist, and their weight in a
 body weighing 154 lbs.,  are as follows :
                                  lbs.  oz.
   Water, containing oxygen and hydrogen.m  o
   Gelatine,  containing the four elements... 16  o
   Albumen    "        "     "... 4  3
   Fibrine     "             "... 4  4
   Fat, containing carbon and hydrogen.... 12  o

   Water is  found  everywhere  in the body ;
by its agency all other  substances are taken
up into the system.   All  food  must contain
water, and  it is only by  being dissolved in
the water that the  other  substances can  be
used as food.  The  quantities of water found
in 100 lbs. of different kinds of  solid food are
as follows  :
             Vegetable Food.
                                   lbs.
    Potatoes.............................. 75
    Carrots................................ 80
    Parsnips ............................. 79
    Mangel Wurzel....................... gj
    Cabbage............................... 93
    Flour................................. 14
    Barley  meal........................... 14
    Oatmeal .............................. 13
    Indian  meal.......................... j4
    Rye................................. 13
    Peas................................... i4
    Rice.................................. J3
    Beans................................ j.
    Bread ............................... 44
    Cocoa.................................  -
    Lentil*............................. j4
    Buckwheat............................ 14 
168
FOOD
FOOD
               Animal Food.
                                  lbs.
     Milk.................................86
     Bacon............................. -3°
     Veal................................62
     Beef..................................  So
     Lamb................................  5°
     Mutton................................  44

  Thus, whether we take water or not in ad-
dition to our solid  food, we  find  that large
quantities exist there.   This will explain why
it is some articles of food require more water
when eaten than others.   Thus  it will be
seen that while potatoes contain 75 per cent
of water, rice and oatmeal contain  but 13 per
cent.   Among  animal  foods,  while milk
contains 86 per cent of water, bacon contains
but 30 per cent.  In the purchase of food, the
above facts  should  be kept in mind.   Thus,
as far as solid food is  concerned, a pound of
rice  at  fivepence would  be cheaper  than  a
pint of milk at a penny.
  Fat is a  very important constituent of the
body ; it is found diffused  around all the  tis-
sues.   It is the fat that gives  roundness and
plumpness to the body.  When it is deficient
persons are said to be "thin" or "lean."
When people weigh above their weight (see
Weight and HEiGHT),it usually arises from
a deposit of fat.  In wasting diseases, as con-
sumption and scrofula, the wasting arises from
the loss of  the normal fat of the body.   In
such cases it  is usual to recommend  a fatty
diet, and cod-liver or other animal oils (see
Cod-Liver Oil) are given.
  Albumen and Fibrine are two constituents
of the body which contain the four organic ele-
ments.  Albumen differs from fibrine chemi-
cally but very slightly.  It is, however, solu-
ble  in water, and easily separable from it by
heat, alcohol, nitric and other  mineral acids.
It is found  dissolved  in the  blood, where it
exists in the proportion of about four  per
cent.   It constitutes the chief compound of
nerve-matter,  out  of  which the  nerves  are
formed.   It enters into  the composition of
the eggs of all animals. Its property of coagu-
lating  when boiled, forming the " white" of
the egg, is well known. Fibrine is found in
small quantities in the blood, but is principally
distributed over the body, of the muscular tis-
sues of  which it constitutes a large proportion.
  When fibrine and albumen have  performed
their duty, and are  about to leave the body,
they  appear to be converted into gelatine.
This  substance  is  much  more conspicuous
in the  human body than either albumen or
fibrine.  It constitutes the cement of the bones,
and is  the  substance out of which  the cell
walls of all the tissues of the body are formed.
It is the waste of these substances that ren-
ders food necessary.  They do not, however,
waste with  equal  rapidity.   Water  passes
away most  rapidly.  This is  necessarily the
case. A man sometimes drinks in ten days as
much  water as there is  contained  in  his
whole body.  The water passes away by the
lungs, the skin, the kidneys, and the bowels.
The fibrine  and  albumen  pass  away  less
quickly than water.  Then come gelatine and
fat.  Last, the mineral matters which are em-
ployed in constructing the tissues of the body
are removed.   Calculating  the quantity  of
material  removed daily, it would appear that a
period of forty days would suffice  for remov-
ing the whole of the used material of a human
body.  Consequently, a man  should  eat and
drink a quantity  of food equal to the weight
of his own body in forty days.   It is food that
must supply this perpetual waste of the tissues
of the body, and  the class of foods which
supply the waste  of  the fibrinous, albumin-
ous, and  gelatinous tissues are  called " flesh-
giving."   They all contain also the element
nitrogen   or  azote,  hence  they  are called
" nitrogenous or  azotized" foods.  They do
not, however, pass away from the body in the
form in which they go in.  They are thrown
off the body in  the form of a substance which
is  known by the  name of urea.  This com-
pound appears to be formed  in  the blood,
and is drawn  out of it by the kidneys and
then passed to the bladder, dissolved in  the
urine.  Urea is composed of the four organic
elements, and  undoubtedly  represents  the
form in which the nitrogen  is got  rid of.  But
there is another function of the body, for the
due performance of which food is necessary.
The functions  of  life are attended with the
development of heat and the  production of
force.    Although all food which  contains
carbon is capable of  aiding this function, yet
there is no doubt that some foods are better
adapted  for  sustaining  this  function than
others.  Heat is generated in an animal body
by the union of the carbon of  the blood with
the oxygen of the air.  The oxygen  is intro-
duced  into  the blood by the  agency of  the
function  of respiration, which  consists in the
taking into the lungs oxygen gas,  and  the
returning to the air carbonic  acid gas.  The
quantity  of  carbonic acid thrown out is pre-
cisely the measure of the quantity of carbon
consumed in the food and  the oxygen taken
from  the air.  This is the way in which the
carbon taken in with the food is principally
got rid of.   While the oxygen is uniting with
the carbon, an  increase of temperature takes
place, and the heat  of  the animal  body is
thus maintained at a given temperature. This
temperature is  different in  different animals,
but in man it is 980 by Fahrenheit's thermom-
eter. This heat is quite independent of exter-
nal temperature, and whether a man is ex-
posed to the heat of the equator or the cold of
the poles his temperature is  the same.  The
great agent by which this  is 'effected is the
skin.   The  skin  is copiously  supplied  with
blood-vessels which are distributed  over its
surface and are  influenced by the  external
temperature, so that when the temperature of 
FOOD
FOOD
1C9
 the air is great, the water in the blood is con-
 verted into vapor, and so delicate is the opera-
 tion of this structure that the temperature is
 always kept at the same  point, whether the
 atmospheric heat is great or small.  The food
 possessing this power of maintaining animal
 heat and force is sometimes called " heat and
 force-forming."   It  embraces  certain sub-
 stances not existing in the animal body, known
 by the names of starch and sugar.  It is quite
 impossible to estimate accurately the quantity
 of  food that  any individual ought to take.
 All the food that is taken is  not always  di-
 gested and made into blood.  Many of the ma-
 terials of food are not converted into chyle
 (see Digestion), and pass  off by the bowels.
 The following table is an attempt to estimate
 the quantity of  food  daily taken  into the
 stomach and  changed  during  twenty-four
 hours:

             FOOD ACCOUNT.
                 Taken in.
                   gases.                oz.
 Oxygen........................................... 24
                  LIQUIDS.
 Watei—                            oz. gr.
    In beverage.........................  68  o
    In food .............................. 25   o
                                  -----   93
                  SOLIDS.
 Flesh-forming—
    Fibrine................................  3'  o
    Albumen..............................  o 300
    Castine in cheese.....................  o 137
                                 -----    4
 Heat-giving—
    Starch................................ 12   o
    Fat and butter.......................   5   o
    Sugar.................................   2   o
                                 -----   z9
 Mineral matters.................................    1

                                       141

                Given  out.
                  gases.
Carbonic acid—                 oz. gr. oz.  gr.
   Carbon......................... 11  o
   Oxygen......................... 24  o
                            -------33    o
                 LIQUIDS.
Water— ^
   By Kidneys.................... 5r  o
     Lungs...................... 31  o
     Skin........................ 16  o
     Bowels.....................  5 237
                            --------  103  237
                  SOLIDS.
  Urea...........................  1200
  Mineral matter..................  1  o
                            --------2  200
                                    141    o
  This table must only be regarded as an es-
timate.   One pet of food-substances may be
substituted for another, and the quantity of
food taken may not be digested or taken into
the system.  The table  is drawn up on the
supposition that all the food taken in passes
into the blood, and is disposed of as indicated
  by the  substances  thrown out.  The proba-
  bility is that a large quantity of the matters
  taken  in pass  through the bowels  without
  being  changed.    Persons  take food  very
  differently, according to age, height, occupa-
  tion,  climate,  and  season.   Children   and
  young  persons take  more in proportion to
  their size than adults, as their food supplies
  the material of growth as well as waste.  The
  height of individuals determines their weight,
  and according to the quantity of flesh and the
  waste is the necessity of supply. Persons em-
  ployed in sedentary and indolent occupations
  do not require so much food as those who are
  more  actively  employed.    Climate  also
  makes  a great difference in  the demand for
  heat-giving food. Those who live in cold cli-
  mates consume more heat-giving food  than
  those  who  live in warm and tropical  cli-
  mates.   The same  circumstances also influ-
  ence the form in which  the elements  of  the
 food are given out from the body.  The excre-
 tion of carbonic acid  is  greatly increased  in
 cold weather.   Water is also very variously
 got rid of by the skin, the kidneys, and the
 lungs', in proportion as the body is exposed to
 external heat or cold.  It is not all food that is
 taken  into  the stomach that  is  digestible.
 Mixed with  the  nitrogenous and  carbona-
 ceous  constituents  are  other  substances.
 Thus, the cell-walls of all plants are composed
 of cellulose.   This substance, though  appar-
 ently digested by many of the lower animals,
 is not digested by man.  It therefore  passes
 through  the bowels unchanged. Another sub-
 stance,  called gum,  is not absorbed  in the
 stomach or  bowels,  and therefore cannot be
 regarded as nutritious.   Some doubt has also
 been thrown  on the question  as to whether
 the gelatine so largely  entering into  animal
 food is taken  into the  blood and rendered a
 nutrient  agent.   At  any rate there is  one
 fact known, and that is that gelatine alone  is
 incapable of supporting the life of an animal.
 Perhaps  for the present it is better to regard it
 as a valuable accessory to our food  than as
 one of the assimilable and  necessary articles
 of food.    Besides  substances necessary or
 accessory there are a number of things taken
 as food  which are not necessary, or mixed
 naturally with nutritious food.  These sub-
 stances are mostly added by choice, or volun-
 tarily sought by man either  to gratify his pal-
 ate or to act upon his nervous system. These
 substances are called " medicinal" or " aux-
 iliary" foods.   Medicinal,  because they  act
 like medicines on  the system ; auxiliary,  be-
 cause they stimulate  the powers of the  stom-
 ach and  aid  in the  digestion  of  the  food.
 This class comprises such substances as alco-
 hol, volatile oils, tea, coffee, and tobacco.
  In order to get an  idea of  the various kinds
of food and the purposes they supply in  the
system, some  kind of  classification  must be
pursued.   The following table is supplied  in 
170              FOOD                                       FOOD
order to give a general  view of  foods and
their principal action.

       CLASSIFICATION OF FOOD.
   Class I.—Alimentary or Necessary Food.
Group i. Mineral.
       Examples.  Water, salt, saline constituents of
       plants and animals.
Group 2. Carbonaceous, respiratory, heat and  force-
  giving.
       Examples. Starches, sugars, fats, acids.
Group 3. Nitrogenous, nutritious,  or  flesh-forming;
  proteoids.
       Examples. Albuminous compounds, fibrine  of
        meat, caseine of milk.
          Class II.—Accessory Food.
       Examples. Cellulose, gum, gelatine.
   Class III.—Medicinal or Auxiliary Food.
Group 1. Stimulants.
       Examples. Alcohol, volatile oils.
Group 2. Neurotics.
       Examples. Tea, coffee, tobacco, opium.

  One of  the best types' of animal food  is
milk. It is supplied by the mothers of all ani-
mals  belonging to the group of mammals,
and is capable of furnishing all the materials  of
their  growth till they are several months or
years old.   It must therefore contain all sub-
stances necessary for the growth of the  body
and the maintenance  of its various functions.
The following is the analysis of cow's milk :

   Water.  ...     86.0 ( M;neral group.
   Mineral matter..   i.o|        fa  e
   Butter...........   3-5) Heat  and  force-giving-
   Sugar...........   4.5I   group.
   Caseine..........  5.0  Flesh-forming group.

                 100. o
  From this table it will be seen that with the
exception of the accessory group, every class
of food is  represented  in cow's  milk  (see
Milk).  The principal difference between the
diet of adults and that supplied by nature for
the young consists in the fact that  the diet
of the adult contains less water, and is sea-
soned with more or less of the group of ac-
cessory foods.
  We shall now speak of the various groups of
foods, as given in the above classification :
  1. Mineral Foods.—The importance of water
in this group is  at   once  evident, and  al-
though so large quantities ate found in all our
solid  food, it is necessary to add more for the
purpose of  dissolving all those constituents
which are necessary to the functions of life.
Although the group of heat-giving and  flesh-
forming foods are many of them insoluble in
water, they are  rendered so during the  pro-
cess of digestion.   (See Digestion.)  Starch
is rendered soluble by the action of the sa'.iva
of the mouth, by which it is converted into
sugar.  The proteoids are acted on by the
gastric juice, and are thus rendered soluble in
water.  The fats taken as food are decom-
posed by  the bile and pancreatic juice, and
converted into soluble soaps, which are readily
dissolved  by water and taken into the blood.
  Water is taken either cold  or  hot.   It  is
made into soups, tea, coffee, and chocolate,
by the infusion and  boiling in it  of various
substances.   Although  water is  taken cold
alone, or  with  alcohol, as wines  and  beer,
there is a general tendency to take this  liquor
hot.   The savage likes his solid and liquid
food hot.   It  was death to the Roman slave
to bring up the water cool or tepid to the table.
This  craving  for  hot  food  and beverages
seems to rest on the fact that when cold sub-
stances are introduced into the stomach they
lower its natural heat, and render it less ca-
pable of digesting the  food.   At the same
time the use of  cold is refreshing, and in hot,
and even cold countries, water is taken  in the
form of ice.   This practice  needs, however,
to be cautiously indulged in,  especially  in
cases of debility from disease, and in all diet-
aries  of  persons  exhausted  and  debilitated
from  attacks  of fever.  (See  Diet.)   In all
cases where water is taken pure, the greatest
precaution should be taken to render it free
from impurities  which can generate  disease.
There is no doubt that diarrhoea, cholera, and
typhoid fever spread by  the agency of impure
water or water contaminated with the poisons
that generate these diseases.  The water-sup-
ply of a house should be well  looked to, and
when any  suspicion exists the water should
be boiled and  filtered before it is drunk. (See
Water and Filters.)
  The other substances besides water belong-
ing to the  mineral  group  are  common salt,
and salts.  Common salt is chloride of sodium,
and exists  in abundance in spa-water.  It has
the power of  preserving vegetable and ani-
mal  substances from decomposition, and  is
found in certain quantities in the bodies of all
animals.   The  human body  contains  about
three ounces, which is  principally found  in
the blood.    Unless  certain  quantities arc
taken daily, diseases characterized by debility
are likely to occur.  It may be taken in large
doses from day  to day, and no harm occurs,
as that which  is not necessary for the  use  of
thh body is got  rid of.
  The other saline matters found in the hu-
man  body, and which  are  excreted by the
urine and bowels, are obtained from all forms
of food.   Animal  and vegetable food lose
some of these  saline matters by  cooking ;
hence the importance of taking uncooked
food  of some kind  or  another  every day.
This should be effected by fruit, or vegetables
in the form of salads. (See Salads.)   An in-
stance of the value of fresh vegetables as  an
article of diet is seen in  the treatment  of sea
scurvy.  This disease is  brought on  by the
absence of fruit, vegetables, or fresh meat  on
board ships.  It is  prevented by  the  supply
of lemon or lime juice, and vegetables cooked
and preserved in tins.
  2.  Heat and Force-giving Foods.—These
consist principally of starch, sugar, and fat. 
FOOD                               FOREIGN BODIES        171
 At the same time they may be divided into
 two groups.  The starch and sugar have the
 following composition :
      Carbon.................  12 parts.

      oxyydgSe9-9::::::::::::[Water'i8Parts-
 In fact, they contain oxygen and hydrogen
 in the proportion in which those elements
 form  water,  and when  taken the carbon is
 alone oxidized, and forms the heat-giving ele-
 ment.   It is different with fat and oleaginous
 foods. Their composition is as follows :  Car-
 bon, 11 parts ; hydrogen, 10 parts ;  oxygen,
 1 part.  Not only the carbon, but a large part
 of the hydrogen is  thus  left free to be oxid-
 ized by the oxygen  taken in during respira-
 tion.  It is in this way that fats, butter,  and
 oils are much better supporters of combustion
 in the body than starches  or sugars.   One
 pound of fat or  oil is equal in combustible
 agency  to  two  pounds and a half  of starch,
 and two pounds and a quarter of sugar.
   Starch is found in nearly  all our articles of
 vegetable food.  It exists in very varying quan-
 tities, from 80 per cent in  rice to 3  or 4 per
 cent  in parsnips  and carrots.   It  is almost
 pure in arrowroot, sago, and tapioca.  It is
 also contained in a peculiar form in seaweeds
 and Iceland moss.
   Sugar is found in  both  plants and animals.
 It is taken as food in the form of cane or crys-
 tallized  sugar,  and  grape  sugar or  glucose.
 The latter is found in all fruits.  (See Sugar.)
 It is the only form which undergoes fermenta-
 tion, and is the basis of  all fluids containing
 alcohol. Sugar is found also in animals.  The
 sugar of milk, although  differing  but little
 from grape sugar, has, nevertheless, a distinct
 composition,  and, of course,  is  constantly
 taken where milk  is used  as an article of diet.
 (See Milk.)  Sugar is also  found in the liver
 and the blood, and its increase in the system
 constitutes  a  disease called  diabetes.  (See
 Diabetes.)
   Oleaginous foods are  those which consist
 principally  of oils,   butter, fats, or lards.
 These foods are not generally eaten alone,
 but are added to starchy diets.  The action of
 oils on the system is principally to maintain
 animal heat and force, and, practically, they
 are most largely eaten by those who do  the
 largest amount of  work.   They not only  act
 in this way, but  they also assist in the diges-
 tion and assimilation of other foods.  It is on
 this  account  that cod-liver oil. pancreatic-
 emulsion, and butter, cream, and fat have been
 recommended as articles  of diet in  cases of
 consumption, scrofula, and other wasting dis-
 eases of the body.
   3.  Flesh-forming  Foods.—The substances
which lie at the foundation  of this group of
foods are albumen, fibrine, and caseine. These
compounds are found nowhere pure,  but  are
taken in various forms of vegetable and ani-
mal food.  The most common form in which
 the flesh-formers are taken  is bread.   (See
 Bread.)  Bread contains fibrine.   The flesh
 of animals, birds,  and fishes  also  contains
 fibrine.  Albumen  is found  in the white of
 eggs, and also in the blood of animals. Case-
 ine is found in milk.  It is separated with the
 butter in cheese. (See  Cheese.)
   In addition to the flesh-forming principles
 and fat, animal  food contains various  other
 chemical compounds, which are the result of
 the life of the animal, and act in a beneficent
 manner on the system.   If, for instance, we
 take the flesh of an animal and squeeze it, we
 get out a juice  called the "juice of meat,"
 and, when evaporated,  it is  called the  " ex-
 tract of flesh." This compound contains little
 or no albumen,  no  fibrine cr  fat, but it  con-
 sists of salts  and organic substances, resem-
 bling in their composition quinine.  They are
 called by such  names  as creatine and sarco-
 sine.   When this  substance  is taken with
 water, in the form of tea. it increases the ap-
 petite, and renders  digestible the food that is
 taken with it.  It should be remembered that
 this substance is not nutritious, but lhat it
 stimulates the  digestive  function, and  thus
 renders it possible  for  food   to be  digested
 where none  could  be  before it was taken.
 (See Meat, Extract of.)
  4. Medicinal or  Auxiliary Foods.—These
 constitute a very large  group of substances,
 which are used for the  sake of  flavor, and
 their action on the nervous system and circu-
 lation.  Their various sources, qualities, and
 uses will be found under the head of their va-
 rious  names.  (See Alcohol, Beer, Cocoa,
 Coffee,   Condiments,  Spices,  Tea,  To-
 bacco, Wine.)
  FORCEPS.—Scarcely any instrument has
 so many different forms or uses as the forceps,
 suited as they are to almost  every operation
 in surgery.   The most common and perhaps
 most   useful, are   the  ordinary,   simple,
 bowed, or  dissecting forceps,  which can be
 most conveniently applied for the  removal of
 foreign bodies, such as  thorns, splinters, etc.
 They should  not be too strong in the spring,
 and should  have broad and deeply serrated
 blades,  best  with  a groove  in  the centre.
 Then there are forceps named  specially after
 the operations for which  they are  used, such
 as bullet forceps, lithotomy or stone forceps,
 tooth forceps, polypus  forceps, urethral  for-
 ceps, vulsellum forceps, artery forceps, etc.
  FOREIGN  BODIES   are   substances
 which  have   been   introduced  into  some
 structure or cavity in the body, foreign to it in
 composition.   In some  cases  nature will ex-
 pel such bodies ; in any attempt to do so, as-
 sistance is in almost all  cases needed.
  In the Windpipe.—Morsels of  food more
frequently than other substances get into the
larynx or trachea,the accident happening when
a person  is engaged in laughing  or talking
when the mouth  is full of food, the symptoms 
172        FOREIGN  BODIES
FOREIGN BODIES
 being sudden spasmodic cough, protrusion of
 the eyes from the sockets, blood or  froth is-
 suing from  the mouth and nose ; the patienl
 gasps for breath, turns  black in the face, and
 perhaps falls down insensible.  If the morsel
 of food be light and of small size, it is  some-
 times expelled during a fit of coughing.  Many
 bodies  may find their  way into the larynx
 and trachea,  coins, cherry-stones, beans, or
 in fact anything which  may happen  to be in
 the mouth, and their presence sets up precisely
 similar symptoms.  It must be remembered,
 that although occasionally these substances
 have been expelled naturally, or with the  as-
 sistance of an emetic, this remedy should not
 be recommended, as it  has the effect of im-
 pelling  the substance against the larynx, from
 the  spasmodic action  of  the stomach  and
 oesophagus, thus endangering the  patient's
 life.  Inversion of the body, combined with a
 shaking or  jogging motion, will sometimes
 cause  the foreign body to fall  through the
 larynx,as in the celebrated case of Mr. Brunei.
 The operation of  laryngotomy and trache-
 otomy are generally needed.
  In the Nose.—These are often introduced
 by children  ; such substances as peas, beads,
 pieces of pencil, etc.  They are generally re-
 moved readily enough by a small polypus for-
 ceps or a scoop, remembering that the  direc-
 tion of  the floor and roof of the nasal cavity
 is nearly parallel  with the ground, so that
 digging  attempts upward toward the  head,
 are attended with considerable  danger.   If
 the  body cannot be  extracted through  the
 mouth,  it should  be  pushed  backward into
 the pharynx, taking care that it does  not pass
 into the  larynx.  Very  frequently they work
 out if left to themselves.
  In  the Ear.—The  substance introduced
 frequently becomes covered and escapes with-
 out surgical  interference, but in cases where
 instruments must be used for  the purpose, it
 must be remembered that the ear passage is
 widest at the external  orifice, then  narrows
 somewhat, and again widens toward the mem-
 brana tympani. In introducing a small scoop
 or forceps they should be passed along the
 upper wall,  so as to  avoid the  membrane."
 The passage should be syringed with, warm
 water, a proceeding which alone frequently
 removes a foreign substance.  A piece of wire
 bent into a loop and insinuated around the
 substance is  a method  sometimes attended
 with success.  Insects and larvae sometimes
 lodge in the  ear, causing severe inflammation
 and local suffering, with great constitutional
disturbance  ; warm oil dropped into  the pas-
 sage until it is  filled, or white  precipitate,
 suspended in  milk, and injected,  will  be
 found sufficient to  kill  the animals.  Oil or
water poured into the ear, with  the  head on
one  side, will generally bring them to the
surface of the fluid, and allow them to be re-
moved.
  In the Eye.—The cornea (see Cornea)
 should be first examined by everting the lid and
 telling the sufferer to look up, or down, so
 lhat both the upper and lower surface of  this
 part of the globe can be seen.  A substance,
 such as a piece of  cinder, or a piece of metal
 or wood from  a turning-lathe, etc.,  sticking
 in the cornea, can  generally be removed by a
 silver toothpick or fine forceps, or still bet-
 ter,  an eye " spud" or scoop. If the substance
 be lime or mortar  the lids should be everted
 and  the eye well syringed with weak vinegar
 and  water, or oil, or water only.  A  drop of
 castor oil or  of  pure glycerine  is a most
 soothing application in painful cases where
 the conjunctiva (see Conjunctiva) has been
 scratched or stripped off the cornea.  Very
 often a piece of  dust may be removed  by
 blowing the nose smartly.
  In the Rectum.—These consist of the fol-
 lowing, viz., those composed  of materials
 which have first passed along the upper part of
 the alimentary canal, and those introduced
 into  the anus.   In the first class  we find
 bones, apple or pear cores, fruit stones, scy-
 bala, substances taken as  medicines, coins,
 etc.  The presence  of these bodies is indicated
 by pain in passing motions, accompanied by
 blood, with  frequent desire  to evacuate, but
 assuming a something sticking there which
 will not pass out.  These bodies must be re-
 moved with care, the  bowel must be well lu-
 bricated with oil, and a warm water injection
 used.  If this will not dislodge the mass, this
 must be seized with  forceps or  broken up
 with some instrument, and removed piece-
 meal. A full-sized speculum should be first in-
 troduced, so that the bowel be not lacerated or
 hurt by these attempts at removal.
  In the Vagina.—Substances are frequently
 introduced  into the passage, and one of the
 most common  is  a  pessary ; the  strings
 break and the instrument remains in, setting
 up a most offensive discharge.  Glass bottles
 are occasionally made use of, and set up ul-
 ceration, establishing an unnatural  opening
 into   the  bladder  - (vesico-vaginal   fistula).
 These bodies require great care in their re-
 moval,  which  should be   attempted  with
 strong forceps,  taking care  that the  margins
 or extremities of the impacted  substance do
 not injure the mucous membrane.  The spec-
 ulum is frequently  required.
  In the  Throat.—Substances  retained  in
 the oesophagus.are usually held at the com-
 mencement opposite the cricoid cartilage (see
 Larynx), or at  its  lower  extremity, just
 above the diaphragm,  as the tube  is the nar-
 rowest at- these points.  Various substances
 have been cited as having  been  retained in
 (he  oesophagus ;  thus  crust,  imperfectly
 chewed meat,  bones, coins,  stones, pins,
 needles,  buttons,   knives,   forks,  scissors,
spoons, keys, chestnuts, a small  apple, fish-
hooks, artificial teeth,  the handle of a punch- 
FORMICATION
FRACTURE
173
 bowl, a  pencil-case, etc.   The  symptoms
 produced by the presence of such a body vary
 of course with its size ; if  it be  small it pro-
 duces considerable irritation,  with difficulty
 in swallowing.   It sets up in time inflamma-
 tion, followed by ulceration of the oesoph-
 ageal  coats, causing  most serious  conse-
 quencejs and oftentimes terminating fatally.
 Small, sharp-pointed substances, such as pins,
 needles, fish-bones,  etc., may perforate  the
 walls of the tube and remain firmly impacted,
 or may perforate the aorta or  trachea, and
 there are instances where such bodies have
 been swallowed, appearing at the surface of
 the body after the  lapse of years.  When a
 foreign body is impacted in the oesophagus it
 should be removed as quickly as possible ; in
 the instance of a  small piece of  bone  it may
 be  propelled  onward  to  the stomach,   by
 making the patient swallow  a  good mouthful
 of bread.   If the substance  is one which  on
 its arrival in the stomach  could  be easily  di-
 gested, it may  be pushed  gently  down the
 canal with an instrument termed a probang.
 If high up,  it may be reached with  the finger
 or long forceps ;  gentle  pressure  with  the
 finger on the side of the neck, opposite to the
 spot where  it is felt, will sometimes dislodge
 it.   Hard,  angular  masses, such as glass,
 stones, etc., require removal with forceps.  If
 no other means are  at hand the  induction  of
 vomiting is occasionally of use.  A  dilute
 solution of a mineral acid has been known to
 be of use in the  case of the impaction of a
 piece of bone in the fauces or oesophagus.   It
 should be taken through a tube to prevent  its
 action on the teeth, and  its strength modified
 to the degree of sensibility  of the parts over
 which it has to pass.  In cases where all these
 means fail  the operation  of cesophagotomy
 must be performed.
   FORMICATION is the  peculiar feeling,
 like the creeping of ants, which is felt in the
 onset of some forms of paralysis ; also around
 the arms, when the patient  is suffering from
 worms, and in the limb when a nerve has
 been  pressed  upon and is  cramped,  as  in
 hanging the arm over the back of a chair.
   FOUSEL OIL  or Potation  Spirit, also
 known as Amylic Alcohol, is  contained  in
 greater or less quantity in all forms of crude
 spirit, from  which it requires to  be  carefully
 separated by redistillation.   Being much less
 volatile than ordinary alcohol,  it  comes over
 last, or may be allowed to  accumulate in the
 last portions of spirit  whence all the  good
 spirit has been distilled.  It  is the  substance
 to which bad spirit mainly owes its noxious
 qualities.  By  oxidation it forms  valerianic
 acid, and it  is  for this  purpose only that it is
 used in medicine.
  FOXGLOVE.  (See Digitalis.)
  FRACTURE is a term applied in surgery
 to the breaking of a bone, which, after incised
wound, is probably the most frequent'serious
accident in civil life.    When one or more
bones have been broken, while the skin and
subjacent soft parts are not torn or wounded,
the injury is called a simple fracture.   When,
in addition to the breaking of the bone, there
is a large wound through the skin and muscles
leading down to the seat of injury, and ex-
posing  the  fragments, the fracture  is called
compound.  When a portion of bone is broken
into several small fragments, it is said to be
comminuted.   Fractures,  both simple  and
compound,  may be Complicated—by disloca-
tion at a  neighboring joint,  by  wound or
division of  a  large  artery  or nerve,  or by
stripping away from the  surface  of the frac-
tured bone of a large extent of the periosteum
or external  membrane.   During infancy and
childhood fracture is met with in the same pro-
portion in males and females.  From the age
of ten  to that of  fifty years, the  number of
males with fractures greatly exceeds the num-
ber of females.  From the age of fifty to that
of sixty years, the numbers are again about
equal,  and, finally, above  the age of sixty
more women  than  men  are  the subjects of
fracture.  The bones most frequently broken
are : the clavicle or collar-bone in children ;
the bones  of  the leg  and  forearm, and the
thigh-bone in  middle-aged persons ; and the
neck of  the thigh-bone  and  the  lower ex-
tremity of the  radius or spoke-bone  near the
wrist in persons beyond the age of sixty years.
The immediate  causes of fracture  are two :
external force applied ekher directly to the
bone at the seat of breakage, or at some more
or less remote part, and sudden and powerful
contraction of muscles.   The latter is a com-
paratively  rare  cause ; the tones  most fre-
quently broken in this way are the knee-pan,
the prominent extremity  of the cubit-bone at
the back of the  elbow,  and  the heel-bone.
The bones of weak and sickly persons can be
more readily broken than the bones of those
in robust health.   In the subjects of cancer,
rickets,  and of a peculiar disease of  the bone
called mollities ossium, and also in those who
have been  confined to bed for a long time,
fracture may be  produced through slight vio-
lence.   Sometimes infants are born with  one
or more bones  fractured, the  injury having
been caused by  strong  contractions of the
womb during labor, or by a blow or kick  on
the abdomen of the pregnant mother.
  The symptoms of fracture are not very diffi-
cult to make out ; a stout muscular man walk-
ing along the street makes a false step or
slips, and then  falls heavily to the ground,
with the right leg twisted 'and bent  under
him ; in his fall he hears  a sharp crack, and,
on attempting to  move,   finds that there is
great pain and loss of power in the right limb
at a short distance above the ankle.   He feels
also a peculiar grating sensation—the so-called
crepitus—at the seat of  pain,  and   finds, on
looking at the  injured limb,  that at   this part 
174           FRACTURE
FRACTURE
there is  swelling,  distortion, and unnatural
mobility.   The  most decisive symptoms  of
fracture  are  mobility of  the  bone at the in-
jured part, and the peculiar grating noise pro-
duced by  rubbing  together the ends of the
fragments ; but  these. may  often  be absent.
In fractures  of  the ribs,  the  haunch-bones,
the skull, all  small and  short  bones, and the
extremities of  long bones,  it is  generally
difficult to make out the nature of  the injury
without submitting the patient to a close and
prolonged  examination.   In  fractures of the
shafts of long bones, as the thigh-bone, the
arm-bone, and the bones of the leg and fore-
arm, all or most of the symptoms can be  read-
ily recognized, and the result of the accident
learned without delay.   In most cases of frac-
ture  of the bones of the limbs, beyond the pe-
riod  of   infancy, the  patient  has generally
from the first moment  of the injury a firm
and  correct  conviction  as to  its nature.   A
simple fracture involving the  middle portion
of one or two long bones of a limb sets speed-
ily, and with  good results.  A similar injury
near the joint end of a bone is not  so promis-
ing,  as the neighboring  joint is usually more
or less affected, and remains stiff  and swol-
len for  a long time after the setting of the
fracture.  Fractures of bones  which are sur-
rounded by thick and powerful muscles are
more difficult to cure, without shortening of
the limb and  deformity, than bones which can
be felt close under the skin.  When a bone  is
broken in several places or into several small
fragments,the case is much more serious than
that  of  a simple transverse fracture.   The
greater the obliquity of the fracture the more
unfavorable  is the case.   In debilitated or
diseased subjects the setting of a simple frac-
ture  takes an unusually long time.  Compound
fractures are always very serious  accidents.
When the wound in the  skin is large, and the
muscles, blood-vessels, and nerves are much
lacerated, amputation of ihe limb will be ne-
cessitated.   In less  severe cases the patient is
slid  liable to the  dangers of inflammation,
erysipelas, tetanus,  and pyaemia.   The most
severe fractures  are those of the skull, chest,
and  pelvis, on account  of the'important vis-
cera  contained  within  these cavities,  and
which may be primarily or consecutively in-
volved.   Fractures of  the upper extremity
are  less serious than similar injuries in the
lower extremities.  The former do  not pre-
vent locomotion, or  compel  the  patient  to
keep to the house until the broken bones are
firmly united. Fracture  of one or more  of the
long bones in the  arm or leg frequently re-
sults after union in puffiness of the skin, wast-
ing of the muscles, and weakness of the whole
limb.    Stiffness of the  joints immediately
above and below the broken bone is also a fre-
quent after affection.  Those affections retard
the convalescence, and sometimes  last for sev-
eral  months, but are usually much relieved by
 stimulating liniments,  shampooing, and  the
 cold water douche.
   In the treatment of fracture the surgeon  has
 two objects to fulfil ; in the first  place he re-
 moves any displacement that may exist, and
 returns the fragments to  their  proper posi-
 tion, both in  relation to each other and  the
 parts around.  This having been done, he
 then applies splints  or some retentive appa-
 ratus to  keep these  fragments in place, and
 the  whole limb  below the  fracture in a cor-
 rect anatomical  position until  the  injured
 bone is thoroughly  set.  The  process of re-
 covery consists  in the effusion between and
 around the ends of the fragments of a plastic
 material,  which  sets as it were into tough
 gristly tissue, and is finally converted into a
 mass of true bone, which is called the callus.
 In the long bones of  the extremities the frac-
 ture is not firmly united until  the end of six
 weeks or  two months ;  in fractures of  the
 ribs,  collar-bone, and lower jaw the process
 of recovery  occupies a shorter period.   If
 union be  allowed to take place without  pre-
 vious removal of  displacement at the seat of
 fracture,   the   limb  becomes   permanently
 shortened, and perhaps distorted.   The re-
 moval of  the  displacement, reduction, or re-
 position,  as  it  is  called  by surgeons, is
 effected simply  by  keeping the upper frag-
 ment fixed, and  pulling downward  the lower
 fragment  until both are in the same line.  Re-
 duction is sometimes unnecessary, and occa-
 sionally has to be  deferred in consequence of
 much bruising and  inflammation, and also of
 muscular  spasm.    In some  instances  the
 fragments are so  interwedged  that  the  dis-
 placement cannot be removed.   There  are
 several methods of  keeping  the fractured
 bone in   position :  most  surgeons  in   this
 country use splints,which are flat slightly hol-
 lowed pieces of wood or iron,  well padded
 with  tow,  cotton-wool, or some other  soft
 material.  These are applied in varying num-
 ber to the surfaces of the fractured limb,  and
 are retained  by  means of  bandages.  They
 have a double  object : to  keep the broken
 ends of bone in their proper position, and to
 restrict the movements more  or less of  the
 limb, and to keep the whole of the broken bone
 together with the joints immediately above
 and below,  at perfect rest.  In fracture of the
 thigh-bone  a long splint  is usually  carried
 from the  arm-pit to the  foot along the outer
 side of the injured limb for the object of  pre-
 venting shortening.
   The management of the patient immediately
 after the  accident, and the  precautions to be
 taken in his removal to home or hospital,
 are matters of great importance. Much barm
 is often done by moving the patient without
 taking any preliminary means to protect the
| injured  limb, especially in fracture  of the
 lower extremities, and the fragments of bone
 i are moved and perhaps forced into  the  sur- 
FRACTURE                                FRACTURE           175
 rounding muscular  tissue, causing consider-
 able pain and subsequent inflammation.  In a
 case of injury to the arm or leg, the first thing
 to do before allowing the patient  to move is
 to expose the seat of injury.  If the pain  be
 great, the clothes covering the limb should be
 cut, and not. pulled off as in the usual way,
 and the sides of the  boot  divided  with a
 sharp knife.   The situation of  the fracture
 will then be indicated by deformity, swelling,
 and local tenderness.  If one or both bones
 of the  forearm have been  broken, the  limb
 should be placed in a sling  made of a hand-
 kerchief or neck-wrapper, the ends of which
 are tied  lightly at the back of the neck.   In
 cases of fracture of the arm-bone at some
 point between the elbow  and shoulder, some
 thick pad—a  small pillow  or thin cushion
 will answer the purpose very well—should
 be placed between the arm and the side of the
 chest, and the injured limb then fixed to the
 body by some extempore bandage, the elbow
 and  forearm  being  supported  in a  sling.
 After the patient has been helped into bed,
 this  apparatus should be removed, and the
 arm laid out on a pillow at an acute angle to
 the side of  the body with the forearm bent.
 In a case of fracture of the leg or thigh it
 should be a  rule never to transport the pa-
 tient in a carriage, cab, or any kind of vehicle
 which  will not permit of  his lying  at  full
 length.  If  the distance be not very great, the
 best means of transport will be an ordinary
 stretcher, or, in the absence of this, a shutter
 or door, or an* extempore stretcher formed by
 laying boards  on two  stout poles. A very
 convenient supporting apparatus for the whole
 body may be made  by fastening  with cords
 the sides of a long piece of canvas or sacking
 to  two long poles.  The best  temporary ar-
 rangement  of  a  fractured thigh or leg is to
 place the limb, when half-bent at the hip and
 bone, on its  outer surface.  In  this position
 the  muscles  are  relaxed,  and  ihe  whole
 length of the limb is supported.    Extempore
 splints may be made of thin pieces of  wood.
 These should be covered  on one  surface by
 thick pads, made of linen, folded into several
 layers, or of single layers of linen inclosing
 low, cotton-wool, feathers, bran, or, if noth-
 ing else is at hand, and the accident has  oc-
 curred  in the  country, dry grass.   Useful
 temporary splints  may  be  made of  bark,
 leather, pasteboard, and of wheat-straw  or
 reeds  tied  tightly  into  compact bundles.
 Splints should be fixed over the  seat of frac-
 ture by two  or more handkerchiefs, or by a
 bandage formed by tearing a sheet or table-
 cloth, great care being taken not to constrict
 the seat of injury so as to give  pain, and  to
 obstruct the  upward flow of blood through the
veins of  the  limb.  If  the skin has been
wounded, the blood  should  be gently  wiped
away, and a  piece of  linen dipped in cold
water placed over the raw surface. When the
patient has been placed in bed, and the frac-
ture again exposed by  removing  the tempo-
rary splints and bandages, cold should be ap-
plied to the injured part either through rags
dipped in cold water,  or through ice placed
in a sponge-bag or sheep's bladder.  If the
injury be seated  in the lower extremity,  it
will be necessary,  in order to avoid the pain
and  inconvenience attending an  early shift-
ing of the  patient from one bed to another,
to see  that he is  placed on a couple of firm
horse-hair mattresses, under which should be
laid  some  boards  extending  transversely
from one side of  the bedstead to the other.
The surface on which  the  patient has to lie
during the treatment should be firm and level,
and  therefore  no feather-bed should be allow-
ed.  The head-pillow should be removed and
replaced by a  bolster.
   Nasal Bones.—Generally caused by a blow
of the fist.  As this injury is frequently as-
sociated  with  much bruising and swelling of
the  soft  parts, it  is  frequently  overlooked.
The lower fragments  are  usually  displaced
backward, and if not returned to their proper
position  and  kept there by  plugs of lint or
cotton-wool introduced into  the   nostrils,
give rise to great subsequent deformity.  A
fractured nasal bone unites in seven or eight
days, more rapidly perhaps than any other
bone in the body.  This accident is frequently
complicated by a  wound in  the  skin and by
bleeding from the nose.   During and after
treatment the patient  may be troubled with
ulceration and a discharge of ill-smelling pus,
death of bone, lachrymal fistula, impeded  res-
piration, and  impairment  of  the  sense  of
smell.
  Lower Jaw.—Generally caused by a direct
blow.  The bone is generally broken at some
point between the  insertion of the middle in-
cisor and that of  the first bicuspid teeth, the
fracture extending through  the  whole width
and thickness  of the jaw. Sometimes the  jaw
is broken on each side of the middle line, so
that  the  piece carrying the  incisors, or the
incisors and canines, is loose and detached
from  the rest of  the  bone,  and displaced
downward and backward.  Sometimes, though
not so frequently,  the jaw is broken through
at its ramus or ascending portion, or at  the
neck or  part  immediately below the head,
which is forced into the socket in  front of the
external ear.   The symptoms of this fracture
are generally well  marked.   Crepitus can be
distinctly felt  on  moving the fragments on
each other ;  there  is free mobility,  and also
some distortion ; the pain over the seat of in-
jury  is in nearly all cases unusually severe  ;
the gums arc  frequently wounded, and one
or more teeth  loosened and  perhaps entirely
detached.    Fracture of  the  lower jaw gen-
erally unites  speedily  and  firmly,  although
with some  distortion along the chin, and ir-
regularity of   the lower row of  teeth.  The 
176            FRACTURE
FRACTURE
treatment of this injury is attended with great
difficulties, as it is often impossible to keep
the bone at rest for any length of time.  The
patient ought to make  up his mind to speak
as little as possible, and to live for two or
three weeks on fluid nutriment alone.
  Collar-Bone.—This, with the exception of
the outer bone  of the forearm, is more fre-
quently broken  than any other bone of the
body.  An  oblique  fracture at  the  junction
of the outer and middle thirds  of the collar-
bone is a very  frequent injury in  children,
and is caused  generally by a fall upon the
hand when the  arm is stretched out.   It is
sometimes produced in adults  by  a  blow
upon the front of  the  shoulder, as in the re-
coil of an overloaded gun. In this fracture the
shoulder falls  downward, forward,  and in-
ward.  The patient leans  toward the injured
side, and with the  opposite hand sustains the
elbow corresponding  to the broken collar-
bone, so as to prevent its dragging downward.
The inner fragment of the  broken bone is
very prominent, and externally  to this there
is a depression caused  by the downward sink-
ing of the outer fragment.  The patient feels
great pain when he attempts to  raise the arm
from the  body,  or  to carry  the  forearm
across the front of the chest.   He is unable
to raise the hand to his head, or to  move it
forward or backward, without suffering.  On
drawing  back  the  shoulders so as  to bring
the fragments of collar-bone into contact, dis-
tinct crepitus may usually be felt.  A broken
collar-bone unites  speedily and  strongly, but
always with some amount of shortening and
deformity.   It is  a very difficult matter to
keep this bone at perfect rest, and to restore
the outer fragment to its proper position. The
most certain method of treatment to insure
union without deformity, is for the patient to
remain in bed until the fracture  has been set,
the head being kept as much as possible in one
position, and the arms confined  to the side of
the body.  This position,  however, to  most
patients is intolerable.  In .infants the frac-
ture generally unites well without any treat-
ment, and the deformity and swelling, which
at first are very considerable, gradually sub-
side.  With children and adults,  the usual ap-
paratus consists in a figure-of-8  bandage car-
ried from  one shoulder to  the other across
the back  of the chest, a stout wedge-shaped -
pad in the arm-pit on the  injured side,  a
broad bandage to confine the arm to the side
of the chest, and, finally, a  sling to support
the elbow.
  Thigh.—The most frequent seats of fracture
in this bone are  the  upper extremity and
neck,  the  middle of  the shaft,  and a part
about four inches above its lower extremity.
The rounded head of  the  thigh-bone is in-
vested by a loose membranous bag,  which is
inserted below into the base of a  jutting sup-
port, which is called the neck of the femur or
thigh-bone.   Fracture of this neck may occur
either within or without this bag or capsule. In
the former case it is called intra-capsular frac-
ture, and in the latter extra-capsular fracture.
The intra-capsular fracture occurs in old peo-
ple ; is produced by very slight violence—the
most frequent cause being a slip off the curb-
stone ; is attended with very little bruising and
not very severe pain; and hardly ever unites by
bone, the two fragments being joined together
by ligamentous tissue. Extra-capsular fracture
on  the other hand, is generally  the result of
great direct violence, as in a heavy fall upon
the outer part of the hip, is followed by much
bruising and intense pain, and almost  always
ends in firm bony union. The common symp-
toms of these two kinds of fracture are,  loss
of power in  the limb, shortening, eversion of
the foot.   Crepitus is usually absent or  very
indistinct.   The subjects  of  intra-capsular
fracture are  in most cases over sixty years of
age ; extra-capsular fracture may occur at any
age beyond  thirty. There are several difficul-
ties attending the treatment of fracture within
the capsule.  The patient is generally old and
infirm, and may sink rapidly in consequence
of confinement to bed.   When this  is the case
it would be well to allow the patient  to get
up  and make  as much use  as possible of
crutches.    When the  patient seems to be
strong  and hearty he should be kept  in  bed
for five or  six weeks with  the  whole  limb
stretched down between two large sand-bags,
or with the hip and knee bent and the thigh
and leg supported by a well-cushioned  double
inclined  plane,  made  of  pieces of  wood
which  can be lowered  or elevated at  will.
For extra-capsular fracture the  usual treat-
ment  is  a  long  splint  of wood  about four
inches  in width, extending from the arm-pit to
beyond the sole of the foot.  The foot  having
been secured  to the lower  end of  this by
means  of a bandage, a band, the central part
of which is  composed of tow or cotton-wool
covered by wash-leather, is carried round the
inner surface of  the thigh at its upper part,
and its two ends are  then fastened to the
upper  end of the long  splint which touches
the arm-splint,  the foot of the injured  limb
having previously been  dragged  down to the
level of the foot on the  opposite thigh.   The
leg and thigh are then bandaged to the splint,
and a broad band or sheet is carried round
the chest and the upper  part of the splint. By
pulling at the ends of the band which  passes
under  the upper part of the thigh the whole
limb can be  extended.   When the  two limbs
are of  equal length the injured one is kept
stretched by tying together the ends  of  this
band after they have been passed through two
holes bored  through  the long splint near its
upper extremity.   The shaft of  the thigh-
bone is most frequently fractured at its middle
third.  This  injury may  be caused by the  pas-
sage of a heavy body across the thigh, by the 
FRACTURE
FRACTURE           17?
 fall upon the limb of some heavy mass, or by
 the patient falling from a height.  The line of
 fracture is usually oblique, and there is short-
 ening to the extent of  one or one and a half
 inch.  There  is  much displacement of  the
 bones, and consequent deformity, and crepi-
 tus can be distinctly felt.  This fracture and
 also that near the lower end of the bone are
 usually treated by the  long outside splint, ap-
 plied as in last mentioned fracture.
   Knee-Cap.—Of this injury there  are two
 varieties. In one the bone is broken into sev-
 eral fragments, in the  other  there is a simple
 transverse line of fracture extending from one
 lateral edge of the  bone to the other.  The
 cause of the first, the stellate fracture as it is
 called, is direct violence, as a  blow or fall.
 The  second or transverse fracture is usually
 produced in the  following  manner :  the  pa-
 tient in walking or in going down stairs makes
 a false step and  then  attempts by a sudden
 effort to recover himself ; the knee being half
 bent and the knee-cap  resting by  only a part
 of its posterior surface  on the  lower end of
 the thigh-bone, the whole contractile force of
 the powerful  extending muscles  in  front of
 the thigh  is,  in  consequence of  this effort,
 brought to bear upon  the bone  which is thus
 poised.  Transverse fracture then  takes place
 with an audible snap, and the patient falls to
 the ground.   In  this  injury there is a wide
 separation of  the two fragments, forming a
 distinct gap, and  a depression in front of  the
 joint.  The limb cannot  be  straightened by
 the patient, and there is  generally much pain
 and swelling of the knee.   This  fracture, like
 that of the neck of the femur within the cap-
 sule, unites by ligament  instead  of  by true
 bone.   The  injured  limb  always  remains
 weaker than the other, and patients who have
 been laid up  with fracture  of one knee-cap
 often, sooner   or  later after their recovery,
 break the bone on the opposite side.  This
 fracture may be treated by keeping the limb
 stretched on a mattress  between two  large
 and firm sand-bags, reaching from the upper
 parts of the thigh to  the sole of the foot. The
 limb may be kept steady by fastening a long
 handkerchief around both sand-bags in  the
 middle of  the leg.  The  inflammation and
 swelling of the knee may be best treated by
 the local application  of ice or of linen rags fre-
 quently dipped in  cold  water or weak lead-
 lotion.  The patient should be kept in bed for
 at least six weeks.
  Leg.—The following are the fractures most
 frequently met with in this  region ; that  of
 both  bones at the middle  or lower thirds ;
 that of the shin-bone alone at its upper third ;
 that of the splint-bone  alone at a point about
 two and a half inches above  its lower  extrem-
 ity.   In the  first  mentioned fracture  there is
generally much displacement and free mobil-
ity  of the fragments,  and  crepitus  can  be
easily  felt ;  it  is  frequently  associated with
much bruising, and large blebs, containing a
thin and dark red fluid, are formed on the
surface of the skin.  In  fracture through the
upper  part of the shin-bone the nature of the
injury is not so evident ; there is very little if
any displacement, and crepitus is usually very
indistinct.   Fracture  of the  shin-bone  at its
lower third is in most instances marked by a
peculiar distortion and outward displacement
of the foot ; the lower end of the shin-bone
projects very much at the inner surface of the
ankle,  and the outer edge of the foot is drawn
upward and outward, and corresponding to
the seat of fracture in the splint-bone there is
a well marked superficial depression.  When
both bones are fractured with much displace-
ment, the limb is generally  placed upon an
iron splint, and  compressed  laterally   with
two well-padded splints of wood which extend
from above the knee to the foot.  In cases of
fracture of one bone only, and when the frag-
ments  are  not displaced, the best treatment
seems to be the application of the starched or
plaster of Paris bandage, as the patient  may
then be allowed to get up and move about on
crutches.  In fracture near the lower end of
the shin-bone, associated with dislocation of
the foot, the lower limb should be well flexed
both at the hip and knee, and then be placed
on its outer surface, either on a bent wooden
splint or between sand-bags on a hard  mat-
tress.  This last  injury is  generally followed
by some deformity and  much stiffness in the
ankle-joint.
  Arm-bone.—This bone  may be broken at
any point between the head and the lower ex-
panded extremity, but most frequently about
its middle.   Of fracture  near the head  there
are several varieties, and  much surgical skill
and experience is required to distinguish  these
from each  other, and to decide whether the
case be really one of fracture or of simple dis-
location at the shoulder.  When there is much
bruising and  severe pain, and crepitus can be
felt distinctly on  grasping the upper end of
the arm-bone and moving the elbow, the case
is one of fracture. The most simple treatment
of  a fracture in this region is to place be-
tween  the injured arm and  the  side of  the
chest a small pillow or a  cushion, arranged
so as to form a pyramid, the  apex of which is
to be applied to  the arm-pit ; the elbow and
arm are then to be fixed by means of a band-
age carried round the chest.   When  there is
much displacement, it will  be better to apply
a bent leather splint, one limb of which is  to
be fixed to the side of the chest, and the  other
to the  inner surface  of  the  injured arm, so
that the angle occupies the arm-pit. Fracture
of the shaft of the bone is generally caused by
direct  blows.  The line  of  fracture occurs
more frequently below than above the middle
of the  bone ; it is generally  very oblique,  so
that there  is  much displacement and distor-
tion, rendering the diagnosis of the injury easy. 
178            FRACTURE
FRACTURE
In this fracture there is generally consider-
able bruising, and also some swelling  of the
whole limb.    It  almost always  results in
shortening and a  certain amount of deform-
ity.  Union sometimes fails, and a false joint
or ununited fracture  is formed.   The treat-
ment of a broken arm consists in the applica-
tion of a long external splint extending from
the tip of the shoulder  to the elbow, and of
two or three smaller splints  to the other sur-
faces of the arm ; all be'ng well padded and
retained in place by bandages.  The forearm
should then be  supported  by a sling carried
under the wrist  and  not  under  the  elboio.
Fracture at the lower and expanded extremity
of the arm-bone is a common injury in chil-
dren, in consequence of blows or falls on the
back of the elbow.  Here, as at the upper ex-
tremity, there are several varieties of fracture.
Sometimes the line of fracture extends into
the elbow-joint, and  causes much swelling j
and subsequent stiffness, and impairment of j
the  articular movements.   In  cases  where
there  is  preternatural mobility above  the |
joint, great  pain and  swelling, and distinct
crepitus, a large pad should  be  placed  in the |
bend of  the  elbow,  and the  forearm bent
ever this, and retained in the same position
by means of a bandage.  It should always be
remembered  that  fractures  in the region of
the elbow are very difficult to treat, and often
result in  permanent deformity and stiffness
of the joint, notwithstanding the most  skilful
surgical treatment.
  Forearm.—The prominent upper extrem-
ity of the internal or cubit bone of the fore-
arm is sometimes  broken in adults by a fall
on the back of the elbtfw, the detached frag-
ment varying in  extent in different  cases
from  a mere shell  to  the whole of the pro-
cess.   It is generally  widely separated from
the rest of the bone, inconsequence of  being
pulled upward by the strong extending mus-
cle which runs along the back of the arm.  In
this  injury  the movements of  the arm  are
much impaired.  In treating  it the arm should
be kept straight on a  padded  splint of wood
or stout gutta-percha, extending  along  the
front of  the  limb from  the shoulder to the
wrist.  The fragment is subsequently joined
to the rest of the bone, not by bone, as in the
union  of most other fractures, but by tough
flexible tissue resembling ligament.  One or
other of  the bones of the forearm may be
broken singly, or both may  be broken  at the
same time.   The  outer bone  or radius  is
broken much more frequently than the cubit
bone.  Fracture is of much more frequent oc-
currence in  the forearm  than in the  arm
above the elbow.   In  fracture of the shafts of
both bones, there is distinct crepitus, and the
forearm is much  bent.   In fracture of the
shaft of one bone only, there is less deform-
ity but usually much bruising and swelling of
the soft  parts.  Crepitus may  in most  in-
stances be obtained by holding the upper frag-
ment firmly and moving the  lower fragment
from side to side.  The usual treatment for
fractures of these bones is the applic ation of
two long wooden splints ; one to the poste-
rior surface of the forearm, the other in front.
The  front splint should extend from the bend
of the elbow to the ends of the fingers.  Both
splints should be furnished with pads so made
as to  be  thicker in the middle  than  at  the
sides, in order to press between the  bones of
the forearm and to prevent the broken pieces
of bone from falling inward.   The lower ex-
tremity of the radius is the seat of a very well
known fracture, which occurs very frequently
in women above the age of forty-five or fifty
years,  in consequence of a fall upon the palm
of the hand.   This injury is attended with
much pain and  considerable  deformity about
the wrist.   The lower fragment of the broken
bone forms a marked projection at  the back
of the limb, and leaves in front just above the
line of the wrist-joint a corresponding depres-
sion  ;  the lower pointed extremity of the cubit
bone is unnaturally prominent, and the hand
is carried backward and outward. In old pa-
tients  this is a very  serious accident, as it
often leaves the hand a crooked, unsightly,
and  permanently disabled member.   In  the
most favorable  cases months pass before the
patient becomes  free from pain  and uneasi-
ness, and  is able to use the hand and fingers.
There are several methods of treating this in-
jury.   The  chief point is to keep the hand
turned toward the inner side  of  the forearm.
This may be done either  by  a single  curved
or pistol-shaped splint applied along the front
of the forearm  and the palm, or  by fixing the
hand between a front  and a back splint car-
ried downward from the forearm. Mr. South
recommends ordinary  straight  splints  for
the forearm, but the  rollers by which  the
splints are secured in place  are not allowed
to extend lower than the wrist ; so that when
the forearm is  suspended  in a sling in a state
of semi-pronation, the hand  shall fall by its
own  weight to the ulnar side.
  Fingers.—The first or  long Bones of the
thumb and fingers extending  from the wrist
to the web  of the  hand, are  occasionally
broken by direct violence, as in a  fall or in
giving a  blow.  The bone most frequently
broken is  that of the thumb.   There is usually
distinct crepitus, and the end of the  lower
fragment  is often displaced, and projects at
the back  of the hand.  This injury  is best
treated by  causing the hand to  grasp a bill-
iard-ball,  a large circular pad  of  linen, or
an ordinary rolled bandage,  and then to fix
the fingers over this by means of strapping or
a few  turns of  a bandage.  One or more of
the bones of the fingers, most frequently the
bone nearest the hand,  may be broken by
direct violence.   These fractures are  usually
associated with  much bruising  of  the  soft 
FRANKINCENSE
FROST-BITE           179
 parts and wound of the integument.  When
 the fracture  is simple, that is to say, uncom-
 plicated with wounding,  a narrow splint  of
 gutta-percha or thin wood should be applied
 to the front  of the injured digit, and be car-
 ried upward  over the palm of the hand as far
 as the wrist.   In compound fracture, if there
 be any chance of saving the finger,  the same
 treatment should be carried out, care being
 taken not to  apply the bandage too tightly.
 The wound should be covered by wet lint.
  Ribs.—One or more of these bones may be
 broken, either by very great force applied di-
 rectly or by counter-strokes.  The ends of the
 fragments  project inward in the former case,
 and  outward in the latter.   These  injuries
 are of frequent occurrence, and  are produced
 very  often by the wheel  of a  cart or  some
 other vehicle passing over the chest, or by
 crushing in a crowd.    Fracture with inward
 projection of the broken bones is generally a
 very serious  injury, as it may be complicated
 by wound of the lung or  compression of  the
 heart.  It is very often followed  by pleurisy
 and inflammation of the lung. The ribs most
 liable to be broken are the fourth, fifth, sixth,
 and seventh.  The most frequent seat of the
 fracture is at some point in the anterior third
 of each rib.  The fracture  unites in about
 twenty-five days. The chief symptom of frac-
 ture of the ribs is an acute pain over the  seat
 of injury, which is much intensified when the
 patient  coughs or takes a deep breath.  Crep-
 itus  cannot always  be felt.   This injury is
 usually treated by applying broad pieces  of
 plaster to the injured side of the  chest, each
 piece being carried from the spine as far for-
 ward as the breast-bone.  The plaster should
 be carried to about four  inches  beyond  the
 fracture in  both the  upward and downward
 direction.  Another  plan of treatment is to
 roll  firmly a flannel  bandage  about eight
 inches in width around both sides of the chest,
 and to fix it securely by stitching.
  FRANKINCENSE  is the  product of a
 certain species of pine growing in the South-
 ern States.   When it exudes  from the tree it
 is fluid, but speedily solidifies.   It has little
 use in medicine, and its properties correspond
 with  those of ordinary resin.  Fine Frankin-
 cense, the product of another pine, is not im-
 ported into this country.  It forms an ingre-
 dient in incense, and in fumigating pastiles.
  FRECKLES are minute spots or specks
 of pigment  or coloring  matter,  which  are
 often seen on the skin ;  ephelis is the technical
 name given to this  condition, while the term
lentigo is used when the  freckles are  more
permanent than  usual.   Yellowish-brown,
round or irregular spots or patches  are thus
produced on  exposed parts, especially in per-
sons of  fair complexion.  They  are most fre-
quent in those parts which are exposed to the
action of the sun's  rays,  so the face is  the
part most often affected.  The attempt to re-
move freckles by local applications seldom suc-
ceeds, but the following may be tried :  Take
of muriatic acid,  one drachm ;  rain-water,
half  a pint ;  spirit  of  lavender, hali a tea-
spoonful ; mix  well.   Apply it two or  three
times a day to the freckles with a bit of linen,
or a  camel's-hair brush.
  FRIAR'S  BALSAM.  (See Benzoin.)
  FROST-BITE  varies very much in  se-
verity.  The  simplest form and  the  most
common  is  the  ordinary  chilblain ;  in a
more intense  form  the affected  part  be:
comes cold,  livid, and  puffy, and feels  be-
numbed.  This latter condition, if the cold be
no further prolonged, is followed by  intense
heat  and  redness, and all  the symptoms ot
acute inflammation,but if no heat or protection
be then  afforded, passes at once to mortifica-
tion.  This last stage of frost-bite has been
very frequently met with in campaigns carried
on during the winter.  In this country,  how-
ever, except among the very poor and destitute,
mortification from  frost-bite is a rare affection.
The  subjects  most frequently affected  are
old people and those whose circulation is slug-
gish, badly-nourished individuals, and drink-
ers.   Though met with in a great majority of
instances in the winter  months, it is not so
often produced  by frost as by cold and wet
together.   Continued  compression or  con-
striction, associated with cold, is occasionally
a cause of local mortification.  A  case is on
record of a boy who, after sleeping during two
nights of cold  and damp weather with  his
boots on, suffered from gangrene of the toes
of both  feet.   Gangrene may also be  pro-
duced by suddenly  submitting to  heat any
part  of the  extremities  that has  been exposed
for several  hours to the influence of cold and
has become numb and  livid.  In the most ad-
vanced  stage of frost-bite the  affected  parts
are black and dead ; between this portion and
the  sound  skin there  is a groove lined by
florid tissue resembling that on the surface of
a healthy ulcer—the so-called line cf demarca-
tion, and beyond this the surface  of the skin
for a short distance is reddened.   In some
cases the skin only is mortified, in others all
the tissues  of an extremity down to the bone.
On the  formation  of the line of  demarcation
the dead tissues commence to  separate, and
the subsequent  changes  are similar to those
which take place in ordinary gangrene.   The
above morbid changes are  primarily due to
the action of cold which suspends and arrests
the flow of blood through  the veins.  The
parts most frequently  affected are the  toes,
the nose and ears, and  the fingers ;  those
structures,  in  fact, which  are  most  remote
from the heart and most exposed  to external
influences.
  Treatment.—The treatment of  the mildest
and  the  advanced  gangrenous forms of frost-
bite  should be similar to  that of chilblains. A
person,  when exposed to the risks of frost- 
180     FROZEN LIMBS, ETC.
FUNGUS IICEMATOIDES
 bite,  should endeavor by active  exercise to
 keep  up the circulation of the blood until he
 obtains some protection against  the  cold.
 When a part is livid and  cold  great  care
 should be taken not to submit it suddenly to
 heat—to place it in hot water or to place it
 near  a fire.   The temperature of the frost-bit-
 ten part should be raised gradually, first by
 friction with snow,  if obtainable, then by fric-
 tion  with the hand, and finally by surround-
 ing the  part with  thick layers  of warmed
 cotton-wool.
   FROZEN LIMBS, ETC., are a frequent
 result of  our severe climate  and  sudden
 changes of temperature.   In treating them,
 great care  must be taken to avoid sudden
 changes of temperature.   Should a person be
 found quite  benumbed with cold, take him
 first  to a barn, or shed, or cool room ; it
 would probably cost him his life if  he were
 taken direct to a fire or into a  very warm
 room.  If the clothes are wet, remove them,
 and  rub the  body  dry ;  then wrap him in
 blankets and give a little weak  spirits  and
 water or tea.  After a while  remove him to
 a warm room, but still avoid taking him near
 a fire.  Rubbing the skin is the most impor-
 tant restrative agent ; it should be done either
 with  snow or with  the coldest water that can
 be had.  Continue  this  rubbing  for several
 hours if necessarv,  till the parts are quite soft,
 and  something like the  natural  color is re-
 stored.   Even when  this point is reached,
 rubbing with  flannels, continued for  some
'time, will be  of great advantage.   After this
 has been done the parts may  be anointed with
 sweet oil or lard, or with lime-water and oil
 (equal parts), and wrapped up well with flan-
 nel.  If there should be any sores, dress them
 the same as burns (see Burns).
   FUMIGATION is often resorted  to in
 order to give still greater completeness to the
 disinfection required for an infected room or
 dwelling (see Disinfectants). Dr.Elisha Har-
 ris gives the following Rules for Fumigation :
 " Thick woollen stuffs, carpets, etc., to which
 boiling heat cannot be applied, fumigate with
 sulphurous  acid,   thus :   First,  arrange  to
 vacate  the  room for twelve hours ; suitably
 arrange all the movable  articles that require
 disinfection ; close every window and aper-
 ture, and,  upon an  iron pipkin, or kettle with
 legs, burn a few ounces of sulphur ; the quan-
 tity  required for  effectual work will depend
 upon cubical space of the apartment, allowing
 \% lbs. to  every  iooo  cubic feet of space,
 and there should be enough to burn rapidly
 until want of oxygen in the air shall  extin-
 guish the  flame.   Instantly after kindling it
 every person must withdraw from the place,
 and the room must remain closed for the suc-
 ceeding eight hours, or even for an entire day
 or night.  If any other fumigation is resorted
 to (as that  by chlorine, bromine,  or nitrous
 acid), a sanitary officer or a  chemist or physi-
cian should superintend the process. Fumiga-
tion should be resorted  to in dwelling-houses
only under the  personal superintendence of a
competent medical man, as the disinfecting
gases are very poisonous."  The term " Fumi-
gation" is also  applied to a plan of treatment
which consists in bringing the vapors of a me-
dicinal agent into contact with the surface of
the skin, either at a certain diseased  part or
over the whole of the body.  The vapors thus
applied act locally and at the same time are
absorbed  by the skin, so that the  remedy is
diffused throughout the  system.  Fumigation
is seldom  carried out save in the treatment of
venereal disease by mercury.  Here it is fre-
quently used, and is considered by many sur-
geons to have advantages over the  inunction
plan or rubbing-in of mercurial ointment, and
over the  ordinary  method of administering
blue pills and gray powders by the mouth. A
smaller quantity of mercury is required, the
action  of  the medicine  may be  readily con-
trolled, the stomach is not disordered,and sali-
vation is less frequently produced.   The com-
pounds of mercury that are used in this way
are the bisulphuret, cinnabar, corrosive sub-
limate, and, most  frequently and most effec-
tually, calomel.   The selected  powder is
placed either on one of the several kinds of
lamp that have been specially designed for
this purpose, or on a brick or tile heated to
redness and deposited in  a pan  containing
boiling water.   The lighted lamp  or heated
brick is placed under a  cane-bottomed chair,
and the patient, stripped of his clothes, then
sits  upon the  chair   and covers himself
closely, except  over the face and head, with a
warm blanket, or a mackintosh, or American
cloth coat. In the course of ten minutes light
mercurial powder is deposited on the surface
of the  skin.  When all the  mercury is volatil-
ized the patient should at  once  get into bed,
taking care not to remove any of the grayish
deposit from the skin, as this, during the
night,  may be partly absorbed.  This proceed-
ing is generally repeated every  night, or  on
alternate nights, until the gums become sore.
In a general fumigation the amount of calo-
mel usually  required  is about ten or fifteen
grains.   This  plan of  treatment is not well
tolerated  by every patient, one  bath even
sometimes causes great prostration and gen-
eral disturbance.   Great care,  too, is neces-
sary on the part of the patient to avoid catch-
ing cold.  Venereal affections of  the mouth
and throat, and ulcers on certain limited parts
of the surface of the body, are often treated
by local fumigation, the vapor of calomel or
other  mercurial agent  ascending from  the
lamp  or   heated  brick, and  being directed
upon  the  seat of the disease  through tubes
specially  adapted  as to shape and length for
this purpose.
   FUNGUS HCBMATOIDES.—This is  a
variety of soft  or  medullary cancer, in  which 
FUSEL OIL
GALL-STONES          181
the tumor is large and of rapid growth, and
composed of very soft and pulpy cancerous
tissue, mixed with large clots of blood.  The
tumor often throbs like an aneurism or vas-
   GALBANUM is a gum resin that is a mix-
 ture of gum and resin of unknown origin.  It
 comes from Western Asia  in small aggluti-
 nated masses of a greenish-yellow color.  It
 contains a valuable oil something like turpen-
 tine and a peculiar resin.  Its odor is peculiar,
 something like that of assafoetida, but less in-
 tense,-and is not so disagreeable. In its prop-
 erties, galbanum is supposed to approximate
 to  assafoetida, and is contained in  the com-
 pound assafoetida pill.  Probably it is of little
 value, but may act by  virtue of its oil as a
 stimulant substance.
   GALL.  (See Bile.)
   GALL-BLADDER, an oval sac or bag,
 about three inches long, forming an append-
 age to the bile duct,  and situated on the
 under surface of the liver ; it is a receptacle
 for any surplus bile, and  sometimes gall-
 stones are formed in  this cavity.
   GALLS, or Gall-Nuts, are  small excres-
 cences produced upon the buds of the Quercus
 infectoria, growing in Asia Minor, by means
 of an insect.   This insect deposits its eggs in
 the young buds of the tree, and around them
 grows a hard  mass, which  in  course of  lime
 becomes  the gall-nut.  These so-called nuts
 are more  or less globular in shape, and tuber-
 culate on  the surface, and are generally about
 the size of a  marble.  Galls  contain a large
 amount of tannic acid, and a smaller amount
 of gallic acid ; they owe their properties en-
 tirely to these two substances.  (See Gallic
 Acid ;  Tannic  Acid.)
   GALLIC  ACID is  prepared by making
 the powder of gall-nuts into a thick paste with
 water and keeping  it in this  state for six
 weeks at  a temperature of 6o° or 700.   This
 paste is then boiled  and strained, and  gallic
 acid is allowed to crystallize out of the fluid.
 After this it requires to be purified.  In the
 pharmacopoeia  there is a glycerine of gallic
 acid, which is a useful astringent  application
 in certain forms of sore throat, especially to
 the tonsils after being inflamed, when  they
 show  no tendency to  contract to their proper
 size, and there seems danger of their remain-
 ing permanently enlarged.  Gallic acid is fre-
 quently given internally, mainly for checking
 bleeding.   It  is usually combined with sul-
 phuric  acid, and may  be  given in doses of
 from  5 to 20 grains.  It is used this way in
 bleeding from the lungs and stomach espe-
 cially.   It may be also used in bleeding from
the kidney, but with less  hope  of success.
Care must be taken not to order it along with
iron, or ink is produced. Soo, too, these reme-
cular  growth, and when ulcerated or broken
at its surface bleeds very freely.  (See  Can-
cer.)
  FUSEL OIL.  (See  Fousel Oil.)
dies should  not be given  closely following
one another, or the same change  may take
place in the bowels, and the patient may be
alarmed at the color of the faeces.
  GALL-STONES,  or  solid  concretions
formed of bile, are  usually formed  in the
gall-bladder,  but sometimes,  though  rarely,
also in the bile ducts.   During the intervals
of digestion  in  the small intestines the bile
secreted   accumulates   in  the   gall-bladder
where it becomes thickened, both by the fact
of the water  being  absorbed, and by  the se-
cretion of mucus from  the  walls of the gall-
bladder.   Most  gall-stones  are mainly made
up of a fatty  material of crystalline character
called cholestrine,  mixed  with the coloring
matter of bile,and may grow to very consider-
able size.   When there is  only one gall-stone
in the bladder it may grow to the size of a
hen's egg, which it somewhat resembles in
 shape.    More  frequently   a number  are
formed, and then they have  facets or smooth
surfaces, corresponding to  the points where
they have come in contact one with another.
They are very light, and when dried, float in
water till they have absorbed  some of  it, and
then slowly sink. Gall-stones are always evi-
dence of something wrong in the state of the
bile but not of anything in the state of the liver
itself.  They are  more common in women
than men,  perhaps owing  to the modes of life
differing considerably,  for,  of  all inducing
causes, sedentary  occupations and confine-
ment, seem to be the most potent. If the bile
have a tendency to form  deposits, whatever
favors long retention of it in the  gall-bladder
may  lead  to the formation of  gall-stones.
The formation  ot gall-stones does not seem
to be specially associated  with any diseases
of the substance of  the  liver,  except one,.
that is cancer ;  but, inasmuch as  that disease
in its later  stages is frequently associated
with obstruction to  the flow of bile into the
alimentary canal, it is most probably the con-
dition so induced which favors the formation
of gall-stones rather than the disease itself.
So too, age has some effect in the same way,
for gall-stones are  rare during the most ac-
tive  period of life,  that is, under 30.   Their
formation is often associated with a tendency
to gout, and  may possibly be accounted for
in the same way, viz.,- a sluggish  life of over-
eating and drinking. This is hardly the place
to speak of the effects of gall-stones in  giving
rise to diseased conditions of the gall-bladder
and its appendages, which are rather the sub-
jects of professional study than of general in-
G. 
182          GALL-STONES
GALL-STONES
terest, and so we pass to the modes in which
gall-stones may be got rid of. Most frequently
when of small size, the gall-stones may be dis-
charged through the natural passages into the
intestine, but sometimes they,are got rid of by
ulceration  of  the  gall-bladder or bile ducts
into the  intestine lower down in its course.
Sometimes, instead of escaping into the gut,
the gall-stone may give  rise to inflammation
or sloughing of the part where it is confined,
and so escape  into the general  cavity of the
abdomen.  This is followed by inflammation
and death, but its occurrence is rare. Usually
the inflammation causes adhesion to the wall
of  some portions of the intestine, and so the
two walls giving way. The escape of the gall-
stone costs much less pain than  does its pas-
sage along the natural channels, presently to
be described.   Gall-stones are at the bottom
of a large proportion  of ailments of  the  liver
complained of in  this  country.  They  may
long remain quiet, but when they do begin to
give rise to painful symptoms in their passage
toward the bowel the pain  is frequently hor-
rible. In the gall-bladder, the only symptoms
ordinarily produced  by  gall-stones is  a feel-
ing of weight in the  right side, or  at the
lower  corner of the  corresponding  shoulder
blade.   In the tube  which lies between the
gall-bladder and the liver they may cause lit-
tle  inconvenience  beyond obscure affections
of the digestive powers,  but in the tract lying
between the liver and gall-bladder and the in-
testine, what is called the common duct, they
ordinarily give rise to jaundice.  The symp-
toms  from the passing of  a gall-stone, gen-
erally come on quite  suddenly, often two  or
three hours after food, and the pain is de-
scribed as a kind of spasm.   Its situation is,
however,  peculiar ;   it  is distinctly on  the
right  side  of  the  abdomen, just below  the
false  ribs, and generally extends through to
the back, near the lower angle of the blade-
bone, or between that and the spine. The pain
is not constant ; if it were, in  some  cases it
would destroy life ; it comes by fits and starts,
and, while it lasts, is  so severe  that the pa-
tient writhes in agony, or rolls on  the floor,
pressing his hands on his  side, for  pressure
frequently  relieves the  pain.  This pain is,
moreover,  attended with a feeling of constric-
tion in the lower  part of the chest,  which is
frequently  interpreted as a difficulty in breath-
ing so that a slight attack  may be put  down
to pleurisy.  The fit,  as it  is called, of  gall-
stones, produces severe exhaustion, the pulse
becomes  weak, the face pallid, and the whole
body  covered  with cold  sweat.  Often the pa-
tient questions whether life is  worth having
on these terms.  The pain or irritation in the
vicinity of the stomach causes it to contract,
and so there is vomiting, which sometimes
aggravates, but more frequently relieves the
pain.   Perhaps the nausea arrests the spas-
modic contraction of  the bile duct round the
 stone  to which  doubtless  the pain is due.
 Jaundice, as already pointed out.is a common
 symptom, but not necessarily  present  in all
 cases. If the stone be small or angular, it may
 give rise to some degree of irritation in pas-
 sing, but may not be large enough  to  choke
 up the duct, and so  not produce  jaundice.
 Nevertheless,  even  if  these do  not pass
 quickly, the gradual accumulation of bile due
 to its obstruction may give rise to a  consider-
 able degree of jaundice.   It is rare for gall-
 stones  to  cause  death during their passage
 through the  bile ducts, and  in the  majority
 of cases, especially if the period of the passage
 has been short, as soon as the passage is ac-
 complished, the patient is well, though, if the
 passage has been long delayed, or gall-stone
 follows gall-stone as sometimes happens, the
 constitution may be greatly shattered.   Once
 in the  intestine, as   a rule,  all danger  is
 past ; but if the  stone be very large it may
 stick in  the intestine, and cause obstruction
 of the bowels, or if it be very small, it may be-
 come fixed in that troublesome spot, the ver-
 miform appendix, and so  cause inflammation.
 Either event is rare.   Individuals who have
 once suffered from  gall-stones are unfortu-
 nately liable to do so again.  This  comes in
 two  ways as pointed out ; several gall-stones
 may exist and only one at a time be passed,
 or the conditions which gave rise to one may
 prevail and give  rise to others.  In  all cases
 it is  desirable to  secure the stone by carefully
 examining the faeces,  as  indications are fur-
 nished by it as to the existence of others, or
 as to a likelihood of the return of the symp-
 toms.
  Treatment.—The treatment of gall-stones
 is a matter  of the very greatest importance,
 for inasmuch as they seldom kill, but give rise
 to terrible pain, much is left in the  hands of
 the physician.  Accordingly, the first thing to
 be done  is to relieve the pain  and  spasm
 while the stone is passing, and to attempt to
 get rid  of those  still  left in  the gall-bladder,
 if any, by dissolving them, and so to prevent
 new  ones forming.   For relieving  the pain
 and  spasm there is nothing like opium.   For-
 merly it was not easy to give this, as the
 stomach rejected it, however cunningly con-
 cealed, during the vomiting  produced  by the
 disease ; now, however,  by  the hypodermic
 injection, we can give it  as  we please.  But
 the sickness is a thing not to be slighted, and
 so for it we prescribe spirit of  chloroform,
 ice,  and the  like kinds  of remedies.    Fre-
 quently, however,  for  this  purpose  large
 draughts of hot water and carbonate of soda,
 may be given partially effervescing  with tar-
taric acid, for the effervescence passes off in-
 stantaneously, and does much good. The hot
 water may be repeated as often as necessary.
 On  the other hand, ice is  one of the best
 remedies we can use.  But if hot water  inside
 does good, the  hot  bath  sometimes  does 
GALVANISM
GARGLES
183
 more, especially accompanied  by opiate sub-
 cutaneous injections.  Thus sleep may often
 be procured, when such is possible in no other
 way.  Chloral too, would be well worth try-
 ing in good full doses, but meantime, our ex-
 perience with regard to it in these cases is
 almost nil.  To get rid of any  gall-stones left;
 in the bladder, various remedies have  been
 recommended.   Chief among these are alka-
 lies and aikaline carbonates, and chloroform
 or ether.  At one time a mixture of ether and
 turpentine was greatly in vogue in France.
 On the  whole,  what applies  to this, applies
 also to the avoidance of these formations in
 future.  Chief among preventives are air, ex-
 ercise,  and  plain  food.  Beer should  be
 avoided, but a  fair allowance of light  wine
 may be  taken.  The bowels should be moved
 daily,  if necessary ; in the evening a  small
 dose of blue pill may be taken from time to
 time.   If  the patient can afford to travel,  he
 should  try  a residence  at an appropriate
 watering place.
   GALVANISM is a power like electricity,
 named after  its  discoverer,  Galvani, and  is
 often applied to the body in case of nervous
 pains, by means of a small portable machine.
 An invention  known as  " Pulvermacher's
 Chains" is a form  of machine which is very
 portable, and the electric current is continu-
 ally kept  up, passing through the body al-
 most imperceptibly.  (See Electricity.)
   GAMBOGE is a kind of green resin, pro-
 cured  from Siam.   The juice  of the tree is
 collected in hollow bamboos ; hence the out-
 side of the pipes or sticks, in which form the
 drug is imported, is marked with streaks cor-
 responding to those on the  inside of  the
 bamboo. It is hard and brittle, breaking with
 a shiny fracture, bright yellow in  color.   It
 is easily produced, and when from the powder
 the resin is extracted, that is found to have
 acid properties.   Rubbed up with water, the
 gum dissolves and  suspends  the resin, form-
 ing an emulsion.  It is more used as a pigment
 than as a drug. Its only preparation is the com-
 pound  gamboge pill which is not often used.
 Gamboge  is a  powerful drastic purgative,
 giving rise to copious watery motions.   Not
 much is required to do  this, and sometimes
 children, with whom it is a favorite plaything,
 by  merely  licking it so  as to get it to paint,
 as they say, are severely purged  as  a conse-
 quence.  It often causes vomiting, and al-
 ways gaping, and so is seldom given by itself.
 Perhaps, if given at all, cream of tartar is the
 best adjunct.  The two cause copious watery
 motions  of the  bowels.   Ginger,  cayenne
 pepper, or  some oil should  always be given
along with  it to  prevent  the griping. ' It is
mainly given as a purgative in dropsies where
the power of causing watery stools is of value.
It is also sometimes used to get rid of worms.
It is the basis of  some quack remedies, and
being used  injudiciously, as  these are apt to
 be,  has  given rise  to  inflammation of  the
 bowels, and so to death.
   GANGLION in surgery is  a tumor  con-
 nected with  the sheath of a tendon, either
 arising from a partial, sprain, the fibrous and
 synovial sheaths  being  torn,  or from  the
 sheath being  attenuated  and distended  with
 the albuminous secretion.  It appears  as  a
 fluctuating, translucent swelling,  compressi-
 ble,  varying in size and shape from that of  a
 small  pea  to  a hen's egg, and the swelling,
 though  tense,  distinctly  fluctuates.  Their
 usual situation is at the back of the wrist or
 upper aspect of the foot.   It will be noticed
 in many  instances that they appear to be mul-
 tiple, or that there are several ;  this, however,
 arises from the fact of the tendons, generally
 extensor, passing  over  them  and dividing
 them into  apparently distinct compartments.
 The fluid  contained is  thick, rancid,  and
 glairy, like white of egg, or what artists know
 as  "' Macgilp,"  secreted by  means of  the
 epithelial cells on  the surface of the synovial
 membrane, and especially by those which are
 accumulated on  the  edges and  processes of
 the synovial fringes.   It consists of water,
 mucus,  and  epithelium,  fat,  albumen,  and
 extractive  matter, and  salts.  The  treatment
 consists,  if they are very small and have evi-
 dently thin walls,  in dispersing them into the
 surrounding tissues by a smart squeeze of the
 thumb, or  a  sharp blow, friction, and  pres-
 sure ; these generally cure them.   A blister
 placed immediately over the tumor often  ex-
 cites a sufficient amount  of irritation in  the
 sac to absorb the contents.  In larger cysts,  a
 fine knife should be introduced flatwise through
the walls of the ganglion,  so that by pressure
 its contents may  be  extended into the  sur-
 rounding structures,  and becomes absorbed
 after dispersion.   A  compress  and bandage
 should next be applied,  and if the  cyst refills,
 the process must be repeated.   Sometimes
 the tumors may be dispersed by iodine  or  a
 mercurial ointment.  Persons who  are subject
 to these ganglia should wear some firm india-
 rubber webbing round the wrist joint, when
 about to  use the hand much, or if subject to
 them on  the back of the foot,  firm,  well fitting
 boots,  bracing up  the instep.
  GANGLION in Anatomy is a  swelling
 consisting  of  nervous matter.  Ganglia are
 found in  all forms of the nervous system.
  GANGRENE is  the  partial death  of  a
 part of the body—the  preliminary  step to
 mortification, or the absolute  death of a part.
(See Hospital Gangrene.)
  GARGLES,  or  Mouth   Vvrashes,  are
 remedies in a liquid  form intended  for  local
application to the mouth and  throat. The art
of gargling properly is easily  learned, but re-
quires some little skill, and accordingly such
remedies cannot be made  use of among chil-
dren.  Among them  some adherent form of
remedy should be employed which can  be 
184      GASTRIC CATARRH
GASTRIC ULCER
smeared over the parts. Gargles are intended
to  fulfil various purposes.   Some only  to
cleanse the parts, some  to  brace  them up,
some to allay  inflammation, some to  heal
sores, and so on. Of those intended to cleanse
the mouth pure water may take  the lead.   It
should  be warm, and in this  form  too it
proves  of  great service in the acute stage of
inflammation of  the  tonsils, to which many
are very liable.   Not infrequently it happens
that  from  some cause the covering of the
mouth and tongue forms on  its  surface a
mass of decaying material, the odor of which
is excessively unpleasant.  To  remove  this
something more than water is necessary, and,
on the whole, there is nothing better for the
purpose than carbolic acid and water. Where
there is at the same time inflammation of the
throat sulphurous acid and water had  better
be used.  Certain  conditions  of constitution
are  accompanied  by relaxation  cf the soft
palate and uvula, for  which gargles are com-
monly employed.    Chief among the sub-
stances used this way are tannin  and alum,
cither separately or in combination.  Tannic
acid, or catechu lozenges, may be used  for
similar purposes. If there is ulceration of the
mouth,  as in children, ether  spray must be
used or sticky stuff used. Borax and honey is a
favorite remedy. If the ulcers are very foul, as
sometimes happens in syphilis or after saliva-
tion  by mercury, the  best gargle to use  is
made by adding hydrochloric acid to chlorate
of potass.   This may  be used freely, well
diluted  with water.   Occasionally a  little
laudanum or tincture of belladonna may be
added  to the warm water if the inflammation
is very acute, but the practice is not void  of
risk  ; and, as a rule, hot water and  steam
suffice.    Atomized  fluids, produced by the
spray instrument, have to a considerable ex-
tent  replaced the use of gargles but cannot do
so entirely.
  GASTRIC CATARRH.   (See Indiges-
tion.)
  GASTRIC FEVER, another term for ty-
phoid fever.  (See Typhoid Fever.)
  GASTRIC JUICE  is a  thin  acid fluid,
poured  out from  the glands of  the  stomach
during digestion.  Its acidity arises from the
presence of hydrochloric or  lactic acids, but
in addition to  these constituents the gastric
juice possesses  another  called  pepsin,  to
which  most of its peculiar  action is due,
When  the food is swallowed and enters the
stomach, the movements of that organ, when
its walls contract,  roll the  food  about and
thoroughly mix it with the gastric  juice.   If
small pieces of meat  or hard-boiled egg  are
placed in  acidulated water with which  some
gastric  juice has been mixed, and kept at a
temperature of 100° Fahr., it will be found that
in a  few hours, these substances have been
nearly,  if not quite,  dissolved  and reduced
to a  pulpy state.  This is  called  artificial di-
gestion, and it has been proved that precisely
similar changes go on  in  the  stomach of a
living animal.  There, soluble substances are
then rapidly  absorbed by the vessels of the
stomach while some portions go on  to enter
the intestines.  Advantage has been  taken of
this  lact to aid digestion by giving the pa-
tient pepsin a short time before a meal ; this
is usually obtained from the stomach  of a pig,
and since the active properties, of the gastric
juice are mainly due to this body, it follows
that much benefit may, in some cases, result
from its use.  (See Diet, Digestion, Food,
and Pepsin.)
  GASTRIC ULCER, or Simple Ulcera-
tion of  the Stomach, is an accident of  by
no  means uncommon occurrence, though in
its worse aspects it is  comparatively speaking
rare.  It occurs most frequently in youngish
persons,  especially females of the  servant
class, though by no means limited to  them.
Its symptoms  are mainly these—pain, vomit-
ing,  bleeding ; in  females, absence  of men-
struation, there is loss of flesh  and pallor of
countenance, and finally the  ulcer may per-
forate the wall of the stomach, give rise to
general inflammation  of the cavity of the ab-
domen, and so cause death.   To take each of
these in turn.  The pain, which  is usually the
first symptom, is very characteristic.  It com-
monly begins from a  few minutes to half  an
hour after taking food.  At first it resembles
a feeling of weight, later it resembles burn-
ing, later gnawing and sickening, but rarely
if ever of the sharp  darting character com-
mon in cancer.  When this pain is severe it
often ends in vomiting, after  which  the pain
is relieved. The pain is most frequently situ-
ated just below the  extremity of  the  breast
bone, and there is often a corresponding pain
in  the back, between the shoulderblade and
spine.  The  spot  where the pain  is  felt  is
generally very tender on pressure,  but not
always so, and  the painful spot is rarely of
any considerable size.   As the  ulcer  is rarely
at either end  of the stomach but generally in
its middle, and  most frequently on  its back
wall, lying on the face will sometimes relieve
the pain very greatly.  The  pain is,  more-
over, very greatly affected by different kinds
of food.  Some articles can hardly be borne—
tea and beer, and though, as a rule, brandy
and hot water cannot be taken, in some cases
it gives relief. Vomiting is a symptom of gas-
tric ulcer of very grave significance,  and may
itself be  the  source of very  considerable
danger.  It is very various in amount, some-
times only amounting to  a slight regurgita-
tion, as if the food rose in the  throat and fell
back  again, but as a rule when  it begins it
empties  the  stomach.   Ordinarily  it  occurs
when the pain is at its height, the whole con-
tents are evacuated, and relief to the pain fol-
lows.  If vomiting comes on speedily after
taking food, the food  itself comes  up little 
GASTRIC ULCER
GASTRIC ULCER        185
 altered, if digestion has advanced somewhat
 then the matters ejected are sour,  and later
 still they may be mixed with bile.  Occasion-
 ally  the vomiting has no reference to the
 swallowing of food, it comes on in the inter-
 vals  of digestion ;  if  so  the substances so
 ejected  may consist mainly of  glairy mucus.
 The danger of this symptom consists partly in
 that the food being completely expelled none is
 retained to nourish the body, and so wasting
 and  weakness  follow.  Besides there is the
 fatigue engendered by the act  of vomiting,
 which, in a wasted frame,  is no slight matter.
 Moreover, the violent straining of the stom-
 ach may  favor  the occurrence of  the  two
 most fatal accessories of gastric ulcer, bleed-
 ing and perforation;   Haemorrhage or bleed-
 ing is a very grave symptom, and one which
 not unusually proves fatal.  It  is due to the
 ulcerative process eating through the coats of
 the stomach until that v/here the larger ves-
 sels are situated is  reached.   Usually, as the
 ulcerative process goes on, the  vessels which
 are eaten through become  plugged up, and so
 bleeding is prevented, but it often  happens
 that a vessel of some size  on the floor of the
 ulcer is corroded and gives way before it has
 time  to be plugged, and so the  blood escapes
 into the cavity of the stomach.  This is most
 likely to happen during digestion, especially
 if the stomach has been distended by a big
 meal.  If the bleeding be small in  quantity
 there  may  be no  sign of it except that the
 fasces are a little blacker than ordinary, which
 it is not easy to  detect.  But should the ves-
 sel be  of some size and  the bleeding free,
 speedily the stomach becomes distended with
 blood ; vomiting is set up, and the blood is at
 once  detected.   Blood  ejected  in this way is
 usually dark,  rarely,  however, it is bright
 red.  More rarely  still  the vessel  opened
 bleeds  so freely that  the  patient  faints  and
 dies before there is time to vomit.   In these
 cases after death the stomach and bowels are
 found  enormously  distended  with  blood,
 often clotted.  It does not always follow  that
 because blood is vomited  it comes from the
 stomach.  Thus,  if there be bleeding from the
 nostrils  behind  where they  open  into  the
 throat,  part of the blood may be swallowed,
 and subsequently causing sickness, is ejected.
 So, too, in bleeding from the back part of the
 throat, especially  in children,  the  blood is
 often swallowed and afterward  vomited.   In
 bleeding from the  lung, too—what is called
 haemopiysis—part of the blood  ejected is fre-
 quently swallowed and subsequently ejected.
 All these chances of error must be borne in
 mind.   Usually in gastric ulcer the  bowels
 are constipated, but not  always so.   The
 small quantity of food  which passes on into
 the bowels is one great cause of this.  There
is  nothing to void.    In  ulceration  of  the
bowel itself this is quite different ;  in it diar-
rhoea  is the rule, with  hardly any exception.
 Perforation is at once the symptom  and the
 result most to be dreaded in gastric ulcer. If
 the  process of  ulceration  go  on  uninter-
 ruptedly by-and-by the coats get very thin  ;
 from some unusual distension or exertion the
 thinned  part  gives  way  and the contents of
 the organ escape freely into  the cavity of the
 abdomen.  The signs of such an occurrence are
 unmistakable.   After  suffering more or  less
 severely from the symptoms already described,
 the patient is suddenly attacked with excrucia-
 ting pain in the abdomen,spreading rapidly all
 over it.  The patient  becomes collapsed, the
 pulse fails, and in not many hours the patient
 sinks and  dies.   Dilatation  of  the  stomach
 sometimes results from a healed ulcer causing
 constriction at one part,  but this is not very
 common in simple ulcer.
  Treatment.—To begin with,  the  simplest
 and the best,  ice,  especially when  there is
 bleeding, can  rarely be dispensed with.  The
 patient may eat it freely,  not sucking it only,
 but  champing it and swallowing  it  in  the
 rough. When there is bleeding, ice should be
 also kept applied over the pit of the  stomach
 and below  the false ribs on the left side.   Let
 it be given and applied freely ; it can do no
 harm, and  is more likely to do good in bleed-
 ing than anything else.  For the pain, which
 is often very severe, perhaps opium is the best
 remedy, and it is best given locally,  that is,
 by the stomach, in this particular case.  The
 best preparation  is  the extract made  into
 small pills—the  smaller  the  better, half a
 grain at a time.   If  these are  rejected, mor-
 phia in smaller dose, might be tried the same
 way ; if that  fail it must be given subcuta-
 neously.   For the pain, when there is no
 bleeding, bismuth is often one  of the  best
 remedies we can give, but it must be in goodly
 quantity of 20 or 30 grains or more.   As re-
 gards the vomiting, that we  have seen to be
 a dangerous symptom, and one which conse-
 quently demands close attention.  It is  not
 easily dealt with.  Upon the whole ice is the
 best remedy—and rest. The stomach  will not
 bear food, and so food must be  given in the
 smallest possible quantity,  and  of the most
 unirritating possible quality.   Of  all foods
 perhaps the best is milk ;  after a time  essence
 (not extract) of meat  is to be given,  but not
 at first.  In case of vomiting still continuing,
 all food must  be stopped and nutrient injec-
 tions used.  When  bleeding occurs the same
 rules are to be carried  out, together with ab-
 solute  rest.   Stimulants are  not admissible,
except   excessively  dry  iced   champagne.
 Remedies,  however, may be  given to arrest
the  bleeding, opium among the number.  The
 most reliable  undoubtedly is gallic acid, 20
grains  for a dose, along with 10  drops of di-
lute sulphuric  acid, given  in the smallest  pos-
sible quantity  of water which will enable  the
patient to swallow the mass in comfort.   By
and by, when  the patient begins to improve, 
180           GASTRODYNIA
GELATINE
iron is to be given, but cautiously, beginning
with weak non-astringent preparations like
the ammonio-citrate or tartrated iron.   Infu-
sion of calum^a, too, is most useful, especially
later on, when  a few drops of acid can  be
given with it to aid digestion.  Of course such
a mode of treatment confines the bowels, and
these must be opened ; first of all by  injec-
tions later  by gentle laxatives, such as com-
pound rhubarb powder or castor  oil.   Great
care in dieting must  be  observed long after^
recovery,  for relapse is frequent and danger-'
ous.
  GASTRODYNIA,  with which are some-
times used as  synonymous  gastralgia and
cardialgia,  strictly means pain in the stomach,
using the word in its strict sense as indicating
a particular  organ, and not  as vulgarly the
whole abdomen.   In this country, cardialgia
is more commonly associated  with the idea
of acidity,  and is used as synonymous with
heartburn (which  see).  As  used here, gas-
trodynia is meant to  include all  degrees  of
pain, from the sensations that  one possesses
in stomach-ache  to  pain of an almost  unen-
durable character.  This pain  is  not always
felt  in the same spot, nor is it of the same
character.  Weight, oppression, and disten-
sion are the sensations most frequently com-
plained of ; and this is the form which ordi-
narily indicates slight forms of disease of the
stomach.   More severe forms are commonly
accompanied by a sensation of burning—not
heartburn—and others still by a horrible feel-
ing of gnawing or tearing.  Pain in the  stom-
ach may come from various  causes, such  as
the presence  of irritant matters, disease of  its
walls, alterations in its own secretions, and
perversions of its innervation.  Foreign sub-
stances of an irritant character may be either
indigestible articles of food, regurgitated bile,
or corrosive  substances swallowed, such  as
strong  acids or  alkalies ;  these, however,
being rare, compared with the former.   The
diseases affecting the substance of the  stom-
ach, and giving rise to pain, are mainly two,
simple ulcer  and cancer.   The pain of the
former  ordinarily comes on soon  after swal-
lowing food,  and is relieved when  the food is
ejected  or  passes on  into the bowel.   The
pain of cancer, on the other  hand, comes  on
as a rule, either earlier or later, during swal-
lowing, or when the food begins to pass away
from the stomach. It is, moreover, somewhat
different in character ; sharp and lancinating,
instead of dull and heavy.  Cancer, too, situ-
ated at the  end of  the  stomach next the
bowel, obstructs the passage of food into the
intestine, and so gives rise to changes in it
of a putrefactive kind.   These, in  their turn,
cause flatulence and eructations of a very dis-
agreeable kind.  Altered secretions are a very
important cause of pain. But most frequently
the excessive acidity complained of is not so
much due to  alteration in the gastric juice it-
 self, as to alterations in the  food.   What are
 technically known as neuroses, that is to say,
 disorders  purely  nervous, have much  to do
 with pain  in the stomach ; for when there is
 other disease,  this  element aggravates  it ;
 and where there is other cause  of  pain, this
 abnormal  susceptibility increases its effects.
 This variety of pain is most  common in deli-
 cate nervous women,  and in hypochondriac
 men, broken   down   by  some debilitating
 cause.  A kind of cramp of the stomach, too,
' may occur.   Pain may be  reflected to the
 stomach from  the womb or  ovaries in fe-
 males,  or it may be due to pure  neuralgia.
 The  meaning  of  pain  in the stomach  is far
 from easy to understand, for pain, exactly the
 same in character, may have  a totally different
 signification.   The great point is to find out
 which pain  is  neuralgic, and which due to
 disease of the organ itself.  This is very diffi-
 cult ; still  some clue is afforded by  the fact
 that in pure neuralgia food  often relieves the
 pain, whereas  in ulceration this is commonly
 the  reverse.  So, too,  nervous symptoms, if
 purely  nervous, are seldom limited to the
 stomach, but manifest themselves  elsewhere
 also.  So, too, the  effects  of pressure and
 position help, as pressure is generally badly
 borne where the surface is  broken, but does
 good in neuralgia.   Change of posture may
 often entirely relieve in ulceration ; but, ex-
 cept  as increasing pressure,  is not likely to
 influence nervous pain. The reader must not
 conclude  that  all pain felt  just below the
 false ribs  on  the  left side, or in the hollow
 just below the breast bone right in the mid-
 dle is due  to affections  of the stomach.  Fre-
 quently pain in the great gut, which there lies
 close to the stomach,  may  be  mistaken for
 pain in  the stomach ;  but, as a rule, this  is
 generally  due  to  flatulence, and extends to
 other parts of the abdomen, which pain of the
 stomach alone cannot do.   Rheumatic pain
 of the muscles covering the stomach might
 also be confounded with true gastrodynia, but
 it is rare.  So, too, are certain cases of spinal
 disease,  giving rise to  pain  in the region of
 the stomach.   As to treatment of pain in the
 stomach, that must be  entirely guided by the
 nature of its causation, which may be mainly
 grouped under three heads :  Indigestion, gas-
 tric ulcer,  and cancer of the stomach (which
 see).  Heal or cold will, however,  frequently
 give relief, and may be applied  either exter-
 nally or internally, or both.  Neither of these
 is likely to do  any harm.
   GELATINE  can  hardly,  perhaps,  be
 called a remedy, and it is doubtful if  it can
 be called  much of a  food.   In the form of
 calves' foot jelly,  however, it is a favorite ar-
 ticle, used among invalids and  others.  It  is
 used too  for  the thickening of  soups.   The
 gelatine so used  is  commonly called  isin-
 glass, and is the sound of the sturgeon, dried
 and cut into shreds.  It would hardly deserve 
GENTIAN
GLANDERS
187
 notice here were it not for the sake of warn-
 ing the public of the want of nutritious quali-
 ties which characterizes it.   We do not mean
 to say that it is absolutely  innutritious, but
 it does not contain the amount of nourishment
 jellies  arc commonly  supposed to possess,
 and hence people may be cramming the deli-
 cate stomachs of invalids with  an almost use-
 less material.  It is no uncommon thing for
 a patient to be crammed with  what are  sup-
 posed to be nutritious articles,  which contain
 little or no nourishment, and leave the patient'
 starving.
   GENTIAN, as employed in medicine, is
 the dried toot of the yellow gentian (Gentiana
 lutea) which grows on the slopes of the Alps
 and Pyrenees.  As imported the root is in
 cylindrical, often twisted  pieces, and  is very
 tough.   Its odor is sweet, its taste somewhat
 sweetish, followed by  an excessively bitter
 after-taste.   Its active principle   is readily
 given up to water, and the infusion of gentian
 is a favorite preparation ; it, as well  as  the
 gentian mixture,  contains,  however, other
 ingredients.   The extract is also in  use for
 pills.  The tincture  too is used, but  seldom
 by itself.  Gentian is one of the most valuable
 simple  bitter  tonics we possess.  It may be
 given in  a variety of complaints ; but,  per-
 haps, is most  useful in certain  forms of dys-
 pepsia.  It is also very valuable in recovery
 from acute disease,  but  here many  prefer
 quinine.  As  it gives rise to no unpleasant
 symptoms, no irritation of  any organ,  and
 almost  invariably does good, gentian  is one
 of  those remedies best adapted for domestic
 use.  The only precautions  to be taken in
 using it is to see that the bowels are open
 regularly, and that the tongue is moderately
 clean, otherwise it will do comparatively lit-
 tle good.   The infusion, unfortunately, does
 not keep  well, but this may  be overcome by
 adding  to  it a small quantity of spirit, such
 as  brandy.   In preparing the infusion  for
 home use,  half an ounce of the root chopped
 may be used for a pint of water. After stand-
 ing for about five-and-twenty hours it will be
 ready for use,  two table-spoonsful for a dose.
 It is better to add a small quantity of spirit
 and some  bitter orange peel  when it is set
 aside to steep.
  GIDDINESS.  (See Vertigo.)
  GIN.  (See Distilled Spirits.)
  GIN-DRINKER'S  LIVER,  so  called
 because drinking large quantities of gin is one
 of the causes of chronic disease of that organ.
 (See Cirrhosis.)
  GINGER is the root, or rather the under-
 ground  stem, technically called a rhizome, of
 a plant  growing in  both the East  and West
 Indies.  Its appearance is tolerably familiar
 to  all—knotted,  yellowish-white   in  color,
easily breaking,  and possessed of a hot taste
and agreeable  smell.   Its powder  is yellow-
ish-white.  There are two forms, the white
 and the black.  The white is scraped, scalded,
 and dried in  the sun ;  the  black  is  not
 scraped, and hence its color.  It has in  it
 some volatile oil and  some  resinous matter,
 which are probably its active ingredients, but
 it also contains a lot  of starch.  Its tincture
 and syrup are much used, but  the powder is,
 perhaps, more  extensively used than both. It
 is an  aromatic stimulant  substance,  when
 taken   internally   producing _ a  feeling  of
 warmth and  comfort, and frequently appears
 to aid  digestion.   It is accordingly useful as
 an  adjunct   to  griping purgatives, and   to
 other  remedies for indigestion, especially if
 there is much flatulence. When the flatulence
 is troublesome the best plan is  to carry  a
 piece of ginger in the pocket and when a fit
 comes on, as it is apt to do under a variety
 of circumstances, a portion may be broken off
 and  chewed,  the saliva being   gradually
 swallowed.   Ginger tea, too,  will be  found
 excessively useful  in  the flatulence and indi-
 gestion of elderlv people.
  GLACIAL  ACETIC ACID  is a  form
 of the acid which is  solid at ordinary tem-
 perature ; any  little elevation will, however,
 cause  it  to assume the fluid  condition.  Its
 uses are those of ordinary acetic acid,  but
 being  somewhat  stronger  it  has slightly
 marked escharotic powers.   It is  on this  ac-
 count one of  the best applications  possible to
 warts  and  corns, which have  little inherent
 vitality and are easily destroyed.  To that
end the top should be shaved off, but not so
as to make  the part  bleed, then the glacial
acetic acid may be applied to the spot.  The
end of  a lucifer  match is one of the  best things
for the purpose of applying the acid.  It may
cause a little  smarting  at first, but this  soon
 passes away.   Layer  after   layer of  the
 offending growth  crumbles  away  under  re-
 peated applications of the acid till the whole
 is gone.
  GLANDERS is a  peculiar disease met
 with in the horse tribe, which  may either be
 spontaneously  developed or  communicated
 by contagion from animal to animal.  In  the
 horse  there  are two different forms of  glan-
ders.  One is characterized by swelling, con-
gestion, and ulceration  of the  nose, or by a
discharge from  the nostrils:  which  at first is
 thin and watery,  and  afterward  thick and
 sticky  like glue ; and  by hardening and  en-
 largement of  the glands over the  lower jaw.
 This is glanders proper.   The other  form
 called farcy is characterized by cord-like swell-
 ings along the course of the absorbents of  the
 legs, and by hard glandular swellings  called
 farcy-buds, which are  observed  about  the
 lips, nose, neck, and thighs.  In this form as
 in glanders   proper, the  animal  loses  flesh
 and  strength, and generally dies  from  ex-
 haustion.   These two forms  are different
 manifestations  cf one and the same disease ;
 the discharge from the nostrils  of a  glan- 
188
GLANDS
GLYCERINE
dered horse may reproduce farcy in another
horse, and the discharge from a farcy-bud
may similarly reproduce  glanders.  Farcy in
its advanced  stage  is  often  associated with
glanders.   This disease is sometimes, though
very rarely, met with in  man as a result of
contagion from an affected horse.  It may be
communicated from man to man, but is never
developed spontaneously in man, as it some-
times is in the horse.   It is  generally caused
by the  application of the virus contained in
the nasal discharge  of  the diseased horse to
some abraded or raw  surface.  Cases, how-
ever, have been recorded in which glanders
was produced by rubbing the face with dirty
hands and cloths.  In man,  the two forms of
glanders,  viz., glanders  proper, and  farcy,
may be met  with, but in most cases these
forms are associated.  The following are the
symptoms of the disease :  The patient at first
suffers from intense febrile disturbance, asso-
ciated with much perspiration, head-ache and
wandering pains in the limbs ; there is often
severe shivering, and at times mental disturb-
ance and delirium ; this premonitory stage is
then followed by one in which the external
and objective  symptoms  make their appear-
ance ; the  glands in the neck, armpits, and
groins become swollen ; over the face, neck,
and abdomen, there may be seen a crop of
small shot-like papules, resembling very much
those met with in small-pox ; the skin  cover-
ing these breaks down, so as to  leave small
ulcers ;  large and  soft superficial  abscesses
form on the arms and legs, chiefly near joints  ;
the mucous membrane of  the  nostril then
becomes inflamed and furnishes a sticky, thick
discharge  of  a dirty-yellow or tallowy  color,
which is sometimes marked by  streaks  of
blood ; the skin of the face and nose becomes
swollen and shining ; the inner surfaces of the
eyelids also are involved, and their edges are
glued together by a thick gum-like discharge  ;
finally, large  patches of  inflammation often
appear  at different  parts of  the surface  ;
these increase in  size and become livid and
gangrenous.   The severe external symptoms
are associated with diarrhcea, delirium, and
coma.   Most cases of  severe or acute glan-
ders are fatal, death taking place generally be-
tween the fifth and fourteenth days.  The
affection is sometimes chronic, and consists
in a constant discharge of  viscid and very
foetid pus  from the nose, and by swelling
and inflammation of the face and eyelids ;
these symptoms are attended with much con-
stitutional disturbance, and  the patient often
dies from  exhaustion.  In acute farcy, there
are hard and  painful swellings, extending like
thick cords along the limbs ; the  glands in
the groins and armpits are also inflamed, and
there is  diffused  erysipelatous  swelling of
one or more  limbs.  The most characteristic
symptoms of glanders  are the peculiar erup-
tion on the face and chest, and the thick yel-
lowish and ill-smelling discharge continuously
proceeding from the nostrils.   In the early
stage of the disease, however, and before any
external  symptoms  have been  manifested,
there is often great difficulty in determining
the nature of the case, and in distinguishing
an attack of glanders from an attack of rheu-
matism, small-pox, or typhus-fever.
   Treatment.—The  treatment  should  be
directed to  supporting the  strength  of the
patient by strong broths or beef-tea, milk, and
alcoholic stimulants.  Great attention ought to
be paid to the cleanliness of the patient, and
the  nostrils  should  be frequently  syringed
out with lotions containing creosote, tincture
of iodine,  chloralum,  or chlorate of potash.
Poultices  of bread-crumbs  or linseed  meal
should be applied over abscesses and inflamed
glands, and  hot fomentations along the cord-
like swelling.
  GLANDS are small  bodies, mostly of an
oval shape, found in  the skin, and, in fact,
in all parts of the body.  They are very liable
to enlarge,  especially those under  the  chin,
as is often the case in children after an attack
of measles or scarlet fever, or when the child
is suffering from eczema.  They are frequently
called " kernels" by the ignorant  ; they form
a part of the lymphatic svstem.
  GLASS-POCK. (See'Chicken  Pox.)
  GLAUBER'S SALTS, technically known
as sulphate  of soda, is  a valuable  purgative
unfortunately gone greatly out  of repute.  It
is contained in sea-water and in most purga-
tive  mineral waters.   It has been  displaced
by Epsom salts or sulphate of magnesia, but
the change  has not been altogether for the
better.  Perhaps the best thing  to do  is to
combine the two, a couple of drachms of each,
which, taken fasting in the morning, will gen-
erally be followed  shortly after breakfast by
a copious loose motion.  For  ordinary  pur-
poses this  is  what should be  aimed at, and
anything in  excess should be avoided  by di-
minishing the dose.  When  used in dropsies
the case is different.
  GLAUCOMA.  (See Eye,  Diseases of.)
  GLEET.  (See Venereal Diseases.)
  GLOBULIN, a substance existing in the
serum of  the blood, and in some other fluids
of  the body;   it  is  obtained  by passing a
stream  of  carbonic acid gas through serum
largely diluted with water ; it aids in causing
the coagulation of the blood when that fluid
is drawn from the bodv.  (See Blood.j
  GLOSSITIS.  (See Tongue.)
  GLOTTIS, the  upper part of  the air-pas-
sages, also  known as the opening into the
larynx.
   GLUCOSE is found in many plants, and
also in the blood of man, being formed  to  a
great extent in the liver. (See Grape-sugar.)
   GLYCERINE is  a sweet  substance, the
basis of fats, being combined  in them  with
the peculiar fatty  acid characteristic of each. 
GLYCOGEN
GOUT
189
 Accordingly, when  these  fats are  decom-
 posed 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 distil-
 ling 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 exposure  to  heat of a
 moderate temperature.  A high temperature
 decomposes it and sets free intensely irritat-
 ing vapors.   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.   Heated
 with starch it forms a  " plasma" which can
 be used as an ointment.   It is chiefly as an
 adjunct to lotions that glycerine is  of  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 is also used in  many ways where  oil was
 wont to be used,  over which it has the great
 advantage of being readily removed by wash-
 ing with water and not  being  liable to rancid
 change.
   GLYCOGEN, a peculiar substance formed
 by the liver, and  capable  of being converted
 into grave-sugar  or glucose.   (See Liver.)
   GOITRE.  (See  Derbyshire Neck  and
 Graves s Disease.)
   GOLDEN OINTMENT is a bright, yel-
 low ointment in popular use, made  of  finely-
 powdered red precipitate and spermaceti oint-
 ment.  A  patent medicine,  sold  under the
 name of Golden  Ointment, for the eyes, is
 made with one drachm of the  red oxide of
 mercury to one  ounce  of spermaceti oint-
 ment, and is often very efficacious in  chronic
 inflammation of the eyelids.
   GONORRHOEA.  (See Venereal Dis-
 eases.)
   GOOSE-SKIN is a roughness of the  skin
 which occurs when any one is  shivering,  as
 in cases of  intermittent fever.
   GOULARD WATER.  (See Lead.)
  GOUT is a disease about which much has
 been spoken and written, whose characters
 are  perfectly well known,  and which yet
 nevertheless retains much of iis original mys-
 tery.  The acute  portion of the attack gen-
 erally locates itself in some joint, and is ac-
 companied  by great  pain and swelling, gen-
 eral constitutional disturbance, and especially
 derangement of the digestive organs.  _ It has
 a very great tendency  to recur  again  and
 again after intervals at  first of apparently
 perfect health, but afterward  of only partial
 restoration.   Most frequently it  attacks the
ball of the great toe,  later also the hands are
affected.
  Symptoms.—Sometimes, more especially
in later attacks, the gout gives some warning
of its approach.   Digestion  is impaired, the
bowels  are out of order, there may be some
fluttering about the heart, the skin is dry and
hot, and the urine becomes  very thick soon
after it is  passed, with a brickdust sediment.
Usually, however, in earlier  attacks there  is
no warning.   The  victim goes to bed well,
and is  woke up  about two  or three in the
morning with a severe burning pain in the
great toe, the ankle, or the thumb. There may
also be some shivering, but the pain gradually
subsides as  morning  advances,  and  the pa-
tient may  have some  sleep.  When next ob-
served the toe will be red, excessively pain-
ful, and still  more tender, and more or less
swollen. The patient is exceedingly irritable,
and more or less depressed.   His  tongue is
coated with a white fur. his bowels confined,
and his urine scanty, high colored, deposit-
ing a red brickdust sediment on cooling, or
even when passed.  This urine is exceedingly
irritant, it cannot  long be  retained in the
bladder, and  scalds in passing.   Each  night
the patient  is worse than during the day ;
but the attack  does not  last long, in about
four or five days the patient begins to mend,
the swelling  abates  a little,  and scurf is left
behind.   Presently complete  health is regain-
ed, and  the patient feels  better and brighter
than he  had  done  for long before the attack.
This too  frequently  entails  a return  to the
mode of life which has ended in the previous
attack,  and   by-and-by,  after  a longer  or
shorter interval, the gout returns. This occurs
again  and  again,  the   interval becoming
shorter  and  shorter, and  less and less dis-
tinct, until the patient sinks  into the  condi-
tion known as chronic gout.  As the  disease
advances more than one joint is  attacked, the
small  ones having the preference, till almost
every joint  in  the  body  is  seized.   Round
about the joints a matter, at first  fluid, but
afterward  solid and chalky, is deposited.   It
consists of urate of soda, and the deposits are
called chalk stones or tophi.  Small  deposits
of the same  material  are frequently also laid
down in the  ear.   These  cause  much distor-
tion, now  and again they suppurate and form
very troublesome  open sores.   But  gout  is
not alone  manifested by what might be called
gouty inflammation.   During the intervals of
the attack the  patient may suffer from im-
paired powers of breathing,  palpitation, and
the like, and  he  may be  subject to  chronic
bronchitis, which is  not easily removed.
When the attack comes  on  it  may  become
what is  described retrocedent. that is to say,
may leave the limb and  attack some internal
organ, especially the stomach and heart. Ap-
plication of  cold to the affected limb is very
likely to bring this about,  and its occurrence
very frequently means  the death of  the pa-
tient.  So,  too, anomalous gout as it is called,
may manifest itself in various ways.   There
is no regular attack, the patient would be bet- 
190
GOUT
GOUT
ter if there were.   Instead, there is indiges-
tion with flatulence, heartburn, and constipa-
tion, the heart beats painfully and irregularly,
there is pain in various parts of the head, the
patient is easily fatigued, and is  restless and
irritable, wandering pains fly about the bodv.
and any little damp in the atmosphere brings
them on at once.  These symptoms, if  they
are  not relieved or  a good honest attack of
the malady does not burst out,  are  apt to end
fatally in various  ways.  Frequently in  such
patients there  will be some form of  scaly
skin disease, very  itchy and  troublesome.
This coming and going with the other symp-
toms is a valuable indication of the nature of
the malady.  Gout  is sometimes acquired, but
very frequently the tendency to it  is heredi-
tary.  Luxurious  living and  little exercise
are  the  two  great means of producing  gout
anew,  but in many, with a strongly marked
hereditary tendency,  no amount  of  sober-
living  will avail in keeping off the malady.
Nor is it among  the rich  alone  that  such
forms  of the disease are seen.  Among the
poor,  where  porters  and  various forms  of
beer take the place of port and sherry, gout is
perhaps even  more  frequently seen   than
among the rich, considering that among them
muscular exertion of some kind is the rule
and means of  life.    And  there can  be no
doubt  but that those who are the subjects  of
lead  poisoning, especially  the  workers  in
white lead, are more liable to the disease than
are others.
  Treatment.—As to  treatment there  is a
good deal of truth in the  saying of the old
physician that the  best remedies in  gout were
patience and flannel, but like most such  say-
ings it is only half-truth.   In  point of  fact
much may be done for  gout both during an
acute  attack  and during an interval.   These
two naturally separate  themselves into two
separate headings, of  which that relating to
the  acute attack may be taken  first.   The
remedies may be  classified  under  two head-
ings, specific, and  common or ordinary reme-
dies.  Of specific medication we have no bet-
ter example than the use of colchicum in gout.
This remedy given in full doses has undoubt-
edly an  extraordinary influence  in relieving
the gouty paroxysm,  but on what  principles
we cannot tell.   It used to be supposed  that
its use depended on the purging it  gives rise
to in large doses, but this is not so, for it is best
administered in  doses which fall  far short of
those necessary to give rise to  either  vomit-
ing or purging.  Thirty drops of  the wine is
quite enough for the first dose,  and 10 drops
every  four hours  after, until nausea results,
which  should be stopped.  This may be done
earlier if the pain abates, and under no cir-
cumstances should its  use be continued  over
four-and-twenty hours without intermission.
Usually this will stop the attack, but the prac-
tice  is not without  risk, and should  not be
 lightly undertaken. Besides, when the attack
 is arrested, it must not be forgotten that the
 treatment of  the malady only begins.   It is
 forgetting this which  has brought  the treat-
 ment by specifics into disrepute. A still more
 powerful remedy, though  a secret one,  is
 Lavelle's Gout Liquid.  Its effects are closely
 allied to those of colchicum, though its con-
 stitution is different. As to the lying formula
 which accompanies each bottle, that is obvi-
 ously on the face of  it false.   Most likely irs
 efficiency is due lo white or  green hellebore.
 It must be used with great caution and in ac-
 cordance with the rules laid down for colchi-
 cum.  Though not without danger its efficiency
 is undoubted,  yet men who have used it for
 years almost invariably give  it up. Its effects
 are extreme  depression of the heart,  with a
 terrible feeling of sinking and prostration,
 which are far from pleasant.  For these symp-
 toms the use both of colchicum and Lavelle's
 liquid are often  objectionable, and  recourse
 must  be had to other  remedies,  which,
 though  less speedy,  are more likely  to do
 good in the long run.   Chief among these are
 laxatives, and those are best which best unload
the portal system without  weakening the pa-
tient.   For this gentle  saline purgatives are
best, say a double salted seidlitz powder to be-
gin with, and a couple of drachms of sulphate
of soda  and sulphate of magnesia, each with
a few drops of dilute sulphuric acid,  twice or
 thrice a day.   The effervescing form is, how-
 ever, the best, as agreeing  better  with  the ir-
 ritable stomach.   These remedies  must not
 be  allowed  to depress  the  patient, and in
 some  a  more  comforting draught of senna,
 rhubarb, aloes, and ginger, is to be preferred.
 Pullna water is a good remedy, but must not
 be  used too  freely.   One  great  object is to
 get the urine to flow freely, and get rid of the
 half-metamorphosed material in the system.
 Alkalies do good in both ways, they tend to
 increase the flow of urine and they aid meta-
 morphosis.  It is best to give the bicarbonate
 of potass or lithia effervescing with  citric or
 tartaric acid, along wiih some aromatic spirit
 of ammonia and tincture of lavender.  If the
 pain is very great it is hardly possible to re-
 fuse opiates  though  they are to be avoided as
 far as possible, seeing that they tend  to ag-
 gravate the disease by retarding food and tis-
 sue change.  If opium must be given then let
 it be given by the arm,  for so, less will be re-
 quired than by the mouth.  But before having
 recourse to that  it is better to try its effects
 locally.   Thus, a  warm lotion containing ace-
 tate of lead and acetate of  morphia will often
 do more good than anything. Extract of bel-
 ladonna rubbed up with water and glycerine
 and applied warm will often  prove of  very
 great service.   In all  cases warmth  is the
 great thing, cold  having a tendency to drive
 the gout to some internal organ.  Rest must
 be absolute and the diet plain.  It must con- 
GRANULAR DEGENERATION
GRAVEL             191
 sist only of milk, arrowroot, and  the  like.
 All animal food should be  avoided, even at
 first, save  the strength demands  it.   Toast
 and water,  seltzer water, and the like may be
 taken freely.  After a time fish may be given.
 If there is need of a stimulant whiskey and
 water may  be given,  but for  a time  all stimu-
 lants are better avoided.
   Now come the rules  as to treatment in the
 interval.   It is by this only that the disease
 can be cured.   Chief among these are exer-
 cise in the open air, sufficient to  make rest
 grateful but not to fatigue.    Sea-bathing is
 good, so are  early  hours   and  plain  food.
 Indeed  this last is imperative, and modera-
 tion in quantity as well as in quality must be
 observed.   Claret, chablis, and hock may be
 allowed,  so may  whiskey  and water.  All
 other liquors are forbidden.   The bowels are
 to be  kept open, best by  Friedrickshall or
 Piillna water,  and the urine must be kept
 right as far as possible by alkalies.   A visit to
 a foreign  bathing place  appropriate to  the
 case is one of the best things to have recourse
 to.  Vichy, Ems, Carlsbad,  Wiesbaden, and
 Aix la Chapelle,  are the most appropriate re-
 sorts.
   GRANULAR DEGENERATION is  a
 term applied  to  the  appearance which some
 organs assume when undergoing  a fatty or
 fibrous degeneration  ; applied to the liver, it
 corresponds with cirrhosis, while in the kid-
 ney, a similar change marks  a form of chronic
 Bright's  disease.    (See  Cirrhosis   and
 Bright's Disease.)
   GRANULATIONS.—On examination of
 the surface of a healthy ulcer, or of a large
 wound which  has existed for six  or  seven
 days, it will be found covered by small and
 soft nodules of a florid red color. Those nod-
 ules are called granulations,  and it is by their
 development and subsequent changes that
 cicatrization, or  scarring of  the   ulcer  or
 wound, takes  place.  A wide wound on the
 surface of the body, when free from  excessive
 inflammatory  action  or sloughing  about its
 edges, presents on the fourth day  a deposit
 over its surface of a soft, white, and  tenacious
 deposit.through which ruddy granulations pro-
 ject, forming at  first isolated red  clots, and
 afterwards a uniform  granular surface.   The
 granulations then increase in size, and at the
 edges of the wounds reach,and in some cases
 project beyond, the surface of the  surround-
 ing skin.  The rounded and  free extremities
 of  the  granulations  break   down  into  pus,
 which is discharged from the surface of the
 wound, while at the deeper parts the granu-
 lating tissue contracts, and is converted into
 the tough filamentous substance which subse-
 quently forms the scar.  Along the edges of
 the wound, a  pink,  or chalk-white line  is
 formed, which presents a well-marked border
 between the moist granulations  on the one
side, and the healthy  skin on the other. This
border increases in width as it encroaches
upon the surface of the wound ;  it is dry and
smooth, and is covered by soft epidermis.  By
the shrinking of the deeper parts of the gran-
ulations, and by the extension of  this super-
ficial border of newly-formed  epidermis or
scarf-skin, the wound is gradually closed, and
is at last wholly covered by scar-tissue, which
at first is soft  and delicate, but finally forms
a hard, compact, and contractile scar.  Granu-
lations are very vascular, and often bleed pro-
fusely on the slightest touch. They vary much
in sensibility ; those on a superficial  wound
or ulcer, generally give very little  pain when
touched, whilst those lining  the cavity of a
healing abscess are extremely tender.  They
possess the power of absorption, and trans-
mit into the system any deleterious substance,
such as arsenic,  opium, carbolic  acid,  and
mercury, that may be applied too freely to
the raw  surface.   Granulations  frequently
become diseased,  and the wound or ulcer,
instead of  closing  speedily  and  without
trouble,  either remains  stationary and  be-
comes painful, or increases more or less rapid-
ly in size. The raw surface may become very
red  and  inflamed ; its granulations may be
converted  into  large spongy masses of a
bluish color ; or again these bodies may dis-
appear, leaving a smooth and glazed surface.
These  morbid changes are often  due to  local
irritation, caused by dead bone, foreign  ma-
terial, unsuitable dressings, sloughs, etc., and
the local cause is oiten assisted by some con-
stitutional disease, or a bad state of  the sys-
tem, due to faulty hygienic conditions. These
morbid changes  of granulations  and  their
treatment, will be found described at length
in the article on Ulcers.
  GRAPE-SUGAR is a  substance  in  the
juice of the grape, and many other fruits  ; it
possesses the  property, when fermented, of
decomposing into carbonic acid and alcohol ;
this  is  taken advantage of in making alcoholic
liquors ;  it  is made of carbon, hydrogen, and
oxygen.   When  any starchy compound, as
bread,  potatoes, etc., is mixed with the saliva,
this fluid decomposes the starch into grape-
sugar ; it is also formed in large quantities in
the  liver (see Liver), and it is  present in  the
blood and urine in cases of diabetes.   (See
Diabetes.)
  GRAVEL  is the term commonly  applied
to the small stony concretions formed in  the
kidney, and which when passed, seem to form
a gravelly  kind of sediment  in  the  urine.
Stones formed in the urinary  passages  are
very various in their  composition, but those
here referred to, and which are  almost exclu-
sively formed in the kidney, are mainly com-
posed  of uric acid.  Their size varies from
those of a grain of sand, to the largest  that
will pass by the urinary passages.  If this size
is exceeded, they must remain behind in some
part of the track, most probably the bladder, 
192             GRAVEL
GRAVES'S DISEASE
 until by their increase of size, and the trouble
 they give  rise to, they  either cause the pa-
 tient's death, or  are  removed  by art.  The
 simple stones passed from the kidney, gen-
 erally acquire layers of other kinds  of ma-
 terial over the original nucleus.  Here we have
 mainly to do with stones formed in the kid-
 ney and retained  there, or which in passing,
 give rise to what  is called a fit of the  gravel.
 The stone,  if it remains in the kidney, is sure
 to grow, and doing so, gives rise  to very
 troublesome symptoms. There is considerable
 pain in the back,  always increased by jolting,
 and  such accidents are  usually followed  by
 bleeding from the kidney, not  such bleeding
 as we see in ordinary kidney diseases, but a
 well-marked and unmistakable flow of blood,
 which may  coagulate in the passages or  in
 the bladder, and  so give rise to very severe
 suffering. As the  stone grows, the symptoms
 become   aggravated, and  the  health fails.
 Usually there  is  great sympathetic  disturb-
 ance of the stomach,  and digestion is  imper-
 fect.  Little serves to bring on the bleeding,
 and the bleeding weakens the patient ; more-
 over, the pain  is severe.  The stone growing
 gradually, encroaches on  the substance of the
 kidney, which  withers  and may finally alto-
 gether  disappear ;  if  now,  as  not infre-
 quently both kidneys are affected, any slight
 accident happens  to disorder the other, life is
 in great danger, and  not  infrequently  is thus
 terminated.  Sometimes the whole kidney is
 destroyed and  an abscess  left, which has
 been opened and the stone removed, the pa-
 tient recovering ;  sometimes it has ulcerated
 out.   More frequently,  however, after the
 stone has had time to grow  to such a size as
 to be  obstructed  in  its  passage through the
 ureter, it  is  dislodged, and, carried by the
 urine, commences ils  journey  toward  the
 bladder.  If very small, no symptoms are pro-
 duced, if  very  large, it sticks ;  between the
 two are all gradations, from momentary un-
 easiness   to  weeks  of  suffering ending  in
 death.  The symptoms generally begin sud-
 denly, sometimes  with rigors.   There is in-
 tense pain in the back and  loins, extending
 down into corresponding groin  and testis.
 Very likely  there  is sickness and vomiting,
 partly from the great pain, partly from reflex
 irritation.  And this may go on for days and
 weeks.  Sometimes the urine is  suppressed
 and  death by uraemia follows.  On the other
 hand, a few hours' suffering  may end in per-
 fect  ease, as the stone passes into the blad-
 der,  to be followed  a few  days after, by a
 short and sharp attack of pain  as the stone
 passes out of the bladder.  The  symptoms of
an  immovable  calculus   in the  kidney, are
rarely  such  as  can, with  certainty, be diag-
nosed until too  late to do anything sure to re-
lieve the symptoms.
  Treatment.—We question  if  the  solvent
treatment, sometimes spoken of, is ever suc-
 cessful.   Accordingly, when the existence of
 a,calculus in the kidney has been made out,
 everything must be done to avoid further in-
 crease ;  diet must be carefully selected, so as
 to avoid the formation of uric acid in excess,
 and to this end too, it ought to be well diluted,
 and so  diluent drinks should  be freely used.
 Alkaline aerated waters too, as a rule, will be
 specially useful, and liquor potassa, which is
 ordinarily well borne, may be given in good
 large doses.   As regards the passing of a cal-
 culus—that is to say, a fit of the gravel : that
 is a thing to  be carefully  studied and judg-
 ment shown.  The great thing is to  relax the^
 passage as much as  possible, the pressure of
 the  urine behind will drive the calculus on-
 wards.   For  this  chloroform,  or a pipe  of
 strong tobacco may be employed, till the  pa-
 tient is  fairly sick.   He should  also be  kept
 in a warm bath to promote the  same object.
 But these are all expedients which can be em-
 ployed for a short time only, and the affection
 is, as a rule, not such as to be so dealt with.
 We must, therefore, have,  as a rule,  recourse
 to opium,provided the urine is not suppressed,
 and the  patient must be  put under  it, and
 kept under it till the stone  passes. Owing to
 the irritable  state  of the  stomach,  the food
 given, must be, during this  time,  small  in
 bulk.  The opium had better be given by the
 arm.  (See Stone.)
  GRAVES'S  DISEASE, also known as
 Exophthalmic Goitre, is a  malady ordinarily
 characterized  by these  symptoms :  Extreme
 nervousness,  protrusion  of the  eyeballs,  a
 projection and pulsation of the thyroid body
 in front of the windpipe : the heart pulsates
 violently, and there is often  a  bruit at its
 base  coincident with the  first sound.  Any
 one  of these symptoms may be absent ; the
 forms most commonly present  are  the pro-
 jecting eyeballs, the enlarged  thyroid, the
 palpitation, and  the nervousness.  Most wri-
 ters have overlooked the nervous symptoms,
 and the enlargement of the thyroid body has
 misled them into connecting it with  true goi-
 tre.   With  this beyond  the  enlargement
spoken of, it has not the slightest connection,
and  the remedies which  do good in  the one
are  injurious in the other.  Thus  iodine,which
is the best  remedy in  ordinary goitre,  is
worse than useless in this malady : while digi-
talis, which is utterly useless in ordinary goitre,
is most serviceable in Graves's disease.   The
eyes project sometimes so far that the eyelids
cannot close over them, and  in a  few rare
cases the eyeball is destroyed from  the pres-
sure.  The thyroid is swollen  but its  swelling
is rather  that of a  pulsatile tumor  than the
mass of  a goitre.    The vessels in  the neck
pulsate violently, and the heart beats quickly,
violently,  and imperfectly.   The health  is
bad, the bowels  deranged,  and the patient is
easily put out by any little excitement.  Fe-
males are almost invariably the subjects of 
GREEN HELLEBORE
GULLET
193
 this disease, and in them it often  has come
 on after a sudden fright. The menstrual func-
 tions may or may not be affected at the same
 time.   In dealing with such cases the great
 object  is to improve the health and diminish
 the local symptoms.   Iron  and digitalis are
 the chief remedies,  but  as the  bowels  are
 usually deranged, these require to be sharply
 looked  after. A change of air is good.  Usual-
 ly they terminate favorably.
   GREEN HELLEBORE.  (See  Vera-
 TRIM VlRIDE.)
   GREEN SICKNESS.   (See Chlorosis.)
   GREGORY'S POWDER, or Compound
 Rhubarb  Powder,  consisting  of rhubarb,
 magnesia, and ginger, is one of the best and
 safest of domestic  remedies.   Unfortunately
 it  cannot also be called nice, and  though
 wholesome, it  is far from  agreeable.  It is
 chiefly  given to children as  a laxative, when
 the bowels  have become  out of order from
 the consumption of forbidden delicacies of an
 indigestible kind.  The dose for them is 5 or
 to grains, and it is usually given  mixed up
 with some  preserved fruit, and has not infre-
 quently laid the  foundation of a life-long
 hatred to the preserve so employed.   Among
 adults  it may  be  used for similar  purposes,
 but is  not  frequently so used;  rather-it is
 given   combined with  some  other drug in
 small doses over a  long period, for the sake
 of  the  beneficial effects of the rhubarb and
 ginger as stomachics.
   GREY POWDER is the popular  name
 for a mixture of three parts of mercury with
 five parts  of  chalk.   It is most frequently
 given to children with clay-colored  passages,
 in doses of  2 to 3 grains once or oftener in
 the twenty-four hours.
   GRIFFITH'S  MIXTURE or the  Com-
 pound  Iron  Mixture of the  Pharma-
 copoeia, is one of the most valuable means of
 prescribing  iron for delicate  stomachs.  The
 iron is contained in it as  green oxide, and
 sugar is added  to prevent the  changing into
 the  red oxide, but it does so change in a
 short time.  People are apt to suppose, when
 they sec the change, that  the medicine has
 spoiled, and it is  true that the red oxide is
 not perhaps such a good remedy as the green
 one in  certain cases, nevertheless, in  most
 cases it will  do no harm.  It is the best form
 of iron for irritable stomachs and for chlorotic
 females.
  GRIPINGS are painful  sensations  pro-
 duced by  indigestible food in the intestines,
 and caused  by irregular  contractions  of  the
 bowHs and the passage of flatus.
  GROCER'S ITCH is  a form of  eczema
 which occurs in the hands of those who work
 with sugar or other sticky  substances.  (See
 Eczema.)
  GUAIACUM WOOD, and the resin ob-
tained from it, grows in the West Indies.  The
wood is known as lignum vitae, and is exces-
sively hard.  The resin is insoluble in water,
but  soluble in alcohol.   It is brownish in
color, and  produces an  irritant taste in the
mouth.    The  preparation  commonly  em-
ployed is the ammoniated tincture, consisting
of the resin'dissolved in aromatic spirit of am-
monia.  Taken internally the effects of  guai-
acum arc not very certain.  It is described as
stimulant  and  diaphoretic.   It seems  to do
good in certain  maladies,  especially  of  a
syphilitic  taint, which  affect  the  skin, the
bones, or their immediate coverings.  In the
rheumatism of old people, which is relieved
by warmth, and which is sometimes therefore
called cold rheumatism, guaiacum often does
great good.   It  is supposed  to have  some
stimulant  effect on the  womb, and hence is
given in some disorders of menstruation, but
this is doubtful.
  GULLET, Obstruction of.—This  is, as
a rule, of one of two kinds,  simple or malig-
nant.  Simple obstruction or stricture is most
frequently due  to the results of some corro-
sive poison.  The  poison may not have proved
fatal, but may have destroyed the tissues with
which it came in contact to  some depth, and
as  a consequence, when  the parts  were
cicatrized,  contraction  of  the cicatrix has
taken place, narrowing the calibre of the tube
to such an  extent that solids cannot  pass.
The  poisons most likely to give rise to such
consequences  are the strong mineral  acids
and alkalies.   The symptoms of obstruction
may not come on for many months after re-
covery  from   the  immediate  effects of the
poison.   The great thing to be done in such
cases is to  guard against  the contraction
which is almost  inevitable.   To this end an
ordinary gullet tube  should be passed from
time to  time.   This should be done with the
utmost  gentleness, and by taking the poste-
rior wall of  the gullet as our  guide.  If any
resistance offer, is it to be overcome by firm
yet gentle pressure, and any attempt at  forci-
bly driving the instrument past or through it
should be avoided.  If the resistance cannot
be overcome, another and a smaller instru-
ment is to be tried till the obstruction is fairly
passed.  After this day by day an increase of
the size of the instrument should be made, so
that stretching  the part little by little the cali-
bre of the natural  passage  may be  again at-
tained.  Nor should it be forgotten that this
is the only end to be  attained.  For as soon
as the distending  force is withdrawn the parts
will again tend to contract.    Indeed,  some
have worn a  tube habitually with very  great
benefit,  and if that is not used a tube must be
passed at short and regular intervals, or con-
traction will speedily begin. There is probably
a variety  of stricture  of the  oesophagus or
gullet due to syphilis ;  this, however, is not
quite certain.
  True  maglinant disease of the gullet is not
very rare.  Its symptoms are  at first exactly 
194         -GUM  ACACIA
GUMS
 like those of simple stricture oniy there is no
 history of  injury  to  the  part.  Moreover, it
 advances more rapidly, and there may be, but
 not of necessity,  pain.  The food is swal-
 lowed as usual but sticks  at the  obstruction,
 and either accumulates for  a time or at once
 regurgitates.  The vagus nerves frequently
 affected,  vomiting, cough,  and  hiccup  are
 common symptoms.  The patient wastes rap-
 idly, partly from the character of the disease,
 partly from want  of food.   Death rarely re-
 salts from  starvation, as it is wont to do in the
 other  variety of  stricture,  but  the disease
 spreads to some  neighboring part, or bleed-
 ing follows, or the like. Very frequently there
 is  produced a  commun'cation between  the
 windpipe and gullet.   This, too, aggravates
 the cough.  The disease  having been  fairly
 diagnosed  as malignant,  not much, unfortu-
 nately, remains to be done.  The character
 of the disease insures  the destruction  of  life
 in the long run, the only question is a choice
 of evils.   As the disease advances, less and
 less food can be  taken, until  the patient is
 threatened with starvation though surrounded
 by  plenty.   This, too, is  the case in  simple
 stricture, though in that there is much more
 chance of  the obstruction  being overcome.
 Under these circumstances  we must have re-
 course to  nutrient injection, which may be
 used as long as  possible.    At the same time
 the  mouth  may be washed  out  with a little
 water, and kept moist by moistening it from
 time to  time.  The question remains, is it
 right to have recourse to an  incision into  the
 stomach with a view to making  a permanent
 opening for cases which cannot otherwise be
 dealt with.   Well, in malignant  disease this
 is merely prolonging torture, supposing  the
 operation to  succeed in the first instance ;
 either way the  patient must die.  Upon  the
 whole, therefore, to make a permanent open-
 ing into the stomach through the walls of  the
 abdomen in malignant disease of the gullet is
 not an operation likely to be followed with
 success.  The only time when there can be a
 question of performing it is when the stricture
 is a simple one,  but as death has  followed  in
 every instance hitherto, the prospect is not an
 encouraging one.  The conditions are totally
 different from those of opening the  stomach
to remove something in a healthy individual.
 Here the opening is to be  permanent, and
the individual is wasted to the uttermost.
  GUM ACACIA.  (See Acacia.)
  GUM ARABIC.  (See Mucilage.)
  GUMBOIL is the most  common form of
alveolar abscess, invariably associated with a
decayed  tooth, causing inflammation  of  the
 periosteum covering the alveolar process and
of the bone itself.   Tne abscess causes great
 pain and  discomfort,  and  frequently con-
siderable constitutional disturbance.   In  the
earliest stage, when  the formation  of pus is
threatening  rather  than  established,  the
 malady may be cut short by the extraction of
 the tooth affected, or by the  removal of the
 stopping from  some  decaying tooth.  If the
 extraction of such a tooth be undesirable, the
 gum  should be freely leeched, the  leeches
 being best applied through a  glass tube, or
 leech glass (see Leeching), a brisk purgative
 administered, and hot fomentations applied
 to the swelling.  When pus has formed and
 it threatens to  " point," the  walls of the ab-
 scess becoming thinned and soft, it should be
 evacauted by means  of a scalpel.   This is
 followed  by complete  relief,  but  not unfre-
 quently a pus discharging sinus  remains, or
 the disease  may break  out again, unless the
 offending tooth be extracted.   Occasionally,
 in severe cases, the matter will " point" ex-
 ternally on the cheek.  The offending  tooth
 must be at once extracted,  and a vertical cut
 be made  with  a scalpel, between the cheek
 and  the jaw,  so as  to  cut across the  pus-
 containing canal.
  GUMS, Diseases  of.—These structures
 are occasionally affected with ulceration  in
 consequence of mercurial salivation.  In bad
 cases large  and  very  foetid sloughs  are
 formed, but usually may be  observed only
 redness and superficial excoriation  of the
gums. The formation of analogous ulcers is
often caused by the presence  of bad teeth or
 accumulations of tartar, but then the lips and
 tongue generally remain sound, and there is
 no increased secretion  of  saliva.  The  best
treatment perhaps for small superficial ulcers
of the gums is  the local application of solid
 blue-stone or the  use of a wash  containing
alum  or borax.   In old people the gums fre-
quently become soft  and swollen, and  sepa-
 rate from  the roots of the teeth. The contact
 of food is  painful and causes bleeding.  This
 condition  is often associated  with disorders
 of the stomach  and liver.  The usual treat-
 ment consists  in  washing out  the mouth
 with a lotion containing alum  and tincture of
 kino,  and  in the application to the affected
gums of   tannin and glycerine.   Attention
should be  paid at the  same time to the diges-
 tive organs, and the bowels be freely opened
 with blue  pill or calomel, followed by a black
draught.   In cases of  sea and land scurvy the
gums swell and are covered by large spongy
 o.utgrowths  of  a dark  red or purple  color,
 which readily bleed  when touched.   These
 outgrowths  are masses of swollen gum, and
 generally  spring from  the small tongues.of
 gum-tissue which  project between the necks
 of adjoining teeth.   This morbid condition
 disappears with the other symptoms of scurvy
 after  the administration of a  good diet, com-
 prising fresh meat and vegetables.
  Epulis  is a  firm,  painless,  and  slowly-
 growing tumor, which appears on the gums,
 especially over the sockets of  the teeth in the
 upper jaw.    The  surface of  this growth is
 slightly irregular and lobulated, and resembles 
GUNSHOT WOUNDS
GUNSHOT WOUNDS      19d
 in appearance perfectly sound gum.   It gen-
 erally grows forward from the free surface of
 the gum, and its root  is always  connected
 either with a complete and  apparently sound
 tooth or with an imbedded fang.  The tumor
 rarely attains a great size, but in consequence
 of its situation and of the inconvenience to
 which it  may  give  rise,  it often becomes
 very troublesome.  Sometimes the surface of
 the growth becomes ulcerated  and  pours out
 an offensive discharge.   The usual treatment
 for epulis is early and complete removal.  If
 the tumor be merely  shaved off at its inser-
 tion into the gum it will almost certainly re-
 turn.  In consequence of the orgin of the tu-
 mor  from the fang of a tooth and from the
 inner part  of  the  socket, it is necessary for
 the surgeon to extract one or both of  the dis-
 placed teeth, and at the  same time to remove
 with  bone-pliers a portion of the correspond-
 ing alveolar process of the jaw.
   GUNSHOT WOUNDS implies of course,
 in its first sense, such  injury as may arise
 from cannon shot,  splinters of shell, or bul-
 lets ; but it must be remembered that injuries
 inflicted by any explosion, such as the burst-
 ing of a boiler or blasting a rock, for instance,
 possess the same general  characters.  The
 immense improvements of late years  in artil-
 lery and small  arms, from  the fact  of such
 weapons being rifled, have led to changes in
 severity, and, indeed, almost in the nature of
 gunshot wounds, particularly as regards their
 infliction by small arms.  The form of wound
 is of the lacerated and contused character, fol-
 lowed by sloughing and suppuration.  Hemor-
 hage  is seldom very extensive in cases where
 there is much crushing, as the vessels  thereby
 become twisted and thus closed, although  in
 the case  of  the  puncture that a small bullet
 would make, some internal  vessels  may be
 wounded and bleed internally,  while  the ex-
 ternal wound is very small  and  no blood
 flows from it.    Bullets frequently lodge.   In
 the instance of a spherical bullet fired from
 a  smooth-bored musket, the aperture of en-
 trance is small, with discolored and inverted
 margins.  The aperture of exit is larger than
 that of entrance, and its  margins are  ragged
 and everted. If the muzzle of the musket were
 near to the body at  the time of discharge the
 aperture of entrance would be lacerated, gen-
 erally containing wadding  or clothing, and
 scorched with  the  explosion.  The  appear-
 ance of injuries from the conical bullet of the
 modern rifles is different from the  foregoing
 in most cases ;  the wound is more like an in-
 cision, and if the ball passes through, its aper-
 tures of entrance and exit are almost  similar.
 It usually  splits any bone  in  its  course,
 owing to its velocity of rotation.  The course
 taken by  bullets, especially round ones,  is
oftentimes very  remarkable,  as  may be in-
ferred by watching a shot or shell strike the
water and rebound indefinitely, and instances
 might be multiplied of  cases where the aper-
 tures of  entrance and exit  have been exactly
 in a line, and yet  the ball has traversed the
 entire circuit of the trunk  ; or, again, where
 a ball has struck the forehead and emerged
 at  the occiput, appearing  as if it had pene-
 trated the skull, whereas it has made the cir-
 cuit of the integument  only ;  and there are
 cases on record where the  ball has returned
 and emerged at its aperture of entrance, after
 having completed  the circuit.  The shock  is
 proportioned to the extent  of injury, the im-
 portance of  the part affected, and the quan-
 tity of blood lost, and, as in other injuries,  is
 of two kinds, mental and corporeal. The men-
 tal is temporary,  the latter  is often  aggra-
 vated by the former and is  independent of the
 mind. Sometimes fatal injuries are effected
 when there  is not the  slightest sign  of an
 outward  bruise, and bones  smashed, muscles
 and arteries  lacerated ; this  form of  injury
 was formerly called a "  wind contusion," but
 it is now well  known that such injuries must
 have been effected by  the actual  contact of
 the  shot.  The true  extent  and danger of
 wounds  inflicted by gunshot, in the case of
 penetration, can hardly be determined until
 suppuration has been  set  up.  Sloughs be-
 come detached, particularly at the aperture of
 entrance, as at that point the degree of con-
 tusion is greatest, although  the aperture of
exit is always first healed ;  the suppuration of
the slough is  usually complete in  a week or
ten  days.   Many  formidable accidents are
liable to occur, however, such as inflamma-
tory fever, gangrene, erysipelas,  abscesses,
hemorrhage,   sloughing,  phagedaena,   non-
union of  fracture, necrosis,  caries, hectic, tet-
anus, and pyaemia.
  Detection  of Bullets, etc., in  Wounds.
—It  is  sometimes  difficult   to  determine
whether some hard body felt in a wound is  a
ball or a piece of exposed  bone, and for the
purpose of making a correct diagnosis a  probe,
carrying  a small piece of unglazed porcelain at
its extremity, is one of the best, as the absorb-
ing nature of the porcelain allows of a small
stain of the metal being  carried on it on with-
drawing  it from the track (Nelaton's probe).
As soon as the injury is inflicted a most careful
search should be made  for the foreign body
before swelling has come on.  The best instru-
ment lor  making an examination is the finger,
but if that fails to reach  the substance,  a long
silver probe which readily admits of being bent
is required.   Bullet forceps, especially made
for the purpose, are needed  in many  cases,
but if the ball  be near the surface common in-
cision with forceps b sufficient. The external
 wound must  be  enlarged in cases  where
 neither the finger nor the forceps can be in-
troduced. Gunshot wounds  of the skull are
 most unsatisfactory and  fatal.   In the case of
simple flesh wounds, if  not severe,  they will
heal under simple dressing  and quiet ;  if the 
196      GUNSHOT WOUNDS
GYMNASTICS
scalp be severely lacerated, suppuration and
necrosis of the outer table of the skull, and
perhaps meningitis, may follow.  In cases of
fracture of the skull without depression,  the
prospect is  necessarily unfavorable, but  pa-
tients  frequently recover, with,  perhaps,  ex-
foliation of the external table of  the skull. In
such a case cold applications should be kept
to the  head,  and the bowels regularly kept
open.   Perfect rest is  enjoined.  If severe
rigors and head symptoms  occur in  from a
fortnight to a month after the injury, it would
point to the  probability of the formation of
pus.   In cases of fracture with depression of
bone, and the  usual symptoms  of compres-
sion present  (see Compression), then  the
surgeon should trephine ; but if  there are no
symptoms, the operation should be delayed
until  they present  themselves.   If  balls or
fragments of shell lodge  in or penetrate the
skull, they are almost always fatal.   Injuries
of the face may be merely superficial, or of
considerable  importance  when the bones are
smashed ; care must be taken to relieve any
deformity which is likely to arise, by adjust-
ing the parts with sutures, and removing all
spicula of bone, and applying a light water-
dressing.
  Injuries of the Chest.—The several kinds
of gunshot injury  of the chest  may be con-
veniently classed as follows, for sake of refer-
ence.   I, Those in  which the thoracic cavity
has not been opened ;  2, those in which it
has, and a further subdivision is to be made,
of injury and non-injury of its contents.   In
the first class the danger is small, compara-
tively ; and,  in the second, it is  serious from
hemorrhage  and its  complications.   If  the
ball  has lodged in a penetrating wound the
prognosis is unfavorable.  The symptoms of
wounded lung are—great collapse, blanched,
anxious face, difficult breathing, and  gen-
erally frothy expectoration, frequently emphy-
sema (see Emphysema),  from the fact of a
rib having   been  fractured.    The  patient
should  be carefully examined, to find out in
the first place  if the ball be  in  the  thoracic
cavity, or if it has passed out at some counter
opening.  Splinters of broken ribs must be
carefully removed,  and  some  light water-
dressing be  placed  over the wound.  No at-
tempt  at rousing the  patient from  his  col-
lapsed condition is to be made, as it is favor-
able to the arrest  of  internal  hemorrhage.
He should be placed on his wounded side, so
that the escape of pus may be favored and the
movement of the ribs quieted.  Constitution-
ally, low diet, perfect rest, and  the adminis-
tration of opium, generally suffice.  The un-
favorable symptoms which may arise  are
pneumonia, pleurisy, or  empyema.
  Injuries of the Abdomen.—These are con-
veniently divided into  non-penetrating  and
penetrating.   Non-penetrating  flesh wounds
merely require the ordinary treatment of in-
cised wounds.  Frequently, however, a non-
penetrating wound,  such as is derived from
spent balls, or portions of shell, or of stones
struck up, will cause severe lesion  of some
abdominal viscus, and cause speedy death,
without any appearance  of external injury.
In the case of penetrating wounds the amount
of fatality is very great.   It a  ball passes
through  the abdomen without injuring  its
contents, peritonitis  is usually set up.  If a
large viscus has been wounded, great collapse
is the first symptom noticed ; if the intestines
have  been lacerated or  opened, there is se-
vere vomiting,  great pain, and  passage  of
blood per anum ;  the nature of the discharge
from the wound is itself a guide to what vis-
cus or viscera are implicated.   With regard
to the treatment of these formidable  injuries,
the first thing to  be  done is to endeavor  to
replace  any protruding content, avoiding  all
unnecessary  handling of it, and  in  the case
of a wound noticed in  any portion of the
protruded intestine, its edges should be neatly
approximated, by what is known as a contin-
uous or  Glover's suture, the knots cut off, and
the locality of the wound kept as near to the
external one as possible  in the event of an
artificial anus being  established.  Large and
frequent doses of  opium  are needed, to allay
pain and  overcome  the  peristaltic action  of
the bowels.
  Simple flesh wounds of the extremities re-
quire the ordinary treatment of incised or lac-
erated wounds ; if the  bones be simply frac-
tured, and there is not much external injury,
the limb should be  put  up on  a splint, but
severe contusion  and  lesion of surrounding
muscles and deep structures require  amputa-
tion.  The cases  of  gunshot wounds of the
extremities which require removal of  the limb
are—i,  Those  in which the  limb has been
torn off ; 2, Where there is  severe laceration
of the superficial  tissues, with injury to the
main artery, vein, and nerve ;  3, Severe com-
pound or comminuted fractures, with destruc-
tion of  surrounding tissues.  The experience
of modern army surgeons as to the question
of amputation is that when necessary  it should
be primary.
  Gunshot Wounds of  Joints.—These  are
always serious, even though the  joint be not
opened  by  an  external  wound,  as  in  such
cases the inflammation set up  may, and gen-
erally does,  terminate in  suppuration.  In-
flammation in  the neighborhood of a joint
may set up  inflammatory action in the joint
itself.   In  the treatment of these injuries it
usually  results either in  amputation  or exci-
sion.  In cases where it seems that  the limb
can be saved without risking  the  life of the
sufferer, the case  may be treated as one of
compound fracture, pus being let out by free
incision and constant irrigation by cold water.
  GYMNASTICS, from a medical  point of
view, have  been  far too much neglected in 
GYMNASTICS                             GYMNASTICS          197
 this country, or have fallen into hands little
 adapted for  dealing with  the  complicated
 problems often submitted for  determination.
 By gymnastics we mean both physical edu-
 cation and the use of muscular exercises  in
 the  cure  of  disease, and though these  are,
 strictly speaking, totally distinct, it may not
 be amiss to take them together.   Physical
 education has to a very great extent been  left,
 in this country, to take care of itself.  We are
 no worshippers of the system  which would
 subordinate^  mind  to matter, which  would
 make a well-trained boating-man the most per-
 fect being on earth, but assuredly we do not
 hold to the  other  view, that men may grow
 up misshapen, rickety articles, provided only
 their mental powers are developed  to the
 uttermost. It is quite true that the perfection
 of either mental or bodily training is incom-
 patible  with  the  other.   Nevertheless, men
 may fairly strive to improve their muscles as
 well as their minds, and we strongly hold to
 the notion that, other things being equal, the
 strong man bodily will, in the long run, beat
 the strong man  mentally only.   In point  of
 fact, strength of body is necessary to strength
 of  mind, and  most  men   of great  mental
 vigor, not necessarily of subtlety and  refine-
 ment, are also men of bodily vigor.  Here it
 may be as well to say that physical education
 does not mean what  is sometimes  described
 as " hardening" children.  You see a miser-
 able little wretch,  shivering in  the cold  of
 winter, only  half dressed, and you are  told
 by his parents they are hardening him. Well,
 it is true the result may be satisfactory, but it
 may not ; some live and do well, but a good
 many die in the process.  Physical education
 means taking the material you have got, how-
 ever unpromising, and making the best of it.
 To do so you require good food and clothing,
 air and  exercise, and the cleanliness which
 comes  after  godliness.   True,  you  may
 not be able to get  all this ;  if not, you must
 do  your best, but the best  in this case will
 not be the best  possible.  In physical educa-
 tion the object aimed at is the exercise of all
 the muscles  of  the body, none  assuming an
 undue preponderance over  others.  Most  of
 our ordinary exercises  cultivate one  set of
 muscles at the expense of others, and for spe-
 cial training  this, no doubt, is  what should
 be aimed  at ; but in a process  of  education
 that is not so, there the endeavor should be
 to strengthen the weak  rather than to foster
 the strong.  The foundation  of all physical
 training is, that a part grows by exercising it.
 The more it is wanted to do,  within  due
 limits, and provided due nourishment be sup-
plied, the more it will be able to do. It grows
by exercise ; now the part of the  exercise
which seems to do most good  is the motion.
Suppose you move  your arms backward  and
forward a score of  times :  these will do the
muscles more good than moving  backward
 and  forward,  under greater difficulties, ten
 times ; which leads us to the  conclusion that
 for training purposes, especially among chil-
 dren, apparatus  is of little value, save  as a
 means of directing movements.   Take the
 case of dumb-bells.  They are intended to
 strengthen the muscles which  protrude and
 draw back the arms.  But if you use heavy
 dumb-bells, another thing is called into play,
 viz., the support  of  their weight, whether
 close to the chest, or  at a distance from the
 body, that means the use  of another set of
 muscles, which  will not be  exercised,  only
 strained.   So, too, Indian clubs, first-rate
 things they are for opening out  the chest, but
 if you use them too heavy you  only drag and
 strain the muscles, speedily tiring them out
 instead of exercising them.  But the exercises
 are easier with  clubs  than  without  them ^
 with  them, too, you  can  exercise several
 muscles you could not  without  them, and so
 we prefer clubs,  but light ones.   We  had al-
 most said, the  lighter the better  ; at all events
 not heavy ones  to tire the  individual during
 exercise by weight only.  It would be  useless
 to enumerate all the various kinds of appara-
 tus used for training.  In point of fact,  we
 think, with a pair of light wooden clubs you
 can do all you want. We want  to enforce the
 point that, what is required is motion, and
 motion, if possible, of every joint and muscle.
 There is  one  caution which should  not  be
 overlooked ; that is,  do things by degrees,
j never attempt  violent  exercises all at once.
j The reason is obvious : your muscles may be
 strong and require little training, but  a  town
 life almost  inevitably throws  out of  good
; training the heart  and the  lungs, though  we
 do not  seem to  perceive it until  we attempt
 some unusual exertion. How soon a city man
 is  " pumped," for instance, if he attempts to
 run any distance.  Really for any great  exer-
 tion, heart and  lungs  must be trained even
 more carefully  than  muscles.  And,  of the
 two, more frequently they give  way.
   Medical  gymnastics  are totally different
 things.   Their purpose is  to train,  not the
 whole body, but some one defective part or
 organ, to enable  it to do its  duty  aright.
 Hence medical gymnastics  imply a very inti-
 mate  knowledge of the various organs of the
 body, and also of  those that are  most likely
 to be wrong in a given case, with  the means
 lo remedy them.  This is  really  one of the
 highest departments of medicine, though as
 yet not fully understood.  Let us  take an ex-
 ample : but a few years ago it  was supposed
 that  squinting was due to  one muscle of the
 eye pulling more toward one  side than  its
 antagonist on  the opposite side  can resist.
 Then the plan  was to cut  the  muscle which
 dragged, and  let  the other get  fairer  play.
 Now  it is  well known that squinting is not
 due to any one cause, but is symptomatic of
 many.  It may be a sign of paralysis  instead 
198             GYPSUM
HEMORRHAGE
of over-exertion, and so requires to be treated I gymnastics applied to one particular muscle.
in very different ways ;  stimulation by a gal- | There are scores of other instances we might
vanic battery, so as to exercise the' muscle at I name, but this will suffice.
fault, being one of them.   That is  medical |   GYPSUM.  (Sec Plaster of Paris.)
  HEMOPTYSIS is a term applied to cough-
 ing up blood.  It comes on in the course of
 many diseases of the lungs and air-passages.
 Sometimes it is  very small in  quantity, and
 only streaks of blood are found in the phlegm,
 at other times the flow of  blood is so excess-
 ive as to cause sudden  death.   In pneumo-
 nia, or inflammation  of  the lung, blood is
 always found in the sputum, giving it a rusty
 or  lemon-color look  ; in  the  early stages of
 consumption blood is frequently coughed up,
 but never to cause a fatal result ; in the  later
 stages of  this disease,  when cavities have
 formed in the lungs, a large vessel may  give
 way and cause haemorrhage which cannot be
 stopped.  The bursting of an aneurism  into
 the air passages,  or rupture of the pulmonary
 artery through ulceration of the bronchus, may
 set up fatal hemoptysis.   In  many cases of
 heart disease the vessels in the lungs become
 so engorged from the circulation being  ob-
 structed that blood  is  often  found in  the
 sputum  during  the  last  few days of  life ;
 nothing can be done in these cases with any
 permanent benefit ; now and then,  bleeding
 from  the arm  will, for a time, relieve  the
 over-full vessels.  In some forms of bron-
 chitis, hemorrhage occurs, but very rarely,
 and to no great extent.   Warty growths, ul-
 cers, and cancerous disease of the larynx,and
 trachea or bronchi, may  cause the  patient to
 cough up blood ;  this symptom generally ac-
 companies cancer of the  lung.  Under  the
 different diseases here mentioned, the nature
 of this complaint will be more fully detailed.
  Treatment.—The treatment consists in per-
 fect rest in bed, the head and shoulders being
 generally propped up, as  the  patient cannot
 lie down in comfort.  Ice broken up and ap-
 plied in a bladder to the spine or front of the
 chest is often of service, or small pieces  may
 be slowly dissolved in the mouth.  No speak-
 ing  should be  allowed,  nor any exertion
 whatever on the part of the patient ; the room
 should be warm  (Go0-^3 Fahr.), and the air
 rather moist, so  that any irritation from ex-
 ternal cold may be allayed.  Inhalation of tur-
 pentine vapor is  perhaps the most valuable
 remedy ; a jug may be nearly filled with boil-
 ing water and a  tablespoonful of turpentine
put into it ;  the patient should then hold his
mouth over the  jug  and  inhale the steam,
which will carry with  it the turpentine vapor ;
better  still,  to use inhalers which are manu-
factured  for the purpose, and may be had of
any druggist.   Various astringent medicines
have been  given internally, as iron,  tannin,
 gallic acid, acetate of lead, etc., but they are
 more uselul in cases of hemorrhage from the
 stomach and bowels.   Opium is of service in
 quieting the circulation, and in allaying the
 nervous excitement which is generally asso-
 ciated with haemoptysis.   When the bleeding
 has  ceased,  rest should, for some days, be
 carefully enjoined, and any exposure to cold
 or other exciting cause should be avoided.
 There will be anaemia and debility afterward
 to a greater or less degree, and these must be
 combated by appropriate tonic medicines.
  HEMORRHAGE is an escape of blood
 from an artery or a vein, whether as  the re-
 sult of a wound or from some pathological
 cause, such  as ulceration.   Arterial haemor-
 rhage is recognized by the blood escaping in
 jets, and being of a bright red color ;  venous
 haemorrhage by an oozing of black blood, al-
 though  in the instance of some  of  the  large
 veins being  wounded, and the wound open-
 ing superficially, the term oozing is converted
 into  a rush.   In the case of a cut or wounded
 artery, the rush of blood corresponds  with
 the beats of the pulse, and there is a  provis-
 ion of nature to attempt at a closure of such
 a wound, inasmuch as the divided vessel con-
 tracts so as to  narrow its orifice, and more-
 over, contracts into its natural sheath ; again,
 there is a coagulation  of the  blood at the
 point of injury, and the column of blood, in-
 side  the vessel, coagulates  up to the nearest
branch  given  off from the vessel, and the
 force of the heart's action is materially dimin-
ished by fainting.  In the matter of treatment.
of haemorrhage from an artery, the first indi-
cation is obviously to cut off the supply  from
the heart by applying some  method of com-
 pression between  the wound and the  heart
(see Accidents).   This may be done either
by pressure by the finger, in the course of the
vessel (which follows the inner axis of a limb),
by a tourniquet, or by  tying a handkerchief
round the limb, with a stone placed in it over
the artery, and twisting the handkerchief tight
with a stick.  This arrests immediate danger ;
the surgeon, however, performs the operation
of ligature, by cutting down upon the wounded
 vessel in its track, and placing a hempen or
silken ligature upon  it above  the seat of in-
jury ;  an operation,  of course, demanding
anatomical knowledge and judgment.  In the
case of bleeding from a superficial  small ar-
 tery, if  pressure does  not control it, it may
be caught up  with  a pair of  forceps  and
 twisted  (torsion), or its  end  picked up  and
 tied, or a needle  may be placed underneath 
HAEMORRHAGE
HjEMATEMESIS         199
  it, and a loop of silk applied over the ends of
  the needle, and the inclosed tissue containing
  the  bleeding  vessel  (acu-pressure).   In the
  case  of haemorrhage from  a vein, ordinarily
  it may be restrained by pressure at the spot,
  either by a bandage, and a graduated  com-
  press, that  is, a pad  made  of conical shape,
  applied with its apex downward, or by unre-
  mitting pressure of the finger.or in very severe
  cases  by acu-pressure, or ligature, as in the
  case of arterial haemorrhage.
   Haemorrhage from  the  nose,  or epistaxis.
  (See  Epistaxis.)
   Hemorrhage from the kidneys, is the  result
  of disease, such  as  calculi, or blows, or the
  congestion  consequent on scarlatina.   From
  the  bladder or  prostate  gland, by clumsy
  ratheterism, stone,  or  malignant disease in
  the instance of the  blood coming from the
  bladder, it continues to flow after the urine is
  voided ; the microscope will reveal kidney
  mischief, and  local symptoms, such as  pain
  in the back, would assist in the diagnosis. In
  kidney-haemorrhage,  tinctura ferri perchlo-
  ridi, or gallic acid,  are of chief use,  or if
  there be inflammatory symptoms,  cupping,
  purging, and the administration of acetate of
  lead.    In  bladder-haemorrhage, a catheter
  should  be  passed and  tied  in,  and  small
  doses of turpentine administered.
   fltvmorrhage from  the  urethra  sometimes
  occurs as a result  of  forcible  catheterism, or
  during  chordee ; generally  a   recumbent
  position  will check it ; if not, pressure, far
  back in the  perinaeum, cold, or  the injection
  of tannin or gallic acid are of value.
   Hcemorrhage  from  the rectum is caused
 cither by the bursting of  a  varicose vein in
 piles, or from the vascular surface of internal
 piles,   induced  by defecation.   Should the
 haemorrhage  result from piles,  those  piles
 should be operated on, and  astringent appli-
 cations, such as bark injections, be used.   In-
 ternally, bark and sulphuric acid,  cr  copaiba.
 If the   haemorrhage  be  very  violent,  the
 rectum may be  plugged with  a cork, having
 some stypic applied to it, or  lint or ice be
 thrust up the cavity. Occasionally it is neces-
 sary to distend the rectum by a speculum, and
 endeavor to find  some bleeding  point, to
 which a ligature or an actual cautery must be
 applied.  Frequently, haemorrhage from the
 rectum  is an evacuation, which affords relief
 in plethoric  individuals, to  be combated by
 exercise, temperance,  and aperients.
  Secondary Hamorrhage  is  bleeding which
 comes on some while  after the receipt of an
 injury or operation.  The most  simple form
 is that which occurs after reaction has set in ;
 thus, after a wound  has  been dressed, the
 small arteries will  burst out bleeding.  The
 wound must be opened up again, and bleed-
 ing vessels tied, and, if necessary, the surfaces
sponged with cold water.  Another form is
that which occurs from a wound in an artery
 (generally of  the  lower extremity), when  a
 ligature has been placed upon it, above the
 Wound; although  the haemorrhage is  con-
 trolled for a while, after the collateral circula-
 tion has been established, the blood will find
 its way back out of the original wound.  The
 blood is generally  of a venous or dark color,
 and oozes out.  If the original lesion, however,
 be properly treated, this form  of secondary
 haemorrhage would not  have  happened, as
 the vessel should  have been  secured both
 above and below the wound.  Again, second-
 ary haemorrhage may occur from sloughing,
 or"from the imperfect closure of an artery at
 the point of  ligature, at  the time when  this
 ligature comes  away, which may happen from
 the roots  of the vessel  being  in a diseased
 condition, or from some constitutional malady
 which prevents the proper adhesion  of the
 coats. The extraction of teeth sometimes sets
 up very severe haemorrhage, which may arise
 from the dental artery or from the gum.  A
 small  piece  of cotton wool, soaked in per-
 chloride of iron, stuffed into the cavity will
 generally suffice to stop  it, but in  obstinate
 cases  a very firm  plug  of  lint should  be
 pressed in, with  a  compress over it, so that
 by binding the jaws together by a bandage,
 considerable pressure  is exerted upon  the
 bleeding point.
   HEMORRHAGE,   CEREBRAL,  is
 caused by the rupture of a vessel in the  brain,
 in consequence of  which blood is poured out
 into the tissue  around ; the danger is gener-
 ally in proportion to the quantity  effused,
 but a  small  bleeding  into the medulla  or
 pons, where most important nervous centres
 are placed, is nearly  always fatal.  The seat
 of haemorrhage is, as a  rule, in  or near the
 corpus striatum  cr optic thalamus,  and only
 one side is affected at a lime.   Very profuse
 haemorrhage  may escape into  the ventricles
 and kill in a few hours.   The person attacked
 will then fall down in an apoplectic fit and
 lie  in  a state of coma ; or the  bleeding may
 be  confined  to a very small area, and  the
 patient will recover and find the arm and leg
 of one side paralyzed.  (Hemilplegia.)  This
 condition generally comes in persons of mid-
 dle life or old age, and  is generally associ-
 ated with  diseased vessels ;   it occurs  in
 those who have led intemperate lives, and in
 those who suffer from chronic Bright's disease.
  HEMATEMESIS,   or  Vomiting  of
 Blood, is a symptom  of grave importance.
 It occurs under  various  conditions ;  some-
times from ulcer of the stomach or from can-
cer of that organ, or  from  the mechanical
congestion  caused by disease of the heart or
liver,  more rarely  from  the  bursting  of an
aneurism  into  the  oesophagus  or stomach.
The blood vbmited is generally of a coffee-
ground color and appearance from being acted
upon by the gastric juice, but if  a large  quan-
tity is suddenly poured out from  a  ruptured 
-00         HEMATEMESIS

vessel and  vomited at once, it will have a
dark  clotted character.  If due to heart dis-
ease,  the effused blood is  seldom  large  in
amount ;  the capillaries  and  veins  of  the
stomach share in the general congested state
of the body, and the coats of some  of  them
become ruptured from over-distension.   In
such  cases  there will also  be dropsy of  the
legs and  abdominal  cavity, and the  usual
signs of heart disease.  Treatment is of little
avail, and death speedily occurs, not  because
of the loss of blood from the stomach, but of
the general  condition of the body, of which
the haematemesis  only forms a  part.    In
long-standing disease  of the  kidneys, and
more especially  in that form  which is met
with  in gouty people, hemorrhage fiom  the
stomach is  often present ;  headache, bleed-
ing from  the nose, sickness, a sallow  com-
plexion, and the presence of albumen in  the
urine are generally associated phenomena.
The treatment consists in  avoiding stimu-
lants, keeping up a free action of  the skin
and bowels  by  promoting  perspiration and
giving aperients, and in this way relieving
the kidneys, which are the source of  the mis-
chief.  Cirrhosis, or contraction of  the liver
(see Cirrhosis), often causes haematemesis
by mechanically obstructing the flow of blood;
all the blood from the stomach passes into  the
portal vein  and  then  on to the liver, but if
the latter organ  is so diseased as to prevent
its ready transit, the veins of the stomach will
become over-distended and rupture occasion-
ally.  There will, therefore, be the signs due
to a cirrhosed liver before  the bleeding  oc-
curs , dyspepsia, loss of appetite, sickness, a
jaundiced or sallow skin, and perhaps ascites.
The treatment will consist in keeping  the
bowels open, so as to relieve the liver, giving
light  and nourishing diet,  and making the
patient  lie  down quietly.  In these cases, as
in those  depending  on heart disease,  the
bleeding ought not to be stopped,  as it ready
relieves the  dilated vessels, and if  it could be
stopped in one place it  would only break  out
in another.   But if the haematemesis depend
on an ulcer or cancer of the stomach, it should
be put a stop to as soon as possible. (See Can-
cer and Gastric Ulcer.)   Vomiting is very
common in  some kinds of hysteria, but there
is not often  any  blood  present ; when  there
is it  appears in  red  streaks, and generally
proceeds from the gums, decayed teeth,  or
back of the  throat ; such people do  not lose
flesh, although they seem  to  be  constantly
sick ; they are generally young females, and
arc suffering from other signs of hysteria.
The bleeding is extremely small in quantity,
and can do no harm ; the inside of the mouth
should be examined carefully, as the bleeding
may be done on  purpose by scratching  the
gums, etc.,   with  a pin or  with  the finger
nails ; detecting the imposture is  the surest
way to cure  it.   Haematemesis  from the rup-
             II.EMATURIA

turc of an  aneurism  would  at  once prove
fatal.
  HEMATURIA  signifies  that blood  is
present in the urine.  It is as a general rule, a
grave  symptom, as  it implies that  there  is
some disease going on in the kidneys.   A
common cause  is some severe  blow on the
loins, and may be produced by falling back-
ward, or by a direct blow  being given over
that part.   Great pain is at once felt, and is
often accompanied by sickness with a sensa-
tion of  faintness and inability to walk erect.
In a few hours the  patient finds, on  passing
water, that there is more or less blood mixed
with it,  so  that it is almost the color of  por-
ter.  He may need  to pass water more fre-
quently, and will  most likely have  pain ex-
tending from the loins down by the groin into
the thigh.   The blood is present, because, as
a result of the fall or blow, some  of  the  ves-
sels of the kidney have become ruptured, just
in the same way as the vessels of  the skin arc
ruptured in the case  of a severe  bruise, only
as the kidney is a more important organ, se-
rious results may arise.   The  patient should
be at once  put  to  bed and told  to make no
exertion whatever for several days, as perfect
rest is  the  best and most useful treatment.
To ease the pain, hot flannels,  or flannels
coining out of  hot water and put across the
loins, are very beneficial, and if there is much
pain and  distension of  the abdomen,  they
may be applied in front also.   Morphia, or
some preparation  of opium, may be given
under medical  advice.   The  bowels may be
kept moderately open,  and very plain, simple
diet should  be given.   Nothing should be
taken to cause any irritation to  the  kidney ;
as the patient will  most  likely be thirsty and
feel sick, iced-milk  and water is very grate-
ful ; beef-tea,  arrow-root tea, and  barley-
water may be also  taken.  As  soon as the
urine assumes  a lighter color it shows that
less blood is being  passed, and  that an im-
provement is* taking  place ; this may occur at
the end of a week, and generally in three or
four weeks the urine has  resumed its usual
color, or merely looks a little cloudy when
held to the light.   So long as any blood  is
present the urine  will give a white, heavy,
flocculent  precipitate  of albumen,  when  a
small quantity  is  placed in a glass test-tube
and boiled  over the flame of a  spirit-lamp.
This is a very simple test, and  to  insure a
good recovery  the patient ought to  be kept
to his bed, or at least  to his  bedroom, until
all traces of albumen are gone.   If any exer-
tion is undergone too soon the bleeding is apt
to recur, and may, in fact, lay the foundation
of serious mischief in the future.  For  some
time the patient will feel weak  and will  be
pale ;  to remedy  this tonics   are of  great
value ;  all  preparations containing iron are
good, and  are useful in  checking the hemor-
rhage ;  when the tongue is clean and the in- 
HEMATURIA
HEMORRHOIDS        201
 valid feels hungry, solid but  light and nutri-
 tious food may be given.
   Haematuria may arise from the presence of
 a stone in  the  kidney, and this  rriay be in-
 duced  by severe exercise, such as riding or
 driving over rough  ground.    (See  Gravel
 and Stone.)
   Haematuria is very often  met  with  after
 scarlet fever, and forms  part of the disease
 known as  " dropsy  after  scarlet fever."  It
 comes  on about a fortnight  or three weeks
 after the scarlatinal  eruption has appeared,
 and is often due to a chill  being taken while
 the skin is peeling.  The  urine suddenly be-
 comes  bloody,  and rather  less than usual is
 passed ; there may be  slight  aching pains in
 the loins, but not to  any great  extent ; there
 is often with this condition a  puffiness of the
 eyes and feet, which  is caused by an effusion
 of serum under  the  skin of those parts.
 When the urine stands a short time a consid-
 erable amount of dark brown  flocculent sedi-
 ment is observed, and  on boiling, as before
 described, a good deal of albumen will come
 down.  It is of no  use applying turpentine
 embrocations or blisters in these  cases,  nay,
 it is actually dangerous, as they may aggra-
 vate the congested state of  the  kidneys from
 being absorbed  into the blood and causing in-
 creased irritation.  Hot fomentations may be
 applied and the  patient placed in a hot-bath,
 so as to encourage sweating,  and so making
 the skin  do  the work of  the kidneys.   The
 bowels should be kept gently open. This dis-
 ease  is most common  in  children, and may
 often be  accompanied with convulsions, but
 this is  more  fully discussed under Scarlet
 Fever.   Haematuria  may  occur at the very
 onset of scarlet  fever, but is not then a sign
 of  much  importance  ;  it  is found to occur
 slightly in nearly every severe case of fever,
 but in such cases rarely calls for treatment.
 It may come on after  taking turpentine or
 cantharides (the Spanish fly) ;  these are really
 poisonous agents, and have been occasionally
 given for that purpose.  They cause a stop-
 page  in the amount of urine  passed, with
 great pain and  vomiting,  and often serious
 results.
  Blood may occasionally appear in the urine
 from  eating indigestible food, from over-ex-
 ertion, and  in some  people it is met with in
 very hot weather, when all the tissues of the
 body  seemed relaxed.    In  such cases  the
 haematuria will  only last  a few  hours, and
 may be cured by finding out  the  cause and
 avoiding it.   In  the diseases known as scurvy
 and purpura, blood may appear in the urine
 in a similar way  to the manner in which blood
 is effused  under  the skin.   More recently the
 name " intermittent  haematuria"  has  been
given to a disease where, for a few hours,
blood will suddenly appear in the urine and
as suddenly disappear ; such persons are gen-
erally very sallow, and know  when an attack
 is threatened by feeling a  shivering fit  come
 on ; in some, getting out of bed and going out
 into the cold air will bring on an attack at once.
 Good  diet, rest,  and improving  the general
 health are the chief things  to be done in such
 cases.
   HEMORRHOIDS  are  swellings,  most
 commonly known  by the  name  of  Piles,
 which  are situated in the region of the anus,
 and which by their size and  their liability to
 irritation  and  inflammation, cause  much
 trouble and  uneasiness, and sometimes  in-
 tense pain.  These swellings may be formed
 either  by circumscribed  thickening of  the
 skin just  without the  anus, or of enlarged
 folds of the mucous membrane of the termi-
 nal portion of the gut, which folds are  often
 protruded from the anus.  In the former case
 the affection is  called external piles, in  the
 latter internal piles.  External piles consist in
 a  collection just without the margin of  the
 anus of rounded  hard  tumors  covered  by
 thickened skin, and of prominent  ridges of
 skin. These growths at first cause little or no
 pain, but  as they  increase  in size and num-
 ber the patients complain of difficulty in pass-
 ing the motions, of bearing down pains, of a
 sense of weight about the anus, and of a gen-
 eral feeling of discomfort.  After a time one
 or more of these  piles  may become irritated
 and inflamed, and then give  rise  to  very
 acute pain, with  throbbing and  a  sense  of
great heat, and to a constant desire to go to
 stool. These symptoms pass off in the course
of three or four days, but the attacks are fre-
quently renewed and the piles gradually en-
large and invade the lower portion of the intes-
tine.  This affection orginates in distension
of the veins about the anus  in consequence of
obstruction to the circulation.  It is met with
generally in those  who follow sedentary em-
ployments, and those who,  in consequence of
indulgence in highly-seasoned food and  in
alcoholic drinks,  suffer from congestion of
the liver.    Much horse exercise, long-con-
tinued  standing,  and constipation, are also
causes, of  external piles.    The  presence
within the anus of large rounded and soft  tu-
mors covered by red mucous membrane  is  at-
tended with more serious symptoms.  These
internal piles, when large, come down through
the anus from  time  to time, generally when
the patient is at  stool,  and become engorged
with blood and very painful.  Evacuation of
 the bowels gives rise to a burning or throb-
 bing sensation, and  as  the piles  increase in
 size becomes  more  and more difficult.  A
 dull pain  across  the loins  is complained  of,
 and occasionally the urine  cannot be passed
in consequence of irritation at the neck of the
bladder.^ The most serious symptom is bleed-
ing, which occurs during evacuation of the
bowels, when  the  piles are protruded and
compressed  by the anus.   The blood  is red
and arterial, and is often passed in consider- 
202        HEMORRHOIDS
HAIR
able quantity.   Patients often remain igno-
rant during a long  period of this frequently
renewed loss, and finally suffer from extreme
debility, become irritable  and restless, and
present a  blanched countenance and a weak
and quick pulse. In addition to the discharge
of  blood there is  in  most cases a constant
flow of thick slimy or purulent fluid.  On ex-
amination of the region of the anus there will
be  seen, as  the patient bears down, one  or
more rounded protrusions  of a dark red or
livid blue color, and varying from the size of
a currant to that of a small chestnut.  These
growths, like external piles, are sometimes
inflamed.  Then, in addition  to  intense pain
and other severe  local symptoms, there is
high  fever.  Inflammation of internal  piles
sometimes ends in mortification and in expul-
sion of the mass of abnormal growths  from
the rectum.  The causes of internal are sim-
ilar to those of external piles.  Congestion of
the liver causing venous obstruction in the in-
testines, and direct irritation of  the walls  of
the intestine, are the  conditions which  most
frequently  give rise to this affection.   The
latter  condition is often  due to an immod-
erate  use  of  strong  purgatives,  especially
aloes.
  Treatment.—The  general  treatment  of
piles, both internal and external, consists in
removing congestion of the veins of the  liver
and intestines,  in  keeping up  the strength
and health of the patient, and in avoiding or
alleviating the  results  of certain conditions
favorable to the development of the disease.
The patient should restrict himself  to a care-
fully  regulated  and temperate diet, and ab-
stain from  highly seasoned  dishes, pastry,
and spirits ; wine  and beer ought not to be j
taken, except in moderation.  Walking exer-
cise is to be recommended, and, during the
summer months, sitting in the open air.  Rid-
ing on horseback or in a jolting  vehicle is to J
be  regarded as positively  injurious.    The
affected region  should be well bathed every
morning with cold water  and then  carefully
dried.   To  external  piles  may  be applied
lead lotion or a weak solution of alum.  For
both external and internal piles the compound
gall ointment is a  very  useful  application.
When internal piles protrude after every evac-
uation, they should then be sponged over with
cold  water or  a solution  of  alum, or  be
smeared with gall ointment.   Great attention
should  be  paid to the state  of the bowels, j
which ought  to be  kept  in daily  action by j
some mild aperient, as rhubarb in the form of j
a pill to  be taken at night, or confection of |
senna, castor oil, seidlitz or Piillna water, to I
be taken in the morning before breakfast.  In I
cases of inflammation  and great  pain  in ex- j
ternal  and internal piles, leeches should  be i
applied to the skin at some distance from the
anus, and bran poultices or  poppy-head fo-
mentations  be placed  over the whole of the
| affected region.   When a patient with exter-
 nal piles complains of almost intolerable pain
 in one  pile which is  found to  be  swollen,
 tense, and livid, an incision into this with the
 point of  a  sharp knife will often let out a
 small dark-red clot of blood, and give  imme-
 diate and total relief.  By these means the bad
 effects of both external and internal piles may
 be much relieved, or,  as  occasionally takes
 place,  the  disease  may   be   permanently
 cured.   When,  however, in spite of careful
 attention to diet and to local  ablution, the
 affection increases in extent  and  intensity,
 and becomes to  the patient not only a source
 of annoyance  but also a hindrance  to the
 pursuit of his  means  of support, it will be-
 come necessary  for him to undergo some sur-
 gical operation in order to obtain permanent
 relief.   External  piles  are  generally treated
 by excision, the tumors, together with the
 adjacent ridges  of thickened skin,  being re-
 moved with large curved scissors.   Internal
 piles have been  treated by various  operative
 methods ;  many  surgeons  apply a ligature
 round the base or contracted portion of  each
 pile, other surgeons prefer to cut away the
 pile and  then to  apply to the raw surface the
 red-hot iron.  Fuming niTic acid is often ap-
 plied to the  surfaces of small internal  piles.
 In cutting operations upon external piles the
 surgeon, while endeavoring to obtain for the
 patient effectual relief,  is careful not to take
 away too much of the skin lest contraction of
 the anus should  follow the shrinking of the
 scar.  In these  operations,  but more espe-
 cially in those consisting in excision or inci-
 sion of internal piles, the bleeding is very free,
 and, if it should recur in the absence of a medi-
 cal man, dangerous to life.
   HAIR, Diseases of.—The hair  is subject
 to alterations in  its growth which correspond
 with those  through which  the  body passes.
 Thus after  fevers or exceedingly acute dis-
 eases, the hair, which during the period of the
 disease has remained stationary in its growth,
 generally falls off and  a new growth begins,
 which at first very frequently  differs  in its
 characters  from the   hair  before  illness.
 Then, too, it usually grows  faster for a time.
 In some  individuals  the  growth of the hair
 and the  character of the hair are very differ-
 ent  from those  found  in others.  Usually a
 good growth of strong hair  may be taken as
 a sign of a vigorous constitution. A thin crop
 of sandy, that is, imperfectly  colored hair,
 commonly marks one in whom  the original
 force of bodily  growth has been  deficient.
 Thinning of the* hair may take  place  from a
 variety of causes, and very often precedes ab-
 solute baldness.   (See Baldness.)  The bald-
 ness of old people is generally preceded by
 alteration in the color of  the hair,  which be-
 comes gray.   It generally falls  first from the
 very top of the head, and  thence  gradually
 spreads.   Baldness in young people  arising 
HAIR
HARE-LIP
203
 from parasitic disease  is not preceded by al-
 teration  in color.   Generally there is some
 local irritation, and in this spot the hair begins
 to fall.   This is usually on  the  side of the
 head, and frequently the hair is broken  and
 stubbly  round the bald spot.   This form of
 baldness is commonly called ringworm (which
 sec).   Baldness almost invariably follows
 syphilis during the period  of secondary erup-
 tion. This baldness is sometimes sudden and
 very complete, the hair coming out literally
 by handfuls.  Such a loss adds greatly to the
 mental disquiet of the  sufferer, but he may
 be comforted, for it is almost absolutely cer-
 tain to grow again.  When hair falls through
 disturbance of the  constitution, that  must  be
 seen to ; the hair may be left to take care of
 itself. It is mostly  the custom to give arsenic
 in such  cases, and frequently  when there is
 much nervous debility arsenic does good, but
 not because of its fancied action on the skin,
 rather because it is a really good, serviceable
 tonic.   Iron, quinine,  and strychnine will
 generally  do good.    The chance  of local
 measures  doing  any good will  entirely de-
 pend on the condition of the hair follicles.  If
 these be totally wasted, local measures will do
 no good, but if they are in a  condition to re-
 spond to stimulation, local  applications may
 restore a goodly head of hair. If downy hairs
 are  visible these  may  usually be  made  to
 grow  by stimulation ;  even if  they are  en-
 tirely  absent, good may be done  if the scalp
 look at all natural.  If white, shiny,  and with
 little fat below the skin, there is not much
 hope.   If, too,  the  scalp  be  swollen  or
 thickened, some local application will be re-
 quired.  The  best  for this last is  tincture of
 iodine, but it must  be used with  caution.
 When there is a chance  of getting the hair to
 grow  again,  stimulants  may be  used.   If
 there are downy hairs, let the  head be shaved
 and a blister lightly applied, for of all stimu-
 lants to the growth of hair, Spanish flies (can-
 tharides) are the best.   The application of a
 blister may seem a harsh remedy, but experi-
 ence has shown it to be the best ;  if one does
 not want hair, he need not submit lo the blis-
 ter.   These must be used repeatedly if neces-
 sary. Where the hair is thinned only, the first
 thing is to restore the scalp to a healthy con-
 dition.   The scurf should be got rid of by
 bathing with  tepid  water night and morning,
 and the constant application of glycerine and
 lime-water in the interval.  No fats or oils
are to be used at  this period, as they are apt
to go rancid and so irritate the irritated scalp
still  more, but glycerine and lime-water, or
 fresh olive oil and lime-water may be used.
Cantharides enter into most stimulant applica-
tions to the hair, and a very good compound
for gently acting upon the hair follicles is to
be obtained by adding a few drops of tincture
of cantharides to  toilet vinegar, and gently
 damping the scalp after it  has  been well
 washed with the compound.
   Most  of  the  advertised pomades  and hair
 restorers are humbugs ; they are got up mainly
 for enabling hairdressers to impose upon their
 customers,  which some of them are  not slow
 to do.  Some of these hair washes, too, con-
 tain  lead,  though  said not to do  so by the
 venders and manufacturers ;  these are espe-
 cially to be avoided.   In  short, the principles
 above laid down are those which must guide
 any individual in dealing with the hairy scalp.
 Each may apply them for himself.
   HALLUCINATION.  (See Insanity.)
   HANGING—The cause of death  by hang-
 ing is suffocation, from  the pressure of the
 rope  upon  the trachea preventing the admis-
 sion of air into the lungs,  which is common to
 death by strangulation also, and the  explana-
 tion  that the immediate cause  of death by
 hanging is  pressure on  the nerves  subordi-
 nate to the function of respiration, may be re-
 jected on the grounds that such  pressure does
 not prove fatal  for many hours.   In certain
 cases  of suspension death takes place very
 suddenly,   and  this  may arise  from  two
 causes, fear, producing syncope, or  from in-
 jury to the spinal cord,by dislocation of the cer-
 vical  vertebrae,fracture of  the odontoid process
 of the  axis, or  second cervical vertebra, or
 rupture of the intervertebral substance. These
 injuries to the spine are due to the fall of the
 body from some considerable height, or  to a
 twist  given  to the body at the time of  the fall ;
 these  details are  observed in  legal execu-
 tions, with  a view of producing death as sud-
 denly as  possible.   Death from apncea is
 next in order of  rapidity ; and the least rapid,
 that  produced by  apoplexy,  induced by the
 pressure upon the great vessels of  the neck.
   To  restore  one found  hanging,  the body
 should be  immediately cut down,  and the
 knot  or loop eased  from around the neck.
 Cold  water should be forcibly dashed  over the
 face  and   chest,  artificial  respiration  (see
 Drowning) should  be  employed.   Blood
 should be  taken  from the external jugular
 vein, if  there be turgidity of the face, and a
 galvanic current passed from the nape of the
 neck  to the pit  of  the stomach, to excite the
 diaphragm  through the course of the  phrenic
■nerves, that is,  just in the hollow above the
 collar-bones.  It is obvious, lhat in the case
 of dislocation or fracture of the cervical spine,
 these measures  are unavailing, but  in cases
 where the hanging has taken place  very re-
 cently, or where there has been a  very short
 fall, such measures should be  most  assidu-
 ously applied ; many cases of attempted  sui-
 cidal  hanging have recovered by prompt at-
 tention.
   HARE-LIP  is a congenital  fissure of the
 upper lip, dependent on an arrest of develop-
 ment of the structures forming the upper lip 
204          HARTSHORN
HEADACHE
or its bony  support.  There are two species
of hare-lip,  the simple  and complicated.  Of
the simple,  there  are two or three varieties.
If there is  one, it is almost always on one
side of the mesial  line, though it has been ob-
served in the  mesial line.   If  two  fissures
occur, they  are usually lateral,  and isolate a
labial  segment ; this segment is sometimes
atrophied, sometimes hypertrophied, in either,
attached directly to the tip of  the nose or by
a short septal pillar.  The varieties of com-
plicated hare-lip are, ist. A single fissure of
the lip, and a simple fissure of  the alveolar
margin of the  jaw, the fissure  being either
median, or at some one  of  the  lines of junc-
tion of the intermaxillary and maxillary seg-
ments, existing at the time  of development ;
this split in the alveolar ridge  corresponds
with that in the lip.   2d. A single fissure of
the lip may be  coexistent with  a separation
of the opposing edges of the alveolar cleft,
constantly associated with cleft palate.  This
variety is  most frequently  met with  on the
left side.   3d.  The most frequent variety is
that in which both lateral segments and the
maxillary bone are but imperfectly developed,
while  the intermaxillary attains its  normal
size and position,  a double  fissure of  the lip
is connected with  this condition of the jaw ;
while  the  intermediate  portion is generally
more  or less of an oval or rounded  shape,
and curling upward toward the nostril, leaves
the incisor teeth uncovered  in so unsightly a
manner as to have given rise to  this deform-
ity being called "  wolf's jaw."   4th. With a
double fissure may be entire absence of this
intervening lobe,  and of course,  absence of
the incisive  bone.
  Treatment.—Most modern surgeons agree
that operative proceedings for the cure or re-
lief of  this condition  should be  had recourse
to as  early after  birth  as  possible ; infants
have been operated upon a few days or hours
after  birth  with  complete  success, and al-
though many cases appear,  at first sight, to
be impracticable of  any relief, so much sci-
ence and ingenuity has been expended upon
perfecting surgical operations of this nature,
and the physiological and pathological condi-
tions of arrested development have of late at-
tracted so much attention,  that  no case can
be regarded as  incurable, though the various
processes and  stages of the operation  may
last over some considerable  time.   Opera-
tions on adults  are more easy of performance
than on children,  for the  reason that  they
have command over themselves, by the exer-
cise  of the  will, to keep as still  as possible
during the  proceeding.   Children should al-
ways be chloroformed.
  HARTSHORN.  (See Ammonia.)
  HAY-FEVER, Hay Asthma, or Hay
Cold,  is a  peculiar  disease to  which  some
people are subject in the months of June or
July, or August and September,  or when  the
hay season is about.  It consists in excessive
irritation of the eyes, nose, and the whole of
the air-passages ;  producing, in succession,
itching of the eyes and nose, much sneezing
occurring in paroxysms, with a copious flow
from the nostrils ; pricking  sensations in the
throat;  cough, tightness of the chest,  and
difficulty of breathing, with or without mu-
cous expectoration ; and  more or less fever
and constitutional disturbance.  This disorder
is confined to  a  very few people,  and only
comes on in them when they are in the way
of hay-fields, etc., for if  absent at sea they
will escape an attack.  Such people have not
been noticed to be peculiarly susceptible to
catarrh, nor is any satisfactory explanation to
be given of its  origin, save  that the cause is
contained in the atmosphere and is of vege-
table origin.   It affects both sexes, and gen-
erally occurs in the adult.  In some cases the
affection occurs in successive years precisely
at the same period, and has  a uniform dura-
tion.
  Treatment.—The  only  treatment  that
seems effective is such a change as will carry
the patient beyond the reach of  the provoking
cause of the disease.   A  sea-voyage  affords
instant and complete relief.  There are also
portions of the White Mountains, the Adiron-
dacks, and Colorado  that are  said to afford
entire exemption ; and Dr. Morrill Wyman
(who has carefully studied the disease) thinks
that one liable to it may secure relief by going
to any  point that is 800 feet above the sea.
  HEAD.  (See Scalp.)
  HEADACHE, technically called  cephal-
algia, may for the most part be looked upon as
a symptom, though sometimes also the most
important part of the disease.   Certain pains
in the head, not commonly  called headache,
are rheumatic and neuralgic affections of the
scalp, though these are sometimes also spoken
of as rheumatic and neuralgic forms of head-
ache.   Pains from syphilitic nodes  may usu-
ally be distinguished from true headaches by
the great tenderness over localized points ; in
rheumatism of the scalp, too, there is usually
some tenderness,  but more  diffused than in
the preceding.  The pain  of acute  inflamma-
tion may readily be distinguished by the other
and more characteristic features of the mal-
ady.  Pain  in  the head  is a very constant
but by no means invariable symptom  of  dis-
ease of the brain  and its membranes.  This,
if persistent  and accompanied by  vomiting,
especially if the pupils be affected,  is a grave
sign.  Inflammation of the membrane gives
rise to more pain than does  inflammation of
the substance of the brain, and it  is  usually
of a sharper description in the former than in
the latter.  Another form of headache is de-
scribed  as congestive or plethoric.  It is not
unfrequently  occasioned  from over  brain-
work.  It attacks a different part of the head
than do most others, giving rise to a feeling 
HEADACHE
HEADACHE           205
 of tightness across the head, and a fulness and
 whizzing behind the ears.   It  also occurs in
 females of full habit of body,  in whom the
 menstrual function is  defective or in abey-
 ance, and is especially  troublesome about the
 period  when  this  stops, when it not unfre-
 quently leads to that form of headache indica-
 tive of brain disease by insensible gradations.
   Perhaps the most  common form of head-
 ache is that connected with indigestion.  It
 is sometimes called sick-headache, sometimes
 bilious headache.   Neither is a very good ap-
 pellation,  for  there would seem to be also  a
 purely  nervous form of sick headache, of even
 more distressing character than this, and the
 headache here spoken of is by no means in-
 variably accompanied or followed by bilious-
 ness.  This form of headache most commonly
 follows some  indiscretion or excess in diet,
 and is generally worst in the morning ; some-
 times, however, it becomes aggravated during
 the following day.   The pain is very severe,
 ol a throbbing or bursting character, and the
 sickness is intense.  Sometimes this sickness
 ends in vomiting,  and then the  pain  in the
 head is greatly aggravated for a time, but by
 and by the sickness having carried off offend-
 ing matters lying in the stomach, the  patient
 probably falls  asleep and awakes refreshed.
 Jn point of fact, such headaches seldom last
 long, and  are generally cured by a good long
 sleep.  The best thing to do, in  point of fact,
 is to go  to bed, if this  is possible, for the
 work done with such a headache is not very
 good.  Occasionally these headaches become
 almost constant; if  so, there  is  permanent
 derangement of the digestive organs, which
 must be  set  right before  anything  else is
 done, or before any  permanent amendment
 can be  secured.
   There is still another form of headache very
 common.  For want  of a better name it is
 called nervous, and is very common in wom-
 en.   In point  of  fact, just as  the preceding
 might be  called the  men's headache, so this
 might be called the women's headache, though
 it also occurs in weak and delicate males, or
 those who have been overworked.  Not un-
 frequently this form of headache depends on
 some  distant  irritation,  as decayed teeth,
 which must be removed before any good is
 done.   Headaches  are sometimes classified
 by their site, which indeed aids  us to deter-
 mine sometimes their origin.   Thus,  bilious
 headaches, if slight, are commonly confined to
 the forehead,  others, especially the nervous
 forms, are  felt more on one side than another.
 Occipital headaches are perhaps most frequent
 in the outset of fevers and such like acute dis-
 eases.   Patients who have resided in marshy
 districts, and many, who as far as we know
 have not, are subject to attacks  of headache
 which recur at  definite  periods.  This, how-
ever, is  not uncommon in pure neuralgia, and
so may  have no malarious origin.   Hysteri-
j cal girls are often  subject to acute attacks of
i pain in  one particular spot, which  has been
 likened  to driving a nail into the head, hence
 the Latin  name clavus has been  given to it.
 Purely neuralgic pains are more distinctly
 confined to the line of certain nerves than are'
 the others. As headaches are seldom deadly,
 sufferers do not get always the sympathy this
 pain deserves, and  in many instances they
 are themselves the authors of their own mis-
 fortunes.   Broadly speaking, indigestion in
 some form or  other is at the root of a major-
 ity of headaches ; if  that is present, it should
 be remedied, for this is usually  the first step
 in getting rid of nervous headaches as well as
 those due  to what is called biliousness.
   Treatment.—The treatment resolves itself
 into two parts, the treatment of an acute at-
 tack, and  of the general condition which has
 given rise to it. For a bilious headache, if
 known to be  due to any  error  in diet or ex-
 cess in liquor, perhaps the best thing, if the
 patient  can make up his mind to it, is  an
 emetic of zinc and  ipecacuanha.  Whether
 this be taken or no,  the patient must be kept
 absolutely quiet, with the eyes shut, or in a
 darkened  room, and  pressure on the temples,
 so as to  arrest the  beating of the arteries,
 will  often give relief.   By and  by  he  will
 probably fall asleep,  however severe the pain
 may seem, and he  will generally awake toler-
 ably well.  A cup of strong black coffee, a
 walk and  a fast for  six or eight  hours will
 generally  suffice to set everything to rights.
 When the patient  is suffering  from  nervous
 depression,  as often happens,  drinking  a
 draught containing a dram of  the  aromatic
 spirit of ammonia, with a little gentian, will
 generally do much good.  In the same con-
 dition,  sniffing a bottle  of strong smelling-
 salts will often relieve the pain.  This holds
 true of the purely nervous headache also.  In
 some cases cold is  grateful, in others heat.
 Cold is best applied by means of eau de  Co-
 logne, or some similar  spirit, of  course still
 better by ether ; ice or iced water may also
 be employed.   If heat is best borne, let it be
 applied by heating a quantity of salt in a fire
 shovel,  and binding it   in a  handkerchief
 round the  temples.   If  the headaches  be
 purely neuralgic, recurring at different inter-
 vals, a  full  dose of  quinine, five grains at
 least, should be given as well as a little spirit
 of ammonia.  Some  sedative should  be ap-
 plied locally, and if  necessary, some  should
 be given  subcutaneously.   For  after-treat-
 ment in the bilious form, some laxative should
 be given, blue-pill if there is much tendency
 to biliousness, ipecacuanha and  rhubarb if
 there is not.   Podophyllin is very good for
 relieving congestion  of the liver,  and effect-
 ually emptying the  gall-bladder.  A  dose of
 compound  rhubarb powder  every morning,
 or just  before  dinner in smaller quantities, is
 a very good remedy.   Diet too  must be reg- 
206
HEALTH
HEALTH  RESORTS
 ulated ; it must be plain and unstimulating ;
 beer,  port,  sherry,  and  spirits  should  be
 avoided, but claret and other light wines may
 be taken.  Exercise  should  be taken, espe-
 cially  in the open  air, and  indolent habits
 should be got rid of.   Where the headaches
 are purely nervous and depend on weakness,
 a totally different line of  treatment must  be
 adopted.  The bowels must be regulated, it is
 true, but the remedies to be used are strength-
 ening, and nux vomica or strychnine is one
 of the best, especially with nitro-hydrochloric
 acid.  If acids do not suit, liquor potassae and
 compound  infusion  of  gentian  should  be
 given.  Finally, in a considerable number of
 cases, especially in women, no drug does so
 much good as sal ammoniac (chloride of am-
 monium); its mode of action is not quite plain.
 In these too, if the tongue  is foul, rhubarb,
 ginger, and  bicarbonate  of   potass  will  do
 good.
  HEALTH.  (See Hygiene.)
  HEALTH RESORTS are  partly  dealt
 with under Climate  and  Mineral Waters.
 The places here referred  to acquire impor-
 tance more from their atmospheric qualities
 than from anything else, and many, we fear,
 are hardly in a condition  to  be called health
 resorts at all, for the unsanitary state of some
 of them is alike to be dreaded and wondered
 at.   Change of  air is in many instances the
 clew to the  benefits  derived  from  health
 resorts.   Thus frequently  those living in in-
 land places, remarkably healthy in every way,
 are often benefited by a visit to the seaside,
 while those living near the sea are benefited
 by a visit to the hills.  Then, too, for the in-
 habitants of large cities, the great  thing is to
 get out of town, whether to the country or
 the seaside.
  In this country, aside  from the mineral
 springs, the so-called health  resorts are  for
 the most part places  which are supposed to
 benefit those who are suffering from pulmon-
 ary consumption ; and their indispensable re-
 quirements are warmth, dryness, and equabil-
 ity of temperature.  Those most  frequented
 and most often recommended are in Florida.
 The climate of Florida is one of the finest in
 the world :  though  10 degrees  nearer  the
 equator than southern Italy, the temperature
 is no warmer, and the air far more equable
 and dry.  At Jacksonville  the average mean
 temperature, as fixed by observations extend-
 ing over several years,  is 69.6° ; the highest
 temperature (in July) is 83.4'' ; the lowest (in
 January) is 52.7".   In the south the tempera-
 ture scarcely changes  the year  round,  and
 summer is only distinguished by the copious-
 ness of its showers.  The  average mean tem-
perature of the State is 73° F., and the differ-
ence between summer and  winter does not
generally exceed 20°, while at Key West it is
not more than 11°.  The thermometer seldom
rises above 90° in  summer,  and  rarely falls
 below 300 in winter ;  on the average the win
 ters are thirty or forty degrees warmer than
 in New York, while  the summer months of
 the latter  are ten or fifteen  degrees hotter
 than in  Florida.   Frost is unknown in south-
 ern Florida, and is comparatively light even
 in the northern part of the State.  It occurs
 most  frequently  between   November and
 March, being most frequent in December and
 January, and rarely showing itself in October
 and April as far north as Jacksonville.  As a
 general  thing no frost occurs throughout the
 year  below latitude 28°  N.  Summer  being
 the rainy season in Florida,  the  winters are
 usually  clear  and dry.  In  addition to  the
 mildness of the climate, it is believed  that the
 immense  pine-forests which  cover  a large
 part  of  the State contribute greatly to its
 healthfulness.    The  delicious   terebinthine
 odors exhaled by these forests not only purify
 the atmosphere, but impart to it a healing,
 soothing, and  peculiarly invigorating  quality.
   Of  the principal resorts in Florida those on
 the St. John's River  are Jacksonville,  Mag-
 nolia, Green Cove Springs  (sulphur waters),
 Pilatka, San Mateo, Mellonville, Sanford, and
 Enterprise.  On  the  Atlantic coast  are  St.
 Augustine (with  a singularly equable  climate
 and a mean winter  temperature of  58.080),
 and Fernandina (whose air is bracing but con-
 sidered  too strong  for  consumptives in ad-
 vanced stages of the  disease).  On the Gulf
 Coast are Cedar  Keys  (with a climate  blander
 than  that of Jacksonville,  and beneficial to
 rheumatism as well as consumption),  Tampa,
 which is growing in favor, Manatee, Charlotte
 Harbor, and Key West, where the thermom-
 eter seldom rises above 90°  in summer and
 never falls to freezing  point, rarely standing as
 low as 500.  Its  mean winter temperature is
 69.580.  In the  interior, Gainesville,  Waldo,
 Lake  City,  Monticello,  and  Tallahassee (the
 capital of the State), are much esteemed ; and
 the entire Indian River country has a delicious
 climate.
   The climate of Georgia  is  less  equable
 than  that  of  Florida.  In  the  lowlands in
 summer it  is hot and unhealthy,  and malari-
 ous fevers  are  prevalent; but in  the pine-
 lands farther back the air is salubrious, while
! in the northern portion of the State the sum
I mers  are  always cool  and healthful.   The
 winter climate is delightful, especially in  the
[ eastern  and southern districts ; the. days  are
 bright and  sunny, with little variation in  the
; temperature, and the atmosphere is dry and
 balmy.   The  mean  annual temperature at
 Savannah,  in  the south-eastern  part of  the
 State, is 66.2°, and of Augusta, in the north-
I eastern  part of  the- State, is 63.30.   The re-
I sorts  of most reputation are Savannah and
 Augusta,  where  invalids find the  comforts,
 conveniences,  arid social attractions of large
 cities  ;  7'homasville, on the verge  of the great
 belt of  pine forest  which extends across  the 
HEALTH  RESORTS                       HEALTH  RESORTS      207
 southern part of the State ; and Eastman, in
 the central uplands.
   Of South Carolina the climate possesses
 the same characteristic  features as that  of
 Georgia, the  diurnal variations  of tempera-
 ture being greater than in  Florida.  Con-
 sumptives generally improve faster in the
 highlands of the western part of the  State
 than in the portions bordering on  the Atlan-
 tic ; and here,  amid  vast pine forests,  is
 Aiken, the most frequented winter-resort  in
 America.  The winter climate  of Aiken  is
 wonderfully  mild and  genial, and the air is
 remarkably pure and dry.  The mean winter
 temperature  is  46.40 ;  of the year, 63.1 A°.
 Rheumatic and  gouty patients,  as  well  as
 consumptives, are  benefited by residence
 here.   Charleston, on the  sea-coast, combines
 the attractions of a large city  with a remark-
 ably bland though  somewhat relaxing  win-
 ter  climate.  Summerville,  11  miles  from
 Charleston, is far enough inland to escape the
 east winds that frequently  prevail  on the
 coast, and is growing in reputation.
   The mountain region of North Carolina
 is delightful in spring, summer, and autumn ;
 and Asheville and  its  vicinity has a winter
 climate which has been described  as " mild,
 dry, and full of  salvation  for  consumptives."
 The famous  Warm Springs, in the  valley of
 the French Broad River, are open to visitors
 in winter  as  well as in summer, and have a
 climate  which is considered especially bene-
 ficial to consumptives.
   All the  foregoing resorts are  either  on or
 near the  Atlantic  seaboard.  Crossing the
 continent now to the Pacific coast, we  reach
 the  numerous health resorts of California,
 which are among the  most  famous, in the
 world.    The  climate  of  California  differs
 widely from that of  the Atlantic slope in the
 same latitudes, and probably from that of any
 other country in the world.  It is doubtful if
 any other country has such warm winters and
 such cool summers ; the  mean  temperature
 of  the coldest month being  only about ioc
 lower than that of the highest.  The coolness
 of the summer nights is attributed  to the ex-
 treme clearness of  the atmosphere favoring
 radiation ; and the warmth of winter to the
 influence of the great Japan  current,  which
 performs the same functions in the Pacific as
 the Gulf Stream does in the Atlantic Ocean.
 The wind blows for a part of  each day  from
 the  north and north-west along  the  coast
 nearly the whole year.  During eight months
 of the year the prevailing  wind in San Fran-
 cisco is south-west.   This wind  commences
 pouring  through  the  Golden Gate  toward
 noon, and increases in.violence and chilliness
 till  late at night.  Heavy fogs occur during
 the  night in  tiie months of June, July,  and
 August, but are of rare occurrence in winter,
when the  winds are not so strong.  The
numerous sheltered valleys near the coast are
 comparatively free from winds and fogs, and
 have a delicious and equable climate.   In the
 interior  the extremes are much greater, the
 mercury in the Sacramento Valley often rising
 in summer to noJ and 1120  ; but, owing to
 the extreme dryness of the atmosphere, this
 great heat  is much  less  prostrating  in its
 effects than even a considerably lower tem-
 perature on the Atlantic slope, and the  nights
 are never so hot as  to prevent sleep.   In the
 Sacramento and San Joaquin basin  the mean
 temperature of the winter is  about 40 below
 that of the coast, and  of the summer from 200
 to 30° above.  The greater heat of  the sum-
 mer is supposed to result from the absence of
 the  ocean-breezes and  fogs, and the  cold of
 winter from the  proximity of the snow-cap-
 ped Sierra  Nevada.  Southern  California  is
 said to possess  a better climate than Italy.
 South of  San  Francisco, and in the San Joa-
 quin valley,frost is entirely unknown.   Roses
 bloom throughout the winter, and many trees
 retain their foliage green the year round.  The
 air, peculiarly warm and dry,  is  wonder-
 fully healthful, and highly  favorable to con-
 sumptives and persons  subject to diseases of
 the throat.  Of  the most frequented resorts,
 Santa  Barbara  (mean  winter  temperature
 53-33°). ar)d San Diego (mean  winter temper-
 ature 52.5''), are  on the southern coast ; on
 the  coast near  San  Francisco are Monterey
 (mean  winter temperature 510), San Rafael,
 and Santa Cruz ; in the southern interior are
 Los Angeles and  San Bernardino ; and in the
 great San Joaquin valley are  Stockton,  Visa-
 lia. and other popular resorts.
  The resorts treated  of  so far are those
 which  are frequented in winter by such in-
 valids as require above all things a warm and
 equable climate ; but there is another class of
 invalids—those that are in the incipient stages
 of consumption, for example—who  are mere
 benefited by a cold but clear and dry climate
 than by one which is warmer and more moist.
 It is a well-ascertained fact that the dryness of
 the atmosphere  is an even more important
 factor  in the prevention  and cure of con-
 sumption than its warmth ; and upon not a
 few consumptives a climate which  is  warm
 without being dry has a peculiarly debilitat-
 ing and unwholesome effect.   For this  class
 it is claimed that Minnesota presents greater
 advantages than any other locality in America.
 Though its winters are long, and the cold in-
 tense and continuous, yet the dryness  of the
 atmosphere and the slight  diurnal variations
 of temperature render  the cold far less op.
 pressive  than  in the eastern  Atlantic States,
 where  the moist air  and the rasping winds
seem to tear weak lungs to  pieces. There are
few days of a Minnesota winter during which
an invalid, if properly clad, cannot go  out of
doors for several hours at least ;  and the
bracing air almost  always has  a decidedly
tonic and exhilarating  effect.  The cold in 
208      HEALTH RESORTS
HEALTH  RESORTS
 winter and  the heat in summer,  though ex-
 treme, are subject to but slight  variations in
 short periods, and ail the seasons are remark-
 ably free from those sudden changes that are
 so  injurious  to  persons in delicate health.
 The places in Minnesota most  frequented  as
 health resorts are St. Paul, Minneapolis, and
 Winona ;  but any of the towns in the central,
 southern, or  eastern portions of  the  State
 possess the  advantages of  climate already
 mentioned.
  Somewhat  resembling that of  Minnesota
 in its effects, though very  much milder and
 more equable, is the climate of Colorado.
 The winters,  especially in  the southern  por-
 tions of the State, are remarkably genial, and
 consumptives who go there during the earlier
 stages of the disease are always benefited and
 frequently  cured ;  but  when  hemorrhages
 have supervened, the  extreme  thinness and
 dryness of the atmosphere are likely to aggra-
 vate them.  Asthmatics obtain benefit in any
 part of the State, rheumatism and gout are
 materially alleviated, and  hay  fever is  in-
 variably cured.   The places of highest repute
 are Manitou Springs, Idaho Springs, George-
 town, Pueblo, and Canon  City ;  but  many
 visitors camp out in summer.
  With the growth in reputation of the resorts
 on the main land, the  West Indies have be-
 come less frequented  by invalids from the
 United States ; but their generally delightful
 winter climate, and the advantages of the sea-
 voyage, will always preserve for them  a cer-
 tain degree of popularity.  Cuba has a climate
 which would prove  highly beneficial  and
 agreeable to  those suffering from lung and
 throat diseases  from about  the first of De-
 cember to the last of March.  The most ac-
 cessible and  attractive  points are  Havana,
 Matanzas,  Santiago de  Cuba,  and  Puerto
 Principe.   The Isle  of Pines, which lies  in
 the Caribbean Sea 33  miles off the coast of
 Cuba, has an exceedingly mild and salubrious
 climate, and there is no place in the West In-
 dies that  can  be more confidently recom-
 mended to invalids.  There are several small
 towns on it.   Anssau, on one of the Bahama
 Islands, is perhaps the most frequented winter
 resort, and besides  its deliciously mild and
 equable climate  has excellent  accommoda-
 tions for invalids.   Jamaica  and Hayti,  or
 Santo Domingo, are unhealthy, and but  little
 visited by invalids, though  perhaps the more
 elevated  portions would  prove salubrious.
 In Porto Rico the climate, though very warm,
 is in general  more healthy than  that of the
other Antilles ; and  owing to the  diversified
surface of the island almost any desired de-
gree of temperature can be secured.   The
winters are mild, equable, and comparatively
free  from  rain.  St. Thomas has a warm
winter climate, and is recommended for those
suffering from either consumption or Bright's
disease  of  the kidneys.  Santa  Cruz, or St.
■ Croix, is considered by many the  best  resort
 in the West Indies,  especially for  those in
 advanced stages of consumption.  St. Vin-
 cent exactly  suits those  consumptives who
 thrive in a warm and  moist  climate.   Barba-
 does is warm,but the heat is tempered through-
 out the  year by the sea-breezes.  Curacoa,
 near  the  northern coast of Venezuela, has
 long been a favorite resort for sufferers from
 Bright's disease of  the  kidneys.  The Ber-
 mudas have a warm,  moist  climate, which is
 better for  rheumatism  or nervous diseases
 than for consumptives.
   The health resorts  in the  south of  France
 are numerous, but a  few  words with regard
 to each  will suffice.   Pan is characterized by
 calmness  and  equability.   Its  climate is
 soothing and  sedative, and so is suited to
 those who are of an  irritable type, but quite
 unsuitable  for cases requiring stimulation.
 For patients in whom consumption  is for the
 time  quiescent no climate  could be  better  ;
 for those recovering from most acute diseases
 it is quite the reverse.  Biarritz is a bathing-
 place not very far from Pau, and is a good
 change for patients in the summer. The bath-
 ing is not so stimulating as further north, the
 water being  quite warm.   A/ontpellier had
 once  a great reputation as  a winter station  ;
 that is entirely gone.   Its climate is change-
 able and irritating.  Along the south coast of
 France are a great variety of winter stations,
 now mainly  occupied by English.   Cannes
 has a climate intermediate between Pau and
[ Nice, being less sedative than the former, less
 stimulant than the latter.  It is a very good
| place for a rest if a man breaks down  in win-
 ter.   Cases of  indigestion  accompanied by
 nervous and irritable  symptoms, do very well
 here.   Nice has not  the  reputation it once
 had.  It is found to be exposed to dangerous
 cold winds from the east and  north-east, which
 come rushing  down  gaps  in  the  chain of
 mountains  behind it.   The  climate is not at
 all favorable to consumptive patients, but is
 good  in  many cases of derangement of the
 womb, and in children  of a strumous  habit
 of body.  Mentone is one of the most shel-
 tered  of the  towns along the coast, and the
 night temperature is  mild,  so  that windows
 can be kept open.  The place is  one of the
 best for patients in the earliest stages  of con-
 sumption  and  in  chronic  bronchitis.  San
 Remo approaches  somewhat in quality to
 Mentone.
   Malaga is, perhaps, the only spot in Spain
 which could be called a  true health resort.
 Its  climate is excessively  mild  and equable,
 and it is neither too moist nor too dry. In
 winter there is a cold  north-west wind some-
 times, which is distressing.  It is best adapted
 for those cases where inflammation  of the
 lungs threatens to pass into consumption.  It
 is easily reached by steamship, but the voy-
 age is rather long.   Its drainage is said not 
HEARING
HEART
209
 to be good.  With regard to the cities of Italy,
 they are for the  most part to  be avoided by
 the confirmed invalid. On the  other hand, for
 a convalescent they are very good, provided
 one is fit to travel  from place to place, but
 few are adapted  for a long stay.  Exception
 may,  perhaps, be made to the  Bay of Naples,
 Ischia,  and Capri.   Patients  suffering from
 kidney diseases  often receive benefit  there,
 but the whole peninsula is to be avoided by
 sufferers from consumption.  Egypt has re-
 cently come into repute for  sufferers from
 consumption, owing to its  extremely dry
 climate.   Unfortunately, it is expensive, as
 patients have to  live in boats and take every
 thing with them  if they advance  into  Upper
 Egypt.  The climate is  best adapted for the
 earliest stage of consumption, chronic bron
 chitis, clergyman's sore  throat, and such like
 affections.   The dust seems to be the most
 troublesome accompaniment of the journey.
 Algiers  is another spot  in Africa which has
 been  recommended  for  a  winter resort.  It
 affords an exceedingly interesting winter resi
 dence, and is undoubtedly favorable to those
 suffering from consumption.  Madeira used
 to  be the  favorite  place of  resort  for con-
 sumptives.   Now it has in  great  measure
 been abandoned, the climate being too  moist.
 True, someot the symptoms are relieved, but
 the disease advances.  Certain patients, how-
 ever, suffering from laryngeal and bronchitic
 affections, are   likely  to be  benefited.   Of
 other  health resorts  not  much  is to  be said.
 Natal,  Australia,  and   others  have   been
 named, but in their benefits, or the  reverse,
 is  to be reckoned a  long sea-voyage,  which
 often  does good but sometimes kills.   The
 same remark applies to the Sandwich Islands,
 which are  popular  with  American health-
 seekers, and which enjoy a truly delightful
 climate all the year round.
   HEARING   is   interesting,   medically,
 chiefly in its  absence, which  we term deaf-
 ness.  As to the mode in which  the ear ful-
 fils its functions,  a word or two may be said.
 Sound consists of vibrations either in the air
 or some more solid  body, and these, for the
 purposes of hearing, must be  transmitted to
 the sentient nerve, which is called the audi-
 tory nerve, as nearly as possible unimpaired.
 To  this  end the  sound  is conducted and re-
 flected from the outer ear inward.  It strikes
 upon the drum of the ear, as it is called, and
 through it sets in motion a chain of jointed
 bones which end  in another membrane.  Im-
 mediately beyond this is a collection of fluid
 which can be set  in motion by the membrane,
 and its undulations affect the nerve, which is
 spread out something like the keys of a piano.
 Anything which interferes with the transmis-
 sion of vibrations to  the  nerve gives rise to
deafness more or less complete. But there is
another method whereby the  nervous surface
may be reached, that is, through the bones of >
 the head, which are capable of conducting the
 sonorous vibrations.  Thus, suppose  a man
 holds a tuning-fork in his teeth while vibrating,
 the  sound will be propagated through  the
 bones of the head to the nerve of hearing.
 If now  a similar fork be  tried just outside
 the ear and no sound be heard, but sound be
 heard when it is held in the teeth,  it is plain
 that it is the conducting apparatus which is
 in fault only, whereas, if heard in neither sit-
 uation, we are fain to confess that  the nerve
 itself is  at fault, and the case more hopeless
 than before.   Ear-trumpets and such like in-
 ventions are intended  to  collect  a  greater
 number  of vibrations,  and so render their
 effect  more  intense to  a  dulled ear.  (See
 Deafness and Ear.)
  HEART.—The heart is a hollow muscular
 organ which is the main agent  in propelling
 the  blood through the numerous vessels  of
 the  body.   It  is  situated in  the chest  or
 thorax, resting  on the diaphragm, while its
 upper border is on a level  with the junction
 of the third cartilages with the steruum  or
 breast-bone.   Its shape is roughly triangular,
 the  base being directed  upward,  while  the
 apex points downward,  forward, and to the
 left side ; the apex beat may be felt in the
 space between  the fifth and sixth ribs, and a
 little within a vertical line drawn through the
 nipple.  The weight varies somewhat, being
 rather more in  man  than  in woman ;  the
 average  weight  in man  is between 9 and  10
 ounces, while in woman it is between 8 and
 9 ounces ; in disease its weight may become
 enormously  increased.   The heart lies  in a
 sac made up  of dense fibrous tissue and lined
 within by a very smooth  membrane called the
 pericardium ; this membrane is also reflected
 over the heart itself, so that the movements
 of the heart are attended with  the  least pos-
 sible  amount of friction ; in the cavity thus
 formed  a little  serous  fluid is found,  just
 enough to moisten the opposed  surfaces.  The
 heart lies  between the two lungs, and, for
 the most part, it is  overlapped by their an-
 terior edges,  but as the left lung has no mid-
 dle  lobe the heart becomes superficial and
 appears  close to the chest  wall. The heart
 is divided into four cavities, two of which are
 called  the auricles, and  the two others are
 termed ventricles ; each  side of the heart is
 separated from the other by a  muscular par-
 tition wall or septum, so that  in health the
 blood on the right side of the heart is quite
 distinct from  the blood on  the left  side, and
 since it cannot cross directly from one side to
the other, it has to go a further way  round by
the lungs, and then it arrives into the left cavi-
ties.   There is an auricle and a ventricle on
each side, and the four cavities  are  therefore
named thus : right auricle, right  ventricle.
left auricle, left ventricle.  Each auricle is sit-
uated  behind and rather above its   corre-
sponding ventricle ; each has a  thin muscular 
210             HEART
HEART
wall, and their cavities are generally smaller
than the ventricular  cavities.  The auricles
receive blood  from the veins and pass it on
into the ventricles ; they form, therefore, a
kind of  antechamber, and since they con-
tract  alternately with  the ventricles, they
allow blood to flow quietly into them, and are
ready to fill" the ventricles when these have
completed   their contraction.    The   right
auricle receives the blood from every part of
the body by means of two large veins, known
as the superior and inferior venae cavae ; the
former brings back the Plood from the head,
neck, and upper extremities, while  the latter
performs a similar duty for the rest  of the
body and the lower extremities. This stream
is venous and has already passed through the
various tissues and  organs of the body ; it
now requires to  be oxygenated and to be ex-
posed to the action of the oxygen of the air ;
to do this it must go through the lungs, and the
mechanism of the process  is as  follows:  The
right auricle sends the venous stream through
an opening, which is called the tricuspid ori-
fice, into the right ventricle, and the latter
sends the current on to the lungs by a large ar-
tery called  the pulmonary artery ; this vessel
is about an inch in diameter and arises at the
base of the heart, having a free communica-
tion with the right ventricle ; after  a course
of about an inch and a half  it divides into
two branches, one going to each lung ; arriv-
ing there it breaks up into  several main divi-
sions, and  these again  divide into  innumer-
able small branches which ramify all through
the lung substance and spread  themselves in
a delicate network outside the air-cells or the
ultimate  extremities  of the bronchial tubes.
As  these  arteries diminish in size, so also
their coats become thinner,  until at length
the wall of the vessel appears as a homogene-
ous, microscopic membrane,  which readily
allows of the passage of gases to  and from
the blood.   The air cells also have extremely
thin walls,  so that although the air and blood
can never  directly mingle, yet  the delicate
membrane between them allows those changes
to go on which convert the venous dark blood
into a bright  red arterial  stream.  These
minute vessels are called capillaries,  and they
differ from the arteries only in  their size and
in the simple structure of their walls ; next,
these capillaries join together again and form
veins,  and  these  uniting one with another
form  at  last four large  trunks, which are
termed  the pulmonary  veins  ;  those  enter
the left auricle, and this stream  passes then
into the left  ventricle  through  an opening
called the mitral orifice ; thence it is sent into
the aorta, a large artery arising from the left
ventricle just as the pulmonary artery does
from the right, and then the blood  is sent all
over the  body  by means of various large
branches, which,  after dividing again and
again,  become  finally  so small as  to form
capillaries ;  these again uniting form veins,
and at length by trunk after trunk joining to
form  larger  ones, all the blood  is brought
back  to the right auricle, once more to pass
through the long  circle of  the  circulation.
Arteries carry blood to a part and veins carry
it from a part, while between the  two, but
continuous with each, are the capillaries ; and
the use of the latter  is to enable the different
tissues to  receive nourishment easily  and to
give up their effete products, which could not
be done unless the walls were very thin, and
the blood brought  into the closest possible
connection with the elements of the tissue or
organ.  Thus everywhere there are intricate
meshworks  of vessels, some having a clos'e
web and some with wider interspaces, accord-
ing to the requirements of the part.  Just as
a wide river may be divided into numerous
smaller channels by the husbandman so that
the land may  get more thoroughly watered,
so. the large  arteries break up into little capil-
laries, that the blood may well water the tis-
sues ; and just as rivulet  after rivulet may
unite  and at  length form  a broad flowing
stream, so these capillaries  unite  and finally
form veins.
  This being the course of the circulation,there
remains to be considered the means by which
the blood is,  so long as life lasts, kept in con-
tinual motion.  Each ventricle will hold four
or five cubic inches of blood.  Each ventricle is
made of strong muscular walls, the right one
being about one eighth of an inch thick, while
the left one is about half an inch in thickness ;
this is because the former has only to send
the blood to the lungs, while the latter has to
propel the blood through-all the remaining
parts of the body. The ventricles are lined, as
well as the auricles, with a delicate membrane
called the endocardium .which is also continuous
with the lining coat of the vessels which enter
into or arise from the heart;  further, there
are certain  folds or reduplications  of  this
membrane  at each   orifice which serve  as
valves ; as each ventricle has an entrance and
exit, there  are therefore four sets of valves,
two on each side of the heart.  The tricuspid
valve is formed of three folds of the endocar-
dium, and is situated between the right auricle
and  the right ventricle ; it is attached above
to a circular fibrous  ring round the tricuspid
orifice and points toward the ventricle, so that
when  viewed from   the auricular  aspect it
looks  like  a funnel ; as  the  blood flows
through it from  the  auricle to the ventricle,
the various  segments flap open, while when
the flow is  from the ventricle into the pul-
monary artery, these segments flap  to and
prevent any backward flow ;  they are  pre-
vented from  being  pushed  too  far back by
fibrous cords which  are attached to muscular
prominences  on the inner wall of the heart,
called columnce  carnecc, on the one side,  and
to the different curtains of  the valve on the 
HEART                                    HEART              211
other.   These  cords  are often spoken of as
the chorda: tendincce.  The pulmonary valves
are three semicircular folds of the lining mem-
brane which  are  attached to a  fibrous ring at
the commencement of the pulmonary artery ;
they guard this orifice, and while they readily
open to allow the passage of blood from the
ventricle  into  the  artery, they close directly
afterward, so as to effectually prevent any of
it from returning. The mitral valve is formed
like the tricuspid, but it has only two curtains
instead of three ; it guards  the mitral orifice
or the  opening between the left auricle and
the left ventricle.  The aortic valves are of
similar shape and size to the pulmonary, and
perform similar work.
  Both  sides of the heart,  in  health, act in
perfect unison, and each part  has- separate
duties to  perform ; each auricle  contracts at
the same moment, and each ventricle does
the same ;  the  corresponding  valves  also
open and shut on each side  with  the greatest
precision.  Every minute each ventricle con-
tracts some sixty or seventy times, and some-
times a great deal oftener ;  after the contrac-
tion it rests for a short period while it is being
refilled and then contracts  again.   Any one
who listens to the beating of the heart will
hear a sound just at the same  moment as he
feels the  heart  beat  against the chest-wall ;
this is called  the first sound of  the heart ; it
is followed immediately by a second, shorter
and sharper,  sound, and this is called the  sec-
ondsoundof  the  heart; then comes a short
interval  or pause  before the  first  sound is
heard again  ; each heart-beat,  therefore, is
divided  into three periods, each  of which
varies  slightly in  length,  although all  are
very rapidly performed  ; it may make it sim-
pler to  divide  each  beat  into five equal
periods,  and give  the  length of each sound
thus :
           ist sound, sound.   Pause.
 During  the  first sound both  ventricles are
 contracting, and this  is called the systole of
 the  ventricles,  and the sound is also often
 called the systolic sound ; the rest of the time
 their walls are relaxing, and its state is called
 the diastole ; sometimes the second sound is
 called a diastolic sound, but this is not quite
 correct, as the diastole lasts three fifths of  a
 cardiac  beat,  while the second sound  only
 takes one  fifth  of  the time.  Both  auricles
 contract at the  end of the pause, and there-
 fore they fill the ventricles  immediately be-
 fore the contraction of the latter ; the  rest of
 the time they are passive and allowing blood
 to flow quietly in.   When the ventricles con-
tract the pulmonary artery and  aorta become
full of blood, and  their  coats being  elastic,
are distended ; directly after the systole they
recoil and would send  some of the blood back
again into the ventricle if the valves which
guard  the orifice did not immediately  close
and prevent it ;  the effect of the recoil of the
vessels is still farther to propel the blood on-
ward, while at the same time there is great
pressure on  the valves which thus shut off the
blood from the heart while the ventricles are
being filled again.   This closure'of the aortic
and  pulmonary  valves is accompanied  by a
sharp clicking sound, and it is this which is
called the second sound of the heart.
  The mitral and tricuspid valves are closed
when the other two are open, and are  open
when the other  two are closed ; thus,  when
the left ventricle contracts, the mitral  valve
shuts to prevent  any of the  blood current
going back  to the left auricle whence  it has
just come, while the aortic valves fly open so
as to  allow the blood-stream  to  enter the
artery  ; directly  afterward the aortic valves
close while  the mitral valve is open, so that
fresh blood  may  enter  the ventricle,  in its
turn to be propelled  onward ;  of course  sim-
ilar remarks will apply  to  the action of the
corresponding valves on  the right side of the
heart.   During  fcetal life, that is, while the
child is in the womb, the circulation is some-
what different ; at that period of existence no
respiration takes place, and  therefore there is
no  need for the blood  to  pass through the
lungs ;  so the greater part of the  venous
stream passes directly from the right to the
left auricle  through an  oval opening in the
septum called the foramen ovale ; there is also
a second communication by a small vessel,
the ductus arteriosus, which  joins the pulmo-
nary  artery and aorta, but which  becomes
closed soon  after birth ; by this means that
part of the blood which, in  after life, passes
on to the lungs,  takes in the foetus a shorter
course, and, avoiding the  lungs,  is at once
carried on to the arterial system of the body.
The fcetus derives all its nourishment through
the placenta, a complicated  structure provid-
ing for the  free interchange of nutrient ele-
ments between the mother  and child.   The
heart is  very liable to  disease, and impor-
tant changes may take place both  before and
after birth.   In the former  case they gener-
ally occur as malformations.  Sometimes the
foramen ovale  remains  open,  and  persons
may live a long time  without  being much in-
convenienced by it ;  or the septum between
the two ventricles may be deficient and allow
of an intercommunication between the venous
and arterial  streams  ; this is a serious defect,
and leads to a deficient  circulation, coldness,
and  blueness of the extremities,  and  short-
ness of breath. At other times the large arte-
ries arising from the heart maybe transposed,
or the valves may be deficient or increased
in number ;  now and then  the   heart has
been developed outside of the  body in certain
cases of monstrosity.  Any defect of develop-
ment leads to a  condition called cyanosis, or 
212
HEART
HEART
 general blueness or lividity of the skin, spe-
 cially noticeable in the extremities, where the
 circulation is more feeble than in other parts.
 (See Cyanosis.)
   Diseases of the Heart  arise from many
 causes, as follows :
   i.  Traumatic causes, or those caused  by
 external injuries ; falling  from a  height or
 from a horse when hunting has ruptured some
 of the Valves and set up  heart-disease ;  a
 sword wound,  or stab,  and  a pistol shot,
 would probably prove fatal at once ;  sailors
 are liable to suffer from aneurism of the aorta,
 or  from heart-disease, from  lying  on their
 chests while furling up the  sails.
   2. Inflammation may  take  place in  the (a)
 pericardium or (b) endocardium, or  in the (c)
 muscular wall of the heart.  Inflammation of
 the pericardium or pericarditis causes an alter-
 ation in and a roughness of the smooth lining
 membrane  above  described ;  more or less
 serum is poured out, and the heart's action is
 much  interfered  with.   (See  Pericarditis.)
 Endocarditis is an inflammation of the smooth
 membrane  lining  the  cavities  of  the heart
 and forming the valves ; this disease is far
 more common on the left side than  on the
 right side of the heart ; it is generally  caused
 by an attack of rheumatic fever, but may oc-
 cur after scarlet fever, and many other blood
 poisons, as erysipelas,  pyaemia,  etc.  The
 change consists in little beads or  warts of
 fibrine which are formed on the valves, and
 sometimes these form very long and shaggy
 processes.   Their  presence,  of course, im-
 pairs the action of the valves affected,  and
 gives rise to an alteration in the sounds of the
 heart called bruits, and  these are called sys-
 tolic, diastolic, or presystolic bruits,  according
 as they  occur  during the  systole, diastole, or
 pause.  It  has  been  seen that the  proper
 action of the heart depends upon  a  perfect
 rhythm of its movements, and upon a  perfect
 closure of the  different  valves  at  the right
 time ;  it is  clear, therefore, that if, in  conse-
 quence of disease  a valve will not open wide
 enough, or will not close accurately enough,
 grave mischief will ensue ;  it  is, in fact, like
 putting a lock-gate across a running stream ;
 all the parts behind the  obstruction will get
• too much blood,  and the  parts in front too
 little ; and  the parts that  get  too much are
 liable to dropsy, for the  serum  of  the blood
 exudes from the full vessels  and soaks into
 the  different tissues, making  them sodden
 and cedematous.   Any change in the valves,
 whether  inflammatory or  not,  will cause a
 greater or less mechanical  obstruction to the
 circulating stream, which may end  in dropsy
 and serious  impairment of the affected tissues.
 Each valve has to open and shut, but it may
 fail  in doing one or the other or even in both ;
 now as there are four valves,  they  are liable
 to eight different  forms of  disease ; four are
 called  obstructive,  when  they will  not open
properly, and four are termed  incompetent or
regurgitant, when they will not  close  prop-
erly ; but of these eight, three  are by far the
most common, viz., aortic obstruction, aortic
regurgitation, and mitral regurgitation.
  3. Atheroma of the  valves or  lining mem-
brane of the aorta may occur ;  this comes on
in old age, and in those who have lived hard
or been fed badly ; it consists of a fatty change
which comes on in  the tissues in consequence
of  want of  nourishment.  (See  Degenera-
tion.)
  4. Calcification of the valves is often asso-
ciated with the last change, and it consists in
the deposit of lime-salts from the blood  in
parts in which living changes have ceased to
exist.   Both these varieties may be of very
small extent and cause no harm  ; sometimes
they are so marked as to cause  great obstruc-
tion ; they generally come on  in middle life
and old age, while inflammatory changes may
come on at any period of life,  and are often
seen in  children.
  5. Fibrous  thickening of the valves  may
occur and cause constriction  of  the orifice,
and in that way  obstruct the passage  of the
blood.   The symptoms common to these four
changes  are  shortness of breath, palpitation
of the heart,  pain in the left side  and  inabil-
ity  to  run fast or hasten up-stairs.   These
symptoms  may go on for a long  time, and if
the patient is very careful to live quietly,
avoid any great exertion, take nourishing
food, and avoid bronchitis in the winter, life
might be prolonged for years ;  such,  how-
ever, is not the case generally, for very few
have the opportunity of living so  quietly, yet
every precaution  should be taken to avoid
more exertion than necessary,  and so  not to
increase the  work  of  the heart.  The  lungs
are liable to congestion, and so  in the winter,
or when the  east winds are prevalent,  bron-
chitis is very apt to come on and  increase the
mischief.   Increased shortness of  breath  is
often followed by  dropsy of  the legs, by a
diminution  in  the  quantity of  urine passed,
which is also darker than usual, and deposits
much sand on standing.   There may be also
pain over  the region  of the  liver,   and  a
slightly  jaundiced  skin, and at  last ascites
may come  on.  (See Ascites and OZdema.)
  The obstruction in the valve of course gives
the heart more work to do. and hence hyper-
trophy of the muscular wall takes place so as
to overcome the obstacle ; just as the  biceps
of a blacksmith's arm becomes  hypertrophied
or excessively developed by increased use, so
in a similar manner will the wall of the heart.
Sometimes, however, the patient  is badly fed
and cannot obtain meat and nourishing food
enough  to provide for  this increased growth,
and then the ventricle, unable to withstand
the increased pressure, slowly dilates until it
attains  very large  dimensions ;  very  often
hypertrophy  and  dilatation of  the  cavity 
HEARTBURN                                 HEAT              213
 occur at the same time ; at ether times the one
 is in excess of the other.   When dilatation
 occurs, the apex-beat  of  the  heart is much
 lower than usual, and the heart takes up more
 space than usual in the chest ;  thus the lungs,
 besides being congested, are also much en-
 croached  upon,  and so  the patient is very
 short of breath, and unable to lie down  ; so
 at this stage he will be propped up in bed by
 pillows.  Hypertrophy of the heart is known
 by the increased impulse1  felt by the hand
 when it is placed over the region of the heart.
 Much relief may be given to persons suffering
 in this way by rest  in bed, a warm tempera-
 ture, and light nutrient diet ; in a  short time
 the dropsy will sometimes much subside,  and
 the breathing become easier, and the patient
 more comfortable.    A  belladonna  plaster
 placed over the heart (about four square inches
 in area) and kept on  for ten days or a fort-
 night will  give much relief.  Tonic medicines,
 as iron and quinine, with digitalis, are often
 of much benefit.   The  great object in treat-
 ment is to avoid anything which entails more
 labor on  the  overworked ventricle, while at
 the same time the general health of the body
 is kept up. There are some other diseases
 of the heart which, however, are of very rare
 occurrence,and can only be  merely mentioned
 here.  Hydatids have  been met with in this
 organ, and by their rupture have caused sud-
 den death.  (See  Hydatids.) Rupture  of
 the tendinous cords affixed to  the mitral and
 tricuspid valves has been found, and of course
 it has been attended with a fatal  result.   A
 clot of fibrine may be deposited from the blood
 in the right auricle and  right ventricle and
 cause death by obstructing the circulation ;
 such a clot is called a thrombus; now and
 then a portion of a clot is carried through the
 heart into the pulmonary artery, and it  is
 then  called an embolon.  A more common
 variety is that known as a fatty heart, where
 the walls  become  weak and fragile in conse-
 quence of  a fatty change taking place in the
 muscular fibres.  (See Degeneration.)
  HEARTBURN is a sensation of heat or
 burning  in the region of  the stomach ; very
 often accompanied by  a  desire to belch  or
 bring up some watery fluid  which  burns  the
 back part of the mouth.  It  is due  apparently
 to the presence of excess of acid in the stom-
 ach, and this excess of acid has two distinct
 origins.   It   may  be due   to fermentative
 change in  certain  articles of food, or it may
 be due to  excessive secretion of acid gastric
 juice.  Thus,  many substances of  a  starchy
 or sugary nature readily  ferment and give
 rise  to  acetic and  lactic acids. With  these
 changes carbonic acid gas is separated, and
 so there is commonly flatulence at the  same
time there is acidity.  The other, where there
is excess  of acid secretion, is, as  a rule,  ac-
companied by  less digestive disturbance than
is the other, though the fluid  so  secreted is
 deficient in digestive power.   The pain pro-
 duced by excessive secretion comes on sooner
 after taking food than  does the other,  and
 may be induced as readily by  a slight stimu-
 lus as by a greater one.  The pain is generally
 felt behind the breast-bone, and is worse when
 the stomach is empty.   If at  these periods a
 glass of wine be taken, a  fit of heartburn is
 almost certain to follow, for the gastric juice
 is induced to flow freely by the stimulus of
 the alcohol, and it has nothing to act on save
 the stomach itself.  Food, on the other hand,
 if subject to fermentative changes, is, as  a
 rule,  followed by distress.  Of course with
 either kind, nutrition suffers,  but more if the
 alteration is due  to fermentation than to ex-
 cessive  secretion.   Sometimes the vomiting
 produced  by the acidity is very  trying  and
 tends to reduce the patient's strength.   As
 heartburn, however produced, is but  a symp-
 tom,  in  treating the condition we must en-
 deavor to determine its cause, to treat it right.
 Nevertheless,  as a symptom, it  is very  dis-
 tressing, and  not unfrequently urgently de-
 mands relief.  As it is due to excess of acid,
 it would be natural  to seek relief in  the ex-
 hibition of an alkali, and for the time being
 this often  succeeds—a dose of bicarbonate of
 soda  being frequently  followed  by relief.
i This  is only temporary,  and  other means
I must be sought.   If the acid is due to fermen-
 tative changes in  the food, a drop or two of
 creasote or carbolic acid will  often do good.
 If excessive secretion is at the root of  the
 mischief,  nux  vomica  is  the most likely
! remedy.   In either condition, large doses of
 bismuth generally give relief.    (See Indiges-
 tion.)
   HEAT and its opposite, Cold, which  is
 only less heat, are both excessively powerful
 remedies.   Much  of their power is  due to
 this, that  whereas cold  causes the vessels to
 contract, heat  causes them to dilate, the  one
 obstructing the flow of blood to and  through
 the vessels  of a part, the other favoring it.
 Cold is applied in a variety of ways, by means
 of sponging,  washing, etc., with cold water,
 by the use of ice-bags,  and again by using
 artificial means other than water for reducing
 temperature, as  sponging with spirit, or the
 application of ether spray.  Heat is applied
 mainly by means of hot water as a fomenta-
 tion, or as a warm bath, but perhaps the most
 favorable way of applying heat and moisture
 combined  is in the form of a poultice.  The
 warm bath, which is perhaps  the most com-
 mon mode of applying heat after poulticing,
 is at first a pleasant application to the skin,
 if not too hot ; but if continued too long, the
 effects of   the heat  on  the vessels  become
 marked, and there is throbbing in the head
 and temples, and there is much prostration.
 The  warm bath is sometimes employed in
 Bright's disease, for the sake of getting rid of
 some of the effete matter  contained in  the 
214        HEAT, ANIMAL
HECTIC  FEVER
 system, and from which there is risk of poi-
 soning, but its use is of more than doubtful
 utility, for if it does good in one way, it does
 harm  in another.   Some  forms of pain are
 signally relieved  by heat.  Thus  gripes, as
 they  are  commonly  called,  especially  if
 brought on  by cold, are  better treated by
 warm drinks and applications externally than
 any other way.   The  turpentine stripe is a
 very good way of applying heat and stimula-
 tion at the same time, but  a cloth wrung out
 of water as hot as the hands  will bear often
 suffices.  There is another form of pain from
 which children frequently suffer, a kind of
 nervous pain or earache.  Nothing, as a rule,
 does this so much good as heat, dry heat from
 a warming-pan or hot brick, or the like, being
 best.  It is in diseases  somewhat similar in
 certain respects that the hot  bath  seems to
 do most good of  all.  Such are the maladies
 called a fit of the gravel  and  a fit of gall-
 stones.  Some forms of skin  disease benefit
 greatly by the warm bath.   These forms are
 mainly of the scaly kind,  and  in the  acute
 stage.   The water should be as soft as possi-
 ble,  if  nothing be added  as  a  medicament.
 Sometimes patients have been kept for a very
 long time in baths for the treatment of  these
 maladies.  A similar plan has  been  recom-
 mended for patients the subjects of extensive
 burns, and also in small-pox.  Heat receives
 a variety of other applications  in medicine,
 which  will be incidentally noticed.
  HEAT, ANIMAL.—All animals preserve
 their own  natural temperament  irrespective
 of the  medium in which they live.  The ani-
 mal  heat of various creatures  greatly  differs.
 Thus man,  birds, reptiles,  and  fishes  have
 each their special temperature.  By the action
 of the skin human beings are  enabled to en-
 dure great variations of  external temperature,
 and  yet  preserve  their own animal heat.
 The proper heat of a human body is 980  ; but
 excessive external heat is borne and this nat-
 ural  heat  remains the  same, owing to in-
 creased action of  the skin and excessive per-
 spiration.   Any  diminution  of the natural
 heat of the body denotes  disease, and is  a
 symptom worth attention.
  HEAT - SPOT  is a form  of  eczema,
 sometimes produced by exposure to the sun
 on a hot summer's day  : bathing with  tepid
 water or lead lotion, and keeping the  patient
 cool, will soon cure it.
  HEAT - STROKE  and  Sun - Stroke,
 though closely allied, are not exactly the same
 thing, for there may be heat-stroke without
 any  direct exposure to  the rays of the sun.
 In typical  sun-stroke, the  individual being
 exposed to the effects of  the sun's rays  falls
down suddenly, and may almost immediately
expire.   In heat-stroke, the  onset is more
gradual, very likely there is a dry skin, pros-
tration, and a tumultuous action  of the heart,
there may be difficulty of breathing and feel-
 ing of restlessness.  If now  the bodily tem-
 perature be tested by the thermometer, it will
 be found to be far above the normal, perhaps
 as high as 102" or  1040.  This is the typical
 symptom, and it is  this which causes the dis-
 tress and gives the  risk.   It must be reduced
 or there is no safety for the patient.
  Treatment.—If  the  temperature is  very
 high, say  1050 or 1060 Fahr., sharp means
 must be used for reducing the bodily heat to
 a normal level.  Ice must be used.  Thus it
 may be used  either directly  by  rubbing the
 body, which is the most expeditious way, or
 it may be used to cool  the water in which the
 body is immersed.  The head must be looked
 to specially, and hence a bag of pounded ice
 ought to be applied to  it.   If these remedies
 are  not at hand,  the  douche,  represented
 roughly by  pails  of water, may be used, or
 the patient  put under  a pump and pumped
 on.  No ceremony  can be used ; it  is  a mat-
 ter of  life  and death.   The water, though of
 tolerably high temperature, is sure to be far
 below  that of the body, and  hence each par-
 ticle of it can carry  away some heat from the
 overheated surface.   Some stimulant may be
 necessary to keep the heart going.  Aromatic
 spirit is the best,  but  some iced brandy or
 iced brandy and water may be given.  The
 patient, too, should be  kept absolutely quiet.
 No exertion of any kind should be permitted,
 or the heart may stop, and a fatal termination
 of the disease come about.
  These are the most important means to be
 taken for remedying the effects of heat-stroke,
 but  for preventing  them altogether another
 set are to be observed.   In very hot weather
 it is  desirable to  alter  our habits as well as
our dress   The dress should be as light and
loose as possible, and  as we  have  always a
variable climate,  flannel should be its ma-
terial.   The head should be covered by some
light-colored  texture,  and ventilated well.
Sun-umbrellas of white material should be
used if the heat is very great,  if not, an ordi-
nary one will so.  The heavy meals ought to
be taken in the early  morning and evening.
During the middle of the day exposure to the
sun's rays should be  avoided.   Beer should
not be  taken, nor  spirits. Ice should be used
freely with the drinks, and a cold sponge-bath
taken once or twice a day.  Ventilation com-
mends itself.
  HECTIC  FEVER, as   its   name  ex-
presses, is an habitual  or abiding febrile dis-
order.   It occurs  in connection with certain
destructive diseases of internal  organs, or
results from exhausting drains upon the sys-
tem, either in consequence of a greatly in-
creased amount of normal secretion, as in dia-
betes, or by profuse and prolonged  suppura-
tion, as occurs in death and chronic ulceration
of bone.  The symptoms are very evident,
and the " hectic flush"  together with the hot
 burning hand  and the bright sunken eye, are 
HECTIC FEVER
HEMIPLEGIA          215
well known among all classes as  dreaded in-
dications  of  pulmonary  consumption,  and
other  lingering and fatal diseases.  Hectic is
observed also  very frequently in connection
with progressive  angular curvature of  the
spine, associated with a large abscess extend-
ing downward to the groin, and in severe and
painful diseases of the hip or knee.  The most
marked symptoms of hectic are rapid loss of
flesh,  great heat of skin, especially of  the
palms of the hands, occasional chills during
the day, and toward the end of the  day a dis-
tinct  fit  of shivering,  followed  by  intense
fever, and afterward, when  the patient is in
bed, by profuse and exhausting perspiration.
The pulse  is quick and very irritable, and is
rapidly affected by the patient's movements,
and by mental  excitement or emotion.   The
tongue  is moist and clean, and always very
red.  The skin during the day is hot, dry, and
rough.  During the night  it is  covered by
perspiration.   The appetite  generally  re-
mains good.  The bowels  are readily affected
by any excess in diet,  or  by the  presence in
the food of irritating  matter, but  generally
during the early stages  of hectic are consti-
pated.  The mind remains unaffected.   If
the primary cause of hectic fever still persists,
the patient sinks in consequence of rapidly
increasing emaciation  and loss of  strength.
The pulse becomes weaker  and the tongue
is covered by  white patches (aphthae).   The
ankle and afterward the legs become swollen
and dropsical, while  the skin of  the  arms
and body remains thin and  shrunken, and is
covered by rough branny scales.   The cold
fits become more and more severe,and the noc-
turnal perspiration more profuse.    When the
patient is in this condition, bed-sores may be
formed, the discharge'from which, associated
with diarrhcea, increases the exhaustion of the
patient, and hastens a fatal  determination.
Death takes place slowly and quietly. The fol-
lowing are the  diseases that  most frequently
end in hectic fever : pulmonary consumption,
diabetes,  Bright's disease  of the kidneys,
psoas abscess, ulceration of joint-cartilages
with death or ulceration of subjacent bone.
  Treatment.—In cases where it is impossi-
ble to remove  the cause  of this febrile  dis-
order, the treatment should be  directed to
supporting the patient's strength by tonics,
such as quinine and bark, and by a good diet,
with a free allowance of wine and other alco-
holic stimulants.   The food should consist in
broth, soup, beef-tea, and  milk, and easily
digested flesh,  and be given frequently  and
in small  quantities at a time.  The bed-linen
should be changed often by reason of the pro-
fuse perspiration during the night, and in ad-
vanced  hectic  care should be  taken to pre-
vent, if possible, the formation of  bed-sores.
For further information on  this  latter point,
which in this, as in all exhausting  affections,
is one of great importance, the reader is re-
ferred to the article on Bed-Sores.
  HELLEBORE (Black) is not now  con
tained  in the Phaimacopoeia, but  has  been
used in medicine from time immemorial.  The
parts used are  the  underground stem  and
rootlets of  the Helleborus  niger or Christmas
rose, dark  externally, white internally.   Its
taste is first sweet, then acrid and bitter.   Its
powder and tincture have  generally been em-
ployed  in  medicine.   It  was  formerly  em
ployed for affections of the head, especially
for the  melancholic condition.   It acts as a
powerful drastic purgative, and was supposed
in these cases to remove the black bile, which
our  forefathers imagined  lay at the root of
the disorder.   (See Veratrum.)
  HEMIPLEGIA signifies paralysis of the
arm and leg on one side of the body ; the
loss of sensation is generally very slight,  if at
all  marked, but the  loss  of motion is most
particularly noticeable ; this may be partial
or complete.   The seat of mischief may oc-
casionally  be in the spinal cord,  but,  as a
rule, it is in  the brain, and on  the opposite
side to the  paralysis ; thus, if there  be hemi-
plegia of the right arm and leg, the  disease
will be on the left side of the brain.   Any in-
fluence which interferes with the due supply
of blood to a certain area of the brain  will
cause hemiplegia ; white  softening,  cerebral
hecmorrhage, a clot of fibrine obstructing  the
vessels, disease of the coats  of  the  vessels
from fatty change, and epileptic attacks, will
all cause this form of paralysis.  An ordinary
attack of apoplexy in fact, when the patient
has  recovered from the shock, leaves the in-
dividual in this state  ; it is, in short, a symp-
tom of the mischief in the brain, and  not the
disease itself. Hemiplegia may come on sud-
denly, without any coma  or insensibility, as
when it is caused by a very small clot ; more
generally the two  symptoms are present, and
when sensibility returns the patient finds  he
has lost the use of his arm and  leg.   Some-
times there is stiffness or rigidity of the arm
and leg as well as loss of power, and this
seems to depend on the nature of  the injury
to  the  brain.  In most cases the limbs  lie
useless  and flaccid, and, if raised up, drop at
once when left unsupported.  Improvement
may be known by  the patient being able to
perform simple movements or raise the  limb
a short distance from the side, but for many
weeks or  months the  strength of that side
will be much impaired, and even in favorable
cases the  patient can hardly expect to  fully
regain the use of the injured side.
   Treatment.—When the individual has re-
covered from the shock, friction may be used
to  the  extremities, or a  galvanic current or
rubbing with rough  towels after  a  stream of
cold water has been applied ; this should not
be done until three or four weeks after the 
210            HEMLOCK
HEPATITIS
 disease has  begun, and then only when the
 patient is in  a fit state for it.  In every case
 the  treatment and chance of recovery must
 depend in a great measure  upon the nature
 of the injury.  (See Apoplexy.)
  HEMLOCK  (Conium maculatum) is  a
 plant which grows wild in this country.  The
 fresh leaves and young  branches,  collected
 just when the fruit begins  to form,  and the
 diied  ripe  fruit are the parts  used.  They
 contain a peculiar substance or alkaloid, call-
 ed conia.   This is  volatile,  and  is easily set
 free by means of an alkali like caustic potass,
 with which, when the substance  is rubbed, a
 peculiar and characteristic mousy odor is ob-
 served.  In  many  of its chemical properties
 conia resembles ammonia, but its effects on
 animals are very different. The best prepara-
 tion for use  is the  succus conii,  or  hemlock
 juice,  got  by expressing the juice from  the
 fresh leaves, and adding a little spirit to make
 it keep.  As a remedy, and as a poison, hem-
 lock is of undoubted  power, and yet  many
 animals eat it with impunity.  It used to  be
 employed in the form of a  poultice,  to pain-
 ful  sores,  especially of the  cancerous kind.
 It is not often used in this way now.   Hem-
 lock in large doses  seems  to paralyze  the
 animals to which it has been given, mainly by
 acting on their motor nerves.  It is chiefly of
 use this way, in controlling violent muscular
 movements,  as in some forms of chroea, but
 as yet it has received no very extensive thera-
 peutic application.
  HEMORRHAGE.   (See HaeMORRHAGE.)
  HEMP (Indian) consists  of the dried flow-
 ering tops of our common hemp-plant grown
 under the tropical sun of India.  The female
 plant is to be used, and it should be carefully
 noted  that  the  resin  is still present.    In
 India it is used in  various  forms.  Hashish
 is a form of Indian  hemp, but the term seems
 to be applied to more  than  one form of the
 substance.   It is the resin, developed by the
 great heat and powerful sun, which gives its
 value  to the Indian plant.  This  may be
 readily dissolved out by alcohol or ether, but
 the  addition of water causes its precipitation.
 The solution in spirit evaporated to a paste
 constitutes the extract of hemp.   The effects
 of Indian  hemp are very wonderful  ; but as
 the   preparations obtainable in  this  country
 are  not always reliable, they may frequently
 fail  to make themselves observed.  The resin
 of the plant  gives rise to a peculiar  form of
 intoxication ; this is always attended with ex-
 uberance  of  spirits,  and, if the individual
 sleeps, is  attended  by dreams of a pleasing
 kind.  It  relieves pain, and  in  many  cases
gives rise to  sleep, and  its  after-effects are
not unpleasant.   There is little languor, and
 no loss of appetite, neither does it constipate
the  bowels.   Indian hemp is seldom given to
allay pain  purely ;  but  in  certain cases  of
painful  menstruation it does great good.   It
is best given until the patients  begin to feel
light in the head, after which the pain ordina-
rily  ceases.  Incases too where the menstrual
flow is excessively profuse, it ordinarily arrests
this  excess.  As a rule, it may be  said that if
the drug does not produce its peculiar physio-
logical effects, especially lightness in tii^head,
it will  not affect  the pain.  The dose of the
tincture  should be from 10 to 20  drops, and
it is  best given in aromatic spirit of ammonia
—spirits of sal  volatile.
   HENBANE, also called hyoscyamus, con-
sists of the  leaves of the Hyoscyamus niger,
gathered when  about two thirds of the flowers
are  expanded.   It  is  supposed to  owe its
efficacy to an  alkaloid called hyoscyamine,
about which, however, little is  known,  if it
has even  been  separated.  The preparations
mainly employed are the extract and the  tinc-
ture.  As lo  its action, that seems allied  to
belladonna and stramonium, but milder.  It,
like  these plants, has  the power of dilating
the  pupil, and it has distinctly a power  of
soothing  irritable conditions  of the system,
and  of preventing the  griping action of cer-
tain  purgatives.  Its  main use is as a sedative
where opium cannot be given for other of its
effects,  as when  the  lungs are  congested.
Hyoscyamus is also used to relieve irritability
of the bladder,  and for this purpose has been
often combined with liquor  potassae ; but the
alkali entirely destroys any influence the  hen-
bane may  possess, probably by decomposing
its alkaloid.   In  large doses its  effects are
similar to those of the remedies named above
—dilatation of the pupil, dryness of the mouth
and  throat, slight delirium, and partial  loss
of power.  As  a substitute for opium its effi-
cacy is doubtful, though frequently prescribed
with a view to that substitution. The dose of
the tincture is from 10 to 30 drops.
  HEPATIC  disorders.  (See Liver.)
  HEPATITIS,  or inflammation of the liver,
is a disease which we do not often see in this
country.   It is  exceedingly common in tropi-
cal regions,  especially  in Europeans living
there and who  are careless in their mode of
life.  We shall speak  here entirely of the form
of inflammation which tends to end in soften-
ing and the formation of an abscess.  Other
forms of liver-disease are sometimes spoken
of as inflammations,  but they have  nothing of
the  nature of  that  process.  Such are the
forms of disease which tend to end in contrac-
tion  of the liver and  in gummy deposits in it.
The  disease would seem to  be caused some-
times by free living in unhealthy climates, ex-
posure to marsh or jungle miasms  ; and very
frequently it  is  due to dysentery.
   The onset  of the disease is marked by  pain
and  fulness of  the side, with some degree  of
tenderness, especially  on pointed pressure ;
and  this is all the more marked if the part of
the liver affected  be near the surface and is
easily reached.  Then  there is fever, the skin 
HEPATITIS
HERNIA
217
  is hot, the temperature high ; there is much
  thirst, and the urine is scanty.  The pain in
  the right side is often severe, but sometimes
  absent.  It is much worse by lying on the left
  side or by coughing.  There may be 'a slight
  tinge of jaundice, but not much. Sometimes,
  especially  if the part  of the liver next the
  stomach be implicated, there is vomiting and
  sometimes hiccough.   Usually, too, there is
  a peculiar pain in the right  shoulder,  espe-
  cially about the collar-bone.   More rarely the
  left shoulder is affected.  If the inflammation
  go on to the formation  of an  abscess, as it
  commonly does, the occurrence of suppuration
  is commonly marked by shivering, there is in-
  creased  pain and tenderness very often, es-
  pecially if the abscess be  on the upper part of
  the liver, a dry cough, and a  feeling of weight
  and dragging in the  right side  ; the muscles
  forming the  wall  of the  belly  on that side,
  too, are tense, and kept tight as if to protect
  the sensitive organs beneath.  Sometimes it
  may be distinctly made out  that the liver is
  enlarged, but often this is not the case, and as
  time wears on the patient suffers from hectic
  fever, there is great prostration, and most fre-
  quently diarrhoea or dysentery.
    Inflammation of the liver may abate, and the
  patient  get  well  without any abscess being
  formed ; but generally when  an abscess has
  been produced its contents must be got  rid
  of, or the patient will die. The escape may
  be natural or artificial,  but it is always dan-
  gerous.  Sometimes they burst into the cavity
  of the abdomen ;  if so death is almost cer-
  tain, for  inflammation is  set up, and a fatal
  termination  is not  far off.  Sometimes they
  open into the bile-ducts or gall-bladder, and
  so their contents may escape into and through
 the gut.   Most frequently,  as  the abscess
 nears the surface of the liver, an inflammation
 of its covering is set up, and  thus it is glued
 to the neighboring parts ;  if to the wall of the
• abdomen, an  opening may be made in it, and
 so the  pus escape externally.   It may also
 adhere to the intestines, and  an opening be
 made in them, and the fluid escape that way.
 The same may occur by way of the stomach ;
 or if the abscess tries to escape upward it may
 penetrate  the diaphragm, enter the pleura,
 and finally escape by making its  way into the
 aorta, and so be spat up.
   Treatment.—The  treatment  of  hepatitis
 consists  in a  considerable measure in letting
 the patient alone.   Mercury,  which used to
 be given  freely, is of  more  than doubtful
 value ; but the bowels ought to be kept open,
 but not loose.  If confined, and the tongue is
 brown, and there is much fever,  rhubarb and
 alkalies are likely to do good.  If they are too
 loose, and there is a tendency to dysentery,
 astringents must be used,  especially  in com-
 bination  with ipecacuanha,  in  full  doses.
 When  suppuration  has fairly taken place,
 good nourishing food must be given, probably
  also tonics, and %ve must wait.  If there  is
  much restlessness and  pain, small doses of
  chloral or  morphia subcutaneously will be
  best.  If the abscess has fairly declared itself
  as likely  to burst on the surface, fluid may be
  withdrawn  by aspiration, or that may  be at-
  tempted  beforehand.   If an aspirator be not
  procurable, it is better to let the abscess burst
  of itself.  After that a stimulant and support-
  ing treatment is solely needed,
    HERMAPHRODITE, an individual com-
  bining both sexes in the same organism.
    HERNIA means any protrusion  of the
  contents of a cavity through its walls.   But
  in general the term is applied to the protru-
  sion of  the abdominal  viscera,  constituting
  rupture.  The predisposing cause of hernia is
  a weakness  in  the  walls of the abdomen  ;
  either the natural  openings, such  as the in-
  guinal or crural  rings, are large cr  very
  slightly protected by their coverings, or there
  may be  some  congenital deficiency,  or the
  parietes may give way from injury or disease.
  The exciting cause is compression of the con-
  tents  of  the abdomen  by  the surrounding
  muscles,  which are very powerful, and are
  brought into violent action by rowing, lifting
  weights, pulling, etc.  Hernia is divided into
  the following varieties—reducible, irreducible,
  and strangulated.
    By Reducible hernia is meant one returnable
  into the abdominal cavity, and its symptoms
  are the existence of a compressible tumor in
  the abdominal walls, which  lessens in size if
  the  patient lies  down,  or  disappears  alto-
  gether, receives an  impulse  on  coughing, or
  on any exertion being made,  and  can be
  readily returned  by pressure.  This form of
  hernia can  be  treated  either palliatively or
  radically ; the first  by means of trusses, and
  the second by operation for the closure of the
  aperture through which the rupture passes.
  A truss consists of  a ring of steel, to the ex-
  tremities of which are attached  pads, one of
  which presses upon  the aperture and retains
  the hernia within the abdominal cavity.  There
  are many forms  of  trusses, but the  measure-
  ments to be  taken in writing for  any form
  recommended are the same : thus,  if an in
  guinal or  femoral truss be  required, the cir-
I  cumference of the body at the hips should be
  stated, midway between the spine of the ilium
  and the trochanter.   Great caution  must be
  taken.in the fitting of a truss that it does not
  excoriate the skin, and  that  part of the skin
  upon which  the pad presses  should  be regu-
  larly washed and bathed with eau de Cologne
  or spirit,  or dusted with violet powder or
  fuller's earth.  In children,  an  india-rubber
  band and pad answers generally.
    Umbilical hernia,  or exomphalos,  is  most
 frequent  in   newly-born children, and   pre-
 sents itself  as a protrusion  at the navel ; a
 flat disc of metal, or even a penny-piece, re-
 tained against the protrusion with a strap of 
218             HERNIA

plaster  will  retain the  hernia.   In  adults,
properly adapted trusses must be employed.
   Ventral hernia  is  a protrusion  of bowel
through  the  abdominal  walls  in  the mesial
line,  or  through  any parts of the  parietes
which are not usually the  seat of otherwise
named herniae. There are several other forms
of  hernia which are not likely to  be  de-
tected except  by an experienced physician,
which protrude themselves through those nat-
ural openings in the pelvic or abdominal walls,
which «erve to transmit muscles, vessels, and
nerves to the limbs, or which may be the re-
sult of arrested devlopment or of injury, and
which can hardly be mentioned except by
name—such  as perineal, vaginal, labial, ob-
turator,  ischiatic, and diaphragmatic, and for
which the reader is referred lo  special works
on surgery.
   Strangulated hernia means that a portion
of intestine being protruded, there  is a total
stoppage of  its contents, so that they cannot
be propelled  toward their natural outlet, and,
moreover, that the structure of the  bowel it-
self is so constricted  that it is itself strangu-
lated.  The symptoms of this condition are—
firstly, those of  obstruction of the  bowels ;
secondly, those of inflammation.  The individ-
ual has flatulency, tightness over the belly,
a desire to evacuate the bowels, and an ina-
bility to  do so.   Next, vomiting supervenes,
in the first place of the contents of the stom-
ach, of  bilious matter, and then  of matters
smelling strongly of faeces, in consequence of
the in^esta being detained in the intestinal cir-
cuit.  In  this  state of  things operative inter-
ference is necessary, and that at  once, al-
though, until such aid is  at hand, some assist-
ance  is  to be  derived from what is termed
taxis, from  which,  even  in unprofessional
hands, if properly directed, good results may
ensue.  The patient  should be  placed in a
warm  bath,  and  both the thighs be raised
toward  the belly and placed close to each
other, as a means of relaxing all the muscles
and ligaments connected with the abdomen ;
he should be engaged, if possible, in conver-
sation, so as to relax the respiratory muscles.
Next, the visible tumor should be  grasped
gently with one  hand, to empty it  as far as
possible, and with the other the neck of the
tumor should be kneaded, with a motion tow-
ard the  abdomen.  This operation should be
continued for  some while, a quarter of an
hour or so, if no great pain is produced by so
doing, at the end of  which time, if the pro-
ceeding be successful, a slight gurgling sound
will intimate the  return of  at least a portion
of the tissues.  In some instances when mere
taxis has failed, raising the pelvis and lower-
ing the shoulders  have proved effectual ; thus,
the pelvis being placed on  a chair at the end
of the bed, and the patient's head and shoul-
ders resting on the bed itself, the legs should
be bent upon the  body, with a view  to relax-
                 HERPES

ing the structures which, by their tenseness,
assist in strangulating the  portion of  intes-
tine.   Chloroform  is a great aid in the re-
duction of such  a hernia,  a hot bath (960 -
100° Fah.), a large dose of opium, an injection
of tobacco  (a  drachm  to a  pint of  boiling
water) ; cold, in form of  ice, or of a freezing
mixture placed in a pig's bladder and applied
over  the  swelling.   In  the  event of  these
milder remedies  failing,  a surgeon must per-
form an operation with a view of setting free
those structures which are caused by the con-
striction  and  delaying  the  passage of  the
faeces.
  Irreducible hernia means that form of rup-
ture where,  from some impediment in  the
canal through  which it passes,  it cannot be
replaced in the abdominal cavity.  In such
cases there is no stoppage of  the contents of
the intestine, and the coats of the gut are not
engorged  as to their circulation.  If an irre-
ducible hernia be neglected, it produces many
inconveniences, abdominal  pains, vomiting,
and general  intestinal disturbance, and  the
contents of the bowel may be obstructed in
their natural  passage, causing colic and  con-
stipation,  and,  moreover, the chance of  the
bowel  becoming  strangulated at that point is
greatly enhanced.   With regard to treatment,
it is either palliative or radical, ihe palliative
measures being the application of a bag truss ;
and  all violent exertion or  excess  in  diet
should be avoided.   The radical proceedings,
which  have  been before alluded to, are of
course only  to be  attempted by an  experi-
enced surgeon.  (See Taxis.)
  HERPES is a skin  eruption made up of
clusters of  small vesicles  or blisters * sur-
rounded by a pink or red areola.  It gener-
ally occurs on the upper lip in cases of ordi-
nary cold, and it  often is found therein those
suffering from pneumonia ; it is then called
herpes labialis.  It is caused by the irritation
of the nasal discharge, and commences with
tingling pain and itching and  slight redness ;
in a few hours  the  clear vesicles appear, and
if  they are pricked a little serum escapes ;
they are very harmless, and heal in a few days
by  drying up,  and the  scab then falls off,
leaving no permanent scar.  If rubbed or
scratched, increased irritation may be set up,
and the patch may  become  eczematous.  A
little cold cream  applied night and morning,
or simple zinc ointment, will suffice for a cure.
There is another  variety, named herpes zoster
or shingles, the peculiarity of  which is that it
only affects one half of the body ; it is often-
est met with on  the right side of the chest,
but may occur anywhere ; clusters of vesicles
with red margins are found along the course
of the cutaneous nerves.   The eruption com-
mences with pain  along  the nerves, and in
two or three  days a copious rash will appear ;
it  may occur at any  age,  and  is perfectly
harmless in  its nature.   It  is a common  but 
HICCOUGH
HOMOEOPATHY        219 '
 erroneous idea that when shingles occurs  all
 round  the body  so as  to  form  a zone  or
 girdle, it is always  fatal  ; the  fallacy  lies  in
 the fact that  it never does.   Bathing with
 warm water or smearing on a  little zinc oint-
 ment  is  all the  treatment required, and a
 cure will take  place  naturally  in a few days.
 Sometimes obstinate neuralgic pains remain
 for some time  after the  eruption  has disap-
 peared.
   HICCOUGH, commonly called  " hiccup,"
 is a very troublesome affection, sometimes of
 the slighest significance, sometimes  of the
 gravest.   It consists of a short, abrupt con-
 traction of the diaphragm, and  a sudden jerk-
 ing, imperfect ejection of the  breath.   Most
 frequently it is purely emotional, and brought
 on no one knows how ; and very often it may
 be got  rid of in the  same way  by frightening
 the individual, by exciting the curiosity, and
 so removing the attention  from the hiccup,
 for that is one of the things most favorable to
 its continuance.  A draught  of  cold water  or
 sucking a piece of ice will generally get rid of
 this nervous form of the affection.  A variety
 of it is not uncommon  in hysteria, when it
 may continue  for a very long time,  appar-
 ently resisting every remedy.   In  such cases
 the patients either  have or do not desire to
 have any control  over  themselves, and so if
 the hiccup does not soon cease it  is best  to
 give the patient a narcotic draught of chloral
 or morphia, or if that be objected to, morphia
 under the skin of the arm  may he given.  The
 application of the  galvanic battery to the
 region of the diaphragm,  that is to say, with
 one pole on  the end of the  breast-bone and
 tHe other on the back where the ribs end, will
 in  most cases  put a stop to this  hysterical
 kind.   There is a form of very grave origin,
 however, when gangrene  of any part sets in,
 but especially  grangrene or mortification  of
 the gut ; this proves very troublesome, and
 in most instances it  is a fatal symptom.
  HICKORY - PICKORY.    (See Hiera
 PlCRA.)
  HIERA PICRA, better known ashickory-
 pickory, is a popular remedy for constipation.
 It is not,  an officinal preparation,  but  has a
 large domestic reputation.   It  consists of a
 mixture of  equal  parts of canella bark and
 aloes.  The canella bark is an excellent stom-
 achic tonic,  possessing a warm  and  spicy
 taste, which is agreeable and  comforting.
 The laxative effects of this remedy are due  to
 the aloes which it contains, and its properties
 mainly approximate  to the properties of that
 drug.  (See Aloes and Canella.)
  HIP-JOINT DISEASE.—The  large ball
 and socket, which  is formed  by the articula-
 tion of the head of  the thigh-bone with the
acetabulum  or  cup-shaped cavity in the hip-
bone, is liable to the following injuries and
diseases.   Dislocation  (which  see)  and  a
peculiar  form of disease  known as Morbus
 coxae or coxalgia.  It most frequently attacks
 children between the ages of seven  and four-
 teen, although no age is exempt, and gener-
 ally prevails in cold moist climates.  The first
 symptom  noticeable in a child  is the fact of
 its dragging the affected limb after the sound
 one,  a flattening of  the  natural fold of the
 buttocks, and  pain referred  at  first to the
 knee; and in  standing the patient  advances
 the foot a little, slightly everting the toe, and
 does  not  rest his  weight upon  it.   After a
 while pain comes on in the hip-joint itself, and
 generally  continues   chronic   for   several
 months,  At length the symptoms may disap-
 pear, and  become 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 tak-
 ing place.  Matter now forms in the region
 of the hip and makes its way to the surface!
 and then  after  a tedious  illness  the  patient
 either becomes  hectic and dies, or recovers
 with  a stiff  anchylosed joint and a wasted,
 useless limb.
   Treatment.—The treatment in  the  earliest
 stage consists in maintaining the limb at per-
 fect rest in the straight posture,  and this is
 best effected by placing sand-bags on  each
 side of the limb, the  external one reaching as
 high  as the armpit, and  the body and legs
 kept  fixed straight by a  stout sheet drawn
 tightly over them and fastened  to  the bed-
 stead. Counter-irritation by means of small
 blisters around the hip, and the internal ad-
 ministration of  cod-liver oil and tonics, with
i residence  in  sea air, is the best method of
 treatment  to be depended on.  In  advanced
 cases, when there is  extensive disease of the
 bone, operative  measures, such as removal
 of dead bone, either partially or  by  the oper.
 ation of excision of  the head  of the femur,
 must be resorted to.   This operation  is gen-
 erally attended with the best results, as shown
 by the statistics of  cases treated  in  the Lon-
 don and  provincial  hospitals and private
 practice.
   HOARSENESS,   a common  term  for
 Aphonia,  or loss of voice.  (See Aphonia.)
   HOB-NAILED LIVER, so called because
 in cirrhosis the surface of that organ is rough
 and uneven.  (See Cirrhosis.)
   HOCK.  (See Wines.)
   HOME-SICKNESS. (See Mal-de-Pays.)
   HOMOEOPATHY is a theory of medicine
 opposed to  that commonly known as Allop-
 athy, and  introduced by Dr. Hahnemann, a
 German physician, about the year 1810.  The
 main principle of the practice of  this theory
 is that "like cures  like," and the motto
 " similia  similibus curantur" is adopted by
 Hahnemann  and treated  of in   his  works.
 Homoeopathy professes to cure  diseases  by
 the  employment  of remedies which, if given
 to a healthy  person,  would produce  symp-
 toms  of a disease  similar to the one to be 
220
HONEY
HOSPITAL GANGRENE
treated.  The three points on which the fabric
of homoeopathy may be said to rest are, first,
that like cures like ; second, that the curative
power of drugs is increased in proportion to
their minute subdivision ; and third, as a con-
sequence, that infinitestimal doses of medicine
are  the  proper  treatment of  all diseases.
The reaction against the injudicious and con-
stant use of violent medicines, which  was at
one time the case in ordinary practice, favored
the opposing system of homoeopathy, and pos-
sibly good has been effected in this way.  By
degrees  most people learn that attention to
diet, general habits, exercise, and rest have
more to  do with the cure of disease than  the
absolute medicine  swallowed, and it is thus
doubtless that  homoeopathy has  secured its
present amount of popularity ; moreover,  the
remedies administered  by the homoeopathist
are tasteless, if  not pleasant, and find special
favor with children and those whose fate has
hitherto  been to  supply the victims of nau-
seous domestic doses.
  HONEY is a substance which enters into
the pharmacopoeia as well as forming a pleas-
ant  article of diet.  It is  the sweet juice of
plants and flowers  elaborated by the bee and
deposited in waxen cells in the form of liquid
sugar.  The quality of honey, both in flavor
and richness, depends  greatly on the charac-
ter of the country  over which the bees roam
for food.   Honey is used in medicine as an
emulsion, expectorant,  and  laxative, and  is
often combined with vinegar and squills  to
make a simple remedy for colds, coughs, and
hoarseness.
  HOOPING-COUGH.   (See  Whooping-
COUGH.)
  HOPS are the dried flowers of the female
hop plant collected and dried.   The flowers
consist of scales inclosing a quantity of pow-
der, to which they  owe their peculiar effects.
This powder may  be  separated by sifting,
and is  then called  lupulin.   Various prepara-
tions of hops are in use—the tincture, the  ex-
tract, and the infusion ; the best is, however,
bitter beer.  The  hops themselves are sup-
posed to be slightly narcotic, and  a pillow of
hops has been used to give sleep, but there is
no  evidence whatever to show that any prep-
aration of hops has  this   particular  effect.
Hops are besides bitter, stomachic, and tonic,
and this  wholesome bitter in good bitter ale
is often  invaluable. In convalescence from
acute disease bitter ale  often does great good,
and in aiding digestion in those with  feeble
appetite is often of great service to those who
would  otherwise  suffer  from  indigestion.
Much  of  the beer  used, however, owes  its
bitter to  something else than the hop, and in
many instances  that something  is not quite
so wholesome.
  HORDEOLUM, commonly called a stye,
is a small, hard, painful boil developed in  the
margin of the eyelid.   It is of slow growth ;
 the suppuration proceeds imperfectly, and as
 it increases in size it presses on and produces
 obstruction of  some  of  the  ducts of  the
 Meibomian glands.  (See Eye.) Suppuration
 should be promoted by the frequent applica-
 tion of warm fomentations,  such as  a  hot
 soft sponge, wrung out in boiling water,  ap-
 plied to the eye,  and a hot bread-and-milk
 poultice applied over night.  When the pus
 " points"  a very  slight puncture  may  be
 made, and the warm applications continued.
 If the margin of the eyelid remains thickened
 and painful, and the tissues immediately  ad-
 jacent be indurated, a little citrine ointment
 should be applied along the margin of the lid.
 In some instances in which the suppuration
 is superficial and very scanty, and it enlarges
until it opens at a point where the superficial
tissue has become thinned, by gently pressing
upon its base, a small core or slough is ex-
pelled, and after its expulsion  the healing is
very rapid.  Aperients, and afterward tonics
and alteratives, are always  necessary, as the
complaint  arises in  debilitated  conditions.
Those affected with scrofulous habits, or who
often suffer from  chronic ophthalmia, are
peculiarly liable to be attacked with stye, and
they then occur one or two together or in suc-
cession, plainly indicating something wrong
in the general health.   When stye occurs fre-
quently  in relapses in scrofulous children it is
readily cured by the administration of quinine.
If it occurs in persons or. full habit, spare diet
and  gentle aperients  are indicated.   If the
tumor  remains  indolent, some  stimulating
ointment, such as iodine or critine ointment,
or nitrate of silver, proves  very efficacious in
dispersing it.
  HOREHOUND, the (Marrubium vulgare),
a plant belonging to the Labiate family, has
long been  used in  domestic practice.   Its
uses are ill-defined, but it was supposed to
act as a tonic  and expectorant, and so was
generally used for coughs and colds.   It has
no  place among the remedies of the physi-
cian.
  HORSE-RADISH (Cochlearia Armoracia)
is a plant well known for its culinary virtues,
though not much can be said for its medicinal
 properties.  It is sharply pungent, and will
act  as a stimulant to the flow of  saliva,  prob-
ably also to that of gastric juice.  Its only
officinal preparation is  a  compound  spirit,
which is rarely if ever used, though it has been
supposed  to do  good in chronic rheumatism
and as a diuretic in dropsies.  It is best taken
scraped with roast beef.
  HOSPITAL GANGRENE  includes sev-
eral  gangrenous and  ulcerative  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 gangrene  in
 all  its  forms is both contagious  and infec-
 tious, and seems in some instances to be due 
HOUSEMAID'S KNEE
HOUSES
221
 to epidemic influences, as it has been known
 lo attack isolated patients under private treat-
 ment at periods when it is  spreading  rapidly
 from patient to patient in  the  large wards of
 hospitals.   It is very prevalent among armies
 during military operations, and when large
 numbers of wounded  soldiers are collected
 together in buildings unsuitable as to size and
 internal arrangements for hospital purposes.
 It attacks 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 con-
 verts 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  thick crust at
 last separates, and is  thrown off at the sur-
 face of the deep wound  thus formed, again
 undergoes the  same process, until vessels and
 important structures are laid bare.   This dis-
 ease has been met with chiefly on the Conti-
 nent, 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  generally  high  and of  an  in-
 flammatory kind.
   Treatment.—The general treatment should
 consist in supporting the strength of the pa-
 tient by tonics, stimulants, 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 gen-
 erally directed  toward arresting the spread of
 the gangrene by the application of nitric acid,
 or the red-hot iron. The affected parts should
 be frequently cleansed  by lotions containing
 carbolic acid, or tincture of iodine, and after
 the application of a caustic agent be covered
 by yeast or  charcoal poultices.
  HOUSEMAID'S  KNEE  is a  familiar
 term applied to enlargement of the large bursa
 mucosa  situated in front of the  knee-cap or
 patella, and of  the tendon immediately below
 it  (ligamentum  patellce).  This  bursa or  sac
from its exposed position is very liable to be-
come enlarged  from  kneeling  upon it, as in
scrubbing, cleaning steps, etc. ; and this con-
 dition is frequently noticed in household ser-
 vants, carpenters,  plumbers,  carpet-layers,
 etc.   Enlarged bursae of the patella are fre-
 quently attacked  by inflammation and suppu-
 ration, and usually there is extensive inflam-
 mation  of the surrounding  cellular tissue ;
 sometimes such large collections of pus are
 found in the neighborhood of the sac that Sir
 B.  Brodie considered  that the suppurating
I bursa occasionally gave way, and allowed its
 contents to escape  into  the cellular mem-
I brane.   Sometimes  troublesome  burrowirg
| ulcers remain  after  these abscesses, which
[ are singularly obstinate,attended with fungous
! growths, the  surrounding skin  being dark
| and  unhealthy, with deep burrowings under
 the  integuments   of  the knee, and  a foul,
 offensive discharge.  In severe instances the
j bone (patella) may  become  necrosed.  (See
 Necrosis.)
   Treatment.—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 hydro-
 chlorate of ammonia, or a small blister, will
 often cause it to subside.  If there is consid-
 erable thickening, 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 (see Seton),  composed of  a few
 threads of silk passed through the cyst, and
 by setting up suppuration and the consequent
 contraction and  granulation the cavity be-
 comes obliterated.  When the tumor has be-
 come a  solid, gristly mass, there is no other
 treatment than dissecting it completely out.
 In the cases most commonly brought under
 observation, rest, leeching, hot fomentations,
 and  purgatives, and failing these a free  in-
 cision, usually effect a cure.
   HOUSES  and their construction are of the
 very  greatest importance  from  a  sanitary
 point of view.  Often the health of families
 is  completely lost, very frequently dealh it-
 self ensues, from  defects in household con-
 struction.  If a man sets to work to build or
 select for himself a house on sound principles,
 the first thing he has to satisfy himself about
 is  the site in  which  it  is to be or has been
 built.  We do not, of course, refer to beauty
 of situation,which will always speak for itself ;
 but rather with regard to the  nature of the
 soil.  There are two kinds of sites—the nat-
 ural and artificial.  Artificial foundations, ex-
 cept they  be  carefully prepared, are to be
 strenuously avoided.  It is quite  true that in
 a damp soil a good sound artificial foundation
 is  a very  great  improvement ; but  then  it
 must be  carefully prepared, not made of ma-
 terials heaped together at random. As far as
 site is concerned, the possibility of good drain-
 age ought to be  carefully kept in view.  A
 house with damp foundations is  an  artificial 
222
HOUSES
HOUSES
 hot-bed for rheumatism,with all its dangers to
 health and life ;  and so a situation below the
 high-water mark of rivers is  to be avoided.
 A point much studied in selecting a building
 site, and yet often on wholly erroneous prin-
 ciples, is  the nature  in the soil.  Thus a
 gravelly soil is commonly supposed to be  far
 superior to a clayey soil, on which to build a
 house ;  and so it is, other things being equal,
 which is precisely what  as  a rule they are
 not.  A gravelly soil is good or not accord-
 ing  to the nature of the subsoil and the direc
 tion of the watershed.  If there  is a consid-
 erable depth of sand or gravel, and a distinct
 watershed away  from it, no  better site  could
 be selected ; on the other  hand,  it is  quite
 possible for a gravelly site to  be the  very
 worst site  possible.  If, as  very  often hap-
 pens, the subsoil be gravel or clay, the water
 which falls on the gravel  will sink through it
 till it reaches the clay, and no further, for the
 clay is  not permeable  by  water.  Having
 reached the  level,  it  must  flow  away  as it
 would from a clay surface,  only  percolating
 through the soil  instead  of  running above it
 until it reaches  the  lowest level in a stream
 or otherwise,,  But if it does not flow away,
 if there is no watershed, it will accumulate in
 the  soil, just as it might in a reservoir on its
 surface, and, rising higher  and  higher,  at
 length reach  the foundations  of the house,
 and sap the  limbers of its flooring.  Such a
 condition  of things is  most likely to  occur
 under the following conditions :  Suppose,  by
 the agency of the great forces  at the disposal
 of nature,  a mighty basin has been hollowed
 out  of the clay and subsequently filled  with
 gravel.  This, we know, not  unfrequently oc-
 curs.  Out of this basin there is no escape for
 the ground water, until it topples over the
 clay banks  of the basin,  and so it rises and
 falls according to the season. Such a gravelly
 soil  would be the very worst site for building
 purposes it would be possible to select.  But
 if now in this sea of gravel there was a little
 island of clay, that would be subject  to no
 such variations  in  the rise and  fall of  its
 ground-water.  When  rain  fell it would run
 off its surface into the gravel beyond ; its own
 ground-water would be invariable.  If, there-
 fore, underneath the gravel there is a water-
 shed which will allow of  the free  escape  of
 the  ground-water, no site could be drier or
 healthier ;  if not, no site could be worse.
  The nature of the ground site having  been
 settled, the next  thing  perhaps, especially in
 the country,  is to consider the direction and
 nature of the prevalent winds.  If possible,
 the house should have its greatest exposure
 to the direction whence come  the driest winds,
 and  has the best  exposure  to the sun.   Each
 district and each  situation must be considered
 by itself; protection from the worst winds
 and  exposure to the most favorable  being
sought  in  every case    This, perhaps,  is
 hardly a proper place to speak of the kind of
 trees which should be planted round a house
 with a view to  protection ; but such  should
 be carefully selected with a view to shade in
 summer and protection in winter.   It should
 not be-left  to  haphazard.  The  materials of
 the  house  itself  also  merit consideration.
 Every one may not be  able  to tell the differ-
 ence between good brick and bad brick, but
 there are people who can ; and it  is better to
 pay for such skill  than  to have one's house
 constructed of  bad  material.  In districts
 where stone is  used, this too requires to be
 selected.  Some stones  are  so porous  that
 with a good beating rain on the  outside the
 water pours almost as  rapidly inside.  Such
 houses are always damp ; they cannot be kept
 dry.   Of the wood used little need be said,
 beyond  the necessity to provide  for future
 comfort by having nothing but seasoned tim-
 ber ;  otherwise, imperfect fitting  doors  and
 window-sashes will try tempers and give rise
 to drafts.  As to plan or elevation, each  may
 suit his own fancy ; but from the health point
 of view  there  are  certain broad rules to be
 observed.  If the design is fantastical, certain
 portions of  the house  must  remain unused,
 the rooms being too small,  or if used,  they
 can only be so compatibly with  health by a
 ventilation which can hardly fail of being too
 free, that is to say, the place must  be drafty.
 Besides,  these  odds and ends of  places  are
 difficult to keep  clean.   Simplicity of design
 should as far as possible be aimed at. Again,
 the rooms should be well balanced.  Frequent-
 ly we see in houses the whole building sacri-
 ficed for  one or  two rooms,  and  very often
 these are used almost entirely as show-rooms
 or reception-rooms.
  The living-rooms should correspond to the
 size of the family, and as a rule the bed-rooms
 should be   larger  than the sitting-rooms.
 We consume a very great portion of our time
 in bed, not less as a rule  than one third, and
 during that period most people  have their
 windows shut, so that the air can only change
 by the chimney, and that too is often stuffed,
 and any chinks left in the walls or door.   It
 is desirable, therefore,  that the  sleeping-
 rooms should be so large that the total quan-
 tity of air they contain cannot become very
 greatly fouled, even suppose it is not changed
 during the period devoted to sleep. There can
 be no doubt but that breathing the same air
 over and over  again  is  unhealthy.  Houses
 should always  be built, be the plan what it
 may, so as to admit of through-and-through
 ventilation.   In some parts of the country a
 horrid plan  prevails of  building houses back
 to back, so that the back wall suffices for two
 streets.   Nothing could  be more pernicious
to health than this, for it is impossible, how-
ever desirable, to obtain sufficient ventilation.
 For tnis  reason,  too, houses should not be
built with well-squares in the midst of them ; 
HOUSES
HUMIDITY
223
 that is to say, as hollow squares.  The stair-
 cases  should be so situated that from it, if not
 directly,  every room of the house may  be
 ventilated.  As for the rooms themselves, the
 best system of ventilation is the natural one,
 that is to  say, by the  doors, windows, and
 grates.  All artificial systems of ventilation
 have hitherto proved failures. The perfection
 of ventilation  is  where a room is  kept con-
 stantly sweet  and fresh  by an insensible
 change of air.   If perceptible, the ventilation
 is sure, under other circumstances, to become
 drafty, and drafts are to be carefully avoided.
 The open fireplace is undoubtedly  of great
 service in ventilation, yet it occasions great
 waste of fuel, and has the disadvantage  of
 not keeping up an even temperature.  The
 open grate  draws upward the cold air which
 has entered the room, heats it, and  causes it
 to ascend the  chimney  ; in this way  a  con-
 stant current is kept up.  Often grates have
 this great disadvantage,  that it is hardly pos-
 sible with them to keep up  an  equable  tem-
 perature for the four and-twenty hours,  If a
 good  fire is lit, say at bedtime,  it warms the
 room  to  begin with ;   but as  morning ad
 vances,  and the  temperature outside sinks
 lower and lower, so too the fire sinks, and it
 goes out  just when it is most wanted, that  is,
 in the early morning hours.  This is the  time
 which is most trying to those who  are  sub-
 jects  of chest affections ;  it is then when
 coughs become   most  troublesome.   Such
 stoves as  Arnott's  are  free from this incon-
 venience ; but they necessitate ventilation  by
 artificial means.   But,  besides  air,  houses
 should admit plenty of  light.  The  human
 plant,  just like the vegetable one, grows pale
 and sickly if deprived of air.  Hence big  win-
 dows should be procured, if possible ; if the
 light proves troublesome by its excess, it is
 easily  shut out.   Too many creepers  should
 not be trained  against  the house ;  they are
 picturesque, but they harbor damp.
  There  is  nothing  more important in the
 ordering of a house than the water-closets and
 drains.  In the country, where there is little
 water-power, and no means of getting rid  of
 sewage,  there  is  only one  thing or course
 compatible  with  safety—avoid  water-closets
 altogether.  Even  in towns they are  hardly
 tolerable ; in the country they are intolerable.
 It has  been  clearly proved that many diseases
 are spread by their means, if they do  not in-
 deed arise  from them originally ; and these
 diseases  are very  fatal ; typhoid fever  is a
good  instance.   Even  in  towns  the closet
should be as far from the living and  sleeping
portions  of  the  house as  possible,  and the
drains  ought  not  to ventilate  through it.
Often in the dull days of early winter, when
the atmosphere is light and the barometer
low, the tense gases rush up through the pipes
leading to the closet, and so enter the house.
So too in cold weather, when the doors and
 windows are close shut in order that the tern
 perature may be kept high, often the easiest
 access of air is from the water-closet.   These
 things are not pleasant  to reflect on, but they
 are facts.  The only thing to be done is to let
 the drains  be ventilated by a  shaft reaching
 the top of the house, and having its basis in
 the drains.   The closet is best kept sweet by
 a teaspoonful of carbolic acid in a gallon of
 water.  In  the country earth-closets  alone
 should be allowed in the house, and outside,
 the same dry-earth system ought to be em-
 ployed ; closer attention  to this rule would
 save many a life from typhoid fever.
  Previous to building a house, it is now very
 common to have the drinking-water analyzed.
 This is  a  very good rule, for bad drinking-
 water is a sure source of diseases. As a rule a
 water which contains much nitrate and chlo-
 ride is to be avoided.   They commonly indi
 cate contamination somewhere, and this con-
 tamination may at  any time assume a differ-
 ent character.   Chlorides  and  nitrates are
 themselves  harmless, but their sources may
 not be so.   The storage of the  water in the
 house should be attended to.  Lead cisterns
 used to be the rule ; now galvanized iron ones
 are coming into use.  The lead is  dangerous
 with soft water, if it stands long and  is not
 run off.  This risk  is avoided by the  other.
 The cistern  should always be kept covered, so
 as to prevent rats, mice, and the like finding
 their way into  it, and being drowned remain
 in it to flavor the water.  Moreover the cis
 tern should  be readily accessible, so as to be
 easily cleaned.   Finally, the drains should be
 earthenware pipes : with bricks, rats will get
 in, make holes, and  allow the  sewer gases to
 escape,  to the detriment of the health of the
 inmates.  It is well  to understand  the me-
 chanism of  the traps, so as .0 know if they
 are in working order.  A very little attention
 to this slight detail will  often  save much in-
 convenience, and guard against  detriment to
 health.  (See Ventilation and Warming.)
  HUMAN BODY, composition  of.  (See
 Composition of  the Human Body.)
  HUMIDITY.—The air  is never free from
 moisture under ordinary conditions ; for from
 the surface  of the earth,  and from  rivers,
 lakes, seas, etc., evaporation is going on con-
 stantly ; this aqueous vapor, ascending into
 the higher and cooler regions of the atmos-
 phere, forms  clouds ; and this vapor descends
 to the earth again as rain,  snow, or hail. The
 amount of evaporation varies much at differ-
 ent seasons  of  the year, being much greater
 in summer than in  winter.  The  hotter the
 air, the more aqueous vapor will it hold  ; this
 can be  shown by  bringing a glass of cold
 water into a hot  room, when a dew will be
 deposited outside the glass ; this is due to the
 fact that the cold glass cools the air immedi-
ately around it, and, being thus  cooled, the
air  can hold less aqueous vapor in suspen- 
224
HYDATIDS
HYDROCEPHALUS
sion.   It is to the  presence of  humidity or
moisture in the air that the deposition of dew
can take place.  Instruments, called hygrom-
eters,  have been  devised  to  find  out the
amount of watery vapor in the air at any tem-
perature and at any time.   Hot and damp air
generally has a relaxing effect on the consti-
tution, while  cold  and damp air is unsuited
for those who suffer from chest affections, and
who are liable every winter to bronchitis and
winter cough.
  HYDATIDS are cysts formed by the ova
of the Taenia  Echinococcus or tape-worm of
the dog.  In the article Entozoa it is shown
how tape-worms occur in man ; the ova, how-
ever,  of those tape-worms which infest the
human  subject will  not  produce in  him the
mature worm  at once, but it is developed in
some other animal, as a  Cysticercus ; so in
the case of the worm met  with in the dog or
wolf,  the ova  passing  into  man  do  not de-
velop a worm  but a Cysticercus or  hydatid.
These bodies,  minute at first, pass from the
alimentary canal into the system and may be
carried by the circulation into  the  nearest
organ.  The liver is the organ which is most
commonly their seat ;  but they have  been
found in the lungs, heart, brain, kidney,  pel-
vis, and bones, etc.  When they are deposited
in an organ  a fibrous cyst (the ectocyst) is
formed around, and wilhin this is the en-
docyst, a clear, gelantinous membrane which
lines  the former, and  itself incloses a large
collection of watery fluid holding in  solution
some common salt and phosphates.  These
cysts  vary in  size from a marble to a child's
head, and when they attain such large dimen-
sions, surgical interference is called for ; they
grow for along time without the patient being
aware of  their presence ; at last, perhaps, a
firm,  almost painless tumor is felt in the ab-
domen ; it is nearly always globular and elas-
tic, and gives a feeling as if it contained fluid.
At times inflammation is setup around it, and
then there will be  pain, fever, and constitu-
tional disturbance.  The natural tendency of
these cysts is  to grow larger and larger, and
they  may at length burst ; in this way they
have  escaped into  the heart, pleura, perito-
neum, intestinal canal, etc., and nearly always
with a rapidly fatal result.  No medicines are
of any avail in checking their growth or in
causing the absorption of the fluid.  Various
methods have been adopted to empty the cyst
by drawing off the fluid, and in a great many
cases this is  done  with  excellent results.
Now  and then inflammation of the cyst takes
place and the contents  become purulent ; the
only chance then for the  patient is to have a
free  opening  made and let the matter out.
Still more rarely the cyst dies early and never
attains  a large size ; the contents  become of
a  cheesy  consistence,  and the  cyst may re-
main  in the body for years without giving rise
to any symptoms  whatever.  It  has  been
shown that eating meat is a fruitful source of
tape-worms,  but the hydatid  of  the taenia
echinococcus seems to be taken in by eating
water-cresses or uncooked vegetables, or by
drinking water in which the ova of the tape-
worm have entered. Fortunately this trouble-
some disease is of rare  occurrence ;  when
present, it may attack  any age and may be
met with equally in either sex ;  the danger to
the patient depends somewhat on the seat of
the hydatid ;  it is less fatal when it occurs in
the liver  than  when it  is developed  in the
heart or lungs.   (Entozoa.)
  HYDRAGOGUES are remedies of  the
purgative  class,  which   produce   copious
watery stools.  Some  seem to give rise to
fluid specially, apart or in excess of their pur-
gative effects ; others seem to do so  only in-
cidentally.   Elaterium  is a remedy of this
kind, so are colocynth and most of the purga-
tive  salts.  Gamboge,  too,  produces very
watery stools.   Compound jalap powder is
a remedy much used in this way ; so too is
compound scammony powder.  Hydragogue
purgatives are employed mainly to get rid of
excessive fluids, as in dropsies, especially of
the cardiac kind, or in the earlier and acuter
stages  of renal  dropsies.   Some  forms  of
dropsy are not much affected by them.
  HYDRATE   OF   CHLORAL.    (See
Chloral.)
  HYDROCEPHALUS is  a disease  of
which the main feature is an accumulation of
fluid in  the  central cavities  of the brain.
Sometimes the child is born in that condition,
and then the dangers of delivery are consid-
erably increased ; more generally the symp-
toms appear after birth,  and become more
marked in the second and third years of life.
At  first,  and before  the  child  can  walk,
nothing particular may be noticed, except that
it has a large head.   But as it grows older it
will be found that the child is not so sharp as
others of the same  age,  that it walks with
difficulty, that its teeth are backward in  ap-
pearing, and  that the size of the head is out
of all proportion to the rest of the body ;  the
upper part of the skull enlarges so  that the
face  appears much dwarfed ; the anterior fon-
tanelle remains open ;  the eyes are very apt
to roll about, and there is inability to luok
upward ; the skin over the scalp is smooth
and tense, and often marked  with the super-
ficial veins.   The rest of  the body is gener-
ally  badly nourished, and the  legs are often
bowed if the child has  walked too early, and
the wrists and ankles are enlarged.  The fluid
which distends the brain is poured out slowly,
and  consists of  little more than water  and
common salt ; the ventricles of the brain are
very capacious and  smooth within, while the
brain-substance  is stretched  out over  the
fluid, and  is, therefore,  thinner than  usual.
The  disease is altogether  chronic in its course,
and gives rise to no pain or any urgent symp- 
HYDROCHLORIC ACID
HYDROPATHY          225
 toms ; the appetite may be unimpaired, and
 the general health,  although seldom  good,
 does not seem much affected.   Such children
 are more liable than others to catch infantile
 disorders, such as whooping-cough, convul-
 sions, measles, scarlet fever, etc.   When the
 mischief is but slight  the child may grow up
 to adult life ; but  when  far advanced death
 generally  takes  place before the  child has
 reached five years  of  age.   The  treatment
 will consist in giving nourishing food and tonic
 medicines ;  bathing  with cold water or  sea-
 water may do good.   Bandaging the head has
 been recommended, and various preparations
 of mercury have been  rubbed in,  but very
 little in  this way can  be  done.  This disease
 is often called chronic hydrocephalus, to distin-
 guish it from acute hydrocephalus, an affection
 of quite a different  character, and which is
 described under the head of Meningitis.
   HYDROCHLORIC ACID, also  known
 as muriatic acid  or spirit of salt, is not  per-
 haps so much used as a remedy as is its com-
 bination with nitric acid, called nitro-hydro-
 chloric acid.  The acid itself is a waste prod-
 uct in the manufacture of common washing
 soda, and it is cheap enough ; but it is often
 impure, and requires to  be carefully purified
 to  get rid of arsenic and  other substances
 with which  it is commingled.  The strong
 acid is not used in  medicine.   It is  a power-
 ful caustic, and produces a  white stain in the
 skin which may  be completely destroyed by
 its application.  Several cases of  poisoning
 have occurred through its use, but not so many
 as might be supposed considering its frequent
 use in the arts.   In the dilute  form, given in
 doses of from 10 to  20 drops  well diluted in
 water, it may be found useful given immedi-
 ately after food in aiding digestion.  It is the
 natural acid of digestion, being secreted by
 the stomach for that purpose, and itself  has,
 at the temperature  of the body, considerable
 power in dissolving meat or  solid white of
 egg.   It is also of  some use as a gargle di-
 luted with  water, but it is  best given along
 with chlorate of potass for this  purpose, when
 it has the power of  setting free a substance
 allied to chlorine.  This certainly has a  ben-
 eficial effect in foul ulceration of the throat,
 and in diphtheria where sloughs are formed
 and tend to decompose,  still further poison-
 ing the system.
  HYDROCYANIC ACID.   (See Prussic
 Acid.)
  HYDROGEN (SULPHURETTED) is
 not itself used in medicine, but mineral waters
 which contain it free and in the form of sul-
 phides of the alkalies are of  very great value.
 The smell of this gas resembles rotten eggs ;
 and  the  so-called sulphurous  waters do the
 same.  The baths containing sulphur are ex-
 ceedingly useful  in certain  diseases of  the
 skin,  chronic gout  and  rheumatism,  and
chronic lead poisoning.  A  preparation  for
 destroying the itch-animalcule is made by
 boiling sulphur and quicklime together.  This
 is very efficacious.   Given internally, either
 as  mineral water or as  sulphides, this  sub-
 stance is said to benefit scrofulous ulcers very
 greatly.   Sulphur of calcium is  commonly
 used for the purpose, and it  is described as
 exceedingly efficacious.   Small doses of the
 sulphides seem to relax  the  bowels, as  sul
 phur itself does.
  HYDROGEN is  one of  the  gases  con-
 tained in water, and is notable for its extreme
 lightness ; as far as we know, however, it
 possesses no  remedial action.  A compound
 of it, called peroxide of hydrogen, has been
 tried.  It  possesses  the  property of freely
 giving off the oxygen it contains, and so may
 be  useful in certain  conditions.   Applied to
 the  skin it whitens or bleaches it, and, col-
 lected in a somewhat similar way on  almond
 surfaces, has  been used to  favor the healing
 of sores.
   HYDROPATHY, also   known   as  the
 Water Cure, is a system of dealing with dis-
 ease invented by a German named Priessnitz.
 His doctrine was that plain water outside and
 inside was all that was  necessary to cure dis-
 ease.   Undoubtedly he committed grievous
 errors, but he was not like  a consulting  sur-
 geon or physician ; he had his patients under
 his thumb, and could diet them and manage
 them as he liked.  Undoubtedly, too, he in-
 troduced a very potent means  of dealing with
 some disorders which has  been too much over-
 looked by the regular faculty, chiefly  on ac-
 count of  its  antecedents, and because  too
 much was claimed  for it.  Now,  however,
 things seem to have reached their proper level,
 and many practitioners  are glad to send their
 patients to  hydropathic establishments  pro-
 vided they can rely on their instructions being
 carried out.  Hydropathic establishments are
 generally situated in places of great  natural
 beauty, which induces the patients to exercise.
 The diet at them is usually plain  and  whole-
 some, and early hours are insisted on.  Such
 a change in itself often  does good, and  if to
 that is added the stimulating effects  of  the
 cold-water bath skilfully applied, and  the use
 of appropriate baths for the purpose of reliev-
 ing that great natural organ for eliminating
 refuse matter from the  system, the skin ; if,
 moreover, the kidneys are relieved, the liver
 got to act in a healthy manner, and the bowels
 regulated, the whole cannot fail to do good.
 But too much has been claimed for hydrop-
 athy ;  cases have been sent  to   the  water,
 cure establishments altogether unsuited  for
 the  treatment, and the consequence has been
 disappointment.  The baths mainly used are
 the  shallow bath, in which the individual sits
 immersed up to the hips,  is well  laved, and
finally has a bucket of cold water thrown over
him  ; the sitz-bath, where the water plays on
the  lower portion of the body ;  the rain-bath, 
226    HYDRO-PERICARDIUM
HYDROPHOBIA
where every portion of the body is acted up-
on in the same way ; the shower-bath, where
the rain comes only from above ; the douche-
bath, where a column  of  water of varying
weight and force is made to play on different
parts of the body.   Then there is the Roman
or Turkish bath where hot air is used to in-
duce sweating.  The body is well kneaded,
and  the perspiration abruptly slopped by a
douche or plunge-bath.   But one of the chief
means for dealing with disease is the wet
pack.  This is a  very valuable means of re-
ducing the temperature and getting the  skin
to act.  The  patient must be  in good heat.
He is stripped naked, laid on  a  wet sheet,
and  packed in it like a mummy ; then  follow
blankets in the  same  way ;  a feather-bed
covers over all ; a wet towel is applied to the
head, and the  patient is left usually to sleep.
Presently the  cold gives way to heat, the skin
is enveloped  in  one vast poultice,  and if
there be much irritation of  it the relief  is
magical.  A cold douche or  plunge or rain-
bath ends the  process, which  should not last
much over half an hour.
  HYDRO-PERICARDIUM means a pass-
ive effusion of serum into the sac of the peri-
cardium,  or membrane inclosing the heart ;
it occurs in many cases where dropsy of other
parts is present, as in diseases of  the heart,
lungs, and kidneys.
  HYDROPHOBIA is  the  term  applied to
the  conditions which occur  in the human
being after the inoculation of the saliva of a
rabid animal, most  frequently  of dogs  or
cats.  The term in its derivative sense is not
always  applicable, as the  " dread  of water"
is not always  present either in the  patient or
in the animal  inflicting the  injury.   Mr. You-
att in his treatise on canine madness thus de-
scribes the symptoms of this disease in dogs,
from whom the disease is most  generally de-
rived :  "The disease manifests itself under
two  forms  : the furious  form,  characterized
by  augmented activity of the  sensorial and
locomotive systems, a disposition to bite, and
a continued peculiar bark.  The animal be-
comes altered in  habits and  disposition, has
an inclination  to lick or carry  inedible sub-
stances, is restless, and snaps in the air, but
is still obedient, and  attached.   Soon there is
loss of appetite  and thirst,  the mouth and
tongue swollen ; the  eyes red, dull, and half
closed ; the skin of  the forehead  wrinkled ;
the coat rough and staring ; the gait unsteady
and  staggering ;  there is a periodic disposi-
tion to bite, the animal in approaching is often
quiet and  friendly,  and then  snaps, latterly
there is paralysis  in the extremities ; the
breathing and deglutition become  affected by
spasms  ; the  external surface irritable, and
the sensorial  functions increased  in activity
and  perverted :   convulsions  may  occur.
These  symptoms are paroxysmal,  they remit
and intermit,  and are often excited by sight,
 hearing, or touch.   The sullen form is char-
 acterized by shyness and depression, in which
 there is no disposition to bite and  no fear of
 fluids.   The dog  appears to be  unusually
 quiet, is melancholy, and  has depression of
 spirits ; although he has no fear of water he
 does not drink,  he makes no attempt to bite,
 and seems haggard and suspicious, avoiding
 society, and refusing food.  The breathing is
 labored,  and the bark is harsh, rough, and
 altered in tone  ; the mouth is open from the
 dropping  of the jaw ; the tongue protrudes,
 and the  saliva  is  constantly flowing.  The
 breathing soon becomes more  difficult and
 laborious ; there are tremors and vomiting
 and convulsions."   This disease  has been
 noticed in the cat, horse, wolf, and other ani-
 mals,  and is from them communicable  to
 man.   A knowledge of  the periods at which
 madness attacks dogs is of great importance,
 so as to put them beyond the power of caus-
 ing injury before they become a public dan-
 ger,  and  with   this object  the Council  of
 Hygiene  of  Bordeaux issued the following
 instructions : " A short time, sometimes two
 days, after the madness has seized  the dog it
 creates disturbances in the usual condition of
 the animal which it is indispensable to know.
 i.  There is  agitation and restlessness ;  the
 dog turns himself  continually in his kennel.
 If he be at liberty, he goes  and comes, and
 seems to be sucking someihing ; then he re-
 mains  motionless,  as if waiting ;  he starts,
 bites the air, seems as if he would catch a fly,
 and dashes  himself, barking and  howling.
 against the  wall.  The  voice of the  master
 dissipates  these  hallucinations ;   the dog
 obeys,  but slowly, with hesitation, as if with
 regret.  2. He  does not  try  to bite, he is
 gentle, even affectionate, and  he eats and
 drinks  ; but he  gnaws his litter, the ends of
 the curtains, the padding of the cushions, the
 coverlid of beds, the carpets, etc.  3.  By the
 movement of his paws about the sides of his
 open mouth, one might think he was wishing
 to free his throat  of a bone.   4.  His voice
 has undergone  such a  change that it is im-
 possible not to be struck with it. 5. The dog
 begins to fight with other dogs ; this is decid-
 edly a characteristic sign, if  the dog be gen-
 erally of a peaceful nature.  The numbers 3,
 4,  and  5 indicated are already very advanced
 periods of the disease, and the time is at hand
 when man will be  exposed to the  dangerous
 fits of the animal  if immediate measures be
 not taken.  These measures are to chain him
 up as  dangerous, or, better still, to destroy
 him."   This notice is suggested to be printed
 on the back of  the notice of  the dog tax, on
 the back of the  receipt for this tax, and finally
 on the back of the  permissions for hunting.
    When the disease has attacked the human
 being,  we find striking points of resemblance
 to that already quoted as occurring in  the
' dog, but at the same time several points of 
HYDROPHOBIA
HYGROMETER         227
 difference.   At first no symptoms manifest
 themselves, and it  is usually not  until some
 weeks afterward that the effects of the intro-
 duction of the poison into the system appear.
 The first are general, and  those  of general
 malaise, fever, nausea, loss of appetite, and
 restlessness.  The peculiar or special symp-
 toms,  however, which  set in later,  comprise
 an irritation in the locality of the bite, simu-
 lating neuralgia.  The cicatrix  becomes  red
 and swollen, and discharges a thin unhealthy
 pus.  The  actions and affections are changed,
 children, if the objects  of the injury, become
 shy ; adults, depressed, lonely, anxious, and
 melancholic,  and  anticipatory  of  resulting
 danger.   Some, on the contrary, are  unusu-
 ally irritable and  ill-tempered.   There is  a
 characteristic anxiety, with  a sense of  vveight
 and pressure in the chest,  disturbed  sleep,
 and frightful dreams ;  these symptoms, with
 complications, constitute what  may  be re-
 garded as the  first or  primary stage of  the
 disease.   The second may be regarded as the
 imitative  stage, having " hydrophobia" as its
 characteristic.   It is ushered in with stiffness
 of the muscles of the throat, jaws, and tongue,
 pain in the pit of the stomach, with chills and
 drowsiness, convulsive spasm of  the muscles
 of deglutition, causing swallowing to be diffi-
 cult or impossible.   There is a great dryness
 of the mouth  with burning thirst, there is
 spasm of  the muscles of the larynx, causing
 the peculiar hawking or barking noise in the
 attempts to expel the secretions of the mouth
 and fauces. There are convulsive paroxysms,
 and the sight or sound of fluids produces  ag-
 gravation  of them, the  mind becomes in  a
 state of fearful agitation, dreadful feeling of
 despair.   Sometimes the mental disturbance
 may be slight, but generally it is the reverse,
 bordering on maniacal fury.   The third stage
 or stage of decline,  is attended with rapid de-
 pression and nervous exhaustion, with inco-
 herency and delirium, and death  takes place
 either from choking, or during a  convulsive
 attack, or from exhaustion.   The duration of
 the disease varies from  seventy-four hours to
 six or seven days,  and there are  cases  on
 record which have lasted for two  or three
 weeks.
   Treatment.—The treatment in  the first in-
 stance,  on the receipt  of the bite, must be
 immediate, and the  injured part should be
 immediately  destroyed by some  powerful
 cscharotic, which must  be used unsparingly
 over the whole surface and depth of the bite.
 Thus, nitrate of silver,  caustic potash,  nitric
acid, sulphuric acid, arsenical paste, chloride
 of zinc, the actual cautery (hot iron), boiling
oil, etc., are all of use. In the absence of these
means, the bitten spot should be  cut out at
once ; ligature tightly applied above the bite, is
only of use till more active treatment can be
procured.  The probability of cure  and recov-
ery should  be impressed on the patient with a
view to avert  despondency.  As drugs, stim-
ulants and other antispasmodics, anodynes or
narcotics,  and tonics,  are  frequently indi-
cated.  Thirst should  be alleviated by ice.
The course, however, of the disease  is usu-
ally fatal.
  HYDROTHORAX,  or, as the name sig-
nifies, water in the chest, is met with in cases
of disease of the  heart  and kidney ;  it is, in
fact, analogous  to the  dropsy in  the legs,
which occurs in those affections.  Either from
an alteration in the quantity of the blood or
from a change in its quality, serum is poured
out into the pleural cavity,  and  generally both
sides are affected, although not equally so.
It is attended  by no pain, and its chief result
is to cause an increase in  the difficulty of
breathing,   with  which such   patients are
mostly troubled ; this in  the case  in conse-
quence of the  lungs being compressed by the
effused fluid,  and so there is  less  room  for
the  air to  enter.  The  treatment will consist
in the use of purgatives, so as  to remove the
fluid by the bowels ; by the action of seda-
tives, if the heart's action be  very tumultu-
ous  ; and by rest in bed and nourishing food.
Any special treatment must be  decided upon
according to the particular form of mischief
in the  heart or kidney, and upon the  state of
the patient.
  HYDRURIA means an  excessive secretion
of limpid, watery urine.
  HYGIENE is the science and art .of pre-
serving health, by the  appropriate nourish-
ment of the body and the proper regulation
of its surrounding conditions.  It will be seen
from this definition that the subject is much
too wide to be treated of  in a single article,
and, in fact, by the special stipulation of Dr.
Lankester, the editor, a  very large proportion
of the  present work is devoted  to topics con-
nected  with  Hygiene.  (See  Air,   Baths,
Climate, Clothing, Diet, Digestion, De-
odorants,  Disinfectants,  Food, Fumiga-
tion,    Gymnastics,   Health  Resorts,
Houses,  Light,  Sanitary Regulations,
Vaccination, Ventilation,Water, Water-
Closets, and Warming.)   In  as far  as  the
prevention  of  disease could be dealt  with in
such a work it has been done ; and any declen-
sion from  bodily health into disease is treated
of under the various diseases.
  HYGROMETER is an instrument  for
observing  the  dew-point  or the amount of
moisture in the air, and various kinds have
been made for the purpose.   The   rate of
evaporation varies at  different seasons, being
the greatest in  summer  and the least in win-
ter.  From the surface  of  water, and during
a breeze, it is possible for fifteen  thousand
gallons of  water to be evaporated from an
acre in twenty-four hours during the summer
months, while in winter  time  about  three
thousand five hundred gallons will evaporate
from the same area in the same time. 
228         HYOSCYAMUS
HYPOCHONDRIA
  HYOSCYAMUS.  (See Henbane.)
  HYPEREMIA, a technical term for  in-"
crease in the quantity of blood in a part  ; it
comes on in every case of mechanical ob-
struction to the circulation, and precedes  in-
flammation of a tissue.  A familiar example
of it is seen  in the  phenomenon of blushing.
  HYPERPYREXIA, a term applied when
the temperature  of  the body is very high, as
in some cases of rheumatic fever, when 1070
or no° Fahr. may be reached, and a fatal re-
sult may be  expected ; the only relief at pres-
ent known is by cooling the patient down by
means of a cold  bath, or by packing in sheets
wrung out of ice-cold water.
  HYPERTROPHY, a term applied to  an
increase  of  a  healthy tissue  without any
change in the quality of its component parts ;
thus a muscle is  said to become hypertrophied
when it is increased in size by using it, as in
the arms of  a  blacksmith or athlete.  (See
Heart.)
  HYPOCHONDRIA,  also  known by  the
old English  equivalent of the  Vapors, seems
to be the correlative in the male sex for what
in the female we call hysteria.   The condi-
tions have long been  well  known, though
very various causes have been assigned to it,
the favorite  being for many years the forma-
tion and circulation of " black bile," for mel-
ancholia means  this exactly.  Nowadays we
assign to it a nervous orgin, and though there
may be  no  actual  disease,  the  condition is
one very hard to get rid of.  Most frequently
there is functional derangement of seme part,
generally of the stomach, though sometimes
there is  really  alteration  in  structure.  The
chief characteristic  of hypochondria is a mor-
bid  self-consciousness similar in  some  re-
spects to that of hysteria, but generally tak-
ing a different direction.  The hypochondriac
usually fancies  himself the subject of all  the
ills that  flesh is heir tx  There  is usually a
great dread  of death, and the  patient resents
being told there is nothing the  matter with
him.   This  is so much the case that it is  un-
wise  for a  practitioner to deal with such  a
patient in an off-hand manner ; he cannot be
reasoned out of his malady ;  for the time he
may  feel convinced, but presently,  when he
is left to himself, his fancies resume their old
sway.  Withal such a man always has some-
thing the matter with him—generally a most
obstinate indigestion ; and if that be cured the
patient is generally in a  fair way to be re-
lieved of his mental symptoms.   More rarely
there is nothing the matter except the mental
influences, which become disordered very often
in  consequence  of self-indulgence,  until  the
regularity and controlling power  of  the head
have been utterly lost.  Frequently this mal-
ady assumes the character of insanity, some
member of the body  being supposed to be
lost, or so altered  as to be useless, or worse
than  useless.  Hypochondria seldom occurs
in those who lead  an active, healthy life in
the open air.  It is  most  frequent among
those who,  living well, take  little exercise,
and whose lives are what is  termed sluggish.
Such individuals will often be subject to short
attacks of a malady of this kind, which a little
laxative  medicine and exercise  in the open
air will soon carry off.  It is very frequent,
too, among those who, having led an active
life, retired to comparatively early rest  and
quiet, as they think. Such having seldom any
internal  resources in the way of education
and cultivation, have  recourse to morbid re-
trospection ;  their own feelings, desires,  and
aims become  their only company, and so each
uncomfortable  sensation  is  pondered  over
until some comparatively slight ailment be-
comes a thing of the first magnitude.   This
once established, everything is made to min-
ister to it; the unfortunate individual takes
to looking at his tongue, feeling  his pulse,
and generally observing his bodily condition
a dozen times a day.   Those who have long
had their minds  strained  by overwork arc
liable to a somewhat similar form  of disturb-
ance.  In them, however, the bodily condi-
tion  is  less the subject of notice—it is the
mental ; it is those which suffer most.  They
become miserable objects for the time being ;
they lose their nervous energy, become weak
and wretched ; they fear to cross the streets ;
they live in  constant dread of having done
something wrong,  or of  having  wrong at-
tributed to them ; they are  the shadows of
their former  selves.   Hard  students are fre-
quently so troubled ; among students of med-
icine this generally takes the shape of fancy-
ing themselves the subjects of disease of some
greater organ of the body—lung disease  and
heart disease  are  the favorites ;  but most
men who have worked hard in their time will
confess to having been at one time or another
the supposed subjects of half the diseases in
the nosology.  We have already hinted at
the causes of this malady.   These are essen-
tially the continued use  of one part of the
system, the other being left without due ex-
ercise.
   Treatment.—In one set of cases mentioned
above exercise for the head is  wanted ; in
another exercise  for the body.  For the re-
tired man of  business something is wanted to
keep his mind engaged, and  such  may often
be found in the affairs of the parish or town-
ship in  which he may be placed.  In short,
having given up  attending with all his might
to his own private business, it is well for him
and generally well for  the public, that he
should devote some part of his leisure to tlut
public business which in this country is gen-
erally relegated to private enterprise. To the
other s'rt of patients mental work is already
too  severe  a  burden—they  o#ught to  have
more relaxation,  and this relaxation ought to
be devoted to bodily exercise.  The selection 
      HYPODERMIC INJECTION

of the kind of exercise may  in great measure
be left to each individual.   But this is to be
borne in mind, that extremely violent exercise
for a few moments will not answer  the same
purpose that moderate exercise for a longer
period will.  So, too, violent  exercise  one
day and quiet the next will  net answer : the
great thing is to keep the system equable.
Such men  as desire to excel in mental work
should not attempt to vie  with  an athlete.
The two things are very seldom compatible.
These things are, however, rather to be looked
upon as means of maintaining health in all
these circumstances, or in getting rid of slight
attacks of the malady.  They will not  suffice
for more serious ones. When a man is fairly
" hypped," as it is called,  there  is only one
satisfactory remedy—total  change of  scene
and  pursuits.   If  the condition  has  arisen
from things bodily or things mental, then the
same rule—change of scene and  change of
occupation.  And to this there need be  less
objection, for a man's work, under such  cir-
cumstances, is of little value. If he have only
a certain routine to get through,  which  re-
quires no  considerable use of  the mental
faculties, he may succeed ;  but if the  calling
is such as to require a keen  use of the judg-
ment, the sooner he  gives it up for the time
being the better for all concerned.  It is won-
derful what a  difference  a few weeks or
months may do for a man.   Often we have
seen a new lease of life gained by a short rest
and  change of scene.  After these the gen-
eral rales above laid down are to  be duly ob-
served ;  especially is digestion to be duly
looked after, but only by  proper food  and
appropriate exercise, not  by medicines,  if
they can be avoided.   There is but one final
caution we desire to enforce, and  we do  this
very earnestly.  As a rule, hypochondriacs
sleep  badly—often   those,  especially, who
have too much mental and  too little  bodily
work are troubled with frightful dreams  and
restless nights. To these we  say, avoid  opium
or other sedative ;  if the bowels are not open,
try a blue pill and a black draught.
  HYPODERMIC INJECTION is a  pro-
cedure which has been adopted of late  years,
by which  medicines may  be inserted  under
the skin, and absorbed into the blood, with-
out having first to enter the  stomach.   It has
been found in practice to be a very conven-
ient method ; for not only can a smaller quan-
tity of the drug be  used,  but its action  is
rendered quicker and  more precise, while the
stomach  is not so  much  disturbed.  Thus
there are cases where the   patient  can take
very  little food, and opium  or morphia swal-
lowed in medicine will bring on sickness and
distress ; but if a smaller quantity be inserted
under the  skin, the stomach will be at rest,
the pain relieved  and no disagreeable effects
follow.  The fluid, which is  concentrated, so
that five or ten drops  will suffice, is placed in
               HYSTERIA            229

a small  glass syringe so graduated that one
can easily see  the  exact amount to be  in-
jected.  To  the lower end of the syringe is
attached a fine and hollow needle, so that the
skin can be  readily pierced and the fluid in-
troduced.  It is not necessary to  inject close
to the seat of pain ; any part of the skin will
do equally well, and  a portion which is less
sensitive is the best, as the outside of the arm
or shoulder.   Very slight  pain attends the
operation, but it should not be adopted with-
out medical  advice,  as  poisonous  effects
might follow its use.
  HYSTERIA is a malady chiefly confined
to women, but  by no means necessarily so ;
though if it does occur in the male it is in the
weak  imperfect  creatures,  who approximate
to woman mentally  and morally if they do
not physically.   The  fact that hysteria may
prevail  in  the  male  does away with the
notion that it is in any way  connected with
the womb or ovaries.   Hysteria is apparently
connected with, if not due  to, an imperfectly
balanced  mental and moral  system.  The
controlling faculty  is  either in abeyance or
imperfectly developed, while the  susceptibil-
ity of suspension is often morbid.  It is most
common in young women who are unmarried
after the ages of puberty up to a very variable
period,  this period depending in gieat meas-
ure on the time  when hope of marriage be-
comes faint.  It is much less frequent  in
married  women  who  have children, but  in
married women who have none it is perhaps
most  common  of all.  The hysterical  ten-
dency  manifests  itself  in very many  ways ;
sometimes it assumes the form of a  regular
stereotyped  kind of  fit.   In  others  it may
simulate any disease  under the sun, and fre-
quently it appears in  the most anomalous
shapes it is  well possible  to conceive.   The
true hysterical fit or paroxysm commences in
various ways ; most frequently the patient is
observed for a second or two  staring before
her with her eyes wide open  and then falls
to the ground.   Here she may lie quiet for a
moment as if dead, then suddenly begins  all
sort of shrieks, screams  beating of the breast
with  clinched fists, tearing the hair  or gar-
ments, seizing  and scratching anything near
at hand.  Somelimes the limbs  seem  con-
vulsed and the arms rigid.   Presently the pa-
tient  will be quiet, and suddenly break out
into a fit of laughter,  beating the ground with
her heels ; this again will cease ; she will sob
till you  think she is heart-broken, and this
goes on till she is exhausted, when presently
she will come to herself with a very imperfect
recollection of all that has taken place.  Usu-
ally there is presently a  profuse discharge of
limpid  urine, which  occasionally indeed  is
discharged during the attack,  but this is only
one phase in the  numberless forms  assumed
by  the  malady.   These attacks  sometimes
closely  simulate  those of epilepsy, a similar 
230           HYSTERIA
HYSTERIA
form of malady, and consequently it is of the
greater importance to be able to tell which is
which, the chances of recovery or the reverse
being so  very much greater  in the one than
the other.   In epilepsy there is complete in-
sensibility ; during the attack in hysteria there
hardly ever is ; the patient  generally  has a
notion of  what is going  on, and  sometimes
knows everything perfectly well, as the pro-
posal to saturate her with a pail of  water not
unfrequently brings the patient round. More-
over the breathing is not interrupted, and the
heart-beat is not greatly altered ; the pupil of
the eyes always responds  to the stimulus of
light, and its mode of termination is different.
Epilepsy generally ends in deep sleep, and
the  patient  is completely  unconscious  of
everything ;  not  so in hysteria, as  already
said.  One thing  on  which we  are  wont
greatly to rely is the state of the tongue.  In
epilepsy the muscles of the tongue are con-
vulsed, as  are most of the others.   Accord-
ingly the tongue is thrust forward,  while  the
jaws are ground together, so that it is rare in
a case of well-marked epilepsy for the tongue
to escape laceration ; it is just as rare or even
more so to find it affected in hysteria.
  There are two things very  common in hys-
teria : a choking  feeling in the throat, and
stitches of pain in various parts of  the body.
The choking sensation seems often due to a
ball,  and  hence is termed the globus hysteri-
cus ; the sharp pain, especially as it affects the
head, often goes by the name of clavus hys-
tericus.  Certain  parts of the body are very
liable to this pain  ; these are mainly the left
side under the nipple,  and a corresponding
point behind, so   there may be pain in  the
lower portion of the abdomen, in the knee or
other joints, in the groin, or the top or side
of the head, in fact, in every part of the body,
This pain is often of a very serious character,
and there may be increased tenderness  of
the part, but as a rule a slight stratagem will
serve to divert the patient's  attention, when
both pain and tenderness will disappear.   It
is the opposite condition to this which some-
times enables hysterical  women  to appear
perfectly insensible to all pain or injury to
certain  parts of the body, and  has rendered
efficient service to various kinds of impos-
tors.  Akin to this is a tendency on the part
of some hysterical females to attract to them-
selves public attention, and so deprive them-
selves of  food in  order that they may  seem
to exist without it.  Such usually take to bed,
and as they undergo no exertion an  exceed-
ingly small quantity of nutriment will suffice
to keep them alive.  Such a case  was once
known as that of the Welsh fasting girl, where
the unfortunate creature  was allowed to die
instead of being made to swallow her food.
If carefully watched and deprived of the small
quantity of food they require, and which they
manage to secure unseen, they are bound, as
would be any living thing, to perish.   There
is but a step from this to the shamming of dis-
ease, and there is hardly a disease under the
sun which may not and has not  been simu-
lated by hysterical  women.  But there are
some which are hardly feigned ; chief among
these are cough and shortness of breath or
breathlessness ; hiccup, too, is  another thing
commonly assumed, as is yawning and  sob-
bing, but it is very hard to say where the vol-
untary  and  the involuntary impulses begin
and end.  For it is useless to look upon hys-
terics as other than a real disease, tormenting
alike to the patient and to the patient's friends,
and  to  suppose  its assumption  is  entirely
voluntary on the part of the  female is a great
mistake.  True, the symptoms  can be got rid
of by powerful mental influences, and  not un-
frequently are so got rid of, but the disease is
not cured except the patient be at the same
time removed from  the mode  of life which
has led  to the loss of controlling power ; the
malady is sure to return.  Still worse policy
is it to yield to  such patients one  single iota.
There is one rule, and  one rule only—" kind-
ness and firmness ;"  the judicious use  of
these will  overcome the most troublesome
cases.   There  is  a form of hysteria very
troublesome.  The patient complains  not of
paralysis, but of so much pain that inflamma-
tion is suspected, and the pain sometimes re-
mains  for years.  Occasionally when there
has been injury to a joint, the hysterical con-
dition remains long after the injury has been
cured.   These two classes of cases constitute
the great field of diseases  to various kinds of
quacks,  bone setters  and the like, those who
tell their patients to get up and  walk with the
desired  result.
  Treatment.—The treatment of hysteria re-
solves itself into management during an acute
attack and management during an interval.
Suppose the  patient has a  fit and struggles
about, the best  thing to be done is to remove
all tight fastenings about the body, surround
her by cool air, and prevent her from hurting
herself.   No more fuss should  be  used than
is necessary  to do  this, or  the patient may
continue her struggles very much longer.  If
the attack seems likely to  continue too long,
we must try and stop  it by using sharp but
not brutal remedies.  Cold  water plentifully
applied  to the head and face usually does most
good ; strong smelling-salts held to the nose
are  also beneficial.  Above all,  the  patient
should be kept quite quiet, everybody should
be removed, save a nurse  and the medical at-
tendant, and let her know  that her  case is
understood and  that she will gain no  sym-
pathy.  But the worst of  these attacks must
be allowed to wear  themselves out, for it is
in the interval  that the physician must  aid.
The most important thing is to  obtain  moral
control  over  the   patient. To  this  end
it is  not necessary to  be brusque  or hard, 
ICE
IDIOPATHIC          231
but it is necessary to  be unyielding.   Such
patients  always  have  ill  health,  and  this
must  be   seen  to.   Nervine  tonics,  like
nux vomica  and  oxide  of  zinc,  usually
do  good, and as the  menstrual  function is
generally disordered, iron and aloes may be
prescribed with advantage.  Cold baths and
a healthy, quiet mode of life are of the great-
est service ; early hours should be the rule, and
while the patient  should be treated kindly at
   ICE is the name given to water when it is
 cooled down below 32° Fahr.  Its  properties
 and appearance are too  well known for  de-
 scription.   It is very important as a remedial
 agent.
   ICE-BAGS  are made generally of India-
 rubber, into which pounded ice is placed and
 applied to the desired spot, or it  is equally
 advantageous to break ice into small pieces
 and put them into a bladder ; in this way cold
 can be applied for as long a time  as may be
 wanted without wetting the patient.
   ICELAND MOSS is not,  strictly speak-
 ing, a moss, but a lichen or liverwort,  named
 Cetraria islandica.  The whole frond, as it is
 called, or body of the plant, is used.  It is
 collected  in large quantities in Iceland, and
 is used as food by the natives of Iceland and
 Lapland.   The  soluble portion of the plant is.
 taken up by boiling water, which thickens on
 cooling, and  deposits  a gelatinous-looking
 substance, which,  when  dried, forms a semi-
 transparent mass.  The moss contains a bitter
 principle  of acid  character,  which has been
 called  cetraic  acid.    The decoction  is  the
 preparation used  in medicine as  far  as  the
 substance is used,  and that is but little.  It is
 slightly tonic and demulcent, but has  no
 well-marked property.
  ICHOR.  (See  Pus.)
  ICTERUS.  (See  Jaundice.)
  ICTHYOSIS occurs in two forms.  It is
 met with as  a dryness of the skin in both
 children and adults.   It is usually  congeni-
 tal, and occurs in many members of the same
 family.  The  skin is  dry, harsh, and  rough,
 and it appears as  if  it were too tight for  the
 body.  The epidermis often  peels off ;  on
 the neck it  is rough  and horny, and  in  the
 rest of the body the cracks of the  epidermis
 correspond with the lines in the skin.  In  the
 other form dry and hard grayish or slate-col-
 ored scales appear on different parts of the
body, unaccompanied by any redness or heat
 of skin.  Its most  frequent seat is  on the ex-
tremities, and especially on their outer aspect.
Alkaline baths will remove the  thicker scales,
but they are speedily re-formed. Patients who
are affected with this kind generallydo not en-
joy good health.  Treatment may relieve, but
will not cure this  disease ; the part affected
home, anything like weakness in dealing with
her is worse than folly, is criminal.  Valerian
is commonly given, but about its value opin-
ions do not agree.  The food should be good
and plain ; anything like fancy  in  articles of
diet should  be discouraged ; change of air
and scene are almost always beneficial, as as-
suredly are amusement without excitement,
and an occupation in life.
may be rubbed with oil, and cod-liver oil and
tonic medicines may be  taken internally to
improve the general health.
  DDIOCY might be defined as that form of
insanity where the mind from the first is im-
perfectly developed,  and remains  perma-
nently in this undeveloped state.  This imper-
fect state of the mind seems due to imperfect
development of the brain  itself, and this not
unfrequently  is accompanied  by  defects in
other parts of the body.   A distinction which
is on the whole  useful is commonly drawn
between idiocy and imbecility ;  an idiot being
considered one in whom  mental  or  moral
powers can hardly be said to exist; imbecility
the condition where these exist but are defec-
tive.  Very often the  one is confounded with
the other.   The idiot is  distinguished very
frequently  by  peculiarities of countenance,
and still more commonly by peculiarity of
gait and speech.  Having little governing
power they are liable to bursts of  passion,
and in  these  they may  be  dangerous, but
commonly when excited to passion they  give
way to tears rather than violence.  Notwith-
standing the  defects of  these  unfortunate
beings, much  improvement may be effected
in their condition by careful training.   The
brains of idiots, when examined and weighed,
generally speaking present marked  deficien-
cies.  Say that the average weight of the brain
is 48 oz., the weight  of that of an idiot very
likely does not  amount to  more than half that
quantity ; in some recorded cases not amount-
ing to more than 15, 13, or even 10oz.  Some
of the  parts,  too,  may  be wanting.  Two
very important points need to be borne in
mind with regard to idioc)r : one is, that some
idiots have been known to attain considerable
mental  powers, especially after injury to the
head.  The other is still more important.  It
is a fact finally ascertained that breeding in
and in, as it is called, that  is, intermarriage in
the same family, tends inevitably to lower the
intellect, and  finally,  if  the process be not
arrested, to produce hopeless idiots.
  IDIOPATHIC is a term  of  no distinct
meaning, often used to veil ignorance, and is
given as the cause of a disease  when nothing
else  is known  to give rise to  it ; thus  one
speaks of idiopathic pneumonia and idiopathic 
232         IDIOSYNCRASY
INCISIONS
peritonitis, by which one signifies inflamma- j
lion of the lungs and peritoneum respectively,
in cases where there is no apparent cause for
those disorders.
  IDIOSYNCRASY  is  the  professional
term for that condition of mind or body which j
is commonly known as antipathy. Some per- j
sons are peculiarly affected by certain smells,
sights or noises, and  these we  call their idio-
syncrasies.   The smallest  possible  dose of  a
particular drug will, in some  cases, produce
trie most violent and  peculiar  effects ; some
articles of ordinary diet likewise ; one man
cannot eat any shell-fish without breaking out
in an eruption all over the skin, another can-
not bear the  smell  of  flowers  without faint-
ness, and  these results are technically called
idiosyncrasies.
  ILLUSIONS are sensations without  cor-
responding external objects ;  when the eye is
the seat of the sensation it is spoken of as  a
spectral illusion, phantom, or hallucination ; |
an illusion means a mockery, false show, or I
counterfeit appearance, and  is opposed  to |
delusion, which is a chimerical thought.  An j
illusion of the senses,  if believed to be a real-
ity,  becomes a delusion of the mind.  (See
Insanity.)
  IMPETIGO is a  skin  disease most fre-
quently met with in children  ; it occurs also
more especially in  those who  are  badly or
grossly fed, or who have not  thoroughly re-
covered from an illness, as measles or scarlet
fever.  Generally found on the face, it begins
as small pustules, slightly raised  above the
surface, and surrounded  by  an angry red
blush ; the pustule is about the size of a pin's
point, and of a yellowish-green color, so that
if pricked a  minute quantity  of matter  will
exude.  They are at first separate from each
other, but as the child picks  them  they run
together and  form a bleeding surface covered
with scabs ;  this condition is similar to what
is met with in eczema, and has been termed
porrigo.  (See Porrigo.)  The angles of the
moath, chin, and cheeks, are the parts chiefly
affected,  and  this  disease has a great  ten-
dency to spread, because the matter exuding
from the pustules  is so acrid  and irritating
that if any other   part is touched with  it
another spot  rapidly  develops.   The  child
has often at the same  time spots about the
arms and legs.  The  treatment consists  in
preventing the  child from  picking or rubbing
the spots,  so  as to  prevent their spread as far
as possible ; the eruption  should be washed
twice a day with oatmeal and hot water, and
not  with soap ; zinc  ointment should be ap-
plied night and morning, and the child's health
should be  improved  by a careful diet  and
steel wine twice a  day ; the  bowels may be
kept open by  Gregory's powder, and every
day  exercise  should be taken in  the open
air  ; by this  method  a cure  may  soon be
effected.
  IMPOTENCE, deficient or absent sexual
power, is a subject which in a volume like the
present requires to be handled with delicacy.
Nor indeed would it be  touched  upon at  all
were  it not that the  plan of systematically
ignoring it has  produced disastrous conse-
quences.  There are  few things  which have
given rise to so much mental torture as the
idea of the want of  sexual power, and per-
haps there are few faculties so seldom absent,
but being peculiarly subject to nervous influ-
ence,  it may be  lor  the  time in abeyance ;
then,  too, the idea of impotence tends to per-
petuate the condition.   So, too, still more do
efforts to overcome it, until at last the unfor-
tunate individual is sometimes driven  to acts
of the rashest self-violence.  For such indi-
viduals there is  nothing like peace of mind
and rest of body.  Excitement is  most preju-
dicial.  In all probability the condition will
depart of its own accord in due time.  Mean
time interference is sure to do harm.   Rigid
continence and chastity  in thought, word, and
deed,  should  be practised for the  time being,
until a more healthy condition of things comes
about.  This may seem  very hard counsel,
but it is the best; this refers especially to  in-
dividuals who have led healthy lives, but whom
overwork or over anxiety have  for the time
being incapacitated ;  but there is,  however,
another class who  have  had themselves  in
part to  blame  for  their  condition, real  or
fancied.   In these,  too, the mental condi-
tion is the most important part of  the malady,
especially the habit of studying each inward
feeling or emotion.   Such are often  subject
to exhausting discharges which will not cease
until   the  mind  and  body both  become
healthier.   To both of these classes we very
earnestly desire to speak.  We counsel them,
if they  love  their own  peace of mind and
future comfort, to have nothing to do with
t e class of advertising impostors who prey
on  such unfortunates.   Let them  apply  to
the best and most respectable medical  prac
titioner within  reach,  fearing nothing,  for
these  things  are well known and carefully
studied among such.
  INANITION is  the  condilion brought
about  by bad  feeding,  or  by giving  food
which is deficient in quantity or in quality,  cr
in both respects ; it is a too frequent cause of
death in infant life ; the child gradually loses
flesh and" wastes to a skeleton,"  until finally
death takes place by exhaustion.
  INCISIONS  are a division of the  several
tissues of the body, whether made by  knives,
scissors, or  saws, though the term is gener-
ally applicable to such as are made by a sharp
cutting edge.  In surgery, rules are laid down
for the various incisions requisite in perform-
ing operations ; and it is  only by long  habit
and a just appreciation of the densities of  t' e
various tissues met with, that  freedom and
certainty are acquired.  Such incisions  must 
INCOMPATIBLES
INDIGESTION          233
 be made with some definite purpose, with de-
 termination and steadiness, so  that the oper-
 ator neither injures his patient nor his assist-
 ants.   It is obvious that an accurate anatom-
 ical  knowledge is necessary, and no  one
 should attempt to incise any part of the body
 without  an intimate acquaintance  with its
 structure.
   INCOMPATIBLES are remedies which,
 when mixed together,'destroy  each other's
 effects, or  materially alter them.   It was at
 one time the universal custom to order  sev
 eral substances in the same prescription,  one
 of which, if care was not taken, might neutral-
 ize or destroy the effects of the others.  This,
 of course, had to be guarded against, and so
 lists  of incompatibles used to be given with
 each remedy.    Nowadays we  tend more to
 give remedies  singly, and to incompatibles
 are of less  consequence.
   INCONTINENCE  OF  URINE is  a
 troublesome symptom, occurring at different
 ages from various causes.  -In children ic may
 arise from  bad training, or from some irrita-
 tion in the  penis or bladder ; such  children
 should be  made to pass water just before
 going to bed, and may even be roused in the
 night for the same purpose ; if punishment be
 of no  avail, search should be  made  for  a
 cause, and  sometimes when proper training
 will not cure it, some  tonic, as  iron wine
 combined with belladonna, will do good ;  if it
 is due to any abnormal condition of the penis,
 a surgical  operation may have  to  be per-
 formed.  In adults it  may come on from pa-
 ralysis of the bladder, as in cases of paraplegia,
 where, from over-distension, the urine drib
 bles away ;  the treatment will consist in draw-
 ing  off  the urine  night and morning with a
 catheter, and in keeping the patient  dry  and
 clean so as to prevent the formation ot bed-
 sores.  In  young hysterical women it  some-
 times occurs, and the best thing for them is
 cold bathing, change of air and scene, healthy
 and useful  occupations, daily  exercise,  and
 avoidance of hot  and overcrowded rooms,
 late hours,  and  morbid mental excitement.
 In old  people  this symptom may come on
 from an enlarged prostate, or irritable blad-
 der, and for this condition very little can be
 done except daily catheterism.   In those also
 who suffer from  a fistulous opening  into the
 rectum  or vagina, or in those who have a false
 opening in  the urethra,  this condition may
 prove very distressing from the constant flow
 of urine ;  perfect  cleanliness must be  en-
joined, and  a piece of sponge may be so  ad-
justed  as to catch  any  fluid that dribbles
away ; if  a  stricture of the urethra  is  the
cause, surgical interference must be resorted
to.
  INDIA RUBBER,  or  caoutchouc, is  the
inspissated milky juice of several very differ-
ent trees of tropical  climates.   The juice is
obtained from incisions in the trunk, and is
 poured in successive layers into jars, where it
 hardens.   In  its  pure state caoutchouc  is
 nearly  colorless,  and the  dark blue which
 most of it has in the crude state  of commerce
 is produced by the smoke to which it is sub-
 jected in drying.   The elasticity of soft rub-
 ber  articles is of rather uncertain duration,
 and manufacturers will seldcm  guarantee it
 for more than three months, though it gener-
 ally lasts  much  longer.   Hard  rubber or
 ebonite is  made of pure caoutchouc and sul-
 phur,  subjected to high  and long-continued
 heat.  It is very strong and  elastic, and takes
 a very high finish  ; and optical  and surgical
 instruments are composed in part and some-
 times entirely of this substance.
  INDIAN HEMP.  (See Hemp.)
  INDIAN   POKE.    (See   Veratrum
 VlRIDE.)
  INDIGESTION, or dyspepsia, as it is also
 commonly called,  is mainly due to simple de-
 rangement of  the  powers of digestion,  with-
 out any eventual change in its organs.  This
 derangement is dependent on weakness ; but
 the source of the weakness may  be local, that
 is, confined to the stomach  ; or  general, that
 is, due  to something which  affects the whole
 system.   To this group,  too,  belong the
 changes which  take place   in the digestive
 organs  in  old age.  Another large group of
 indigestions are connected with inflammatory
 changes in the stomach.  These changes may
 depend on various causes ;  very frequently
 improper food—improper, that is, in quantity
 or quality—is at the root of the mischief.  Yet
 another form of indigestion is due to nervous
 influence ;  witness the effects ef anxiety, fear,
 and  the like emotions in completely averting
 not only appetite but digestion.
  It is true that the intestinal fluids are also
 concerned  in digestion, and so alterations in
 the secretions of the liver, pancreas, and other
 organs, poured into the small intestine, must
 have a powerful influence in  retarding diges-
 tion or  rendering  it imperfect.   But  though
 vve can  sometimes clearly distinguish the par-
 ticular form of  indigestion from that due to
 imperfect change in the stomach, it is better
 to consider indigestion first of  all as due to
 the stcmach only.
  Process cf Digestion.—A brief word as to
 the relative functions of various organs con-
 cerned  in  digestion is  necessary to a  clear
 understanding of those defects which  consti-
 tute  dyspepsia.  Our food may  be taken to
 consist mainly of three kinds of  substances,
 which are represented to a different degree in
 almost every article of diet, yet are present in
 some form or other in most  dietaries.  These
 substances are starch or sugar, which can be
derived from starch, oil, or fat, and albumen,
or white of egg, which may be  taken as the
type of all kinds  of meat.   Suppose, then,
our dietary is mainly composed of bread and
meat, we have in this dietary the starchy ele- 
234          INDIGESTION
INDIGESTION
 ment represented in the bread, the  fatty in
 the fat which is contained in all meat, even
 the poorest, and  the albuminous in the lean
 portion of the same.  Bread, too, contains a
 certain proportion of the albuminous element,
 being most abundant in brown bread, most
 scanty in the finest white bread.  The object
 of digestion is to  convert these several ele-
 ments into a material fitted for the nourish-
 ment of the body.   The first secretion  en-
 countered which has any influence on the food
 as prepared and  ready for swallowing is  the
 saliva.   This speedily converts  the starch of
 the food, especially if that starch have been
 cooled,  into sugar similar to  that found  in
 fruits, and called grape sugar.   But the food
 does  not remain long  enough  in the mouth
 to undergo this  change in its entirety ; it is
 swallowed, and passes on into the stomach.
  Now, whereas the healthy saliva as secreted
 is an alkaline  fluid, the fluid secreted by  the
 stomach, and  called  the  gastric juice,  is
 strongly acid.  In it the saliva swallowed can
 no  longer act  ; but it  is  not destroyed, its
 function only remains in abeyance until  the
 fluid again  becomes  alkaline,  when it  can
 again   go  on.   The  acid  gastric juice  is
 specially  intended  to  alter the  albuminous
 element  in  the food.   It converts  it into a
 substance  which  can   more   readily pass
 through  animal membranes  than itself can,
 and all kinds of albuminous food are reduced
 nearly to the same chemical substance.
  When stomach digestion has finished, that
 part of the food which has not been absorbed
 by the  vessels in the inner  surface of the
 stomach passes on into the  small  intestine.
 There it encounters the secretion of the liver
 called the bile,  which promptly puts a stop to
 all further change such as has been going on
 in the stomach.  Here, too, is poured out the
 secretion  of the  pancreas, or  sweet-bread,
 which enters the intestine along with the bile.
 These are powerfully alkaline, and neutralize
 the  acidity  of  the  gastric juice, so that now
 the change in the starch can  begin again.
 Another  substance,  too,  remains  unacted
 on, that is the fat  contained in the food ; these
 two substances act  upon it,  and finally  by
 converting it into a kind of  soap, partly  by
 suspending it, the fat becomes  r~ady  for ab-
 sorption, and is  taken  up by special  vessels
 accordingly.    The  pancreatic  juice has  a
 further influence  on albuminous substances.
 These it  alters something in the same way as
 does gastric juice,  and  renders them more
easily taken  up  by the absorbing vessels.
The refuse of  the  food  is  ejected together
 with certain other  waste products.   Appar-
ently the  most  important stage in  this pro-
cess, or,  at all events, the one which has been
mainly studied, is gastric digestion, and it is
its imperfections we are  now called on to
study.
  Symptoms of Indigestion.—The  signs
that tell us something is wrong with the stom-
ach  are partly such as the patient  alone is
cognizant of, partly  such  as are appreciable
by the skilled practitioner. There are certain
special signs which tell us  something is wrong
with the stomach, such as flatulence, acidity,
or heartburn, acid eructations,  and perhaps
vomiting.  The tongue used to be taken as a
certain guide to  the condition of the stomach
and other digestive organs, and so the indica-
tions afforded by it were carefully studied.
Though of less value than was supposed, still
the signs afforded by the tongue are not to be
neglected.   The  "*fur," as it  is called, is
formed from the scaly covering of the lips
and cheeks, as well as  from the tongue itself.
This is agglutinated by the saliva drying, and
so gives rise to the furred  appearance spoken
of.   Some people sleep with  their mouths
open ; these have almost  invariably  an accu-
mulation of fur  on the tongue in the  morn-
ing.   This may mean  nothing.   Again, any
irritation of the  mouth may give rise to an
unusually  copious production  of this sub-
stance, and so the tongue  be furred.  This fur
often decays and produces  putrid gases, which
cannot fail to be prejudicial to health.  When
the fur is due to stomach mischief, that is
generally  of an  intestine  or semi-inflamma-
tory character, and thus the appearance of the
tongue and mouth affords  not only  valuable
means for making out the nature of the dis-
ease, but  also helps us to some clew to its
treatment.  The  alterations in hunger  and
thirst  are  often  of value  in  enabling us to
come to a conclusion as to the existence and
nature of  stomachic   derangement.   There
may be loss of  appetite  with  dyspepsia ; if
so, the malady is generally inflammatory, and
rather  acute in its nature.   But in itself the
symptoms are not of great value, being due
to an infinite variety of causes, some of which
have their seats anywhere  save  in the stom-
ach.   The opposite condition  (voracious ap-
petite) is hardly a sign of dyspepsia, though it
does occur.   More frequently  it is associated
with such a malady as diabetes or the pres-
ence of tapeworms..  This is  different trom
the  craving or sinking feeling often experi-
enced.   Eating food repugnant to ordinary
appetites is more a sign of hysteria than dys-
pepsia. Thirst is most common in irritative
states of the stomach, and then mostly mani-
fests itself some  hours after a meal.  Of all
the symptoms derivable from such  sources,
thirst and loss of appetite  are  the most valu-
able.
  Flatulence is a very important symptom of
indigestion.  It is due  either to accumulation
of gas  in the stomach and bowels, or it may
be formed there.   It gives rise to uncomfort-
able feelings, and often to colicky pains com-
monly followed by  expulsion of  the  gases. 
INDIGESTION
INDIGESTION          235
 Undoubtedly, too, the  gas may be absorbed
 by the blood  and given off  by the lungs.
 Even in  health there is present a certain
 amount of gas in the bowels, part of  it being
 swallowed  along with  the  food.  That gas
 which  gives rise to flatulent distension is,
 however, commonly derived from fermenta-
 tive changes in the food swallowed, especial-
 ly if these be too long retained in the  stom-
 ach, as when there is obstruction to  its exit.
 It has been supposed that the bowels  can
 secrete air or gas, and it has been  assigned in
 proof of this that in certain forms of disease the
 bowels become  enormously distended with
 air, which can apparently only have originated
 there.  There is  no proof that the bowels can
 secrete gas.  The distension alluded  to is in
 part at least due  to muscular relaxation allow-
 ing the gas present at  all times to occupy a
 much larger space than usual.
   Acidity  is another important symptom of
 indigestion.  It,  too, arises from  two causes
 —over-formation and fermentative  change.
 The  latter  occurs under  the  same circum-
 stances as does the flatulence produced in like
 manner.   For the fermentation  which sets
 free the gas above referred to produces acids
 —acetic, butyric, and lactic,  when starchy or
 saccharine  substances   and  milk  become
 altered.   These  acids are so readily  formed
 that it is not easy to say whether or no  they
 are normal products of the stomach or are the
 result of  fermentative  changes.  Briefly it
 may be said that  whatever favors the changes
 which give rise to flatulence from fermenta-
 tion also give rise to  acidity.   But another
 cause of acidity must be admitted in excessive
 secretion of acid gastric juice.  Perhaps  more
 frequently, however, if  there  be excessive
 secretion on the part of the stomach, it is of
 an alkaline mucus, rather than of acid gastric
 juice. This is especially the case in inflamma-
 tory conditions of the stomach.
   Heartburn, as  it  is called,  is  present as a
 rule whether the excessive secretion be acid
 or alkaline, perhaps even more in the latter,
 though then it may be due  to  fermentative
 changes in the food.  The sensation  is one
 of burning at the entrance to  the stomach,
 with a  desire to bring up something, which
 commonly ends in a hot burning fluid regur-
 gitating to the back of the throat and some-
 times  being  ejected.  If the  acid be  very
 great in amount, it may set up vomiting of
 quantities of acid fluid.   Pain is not constant
 in acidity.  If the acidity be due to  fermen-
 tation, the pain is longer in  coming on, and
 often ends in colicky pains.  The pain  pro-
duced by  over-secretion,  on the other hand,
very commonly  occurs when the  stomach is
empty,  and is very readily set a-going by a
stimulant, such as a'glass of hot  spirits and
water.  Both forms of acidity, if not checked,
may give rise to dangerous symptoms.  Fer-
mentative change,  as  interfering  more with
 digestion in the bowel, is perhaps more dan-
 gerous than the other, but both seriously un-
 dermine health by  the  exhaustion to which
 they may give rise.  The vomiting of preg-
 nancy illustrates the danger, for  though due
 to different causes, it is sometimes so severe,
 and the exhaustion occasioned by it so pro-
 found, as to endanger  life, or  even  prove
 fatal.
   Pain  in the  stomach  has already  been
 treated of  under the heading of Gastrodynia
 (which see).  It is a symptom of  varying im-
 port,  for some of  the severest forms  of  dis-
 ease are attended with little  or no pain, while
 some of  the more  curable varieties are at-
 tended by pain of an excruciating character.
 Pain  in the stomach may be due to irritating
 substances in its interior, derived from with-
 out,  or  perverted secretions derived  from
 within.   It may be due  to profound altera-
 tions  in its texture, or to those  imperceptible
 alterations which we ascribe to altered nerve-
 power.   The question how far this pain may
 depend on altered nerve-power is not easily
 answered.   Usually  this is  accompanied by
 some alteration  in the secretions.  Perhaps,
 too, there may  be a kind of cramp  or spas-
 modic contraction of the  stomach, which may
 give rise  to acute pain.   Undoubtedly, too,
 there  is a neuralgia of the stomach. In these
 cases  of purely nervous  pain digestion may
 go  on well enough  during the intervals of
 ease.  Purely neuralgic pain is especially com-
 mon in  females during  the earlier period of
 maturity, when they are also especially liable
 to other nervous  symptoms.  Some  of the
 cases  which seem to exemplify  pain in the
 stomach are, however, cases of  pain of the
 abdominal walls.
  Vomiting is  a very complex act, and  due
 to many causes.  It is mainly produced by the
 compression of  the stomach against the dia-
 phragm by means of the  abdominal muscles ;
 but the  walls of  the stomach and  various
 other parts participate in the action.   It may
 be induced by irritating  the nerves, either at
 their centres in the brain, or where they end,
 in the stomach and neighboring organs. Con-
 sequently we have vomiting  in head affections
 as well as in affections  of  the stomach and
 neighboring organs.  As a means of diag-
 nosis  it  may be said that  vomiting  arising
 from  irritation  of the stomach  is attended
 with more or less pain, the tongue is furred,
 and there is a feeling of heaviness and nausea
 preceding the act.  These are rare when the
 vomiting is due  to cerebral symptoms.
  Causes of Indigestion.—As to the causes
 of dyspepsia,  the first we shall deal with  is
 unsuitability of food, and the food may be un-
 suitable both as regards quantity and as re-
gards quality.
  The human digestive organs, from the teeth
downward, are fitted for  a mixed diet, partly
animal,  partly  vegetable.   An   undue pre- 
236          INDIGESTION
INDIGESTION
ponderance of  either of these,  therefore, is
likely  to  lead  to  injurious  consequences if
long continued.   The  excess of saccharine
material gives rise to an undue secretion of
acid in the stomach, which is not reabsorbed,
and disorders  digestion lower  down  in the
alimentary  canal.   Excess of  starchy  food
seems  altogether incapable of being digested
under  ordinary circumstances, and so  passes
into ferment  and undergoes  the changes
which  give  rise to flatulence.   Again, a cer-
tain amount of indigestible material is mingled
with all our food.  It  does  good so  far by
distending the bowels  and  so inducing  in
them the movements needful  to carry  the re-
mains  of the food,  digested or undigested,
out of  the body.  If,  therefore, the food is
too nutritious, as in those who live highly,
there is not enough of this material in  it, and
so the  bowels become confined.  On the other
hand,  very poor diet, containing little nutri-
ment, is apt to irritate the bowels, and  to give
rise to  indigestion and, perhaps,  diarrhcea.
Certain, indeed most, articles of  food undergo
in course of time changes which render them
unfit for human use.  This takes place under
almost any condition, but is  more likely to
take place  under some than others.   Thus
putrid  meat or  fish, sour bread, and  imper-
fectly or excessively fermented beer, give rise
to irritation of  the stomach, or even to worse
consequences.  One of the most  potent causes
of dyspepsia is deficient mastication, and this
interferes with the digestion both of meat and
starchy substances ;  of meat, because it is not
sufficiently  triturated to be acted upon with
advantage by the gastric juice ; and of  starch,
because that is imperfectly saturated with the
saliva.  Insufficient mastication  is a common
fault in these days of hurry ;  men  too often,
especially in the morning and mid-day,  bolt-
ing their food.   (This is one grand reason for
postponing the principal meal of the day  until
the hurry is  over.)   Again, from various
causes, people  nowadays, lose their  teeth
earlier than they  were wont, and this loss
sadly interferes with the due pulping of the
food.  The remedy for this  is a good  false
set.  When from any cause the saliva becomes
altered, as it sometimes does, its  action on
starch  may be entirely prevented.   This may
occur when the  secretion of the mouth  itself
is acid.    Such conditions are  exceedingly
liable,  if starch be much used in food,  to give
rise  to flatulent indigestion.   The quantity
of food  is  quite as important as  its quality.
It is  notorious that excessive  quantities of
food, excessive, that is to say, as  regards the
powers of  the stomach, are in a certain  class
the most prominent cause of  dyspepsia.  The
stomach seems in  most cases  only to  secrete
enough gastric juice to digest the food neces-
sary to the wants  of the system ; the  rest is
passed on to ferment or putrefy in the  bowel,
and so give rise to the tortures of dyspepsia.
When the digestion is good, and this surplus
food is digested, obesity results ; or the food
so taken into the system is only imperfectly
consumed, is not readily extruded, and so the
phenomena of gout ensue.
  Irregularity in taking food is a great draw-
back to perfect digestion.  This is the more
so, of course, if the intervals  are  too  small,
if   the   individual   is   constantly  taking
" snacks" between meals, just to  get  rid of
the   faintness.  And  this  must be remem-
bered, that an  interval which is  quite large
enough  for  one is altogether too small for
another.   If  a man is working hard  in the
open air  he  can digest twice as much food—
and many times more of some kinds of food—
as on who lives an habitually sedentary life.
  Deficiency of food, accompanied as this
almost invariably  is by unsuitable food, is a
serious cause of dyspepsia, among  the poorer
classes.   Indeed, among  the  out-patients of
a hospital, three great things  may be said to
lie at the root of most  cases of  dyspepsia,
and they are sufficiently numerous ; they are
tea, hunger, and alcohol.  The hunger leads
to the use of the others as stays, and the con-
sequence is, most  troublesome forms of  dys-
pepsia of the irritative kind.
  Certain causes of dyspepsia are located in
the stomach itself, and these may  be mainly
referred  to  such  conditions as obstruct the
passage of food  through it, or to  alterations
in its secretions.   The stomach,  like other
portions  of  the  alimentary canal,  has the
power of expelling its contents in due time.
But  these movements may be impaired, as
when the stomach  is atrophied and dilated.
The movements of the stomach itself may be
arrested, as may those of other parts  of the
alimentary canal ; but this is not likely in
simple dyspepsia.   So, loo, indigestion  may
result from  obstruction at the intestinal end
of the stomach ; but that being of a cancer-
ous  kind, or of some other  new formation,
withdraws it from the realm of dyspepsia pure
and  simple.   Adhesions of the  stomach  to
surrounding organs interfering with its move-
ments, and  not likely to be discovered  save
through the signs  of  indigestion it gives rise
to, may be referred to here, but only referred
to.
  As to altered secretions—these being two in
number—deficiency of the active one, that is,
the true  gastric juice, is  often  accompanied
by an excess of the  other, which  is mucus,
and that is worse  than useless.   The secre-
tions are undoubtedly influenced by changes
in the blood itself, as is well seen  in Bright's
disease.   And alterations in the functions  of
the other digestive organs, which  take effect
lower  down, will  doubtless  directly  or in
directly influence the stomach.
  The precise mode  in which the nervous
system influences gastric  secretion  is not very
plain,  but that such an  influence exists  is 
INDIGESTION
INDIGESTION          237
patent to all, as witnessed  in the manifesta-
tions of anxiety, sorrow, fear, and even joy.
Most probably  this takes effect through the
sympathetic nerves. There are certain forms
of the malady,  too, which depend  on what
has been called reflex irritation.  Thus con-
stipation is to many, especially to those not
habitually its subjects, one of the surest causes
of a temporary indigestion or loss of appetite ;
but it is just possible  that the  same  cause
which in these has produced the constipation
may also produce the indigestion, more dis-
tinctly if this reflex character is the indiges-
tion due to the presence of worms.   True, in
a considerable number of cases, worms rather
give rise to increased appetite than to loss of
it ; but this  is perhaps true rather of  long
worms  of  the taenia kind than of the small
round worms, which give rise to so much irri-
tation in the  parts infested by them.
  Atonic Indigestion.—The three main va-
rieties of indigestion are the atonic, the nerv-
ous, and the  inflammatory.  The atonic form
is almost invariably chronic, rarely attended
by fever or pain, but indicated by a dull sense
of weight, uneasiness, and languor, especially
after taking food. Very generally, too, there
is  depression of mind—hypochondria  in the
male, or hysteria in the female.  Weakness
of digestion  is very often  accompanied by
weakness of other organs besides the stomach
—weakness,  too, of a hereditary origin.   In
aged people this form of indigestion is almost
habitual, and is exceedingly easily made worse
by any indiscretion of diet, a sub-inflamma-
tory from being thus induced.   Such a form
of indigestion is,  however, still  more fre-
quently one's own act, or at all events depend-
ent on one's  habits of life,  whether  these be
voluntary  or otherwise.   The  digestion  in
these cases is excessively slow, and frequently
continues from one meal to another.  There
is also a feeling not amounting to pain, ex-
cept in hysterical women, but apparently giv-
ing rise  to imperfect respiration or want of
breath, or a feeling as if something had stuck
in the throat.  There is flatulence, and very
likely eructations of acid, or more likely un-
digested or half-digested  food.  Frequently
the eructations  are offensive  or acid, and
these occur some hours  after food.  The flat-
ulence is not confined  to  the  stomach,  but
affects the bowels also, giving rise to trouble-
some distension.   The appetite as  a rule is
impaired, and certain forms of nutriment, as
soups and broths, indeed most kinds of fluid,
markedly disagree.   The  tongue is  pale and
flabby—marked by the teeth at the edges ;
there are marks  of  general  relaxation   in the
mouth and throat, especially about the uvula,
which the patient commonly attempts  to re-
lieve  by hawking.  The bowels are usually
constipated, and the gases passing along them
give rise to unpleasant  noises, though  there
may be no sensation of them.   Frequently
the bowels become distended at one particu-
lar spot  by accumulations, and  ihis is not
relieved by purgatives.  The breath  in these
cases is  ordinarily offensive.  The evacua-
tions are  usually hard and deficient in bile,
but in a good many cases this alternates with
the opposite condition.   In these cases, too,
the pulse is slow and weak, but readily raised,
so that if the  patient be  examined imme-
diately after exertion he would seem to have
an unnaturally fast pulse ;  palpitation, too, is
frequently present ; and these two frequently
lead  the subjects of the complaint  to fancy
themselves affected with heart disease.  There
are no marks of fever about the patient ; the
skin  is soft, flabby, and moist.  The extrem-
ities, too, are  cold, especially after meals.
The  color of the skin is bad generally, sallow
or muddy.  For the same reasons  the nervous
system  is affected, and there is languor and
lassitude and  a sense of  weariness in the
limbs.   Sick headache is  frequently present
from time to time,  and the mental  faculties
are dulled and incapable of prolonged exer-
tion.
  All these general symptoms, as they are
called, point to the fact that this form of indi-
gestion is rather a sign of the constitutional
condition  than that the  constitutional signs
are dependent on the indigestion alone ; for
the stomach  itself  when  examined  presents
nothing which is unusual.  There  may  be
marked transparency and thinness of  the walls
of the stomach,  with  degeneration of  the
tubules which secrete  the gastric juice.   In
slighter  forms  the  particular cells  which
secrete the juice may alone be affected.
  Treatment.—The treatment to  be adopted
for atonic dyspepsia  must have  a twofold
end  : there must be an endeavor to improve
what is called the general tone of  the system,
and special pains must be taken to enable the
stomach to  do  its  duty aright.   It is espe-
cially in cases like the present that due atten-
tion  to food and drink is necessary, and hence
the treatment resolves  itself into dietetic and
medicinal.  As regards diet, we have already
pointed out that in a very considerable num-
ber  of  instances the  indigestion has  been
brought on by overtaxing the powers  of the
stomach by too frequent and  too copious
meals.   It is,  therefore,  necessary here  to
beat back, so to speak, to find the least quan-
tity of nutriment which is required by the sys-
tem, and the greatest which can be  digested
by the stomach in comfort.   Here the condi-
tions of the patient's  life  must be  borne in
mind, for there is a mighty difference  in  the
amount of food which will suffice for a listless
invalid and one habitually undergoing power-
ful bodily exertion.  Moreover,  it is  of  the
first  importance to present this food  to the
stomach m an  easily  digested form.  As al-
ready pointed out, soups  and broths are rarely
tolerated  in such conditions, mainly because 
238           INDIGESTION
INDIGESTION
 they dilute the digestive  fluids too  much.
 Nevertheless, there is one fluid  form of food
 which can usually be taken, that is milk, and
 if it cannot be taken fluid  it may be  coagu-
 lated by rennet.  When arising  from exhaus-
 tion this form of dyspepsia necessitates small
 meals, but these may be frequently repeated,
 and stimulants  may be combined with them.
 Less care  is necessary in the more  ordinary
 forms of the malady, but  there  is the greater
 reason that the necessary care should be taken.
 No salt or preserved meat should be used,
 and  it should be fairly well but not over-
 cooked.  Hence recooked meat is forbidden.
 Mutton and  beef must form the staple diet ;
 game and fowls may be allowed as a change.
 Pork and veal  are  entirely excluded, as are
 ducks and  geese.   Fish  is also permitted
 within certain limits ; herrings and salmon are
 beyond these, and so not allowed ;  eels and
 trout are  on  the  border land.   The best for
 ordinary use are plain boiled turbot,  whiting,
 or haddock.  Shell-fish, except oysters,  are
 entirely forbidden.   Still more care is  neces-
 sary with regard to  starchy food.  All vege-
 table food should be cooked, none raw, and
 it should  be  young, tender, quite  fresh, and
 well boiled. Some authors exclude grease en-
 tirely ;  for our part we are much more inclined
 to exclude the starchy foods, as potatoes and
 over-ripe peas.  It is better on the whole to
 try  stale bread, macaroni,  and  rice, with
 some green vegetables, than to use potatoes.
 Such at least is  our experience.  Light pud-
 dings are permissible, not heavy doughy prep-
 arations,  and all pastry is to be  forbidden.
 Butter may be  used  with  bread,  but  in  no
 other way, and it should be quite fresh.  Fat
 or oil in any other shape is  inadmissible.
 Fruits must be  carefully selected ; but most
 may  be eaten,  or rather sucked,  provided
 everything solid—husks, seeds, and woody
 matter—be spat out again.   Nuts of all kind
 must be rejected.
   But briefly, each  man must be a rule to
 himself : whatever  he  finds disagrees with
 him should be avoided : very often, though, it
 is quantity rather than quality which  is at the
 bottom of the mischief.
   Three meals a day is perhaps the best rule :
 breakfast, say at nine, something about one,
 and dinner at six.  Too  long intervals are
 almost as bad as too short; especially should
 the  sufferer  aim at cheerfulness during  its
 digestion and absorption.   To aid this there
 is nothing better than a moderate quantity of
good wine.   Port rarely suits, and should be
avoided ;  dry  sherry usually  does  well ; a
sweet sherry is  most hurtful.   Good  sound
vin ordinaire suits  most,  if diluted  with at
least its bulk of  water ; while  some  do best
on weak brandy and water.  Laying down a
rule  to  be governed by circumstances, we
should say all others are better avoided.  So,
too, is tea after dinner : that almost invari-
ably does harm ;  not so black coffee, moder-
ately strong, with a teaspoonful of brandy in
it.  As a rule that  suits, but it must not be
swallowed hotter than the temperature of the
body, or a little over, so as to feel pleasantly
warm.
  All the other matters tending to a restora-
tion of  health must be observed.   Change of
air and change of  scene, a sea-voyage, etc.,
will often do great good ;  but as the invalid
is greatly dependent on food for  his cure he
should  seek to recruit himself where good
plain cooking and sound food is to  be had.
Walking exercise, not the mad scrambles on
the Alps of some, but a good steady walk of
twenty  miles a day with an old-fashioned inn
to rest at in the evening, will often do marvels
in the way of cure.   A cold tub in the morn-
ing should be the rule to all who can stand it;
if not, one as cold as possible, but not warmer
than tepid should be used.   If a settled resi-
dence is desired, one of the bracing localities
alluded to  already should be selected.  (See
Climate and Health Resorts.)
  To the mass of the public, treatment by diet
and regimen  is  far  more  important  than
treatment by drugs, as being far more under
their  power of control.  Nevertheless, even
in these most frequent of all maladies, drugs
may  not  be neglected.   Chief, in point of
fact, among the remedies  to be used  is iron
in some one  or  other of its  forms, nor  do
some of the vegetable bitters come far behind
it.  Frequently, however, iron cannot be given
from  the beginning ; some preparation of the
stomach may be necessary to  provide for its
reception.   An alkali and a bitter , as col-
umba, are frequently the best drugs to begin
with.    Liquor potassium  and gentian, too,
are useful, but this is mainly when there is no
inflammation superadded to the atonic condi-
tion.
  In simple atonic dyspepsia we can as a rule
give iron from the beginning, but rarely such
preparations as the  sulphate or chloride.
Usually vve must begin with reduced iron, the
carbonate or ammonia citrate,  and these may
be given along with  meals, though best, per-
haps,  before it.  If  not well borne they may
be given effervescing, but even then they may
cause irritation ; if so, a phosphate  may  be
given.  Usually we may  combine with  the
iron nux  vomica in some shape or other,
though  perhaps  it is sometimes  best  given
by itself.  There are certain cases where the
tincture of the bark of nux vomica does bet-
ter  than the alkaloid strychnia, though  the
latter with  a mineral  acid is a most  efficient
tonic.   Quinine itself does  not  seem to  do
particularly well, but some preparations of
bark,  especially the liquid extract and com-
pound tincture,  answer well where there is
no irritability. Of the other bitters commonly
used besides columba and  gentian, cascarilla
and chiretta seem of undoubted value.  The 
INDIGESTION
INDIGESTION          239
 former, combining slight stimulant properties
 with ils bitter, is very useful in many of these
 cases.  The hop, too, in the form of good bit-
 ter beer, is not to be despised.  Ipecacuanha,
 where  there is considerable irritability  of
 stomach, is valuable ; but its use, and that of
 certain  other remedies,  belongs  to another
 form of dyspepsia  altogether.  In  this form
 of indigestion, aids to digestion are of prime
 importance.  Chief among these are the min-
 eral acids and  pepsin.   The normal acid of
 the gastric juice is hydrochloric, and perhaps
 on that account we  should be led more natu-
 rally to prescribe it than any other to aid di-
 gestion.   Nevertheless, it has seemed to us
 that a mixture of nitric and hydrochloric acid,
 which  acts much in the same  way as does
 hydrochloric acid, is a better preparation.   It
 should be given in doses of 10 or  15 drops in
 some bitter preparation, as tincture of orange-
 peel or infusion of columba, just before, dur-
 ing, or after food ; that is, if the meal con-
 tains meat or allied substances, not otherwise.
   Pepsin  is even a more valuable remedy,
 though  it has been much decried,  probably
 on account of  the very  inferior preparations
 abroad.  It cannot be made  a cheap prepara-
 tion, unfortunately  ; and most  attempts in
 this direction have simply meant impurity or
 adulteration.   It is  found useful not only in
 adults  but also in children.   For  an adult
 five or  six grains will suffice, and it  may well
 be given  with  hydrochloric  acid,  as above
 stated.
   Nervous   Indigestion.—We have  dwelt
 at this  length  on  atonic  dyspepsia both
 because it is one of  the  most frequent  mala-
 dies of  the kind encountered, and  a knowl-
 edge of how to anticipate its effects and to
 dea'l with it dietetically is of the utmost im-
 portance.  The next group  is not  so easily
 defined, or, at all events, not so easily appre-
 ciated by the public  ; we shall call it nervous
 dyspepsia—dyspepsia  or indigestion that is
 due to interference with the functions of  the
 nerves,   In  many respects nervous indiges-
 tion is allied to atonic indigestion, but there
 are certain special  causes worthy  of  note.
 They are much more frequent among women
 than among men ; but exhaustion  or general
 weakness may reduce a man to a somewhat
 similar condition. The whole group  of symp-
 toms, of which the  indigestion is  one, are
 commonly grouped  under the heading hys-
 teria.  The condition in  the male, called hy-
 pochondriac, is still  more closely  associated
 with indigestion. And the depressing effects
 of chronic alcoholism, though these  give rise
to morbid changes of a  specific kind, are in
part due  to  nervous influence.  The reflex
forms of dyspepsia mentioned are,  as far as
the stomach is concerned, of a nervous origin,
especially certain connected with imperfectly
known conditions of the ovaries and womb.
The pain, which is  one of the most promi-
 nent symptoms of this form of indigestion, is
 usually very  severe  and intermittent.  The
 duration of the attack is variable, from a few
 minutes to hours.   Frequently it terminates
 in acid emitations or the ejection of an alka-
 line mucus.   Food produces variable effects ;
 in  one class  it produces  distinct  relief, in
 others it brings the pain on ; most frequently
 food gives  relief, and  these   are  the cases
 about which there is least doubt.  Commonly
 enough in  this class of indigestion, insipid
 demulcent substances frequently give rise to
 more pain than do  matters of  a more irrita-
 ting kind.   This, too, is a very characteristic
 feature.   In  many cases digestion goes on
 readily enough in the intervals of the attack.
 The most typical form of nervous indigestion
 is that to which the term gastric neuralgia has
 been applied.  This commonly is accompanied
 by vomiting.    There are  many  interesting
 pathological  questions  connected  with the
 mode in  which  these  nervous dyspepsias
 originate, but to the public it is far more im-
 portant to  be able  to  recognize them  and
 know what is best  to  be  done  with them.
 We have briefly alluded to some of their main
 peculiarities.   The  pain generally intense,
 often most so  when the stomach is empty,
 and relieved by food ; the tendency to vomit
 without much nausea,  and from no special
 change in the food ; especially, the tendency
 to nervous pains and disturbances elsewhere
 in the same individual.
  Treatment.—As to treatment, nux vomica
 and iron are the mainstays.   In most cases
 iron relieves the neuralgic pain. The carbon-
 ate is the best preparation,  and if the bowels
 are confined, a little aloes  and rhubarb may
 be given at the same time.   Next after these
 comes opium, but that must  be used with
 care.   In some of these cases, where there is
 also constipation, it would  almost seem as if
 opium opened the bowels.  Aromatic spirit of
 ammonia will  also be found of  great value in
 many cases.  Hydrocyanic acid is also given
 with benefit, though not, I  think, with great-
 est benefit, in this form of dyspepsia.   Of
 course it  should never  be given without a
 physician's  prescription and   instructions.
 Where  there  is much vomiting ice must be
 employed.   (See Hysteria, Neuralgia,  and
 Pregnancy.)
  Inflammatory Indigestion. — The acute
form  of inflammation, such as seen in other
organs, is  rare in the  stomach ; but it is
very  subject  to such  forms  of  inflamma-
tion as occur in  mucous  membranes, and go
by the name of catarrh.  This  acute inflam-
mation of the  substance of  the stomach  ap-
parently occurs almost only in  poisoning by
irritant  substances.  Gastric catarrh, as  the
malady of which we now propose to speak is
commonly called, and which may  be looked
upon as the synonym of inflammatory indiges-
tion, may  be either  acute  or  chronic.  The 
240          INDIGESTION
INDIGESTION
 acute form of gastric catarrh is most common,
 perhaps,  in young children, as in them few
 articles of food prove suitable ; and unsuitable
 food generally brings about an acute  attack
 of indigestion due to this malady.  In those,
 too, whose stomachs  have been  weakened,
 from any cause, a slight addition  to  the  in-
 convenience of digestion may  bring about an
 acute attack of catarrh.  Thus atonic dyspep-
 sia, or whatever causes  it, starvation,  drink-
 ing cold  water when the  system  is greatly
 heated—all may  directly or indirectly bring
 about this condition.   Apparently, too, in
 some epidemics there is a tendency  to  this
 malady.   Thus, in cholera times, there  is a
 great tendency to looseness of bowels, and
 often also to inflammatory dyspepsia.  Other
 maladies,  too, seem to affect the stomach, as
 scarlatina, diphtheria, small-pox,  etc.
   Acute indigestion may assume  any degree
 of severity.   Usually it commences  with a
 feeling of fatigue and heaviness, very likely
 with pains in the back, soon followed  by
 uneasiness in the stomach itself—this  some-
 times amounting to severe pain.  There is
 also a sense of faintness, with weak fluttering
 pulse and  cold  perspiration.    Headache
 affecting the forehead, sometimes with intol-
 erance of  light and  sound.  Nausea and in-
 creased flow of saliva follows  till  the offend-
 ing substance is rejected, very likely with a
 quantity  cf  thin acid fluid.   Then, after a
 period  of rest,  relief follows.   Instead  of
 being thus rejected, the  offending substance
 may  pass  on into the  bowels, when follow
 colicky pains and gripes ; probably diarrhcea
 comes on, and so the substance is got rid of,
 though sometimes a purgative is necessary.
 There is  usually in  this state a  loathing of
 food  and  persistent  nausea.  The tongue is
 loaded  and the breath  offensive.  There is
 also much thirst, though few liquids are well
 borne by  the stomach.   There is also dizzi-
 ness, very often  palpitation, and if there is
 much flatus  in the  stomach the  symptoms
 may almost simulate an  apoplectic form seiz-
 ure.  This is most common when the acute
 attack is superadded to a long-standing one.
 The form of headache which occurs with this
 form of the malady is sometimes  called sick
 headache,  though there is  another form of
 headache   of the same  name.  (See Head-
 ache.)
   Very often this form of indigestion occurs
 some hours after food, frequently after sup-
 per, say early in  the morning.  Besides the
 symptoms already enumerated, there may be
 disordered vision, noises  in the ears, and
 throbbing in the temples and eyeballs.  There
 is great depression,  sighing,  yawning, and
 shivering.  The attack  may last  a variable
 period, generally under forty-eight hours, and
 then  passes  away in sleep.  After waking,
the pain  is gone, but the patient is  weak
and nervous and the stomach irritable. Great
 care must be taken of digestion for a day or
 two.
   If the irritating matters  are  not got rid of
 the  condition  may  last much longer,  and
 prove much  more troublesome.   Indeed, al-
 most everything depends on the  treatment  ;
 if properly managed no doubt the  case  will
 do well in a short lime, but if not it may tend
 to become chronic.   There are, however, still
 more severe  forms of the disorder which may
 simulate  the early  stage  of typhoid  fever.
 Usually, however, there is  a good deal of pain
 in the stomach, a sensation  of burning,  and
 obstinate vomiting, brought  on by the small-
 est quantity  of liquid.   Mucus mainly is so
 ejected, sometimes streaked with blood, more
 frequently mixed with bile, and even after the
 stomach is  emptied the retching goes  on.
 The tongue in these cases is loaded at first, but
 afterward becomes raw, and  sometimes both
 it and the lips become cracked.  There is
 thirst, not easily appeased,  as nothing will
 rest  on the stomach, and the appetite is gone.
 Shivering is common from time to time and
 a feeling of cold, though the skin is too hot.
 The pains in  the back and  limbs continue,
 and  during sleep there is  often  delirium.
 The urine  is  scanty and high colored.  This
 form of disease rarely lasts long if left to it-
 self  or treated properly ; if treated badly it is
 very likely to give rise to prolonged suffering.
  Treatment.—The foundation of the treat-
 ment in all these cases is rest.   First of  all,
 if there is any substance, as there  usually is,
 to give rise to  this troublesome condition, it
 must be got rid of by  emetics.   The best
 remedy in  such cases is ipecacuanha, given in
 20-grain  doses, followed by  full draughts of
 lukewarm water.  Sometimes a few grains of
 sulphate of zinc may be added.  Frequently
 tickling the fauces will be sufficient to set  the
 vomiting a going, and it may then  be kept up
 by warm water.  Very often  the warm water
 itself is quite  enough.   If the substance have
 passed into the bowels, a purgative must be
 given.   The  best  is  castor-oil, if it can be
 retained ;  if not, a  few grains of calomel,
 followed by a seidlilz powder.
  In children,  a dose of gray powder with
 some rhubarb,  or calomel and magnesia, is
 perhaps  the  best thing  to give ;   but such
 must be given with cauiion,  for  they are
 easily weakened, and weakened,  are easily
 carried off  by the malady.  A small  dose of
 castor-oil  will  generally suffice to carry off
 the irritant matters, and careful diet  must do
the rest.
  In the adult,  where there is purging, open-
ing medicine should  be used  with  caution,
 nevertheless  its use is sometimes the first
 step  toward recovery.   A very small dose of
 castor-oil,  or.  perhaps  better, of tincture of
 rhubarb, with  a little  magnesia,  may  be
 given,  but  nothing more.  After that it may
 be even necessary  to use  astringents,  cf 
INDIGESTION
INDIGESTION
241
  which compound chalk powder is perhaps the
  best.  The irritant matters being lessened,
  diet must come in ; before,  anything of the
  kind would be useless.   The patient  must be
  kept absolutely in bed,  and it is better, if the
  individual is a fairly strong one, to let twelve
  hours  or so pass without any solid nutriment.
  A  teaspoonful of solid  beef-tea, frozen  if
  necessary, may be given, but nothing more.
  In a considerable number of instances this
  will be all that is required—no other medicine
  will be needed except  attention  to diet for a
  short time. But in more severe cases, where
  food by the stomach cannot be  borne, and
  food is necessary, nutrient injections may be
  given.  The first food  should  be milk and
  lime-water, or  milk with a little bicarbonate of
  soda in  it, and  soda-water (ordinary soda-
  water contains no soda), or the  beef-tea, or
  essence of beef,  which is  better, or, better
  still,  new pulped  meat.   An exceedingly
  small quantity  of this last will suffice  to keep
  life going for some time.  It may be given to
  infants, too, but sparingly.   In them milk is
  the ordinary diet to be given, but largely di-
  luted with lime-water.   We  disallow farina-
  ceous food altogether, but some  permit and
  even recommend it.  As for spirits, they are
  lo be avoided as far as possible, and all wines
  but  champagne  of  the  driest brand  (Bol-
  linger's) are forbidden.   If stimulants are re-
  quired absolutely,  the  best is  cither a little
  soda-water and pale brandy, or the dry cham-
  pagne  alluded  to.  A mustard  poultice,  or
 even a hot simple fomentation over the pit of
 ihe stomach, often  tends to stop the  vomit-
 ing ; but   cold compress,  consisting  of  a
 towel wrung out  of cold water and applied
 to the stomach,  and covered over with flannel,
 often does better.
   With regard  to internal remedies, the first
 is  morphia, and  it may be given  in small
 doses either as a piil or  subcutaneously.   In
 pill not more than a quarter of a grain should
 be given, and under the skin not more than
 one sixth  or one  fifth.   Tf, however, it  be
 necessary  to use emetics or purgatives, it
 should  not be administered until the action
 has ceased.   It is, therefore,  of  most value
 in the severer forms of the  disorder.  Hy-
 drocyanic acid is rarely of much good in such
 attacks—its use is  in the chronic irritability,
 still to be spoken of.  Sometimes it does well
 given in an effervescing draught.  Bismuth,
 too, is perhaps of greater value in the chronic
 form of the malady ; but even in this  it is of
 great use, provided  it be given in full dose.
 It is best given  along  with  magnesia or car-
 bonate of magnesia, and requires to be given
 in 20 or 30-grain doses  for adults ; for chil-
 dren, 5  to 10.  Carbonic acid in the form of
an   effervescing  draught  is  an  excellent
 remedy. The simplest mode of  prescribing
it is in soda or seltzer-water, but these must
be given with care, on account of the bulk
 they occupy.  For some little time after such
 an acute attack, the rules laid down for atonic
 dyspepsia must be obeyed ;  but if the malady
 passes into the chronic form another plan of
 management must be had recourse to.
    Chronic inflammatory indigestion, or chronic
 gastric catarrh, is  one of the most common
 forms of indigestion.  This malady may either
 originate in some severe irritation insufficient
 to excite an  acute  attack,  but lasting  long
 enough to excite and keep  up a  subacute at-
 tack, or  it may follow on an acute attack,
 when that has been improperly dealt  with.
 Or yet again, attack  after attack, each follow-
 ing on the other  at  frequent intervals,  may
 finally leave the stomach in that irritable state
 vve call chronic gastric catarrh.  Such are very
 common after cholera.
    The atonic dyspepsia, of which we have al-
 ready spoken is not easily separated from this,
 the less so that the atonic condition is exceed-
 ingly liable to be interrupted by  a sub-acute
 attack of inflammation, or even by an acute
 attack, which  leaves  the  subacute behind.
 Diseases which tend  to interfere with the ve-
 nous circulation are very favorable to chronic
 catarrh.   Phthisis,  too, is very  frequently
 complicated by  it, which  accounts for the
 digestive troubles  of the unfortunates who
 suffer from this disease.  So, too, contracted
 liver and contracted kidneys are both very
 frequently  accompanied by catarrh of the
 stomach.   Habitual  excess  in  eating  and
 drinking, too, very  commonly end by pro-
 ducing a chronic inflammatory state ; habit-
 ual obstruction to the passage of food from
 the stomach, so that  it is retained and under-
 goes fermentative changes, which  create irri-
 tation, is  a regular  cause of chronic catarrh,
 this, too,  whether the obstruction is due to
 cancer or to simple stricture.  The symptoms
 of the condition are those of aggravated indi-
 gestion.   The most notable characteristic is
 the tendency to exacerbations, and again to
 fall back into the normal catarrhal state wilh--
 out any very apparent cause.   There is at all
 times a sense of weight and oppression across
 the chest, a general uneasiness after meals,
 and a tendency to flatulence, which  may be
 considerable.   Food may not cause pain, but
 it increases the uneasiness.   The pain com-
 plained of is usually under the left  breast, and
 extends through to  the  corresponding blade-
 bone.  There is rarely tenderness or press-
 ure.  Heartburn  and acidity  are generally
 very annoying ; the appetite is very variable,
 and eating soon  brings satiety—even  the
 presence of a meal is  often  enough to turn
the patient against it.   Thirst is usually well
marked some time after a meal, the tongue is
usually furred, and there is a bad taste in the
mouth in the morning ;  the  tongue in most
cases is flabby, and the papillae on its surface
raised  and  reddened.   In  other   cases  the
tongue is raw red, and inclined to crack, while 
242         INDIGESTION
INFANTICIDE
 in yet others it is covered with a thick yellow
 fur.  The bowels, as a rule, are obstinately
 confined, and there is very often  uneasiness
 of the lower bowel, which is increased by the
 distension necessary for the  passage of the
 hardened motions.   Frequently the hardened
 masses  are covered with  a  glassy mucus.
 These motions are  pale from  deficient  bile,
 and for the same reason the smell is unusually
 unpleasant.  Sometimes the stools are frothy
 and loose, and  this  condition  may  alternate
 with the former. As might be expected from
 the habitual constipation, piles are frequent.
 The skin is dry  and harsh, frequently sallow,
 and often with a tendency to scaly eruptions.
 The hair is dry, and tends to split and fall
 off ;  the  nails  are  furrowed, brittle,  and
 marked with white  lines ; and the teeth fre-
 quently decay.  There is usually marked loss
 of flesh and strength, and the  circulation, as
 indicated by cold hands and feet, is  imper-
 fect.   Nevertheless reaction is  easily excited,
 especially by  an alcoholic  stimulant, when
 the  palms of  the lands and soles  of the feet
 burn, so that the patient presses them against
 some  cool surface.   Headache is frequent,
 but not so regular a symptom as in the acute
 form, and the judgment is almost invariably
 not to be depended on.  Irritability, timidity,
 and despondency are generally present.  The
 sleep is disturbed, or there is  sleeplessness,
 and the heart's action is irregular. •
  Treatment.—The  treatment  of  chronic
 catarrh of the stomach  requires modification
 to the various customs.  To use  a  rule, the
 best treatment is the avoidance of the condi-
 tion ; but if there is an acute attack, tending
 to become chronic,  we must  do  our best to
 stop  it.    Bismuth and magnesia,  with  or
 without alkalies, are the appropriate remedies.
 It is in this condition that nitrate of silver has
 obtained  a great reputation.   It does good,
 but must be used with care.   It is best given
 in pill, half a grain for a dose, along with
 opium or  belladonna.  Oxide of' zinc is  of
 value in those cases where the nervous symp-
 toms predominate.    In some cases, especial-
 ly where food  has been the cause  of the  irri-
 tability of  the stomach, blue pill or calomel
 generally do good ; but in children this,  or
 the gray powder more frequently employed,
 must be used with  caution.   When due  to
 obstruction in  the  portal  system,  mineral
 waters are frequently the best  things to pre-
scribe, especially if they can be taken on  the
 spot.  If not, such water as Pauna, Carlsbad,
and  Friedrickshall are the best.
  For habitual use  as purgatives, too, aloes
are of great service, as they act specially on
 the lower bowel, and so tend  to  relieve the
constipation and piles.  Small doses  of  the
aqueous  extract  or  of the  compound  decoc-
tion  are best given.   Castor-oil is also an ex-
cellent remedy for relieving oppression  and
heaviness about the stomach,  frequently re-
storing a healthy appetite.  Strong purgatives
are, however, to be strenuously avoided ; and
in many cases a small dose  of aloes, iron,
nux  vomica,  and belladonna before  dinner
will do more to keep the bowels open than
anything.  If from alcoholic excess, the liver
must be seen  to, and so mild  mercurials and
salines had best be given with opium if  the
irritability of  the stomach  is great.   Even
astringents may be given to check the copious
mucous secretion from  the stomach.   The
dyspepsia of consumption is most difficult to
manage.  Prussic acid often does good, more
so columba and liquor potassa.  In this malady
purgatives must be avoided, for unfortunate-
ly in its course  there is only too much risk
from the purgation which arises from the dis-
ease.   Pepsin  and acids  are  both of great
value when the irritability has  been removed.
The rules for food are much the same  as  for
acute catarrh and atonic dyspepsia.
  INDIGO, though an important commercial
product, can hardly be called a remedy, even
if contained in the pharmacopoeia.  It is pre-
pared from various species of  plants belong-
ing to the leguminous order of plants.  The
original substance is white ; but from  it may
be prepared  an  indigo  red and an  indigo
blue.   It is this last substance which is com-
monly employed.  Dissolved in the strongest
sulphuric acid, it forms  a peculiar compound
sometimes called sulphindigotic  acid ;  this is
decolorized by chlorine, and is used as a test
of the presence of that substance. Indigo has
been used in epilepsy, but its value is not un-
derstood.  It appears in the urine as a bluish-
green compound"; sometimes  it is found  in
abnormal  urine.
  INDURATION is a term  applied  to the
hardening of tissues around the seat of pre-
vious  mischief ; thus  induration  may  occur
on the  site of an old scar or wound, or an old
abscess, or in the glands under the  chin, etc.
  INFANTICDDE is a term used to signify
the voluntary murder of  an infant, either dur-
ing the progress of its birth or as soon as it
begins to live an independent  existence from
its mother.  In any case where a woman has
confessed her  condition  and made prepara-
tions ever so  slight for  the  expected infant,
the law looks with a merciful  eye upon cir-
cumstances which would otherwise lead to a
verdict of infanticide.  The methods by which
the life of a newly-born  child may be sacri-
ficed are,  in  medical jurisprudence, divided
into  those which consist  in  omitting  the
necessary services required by an infant, and
by inflicting violence.  It should  not be for-
gotten  that an  infant may die  during or im-
mediately after birth, without any criminality
on the  part of the mother, and  in cases of
great exhaustion, where disgrace and  shame
would  attend the  exposure consequent  on
calling for help.  This is undoubtedly some-
times the case, even where there has been no 
INFANTILE  CONVULSIONS
INFLAMMATION        243
intention  or desire to  destroy life.  Accord-
ing to the law of Scotland, the earliest period
at which the crime of infanticide  can be  sus-
tained is  from  the time of quickening.  In
England the  period  assigned by law dates
from the  seventh month, when  the  child  is
supposed to be capable of living. Experienced
surgeons  are able  by  many signs to judge
•from the dead body of a child whether it has
ever lived or been  born dead ; the most cer-
tain proof  is,  however, by post-mortem ex-
amination.   The state of  the lungs  indicates
whether they have ever been inflated with air,
and if so it  is certain the child has lived ; the
next question, therefore, to decide would be,
whether its death  resulted lrom natural  or
from violent causes,  and on this  decision
rests the nature of the verdict in  such a case.
The objection of a  jury to return a verdict  of
wilful murder in the  case  of  newly-born in-
fants evidently killed is often exhibited.  So
many extenuating circumstances  seem to sur-
round such cases, especially where the mother
is discovered,  that every possible  excuse is
urged for appearances which would otherwise
be condemnatory ; but in the large number
of instances where infants just born are found
thrown away in streets, and  concealed  in all
possible places, there  can  be  no  doubt  that
murder has been absolucely  committed, and
almost certainly by the mother, whose natural
instincts are supposed to render such a crime
impossible.
   INFANTILE   CONVULSIONS differ
in a good many respects from the convulsions
of adult life ; they are exceedingly common
in children from the time  of birth up to their
seventh or eighth year, particularly about the
period of their first teething.   They are pro-
duced in a  variety  of ways, and'  often go off
leaving no  evil effects behind them.   The
earliest convulsive  phenomena of the   kind
are  ordinarily  what are called inward fits ;
these commonly occur a few days after birth.
The baby seems asleep, but  its eyes roll  so
that the whites alone are seen ;  it  breathes
with some difficulty, and the face twitches  or
is drawn first to one side,  then  to the other ;
this  is  commonly  produced  by  indigestion,
the mother's milk may not agree, or improper
food  may have  been  given.  A  little dill
water or a drop of one of the volatile oils,  or
a little spirit of  ammonia will relieve for the
time, but this should be promptly followed by
a teaspoonful of castor-oil.  Almost any irri
tation affecting  the nervous system, local  or
remote, will in certain children produce fits.
The frequency and the fatality of these rapidly
diminish  as the child  grows  older.    The
symptoms of such fits vary. Most frequently
the child is  suddenly  taken, loses conscious-
ness  and stops breathing ;  sometimes the
body is stiffened ; sometimes,  and this  is
rather the rule,  it is agitated  by  smart  con-
tractions  and relaxations  of  the  muscles.
Usually the hands are clinched with the thumb
in the palm, while  the face becomes first red,
then livid.  The contents of the bladder and
rectum are  voided,  and  the  eyes squint.
Presently the limbs  begin  to relax, and the
child gradually recovers, presently falling into
a sound sleep.  More rarely it  passes  into a
comatose state and so perishes.  The action
of the muscles is generally  more violent  on
one  side than  the other, hence one side is
dragged to the other.   Most frequently there
is more than one attack, and sometimes they
leave permanent damage of the nervous sys-
tem behind them.
  Treatment.—As regards treatment there is
not much to be  done during the fit ; every-
thing should be loose about the child, and
some water  may  be sprinkled  on the head
and face.   Should Ihe fit threaten to recur it
is best to plunge the child in  a warm bath up
to the neck and  shower cold water on the
head. The bowels should be seen to, and a
dcse of castor-oil given if necessary.  Some-
times an emetic  does good, and any source
of irritation, be it where it  may  or what it
may, should be  sought for  and removed.
Some practitioners recommend the adminis-
tration of ether or chloroform  if the attacks
are continuous, with bromide of potassium in
the intervals.
  INFANTILE  PARALYSIS.   (See Pa-
RALYSIS.)
  INFANTS. (See Dentition, Diet, Feed-
ing-Bottle,  Cholera  Infantum,  Infan-
tile  Convulsions,  Inward Fits, Labor,
Lactation, Paralysis,  Red Gum, and Yel-
low Gum.)
  INFECTION is a term used to denote that
a disease may be carried from one  person to
another  without  either  coming in  contact.
Thus scarlet fever is infectious,  as it may be
conveyed to a distant part in the clothing, etc.,
of an affected person.  (See Fevers.)
  INFLAMMATION  may be roughly  de-
fined as  an unnatural  process,  which  mani-
fests itself  in increased vascularity and sensi-
bility of  the part attacked, and which is asso-
ciated with more or less of constitutional dis-
turbance.  This process varies much  as to
form and degree of  intensity, the  symptoms
being sometimes slight and harmless, as with
the  transient and superficial  redness of a
small portion of the  skin caused by the bite
of an insect, and in  other instances, most
severe and dangerous,  as in acute inflamma-
tion of the  lungs (pneumonia), or of the thin
serous membrane  of the abdomen (peritoni-
tis).   Very few diseased processes occur in
the organism which  are not at some part of
their  course associated  with inflammation,
and the great majority  of diseases are really
due to this process.  In ordinary cold  in  the
head  there  is inflammation  of  the mucous
membrane  of the nose and the adjacent cavi-
ties, in bronchitis there is inflammation of  the 
244        INFLAMMATION
INFLAMMATION
 mucous membrane  lining the  air-passages,
 and in sore throat there is inflammation of
 the  mucous membrane of  the  tonsils  and
 fauces.  Inflammation follows all severe in-
 juries, and  serves  to repair wounds and  to
 unite together  portions of  fractured bone.
 When the process runs its course quickly, and
 is high and severe, we have acute inflamma-
 tion ; when the process is slow and lasts for
 along time the inflammation is called chronic.
 Sthenic inflammation is an acute form of rapid
 progress, which  is met with  in strong and
 vigorous persons. Asthenic inflammation is a
 low and lingering form, the  subjects of which
 are generally debilitated and unhealthy resi-
 dents  in  towns.  There are many forms  of
 inflammation in which the symptoms of the
 process are modified by some constitutional
 disease, as scrofula, gout,  syphilis, or by
 blood-poisoning, as in cases of erysipelas,
 carbuncle, and the eruptive  fevers.   In  cases
 of  this kind the process is called specific.
 The inflammatory process may  terminate'  in
 complete restoratipn of the affected parts,  or
 in effusion  of  serous fluid,  or solid fibrinous
 material, or of  pus.  In  these latter the in-
 flammation, according to the character of the
 material effused, is called  ademaious,  adhe-
 sive, or suppurative.
  Symptoms.—The chief manifestations  of
 inflammation are the four classical symptoms
 of redness, swelling, heat,  and pain, which
 were taught  by  Celsus  eighteen  centuries
 ago.  Redness of an inflamed part is a neces-
 sary  consequence  of increased vascularity.
 The small  vessels  are dilated and distended
 with  blood,  and in some cases new vessels
 are formed.  This symptom is very manifest
 in catarrhal inflammation of the conjunctiva
 (ordinary  ophthalmia).   Vessels which  in
 the healthy state are so  small as to be barely
 visible to the naked eye become enlarged and
 filled with bright red  blood  and form a close
 vascular network.   Another cause of the red-
 ness is rupture of some of the over-distended
 vessels, and effusion of  blood into the inflam-
 ed tissues.   This condition  is shown  also  in
 some cases of ophthalmia, where one may
 observe irregularly-shaped patches of a dark-
 red  color.  The redness  of  inflammation
 varies much in tint and in intensity.  In acute
 inflammation of the surface of the body there
 is a scarlet blush, which differs from the
 dusky redness of erysipelas  and the coppery
 tint of syphilitic eruptions on the skin.  In in-
 flammation  of  tissues,  which  possess  no
 proper  blood-vessels, the redness  does not
 extend beyond the adjacent structures : thus,
 when the cornea is inflamed, it does not itself
 become red, but is  surrounded  by a zone of
enlarged conjunctival  vessels.   Sivelling  is
due  in  the  early stages of  inflammation to
the  increased quantity of blood contained in
the vessels of the affected tissues, and after-
ward to the  effusion of  fluid.   In superficial
 inflammation of the skin, caused, for example,
 by the application of a blister, a clear yellow-
 ish nuid is poured  out under  the epidermis,
 forming the  well-known blister or bleb.  In
 acute sthenic inflammation of deeper parts of
 the body and  of  internal organs,  a similar
 fluid is poured out into the interstices of  the
 tissues.  The nuid effusion of inflammation
 varies in character according to the intensity
 of the innammatory process and the health of
 the patient. In debilitated patients the exuda-
 tion resembles unhealthy pus, and in chronic
 innammation the  effusion is  fibrinous,  and
 forms a hard and tense  swelling.   In croup
 and  diphtheria  the  effusion  contains much
 fibrine or coagulated material,and forms white
 membranous deposits  on the surface cf  the
 inflamed mucous membrane.   Pain varies in
 intensity, and is influenced more by the struc-
 ture and relations of the part inflamed than
 by the severity  of  the  inflammation.   It is
 most  acute in inflammation of  the structures
 which do not readily yield to  the increased
 tlow of blood and the effusion of serous fluid  ;
 as, for instance,  bone and  cartilage ;  it is
 also very violent when the inflamed structures
 are bound  by thick fascia.  In acute inflam-
 mation  it is not  restricted to the  affected
 parts, but radiates for some distance along
 the nerves supplying those parts.   Pain in
 innammation is due to stretching and  com-
 pression of the  nerve fibres of the intiamed
 tissues.   The temperature of an inflamed part
 is increased in  consequence of the increased
 flow  of blood,  and of  the  active changes of
 tissue which take place in connection with the
 innammatory process.
  No one of the above symptoms is  peculiar
 to inflammation.  Redness may be  due to
 venous  obstruction, and to that process of
 local determination of blood  to a part called
 hyperaemia.   The severe pain of  tic-dou-
 loureux, and other  varieties of  neuralgia, is
 not due to  any inflammatory  process.   In-
 creased heat of  the skin of the face and  head
 follows division in an animal  of the sympa-
 thetic nerve of the neck.  Acute inflammation
 is invariably associated with a train of  con-
 stitutional symptoms indicating the condition
 known  as  feverishness.   This condition  in
 cases  of iodiopathic inflammation, as pneu-
 monia or facial  erysipelas, is termed pyrexia,
 or symptomatic fever ;  and in cases of injury,
 as compound fracture, surgical  or traumatic
fe^er.  The intensity of the febrile symptoms
varies in proportion to  the extent of the  in-
flammation, the importance as to function of
the organ attacked, and the previous condi-
tion as to health and vigor of the patient.  In
a typical case, such as one of  pneumonia or
of compound fracture, the  patient first com-
plains of chilliness, or has an attack of shiver-
ing.   Vomiting sometimes occurs  at  this
stage.  The surface of the body then  feels
very hot, and the mouth and tongue  become 
INFLAMMATION
INFLAMMATION        245
 dry ; the urine is scanty and dark-colored ;
 the respirations are increased in frequency,
 and the pulse is raised to 120° or 130°. There
 is intense thirst, and the patient suffers from
 headache, has no appetite, and feels very un-
 comfortable.  At  times,  especially at night,
 he is " light-headed,"  and if he has  been a
 drinker becomes violently delirious.  These
 symptoms, as has been just remarked, vary
 in  intensity  in  different patients.   In those
 who are delicate and sensitive  even a slight
 degree of inflammation wili serve  to start a
 train of very alarming symptoms ; while in
 other patients of  less  nervous  irritability a
 severe attack of acute  inflammation may be
 followed by but slight constitutional reaction.
 In cases of  inflammation, however, the in-
 variable co-existence of feverishness is shown
 by these two symptoms, high pulse  and high
 temperature.  To  this latter symptom  con-
 siderable attention has been paid by the med-
 ical profession  for some few years, and the
 clinical thermometer has now become a valu-
 able means in the diagnosis and prognosis of
 disease.  When  kept  for about ten minutes
 on the armpit or mouth of a patient suffering
 from inflammation, this instrument will  indi-
 cate an elevation of temperature by four or
 five degrees.  Instead of  98.4° Fahrenheit,
 ihe normal point, the  temperature of the pa-
 tient will be 101°, 1020, or 103°, or even
 higher.  As  a rule it does not rise very far
 above 1020.   This  increased production of
 heat also occurs in the fevers  commonly so
 called, as typhus and typical, and in the erup-
 tive fevers.   The  cause of this increase of
 bodily temperature  in cases  of  inflammation
 has not yet  been  satisfactorily determined.
 According to the  views of many influential
 pathologists the blood as it flows through the
 inflamed part is  warmed, the heat  thus ac-
 quired being accumulated in the general mass
 of the blood, and distributed to all parts of the
 body ; the circulating  fluid, the  temperature
 of which has been thus increased, then under-
 goes active changes and also stimulates every
 part of the  body through which it flows to
 active textural change.  This is produced by
 over-production and increased  excretion of
 nitrogenous waste-products, processes which
 are always associated  with elevation of tem-
 perature.   By other pathologists it is sup-
 posed  that portions of the inflamed tissues
 are disorganized and destroyed, and that the
 products of this destruction are taken up by
 the blood, and produce active changes in that
 fluid and in the tissues  to which it is distrib-
 uted.   It  has been proved  by experiments
 that the  introduction  of dead  and putrid
 organic material  into  the blood of animals
 will cause high fever.
  In acute inflammation the blood  contains
more than the normal amount of the coagu-
lable and sizy material called fibrine.   When
shed into a  vessel, as in the operation of '
 bleeding, the blood coagulates slowly,  and
 the  red  corpuscles  run together and form
 masses which  fall  to the bottom of the  ves-
 sel before the clot is formed. The fibrine thus
 strained, coagulates at the surface of the mass
 of blood, and  forms a yellowish-white clot,
 which contracts and is depressed at its centre.
 When these changes have taken place,  the
 blood is said to be " buffed" and "  cupped."
  Causes.—The causes of inflammation  are
 of two kinds, exciting and predisposing.   Of
 the former the following are  the chief :  In-
 juries, as wounds, fractures, the introduction
 of foreign bodies ; under this  head may be
 included intense heat and cold, the  effects of
 which are shown in  cases of burns and scalds
 on the one hand, and in cases  of frost-bite on
 the other ; catching cold is a  frequent cause
 of  inflammation ;  the structures  most  fre-
 quently affected by the injurious influence of
 cold are  the conjunctiva, the  mucous mem-
 brane of the nostrils, and  sinuses connected
 with the nostrils, and that of  the throat  and
 air-passages ; another  frequent cause of in-
 flammation is the retention within  the body
 of secretions, and of dead and  putrefiable ma-
 terial ; a portion of dead bone or of a slough
 formed after the mortification  of  a portion of
 an organ will generally give rise to prolonged
 inflammation in the surrounding parts ; pov-
 erty of the blood, due to chronic disease or
 to insufficient  nourishment, and a poisoned
 state of that fluid may give rise to inflamma-
 tion.   Professor Billroth  of   Vienna found
 that by injecting putrid fluid into  the blood
 of a dog he could set up inflammation of the
 intestines, of the pleura, or of the pericardium
 or enveloping membrane of the heart.  In-
 flammation of  a part occasionally follows in-
 jury or division of the nerve by which that is
 supplied.
  The predisposing causes of inflammation
 are : advanced age, debility from insufficiency
 of nourishment, and in consequence of some
 exhausting disease ; abuse of alcohol, living in
 damp and badly-ventilated rooms ; great men-
 tal and bodily fatigue,  chronic diseases of the
 blood-vessels, certain morbid conditions of the
 body, as gout,  rheumatism, and scrofula.  In
 favorable cases where the affected tissues re-
 turn at once to their previous healthy appear-
 ance and condition,  on the subsidence of the
 general symptoms of inflammation, the  pro-
 cess is said to  terminate in resolution.  The
 serous fluid effused in  cases of acute  inflam-
 mation  often coagulates,  and is converted
 into a fibrous and living substance,  which in
 cases of wounds and fractures, serves to bind
 together  the  several  parts—termination in
 adhesion.   The process  sometimes  termi-
 nates in the formation  of pus,  which is either
 discharged from an open  raw surface or is
 accumulated in the midst of living tissues and
forms an abscess.
  The process  of inflammation as revealed 
INFLAMMATION                          INFLAMMATION
by microscopical observation has of late years
been a subject of increased interest in conse-
quence of the results of investigations made
by  modern  German  biologists,  and  of the
prevalence  of  new views  concerning  the
nature of certain constituents of the  blood.
The following particulars are gathered from
an able and  elaborate article on this  subject
by Dr. Burdon-Sanderson, contained  in the
fifth volume of  Holmes's System  of Surgery.
  First Stage in the Process cf Inflamma-
tion.—From microscopical  observations  of
the web of the frog's foot and the mesentery
of the frog, it has been found  that on the
local application  of an irritant,  the  smallest
arteries, and subsequently the capillary  ves-
sels become detached  and slightly increased
in width, so that there is  more or  less  con-
tortion of these vessels, at  the  same time
there is acceleration of the biood-current. This
dilatation, on the application of most irritants,
as dilute sulphuric  acid,  acetic acid,  caustic
soda,   etc.,  commences  immediately,  but
where liquor ammoniae or  carbonate  of  am-
monia is used, there is at first contraction  of
the capillaries,  with retarded  flow  of blood,
which after lasting  for an hour or two. is fol-
lowed  by dilatation and  accelerated  flow  of
blood.   Concerning the cause of this phenom-
enon, there  are and have been many views.
Some  pathologists  hold that it  is due  to a
more rapid and violent  contraction  of the
arteries, others that the relaxation of the ves-
sels is  dependent upon the fatigue caused by
their unnatural irritation  ; the most probable
view is that it depends upon irritation of the
nerves which proceed f om the injured or in-
flamed part  to  the  brain,  which irritation  or
impression is then reflected through the spinal
and sympathetic  nervous  system, and finally
along the nerves which are distributed to the
walls of the vessels of this part.
  Second Stage.—The blood contains, in ad-
dition  to  its red corpuscles, a much  smaller
number of colorless corpsucles, which when
examined, after removal of the  blood from
the body, and without any preparation, are
found to be round, pale and clouded cells,  each
containing one  or two  nuclei of  a spheroidal
or flattened  form.  When the blood, however,
is submitted to examination in the living state,
or under  physical  and chemical conditions
resembling those of life, these colorless corpus-
cles are found to be small globular masses of
contractile protoplasm, which resemble amael-
oid organisms in their possessing the functions
of growth and locomotion, and the power of
dissolving and absorbing nutritive substances
on which they live.   In the second stage  of
the inflammatory  process,  the  current  of
blood becomes slower and slower, then oscil-
lates, and finally ceases altogether.   If the
vessels of the inflamed part be examined  in
this condition,  which is called stasis, it  will
be found that the inner surface of each vessel
is lined by a continuous layer or pavement of
white blood corpuscles,  some of which pass
from the vessel into the surrounding tissue in
the following manner :  " Here  and there on
the outer contour of the vessel,  minute color-
less button-shaped elevations spring, just as
if they were produced  by budding out of  the
wall of the vessel itself.  The  buds increase
gradually and  slowly in size,  until each as-
sumes the form of an  hemispherical  projec-
tion,  of  width  corresponding  to that of a
white blood-corpuscle.   Eventually the hemi-
sphere is converted into a pear-shaped body,
the stalk end of which is still attached to the
surface of the vein, while the round part pro-
jects freely.  Gradually the little mass of pro-
toplasm  removes  itself further and  further
away, and as it does so, begins to shoot out
delicate  prongs of transparent protoplasm
from its surface, in no wise differing in their
aspect from the slender thread  by which it is
still moored to the vessel.  Finally the thread
is severed, and the process is complete. The
observer has before  him an emigrant white
blood-corpuscle."   These  phenomena were
first observed  and described  by  Professor
Cohnheim of  Germany, whose words,  as
quoted by Dr.  Burdon-Sanderson, are here
given.   Those white-blood corpuscles then
accumulate in considerable quantities around
the vessels, and together with the serous fluid
of the blood, a liquor sanguinis,  which is
effused at  the  same time,  give rise to the
swelling  which  forms  one of  the  cardinal
symptoms of the inflammatory  process.
  Besides the above changes which have their
seat in the blood-vessels,  there are others
which have their seat in the tissues—textural
changes.  It has been found by  microscopical
examination, both of  the non-vascular tissues,
such as the cornea, cartilage and tendon, and
also of the vascular tissues, as connective tis-
sue and muscle, that in consequence of the
stimulating properties of the effused  liquor
sanguinis, with which an inflamed structure
is soaked, the permanent cells of the affected
tissue which have for their function the main-
tenance  of the  unchanging life of these tis-
sues, germinate as it were and  become meta-
morphosed into mobile masses of protoplasm,
resembling in all respects the white corpuscles
of the  blood.   These bodies when collected
in large quantities form pus, and the inflam-
matory process then  terminates in  suppura-
tion.   These views, as to the textural origin
of these mobile bodies, have not been undis-
puted.  By Professor Cohnheim and his fol-
lowers it is held that these and the pus cells
formed in masses are not the offspring of the
permanent tissue cells, but wandering blood-
corpuscles which have a tendency to escape
from  the vessels,  as has been  stated above,
and then to move  away from the blood-cur-
rent in a direction  at right angles to the axis
of the vessels from which they  have escaped. 
INFLUENZA
INFLUENZA
247
 There seems to be no doubt that pus is formed
 both by  wandering  cells and by the cells
 formed by textural changes, and in acute and
 rapid suppurative inflammation it is probable
 that the pus cells are mostly,  if not all, wan-
 dering blood-corpuscles.
   INFLUENZA is a specific and epidemic
 fever which chiefly attacks the lining mem-
 brane of  the   nose,  larynx,  and bronchial
 tubes, lasting  from four to  eight days, and
 not preserving the individual  from a future
 attack.  This disease has occurred in various
 countries at different times, and has received
 a vast number of names ; in the  seventeenth
 century it appeared in Italy and first received
 Ihe name of influenza, because it was attrib-
 uted  to the influence  of  the stars.  It is sup-
 posed that  this disease has been known cen-
 turies before the Christian era  ; certainly since
 that  time  numerous  epidemics   have been
 most carefully recorded.  The area attacked
 has also much  varied in extent ; sometimes
 only  part of a country has been  affected, at
 other times it has spread over a great part of
 the civilized world.  A disease is said to be
 " endemic" when it  is confined to  a small
 area, as a village or town ;  " epidemic" when
 it spreads over a country ; " pandemic" when
 it invades a large portion of the earth's sur-
 face.   Influenza occurs  in both an epidemic
 and pandemic form ;  it  may  take weeks  for
 ihe disease  to  spread from one  country  to
 another; thus  in  the  year  1832 influenza
 prevailed extensively in  Russia, but  it took
 no less  than eight months to  spread over
 the whole of Germany.  No particular track
 has been observed which this disease particu-
 larly  follows ;  it has travelled in different
 directions  from  time  to time ;  some have
 thought that it usually spreads from  west to
 east.   The  poison  seems to be conveyed by
 the air, and persons at a distance from land
 may become attacked.  Attacking a commu-
 nity,  the  disorder generally remains  among
 them  from six  to eight weeks, but occasion-
 ally it has  remained  longer ;  the epidemic
 will completely disappear then for a time, nor
 is it usual to find an occasional case breaking
 out in the interval  of  epidemics.  It  is com-
 mon to hear people complain in the winter of
 having an influenza cold, but this is a misap-
 plication of the word.  The onset of the  dis-
 ease is generally very rapid, while the  decline
 is more gradual, and may last several  weeks.
 In 1847 it was  calculated  that no fewer than
 a quarter of a million of  people suffered  ;  in
 Paris  between one fourth and  one half of ihe
 population  were attacked,  and  in  Geneva
 about one third.  Various physical conditions
 have been supposed to influence the outbreak
 of  this disease.   Volcanic eruptions were
once thought to be a cause, but there has been
 no  trustworthy evidence of this ;  soil seems
to have no effect, for the complaint has  ap-
peared in every  variety  of country, in high J
 lands as well as in low lands, in hill countries
 as in marshes and plains.  Nor does the time
 of the year seem to have any effect, since it
 has been prevalent at all seasons.   There is
 also no connection between temperature and
 influenza ; it occurs in high as in low temper-
 atures, nor does any sudden variation of cold
 or heat seem to produce any effect.  Moisture
 also has  an apparent influence, nor is  there
 any evidence at present that any atmospheric
 condition has  any effect  on this  disorder.
 The intercourse of human beings does  seem
 to have an influence on the disorder ; thus an
 affected  person  coming into  a village seems
 to be a centre from which the disease spreads ;
 nevertheless it is very remarkable that thou-
 sands may be attacked in the same town in
 the course of a few hours, while in other con-
 tagious disorders the progress is much slower.
 In this  disease, as in other  contagious dis-
 eases,  there seems to be a period of incuba-
 tion, when the poison seems for a time to be
 latent in the system, before any of the marked
 symptoms declare themselves, and although
 in most  cases persons seem to be suddenly
 struck with influenza, yet there is probably a
 period of incubation, which may be very short
 and  may last for some  days.  Most people
 who have suffered from  a contagious disease
 are not liable to a second attack, but in influ-
 enza  one  attack  gives  no  immunity from
 another,  although persons seldom suffer twice
 in the same epidemic.  Various speculations
 have been made as to the nature of the excit
 ing'causes of this disorder.   It cannot arise
 from  contamination  of  water,  as  it  would
 then be confined to a particular locality, nor
 to any kind of food.  The rapid way in which
 it spreads shows that the poison must exist in
 and be conveyed from place to place by the
 air, for in this way alone can we account for
 the rapid transmission of the  disorder.  But
 as to  the nature of the  poison  in the air
 nothing  at  all is  known ; were it  a gas,  it
 would become diluted by mixing with air and
 lose its virulence, but this  is not  the case  in
 influenza, nor  does  it seem to be  made of
 organic  matter, or to  be suspended mineral
 matter.   One thing  seems clear,  that  the
 poison can multiply in the  air and reproduce
 itself.  Race and  sex seem to be equally at-
 tacked by the disease ; the young are said to
 be less liable to it than  old  people.   Over-
 crowded habitations seem in some epidemics
 to have  increased the mortality, and places
 which  are low, damp, and badly  ventilated
 appear to predispose to it.
  Symptoms.—The disease commences with
 shivering or a  feeling of coldness down the
 spine, with a hot, dry skin, quick pulse, thirst,
 and severe  headache.  These symptoms are
 common  to nearly all  fevers,  and they pre
cede, as a rule, any local affection ; sometimes
they  come on  suddenly,  sometimes  they
develop slowly in two or  three days.  If they 
248            INFLUENZA
INFLUENZA
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 ac-
companied by profuse perspiration or a trou-
blesome  diarrhcea ;  in some cases the fever
may last several days longer, but then some
complication 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 tis-
sues or cavities of the forehead, causing great
frontal headache and frequent sneezing ;  the
mucous membrane of the  eyes or the con-
junctiva  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 membrane at once, or, beginning in the
nose, it may spread downward 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, pains
in the side, and a difficulty in smelling.  There
is great distress in breathing, 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  ca-
tarrh, and  perhaps in prbportion  to  the  se-
verity 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 neuralgia pains in  various parts
of the body  or extremities.   The mind is
often  affected, and the patient  may become
stupid or delirious.   These  nervous  symp-
toms often last some little time after the fever
and catarrh have subsided, and thus leave  the
patient very  weak and  retard his  convales-
cence.  The temperature of the body appears
to be raised in most cases, but no  exact ob-
servations on this point have yet been made.
Sweating of the skin often occurs during the
defervescence of the fever, or at the time when
a descent of the temperature  takes place, but
rarely in the  early stages.  Crops of  minute
transparent vesicles,  or little blisters contain-
ing fluid are often seen on the skin.   Menin-
gitis, or  inflammation of the membranes of
the brain, and otitis, or inflammation of the
ear, may come on now and tnen.   Great de-
lirium, as well as intense headache, is a dan-
gerous 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 rup-
ture, or even  abortion in  pregnant women.
There is but slight expectoration at first, and
then  the  phlegm which  is  expectorated  is
stringy  and often  bloody, then it  becomes
more  consistent,  opaque,  and   purulent.
Bronchitis,  or inflammation of  the bronchial
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
indifferent epidemics ; their presence may be
detected by a careful examination of the chest,
and by the increase in the  distress of breath-
ing.  Vomiting and nausea often come on at
the commencement of an attack ;  diarrhoea,
as a rule, occurs later on  in the disease, when
the fever begins to abate.  In some cases the
skin assumes a yellow tint, and  bilious vom-
iting comes on.  As  in most  febrile  affec-
tions, the urine is at first  high-colored and
scanty, and  afterward it often deposits a pink
or reddish sand, made up of lithates. Occa-
sionally there is complete or partial suppres-
sion of the urine.   Now and then swelling of
the glands under the chin or in the neck has
been  observed.   Convalescence is often re-
tarded by rheumatic-like  pains in  various
parts of the body, and by prolonged debility
or unusual nervous depression.
  Mortality.—The mortality varies much in
different epidemics. Yet  at no time is it very
high, for in  1837,  which was looked upon as
a severe epidemic, not  more than  two  per
cent died.  Age seems to have  an  influence
on the death-rate, and it is more  fatal among
the old than among the young.   It is higher,
too, in those who have  suffered from  heart
disease,  bronchitis, or emphysema, and espe-
cially in  those who  have  weak  and  fatty
hearts.
  Treatment.—No means are yet known by
which influenza  may be prevented.  Over-
crowding, and low, damp, or badly ventilated
houses seem to favor the  disease.  When the
disease has declared itself, the  patient must
be kept in bed, and the room should be cool
and well ventilated, although draughts are to
be avoided ; when a person suffers from ca-
tarrh or a common cold, he will prefer to be
in a warm room, but those  suffering from in-
fluenza like a lower temperature. As the ap-
petite is bad, not much solid food can be taken,
and, in fact, for the first three or four days it
had better be avoided.  Plenty of cold drinks
may be given, and if there is much fever they 
INFLUENZA
INFUSORIA           240
 may  be iced ; those are the more grateful
 which are  made  slightly acid ;  barley-water
 and lemon-juice, raspberry vinegar, oranges,
 and cream  of  tartar water may be given with
 benefit.  Stimulants,  except in the case  of
 old and  feeble people, need not  be  given ;
 claret or hock, in combination with seltzer-
 water, may be given if necessary.   But if the
 heart's action  fail, and there be great  distress
 in breathing and duskiness of the face, brandy
 and ammonia must be given, and pretty freely.
 Beef-tea is  not of much use, but the  patient
 may take  plenty of milk.  Too much food
 should not be given, as it will  only tend to
 derange the stomach ;  too much fluid should
 not be given at one time, as it may cause pain-
 ful distension  of  the stomach and flatulence ;
 nor should  any acid drink be taken just before
 or after the administration of milk, as it will
 only cause  clotting of the latter and perhaps
 subsequent vomiting.   The patient may  be
 allowed solid food as soon as the severity of
 the fever has  passed away ; some well-boiled
 mutton  may be given  at first, or any easily
 digestible food ; in these cases, however, the
 diet should  be similar to that which is recom-
 mended in  the article on Fevers.  The air of
 the room should be kept moist by keeping a
 kettle  of boiling water on the fire, or by put-
 ting boiling water in shallow vessels about
 the room ;  in this way the steam passing into
 the air in the room  keeps it moist and eases
 the cough.  Drugs are not of very much use,
 and in slight  cases nothing is  required, but
 some cooling saline or effervescent  medicine
 may be given to check the febrile symptoms
 and to allay thirst. In the early stages a pur-
 gative is often given with benefit, but this
 must not be carried too far ; a dose of calo-
 mel, followed by a saline purgative, will gen-
 erally suffice to open the bowels  enough and
 relieve the patient, but the persistent  use of
 purgatives is  injurious.   In the case of chil-
 dren a dose of gray powder may be  substi-
 tuted for the calomel, or a little castor-oil may
 be given for the same  purpose.   In no case
 should repeated doses of  any mercurial prep-
 aration be given so as  to produce salivation.
 Some  have  recommended  emetics, but  no
 marked benefit has resulted from this practice,
 and  it seems,  therefore, undesirable to give
 them ;  for this purpose tartar-emetic has been
 advocated by some, but it is too lowering for
 the patient ; nevertheless, if  any bronchitis
 or pneumonia  come on in the course  of the
 illness, ipecacuanha, combined with ether and
 ammonia, will  prove of  service.   Opium
 should be administered with the greatest cau-
tion ; in all  cases where there is a tendency to
 congestion of  the  lungs this  drug seems to
intensify the condition, so that  its use may
seriously increase the danger of  the patient ;
but if there be  not much congestion and the
cough be very  violent,  then  small doses of
 Dover's powder may be given or preparations
 containing  belladonna.    If  there  is great
 tightness across  the chest or  a severe stitch
 in the side, hot linseed meal poultices will be
 of great use in alleviating the pain ;  flannels
 wrung out of hot water may be applied with
 the  same  object, or,  if  the pain  be very
 severe, the application of three or four leeches
 will be found  very useful.  Later on, when
 the expectoration is more  profuse, ammonia,
 chloric ether,  and  senega may  be  ordered
 with advantage.   Quinine seems to  be very
 useful as soon as  the  acute stage is  passed ;
 it tends  to promote convalescence,  improve
 the  appetite, and lessen the  severity of the
 neuralgic pains.   Blisters  do no  good, and
 only increase  the patient's sufferings.  In-
 halation  of  steam may be tried, either by
 using an  ordinary inhaler, or  by breathing in
 the steam from a jug of boiling water.  If the
 diarrhcea be moderate it should not  be stop-
 ped, as it is beneficial  to  the patient,  but  if
 excessive it should be  checked.  Should sup-
 pression  of urine come  on,  a hot hip bath
 should be used, and flannels wrung out  of hot
 water ought to be applied to the loins ;  dry
 cupping is also useful, and the patient should
 drink  plenty of linseed-tea or barley-water.
 An ice-bag to the head will often  relieve the
 intense frontal headache,  and  this  may be
 applied by putting pounded ice into a bladder
 or india-rubber bag and kept on for two or
 three hours.  Sometimes a single piece of linen
 dipped in vinegar and water may be applied
 to the forehead with  relief, or  a wet  towel
 may be laid  on the pillow, so that whenever
 the patient turns his head it will come in con-
 tact  with a cool  surface.   During convales-
 cence  iron  and quinine should be given to
 promote an appetite and to act as a tonic to
 the system.  A generous  and nutritious diet
 must be  given, including  milk,  meat, and
 some beer or wine.  For some time after an
 attack the  patient should avoid exposure to
 cold, and wear flannel  next the skin.
  INFUSIONS are preparations of remedies
 which yield their properties  to  hot water.
 The substance  is, as a rule, reduced to coarse
 powder or roughly comminuted, placed in  a
 pipkin, and covered with a measured  quan-
 tity of distilled water.  In most of the prep-
 arations boiling water  is  used, and the time
 of infusion  varies from ten minutes  to four
 hours, according to the time requisite to sep-
 arate the active  ingredients.   In some few
 cases water at  a  lower temperature is used ;
 with chiretta and  cusparia, water at  121° F.
 is used ;  while  with yet others, as columba
 and  quassia, absolutely cold water is  used.
 In any case the great point with  an infusion
 is that no heat shall be applied after the first.
 Infusions are mainly used as vehicles.
  INFUSORIA   are   minute  microscopic
 organisms developed in water in  which ani-
mal or vegetable  matter has been dissolved
by steeping  ; they are  readily produced in a 
250       INGROWING NAILS
INSANITY
few days by making an infusion  of common
hay.
  INGROWING NAILS.  (See Nails.)
  INHALATION is a method  of  introduc-
ing remedies into the system  which has only
recently come into vogue.   Of course  every
substance is not capable of being so used, it
being essential that the material should be
capable of  being volatilized, and at the same
time of inflicting no injury on the lung sub-
stance.   Some  of  the substances  given  in
this  way are nominally in a gaseous  state,
and  only reduced  to  the fluid condition for
the sake of convenience in stowage.  Such is
nitrous oxide, the favorite dental anaesthetic.
Others, again,  are substances  which  very
readily pass from  the fluid to vaporous con-
dition ; such are chloroform and ether.  These
substances  are used to  deaden pain or over-
come sensibility generally, but what are tech-
nically  termed  inhalations  are substances
which, nominally solid or fluid, can be made
to evaporate, and so act as local medications
to the lungs and  air-tubes.  Conium, crea-
sote,  and  hydrocyanic  acid are given  this
way.  Of course it is essential that these and
all similar preparations which are intended to
act on textures so delicate as  those of the
lung, should only be applied to its membranes
at a  suitable temperature.  To enable  the
substances  to be volatilized, and these, too,
at a suitable temperature, proper vessels have
been  made,  called inhalers.   We generally
tell the patient to put some of the material to
be inhaled  in a jug with hot water ; to place
it close to the mouth, and cover  head and all
with a towel.  The plan answers well.   The
smoking of stramonium,  fumigation by  sul-
phurous  acid,  and inhaling the  fumes of
nitrate of potash paper, are all modifications
of this process.
  INJECTIONS.—There  are two kinds of
injections,  one  of  which  is treated of in the
article on Enema,  and the other  in the article
on Hypodermic  InJections.
  INOCULATION really means the  intro-
duction of any poisonous matter, particularly
if that  be of an  animal  origin,  beneath the
skin.  It has come, however, to mean in great
measure  the introduction  of the small-pox
virus into a healthy system.   The  term vac-
cination is  on the  other hand limited  to the
introduction  of cow-pox into the system in
the same way.  The plan  of inoculating with
small-pox has been known in the East from a
very remote antiquity, and  was introduced
into England from Turkey in 1717 by Lady
Mary Wortley Montagu.  The great advan-
tage of the  plan is that a time may be selected
for undergoing the disease, and the malady
so induced  is not nearly of the gravity small-
pox  commonly assumes.   Besides, a mild
case may be selected whence the matter to be
inoculated  is taken, and it would seem that
this  has  something to do with the virulence
or comparative  mildness of the  subsequent
attack.   Nowadays,  when vaccination is  in
this country enforced by law, the practice of
inoculation has fallen into desuetude, and has
in point of  fact  been prohibited by law.
Nevertheless,  occasions  may  arise when its
practice  would be sound wisdom.   Should
the plan be had recourse to, every individual
of the family must  be inoculated, provided
they have not suffered from small-pox, other-
wise the  disease would spread in the ordinary
way, and run in  the  non-inoculated individ-
uals its ordinary course.   The plan of  inocu-
lating is as simple as that of vaccination ; any
instrument sharp enough  to scratch the skin
is to be  selected,  dipped into  the small-pox
matter,   and  the  skin  of  the  upper arm
scratched until the blood begins to appear.
This should be done in  one  or  two  places
slightly apart. Very  probably no other erup-
tive spots will appear.
  INSANITY, being a word of negation, is
not easy to define.  Doubtless we may speak
of it correctly enough as any condition-which
is not that of sound mind, but as this sound-
ness of mind cannot  be judged absolutely but
only relatively, in giving such a definition vve
are simply tossing the ball*from one hand to
the other.
  Each case, in point of fact, must be consid-
ered by itself and as a whole. Broadly it may
be said that the tests of  lunacy, which  are
commonly used in the same sense exactly  as
insanity,  are, in each case, incapacity to man-
age property or danger to the public in crim-
inal 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 meta-
physical speculations as  to the connection be-
tween 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 our
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 functions 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
gives rise to the  more permanent form of the
malady.
  Causes.—The causes of insanity are gen-
erally assumed to  be of two kinds, as is usual 
INSANITY
INSANITY            251
 in medicine—predisposing and exciting, but
 the so-called predisposing causes mean merely
 a state in which the individual is more likely
 to become insane than if the same set of cir-
 cumstances  were operating on him  in  any
 other state.   Accordingly, the term  predis-
 posing cause may be  looked  on as synony-
 mous with tendency, and the origin of these
 tendencies has here to be discussed.   By far
 Ihe most potent of these tendencies  is derived
 from hereditary transmission,  or,  as would
 sometimes seem, transmission from collateral
 branches of the family.  This last is simply a
 modification of the  former,  for though the
 immediate parent may not have been  insane
 and his brother or sister may,  yet the inheri-
 tance was common to the stock of the grand-
 parent or great-grandparent, and so descend-
 ed in the ordinary way after all. It is of the
 greatest possible  importance  to fairly under-
 stand 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  inheritance be
 ignored and  the  individual left to face the
 world like men of  stronger mental  equilib-
 rium, 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 pro-
 foundly secret, or even intentionally  hidden
 away,especially where property  is concerned ;
 the result in many cases  is unfortunate, the
 more so that the consequences of the deception
 frequently fall on the guiltless. We may,  how-
 ever, 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 de-
 terminedly 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 the two-
 fold question to solve—depending on the ten-
 dency these  conditions have  to die out,  and
 the tendency they  have to  be transmitted
 from  generation to generation.  There is al-
 ways a certain r sk, 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  heredity, however,
tends lo 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 in-
creasing numbers thereof.  Thus, a  certain
 number of those tainted will  probably be in-
 capable of propagating the race, and a certain
 number more being locked up will  have no
 opportunity, and so between  the  two the in-
 sane  members of the  family  tend to die out,
 while the stronger having intermarried with
 a more healthy stock, in  course of time be-
 come like other people.   Age has something
 to do  with the liability  to  insanity.  It is
 greatest  between 25 and  40, 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
 of life there is much more violence connected
 with insanity than there is with the later ; if
 this rule is reversed, the  likelihood of recov-
 ery 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,
 especially the time of child-bearing,  etc., are
 likely to have full effect.  It is of course plain
 that men living as we do  in a highly complex
 state of society, with a highly complex brain
 and mind, should be more liable to lose their
 mental equilibrium than  in a more primitive
 state of society.  But,  on the other  hand, it
 is perhaps interesting to know that the poor-
 est counties of  England contribute the largest
 proportion of insane to the district asylums.
   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 instances.  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, es-
 pecially in a mind  which  is badly balanced
 by heredity or by means of the individual's
 own habits  and training.   These  last, how-
 ever, belong rather to  the group of physical
 exciting  causes.   The  most  important,  ac-
 cording to all accounts, is the inordinate use
 of alcohol.
  Symptoms.—The symptoms of  insanity
 differ greatly from the signs of any other dis-
 ease.   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.  Very frequently
 indeed you get the  cue from the attendant,
or those who  have been  in contact with the
insane individual ; for  it  is  wonderful how
many of  them contrive to conceal  their in-
sanity until  their delusion be touched upon,
and then it is just as difficult for them to con-
ceal it.  There are certain words used in con-
nection with the mistaken beliefs  of  the  in- 
252            INSANITY
INSANITY
 sane, which, though in ordinary parlance used
 synonymously,  yet,  strictly speaking, have
 got totally dfferent significations.   These are
 delusion, illusion, and hallucination.
   A delusion is a false belief relating to some-
 thing which has a real existence, but to which
 the insane individual supplies attributes totally
 false.   Thus he entertains a belief that some
 one,  probably the least likely to  do so, de-
 sires to swindle him ;  that  he himself  is a
 prince  possessed  of  boundless wealth, etc.,
 etc.
   An illusion is a false interpretation of  the
 senses.  There is something to be and some-
 thing 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., etc.
   An hallucination is, on  the  other  hand, a
 mistake on  the part of the senses.  The  eye
 or the ear itself seems to be al  fault ; the pa-
 tient 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 imaginings of one whose brain is
 disordered.   These delusions are  sometimes
 of a gloomy description.  The patient is de-
 pressed or  nervous, and proceeds to account
 for this feeling in the way most congenial to
 his fancies.   A rich man  may imagine him-
 self  a beggar ;  a  good  and  worthy  man
 damned to  all  eternity.   Moreover,  every-
 body knows it and  treats him accordingly, or
 he has some special tormentor who will never
 leave him alone.   Mere delusions  have  ref-
 erence  solely and entirely to himself, and he
 has only the power of directing attention  to
 one small part of  his condition at a time ;
 were he able to take a more extended view he
 would be able to see that the  delusions  are
 delusions,  and not, as they  seem to him,
 actualities.   Some paiients entertain  delu-
 sions of  a totally  different character ;  these
 delusions are exalted  delusions.  They fancy
 themselves  rich,  powerful,  and  they   are
 happy ; and yet the bodily condition of some
 of  these poor patients  is most  miserable.
 They very frequently  indicate a form of brain
 disease which advances through what to the
 bystander are exceedingly painful stages to
 certain death.  Such  delusions are most fre-
 quent in the condition known as general  pa-
 ralysis of the insane.  Again, there are  pa-
 tients 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 among  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 a man's sanity.   These acts
have  reference either to  himself,  and then
they are often associated  with  delusions of
exaltation, or lo the  public, and then they
are often founded on delusions of dread ; but
in  neither  instance is the rule invariable.
Among the most notable acts of the insane
are  indecent exposure,  which  vfery  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 recourse 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 sur-
face, and  so tears them off him to get rid of
them forever.  In either case it is a trouble-
some 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. Very frequently in a female
ward two patients, on  being contradicted or
opposed, will promptly set to work, and in a
few minutes  will stand naked  as they were
born, in the middle  of a heap of rags.   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 punishment  has to be devised,
for they know perfectly well what they are
about ; and if these fail, constant watching,
which generally  puts aetop to  the nuisance.
Fantastic  ornaments and dress  are not such
frequent marks of insanity as writers who are
ignorant of the subject would have the public
believe ; yet  some little peculiarity in dress
or appearance is frequent enough.  Perhaps
the reason why there  is not more  oddity is
that there is in asylums such scanty material
for  it.   If,  however, an individual has been
ill for some time before being admitted to an
asylum, and has been allowed to have his own
way, it will generally be found that either in
his  dress or his  apartments is something not
quite compatible with the sane condition.
  Suicidal acts or acts of self-mutilation are
frequently  committed  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 destroy-
ing 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 asso-
ciated  with the  suicidal impulse. The  two
things, however, ought perhaps  to be made
more clearly  distinct ; for there is homicide
and suicide  founded on  delusion, and un-
doubtedly there is, too, homicide and suicide
founded on  mere motiveless impulse, when
the individual previously  has  exhibited  no
signs of delusion or of insanity, other than
general weakness of mind.  The subject of
homicide, however, brings us to the consider- 
INSANITY
INSANITY
253
 ation of those acts which are directed toward
 others  rather  than  to  the  patient himself.
 Not unfrequently homicide  or suicide is the
 result of overpowering terror.  This perhaps
 is the most frequent form assumed in  the in-
 sanity 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 number 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 wanton-
 ness, 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  in-
 sane.  These constitute  the  very worst class
 of insane  patients.  Utterly untruthful, not
 a word can be depended on.  Nor is an at-
 tendant's life  safe  with them.   Before the
 onset of the epileptic fits, if they have them
 at intervals, they generally go through a stage
 of excitement,  in  which they are exceedingly
 dangerous.   Now the  stage  is  sufficiently
 well marked long before the mind of the pa-
 tient is so far gone as to require 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 at-
 tack.   It is, however, with regard to par-
 oxysmal insanity that there is most  discrep-
 ancy 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 un-
 controllable 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 admit-
 ted by the bench. Perhaps, however,we ought
 to make a distinction between momentary in-
 sanity, giving rise to homicide, and the homi-
 cidal impulse with no insanity, momentary or
 otherwise.   We fear  the distinction  is too
 fine to be generally appreciated by those lia-
 ble to such attacks.
  Homicidal mania,  on account of its  great
 importance, is not unfrequently elevated into
a special form of insanity. So too are certain
others, one which, however,we generally hear
of when affecting some of the higher classes
of society.   These  are  kleptomania,   ento-
mania, and pyromania.
  By kleptomania is meant an uncontrollable
tendency to steal things when there is no ob-
ject  whatever   to be  gained  by it.   Most
  frequently  it  seems  to manifest  itself  in
  ladies of a tolerably good position ; but some-
  times also  it seems  lo  affect gentlemen  in
  easy circumstances.   Among them the steal-
  ing is taken as a mark of insanity.   Stealing
  by insane persons, which is common enough,
  is quite another  thing.    Frequently  when
  thefts are committed by men, especially from
  the  ages  of 25 to 40 or 50,  it is one 6f the
  early signs  of  the general paralysis already
  alluded to.   For  with such  patients  stupid
  thefts, like  indecent exposure, are early fre-
  quent signs of the onset of the disease.  There
  are,  too,  very considerable numbers of our
  great body, who really, did they  belong to a
  different class  of  society, would  be included
  in the ranks of these kleptomaniacs.   They
  are lads originally imbecile or nearly so, who
  have had a thorough bad  training, and no
  governing power  whatever.  These had far
  better be  sent; to an asylum at once than be
  allowed to  prey on  society, in the wasteful
  manner which  is habitual to them when not
  locked up.  With  regard to most  cases of so-
  called kleptomania in ladies, the less said the
  better.
    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 in-
  sane patients, the lucid instincts are the most
  prominent of these symptoms. Such instincts
  are exceedingly common in many cases of
  insanity, especially in the early stage of  gen
  eral  paralysis.  It  is, however, in  women that
  the form of the  malady is most marked, es-
  pecially in young women, and it  is this ten-
  dency on their part which renders the refrac-
  tory  female wards of a large infirmary the most
  horrible scene it is ever possible to conceive.
   So of pyromania, undoubtedly a good many
  patients have an inclination to set things on
  fire,  but such a tendency is  hardly to be ele-
  vated to the rank of a special form of insanity.
  In many insane  people  the impulse to de-
  stroy 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.
  With such insane individuals, there is of course
  no regard for what the fire may  do : it may
  destroy numberless lives, but they only desire
  to destroy  property ; sometimes to  escape
  from the asylum in the confusion, or it may
  be for  the purpose of self-destruction.  But
  in all of these patients there are  other signs
  of insanity than a tendency to set a light to
  everything they can.  Many cases of  incen-
  diarism, however,  are the work of imbeciles
  who  sometimes  have  no better motive than
  that  of seeing a good blaze.  Often  in the
  country, in the case  of hay and  straw ricks,
  this is associated with the idea of some evil
  having been wrought by the farmer on the in-
|  cendiary, so that the  motive of revenge, out
I  of all proportion to the magnitude of the sup- 
254
INSANITY
INSANITY
 posed injury, enters into the mind of the im-
 becile incendiary.   Roughly, and in such a
 way as will well suit our purpose,  we may
 divide most cases of insanity into two divi-
 sions : those in which there  is apparent exalt-
 ation, and those in which there is depression,
 and these two we shall describe as mania and
 melancholia ; but both  of these  tend  in the
 long run to end in a condition characterized
 by absolutely no mind—what we  term demen-
 tia, though there is a condition not  inappro-
 priately  termed acute  dementia.  (See  De-
 mentia.)
   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 con-
 fusion of intellect ;  bad sleep  at night, arid
 the patient is easily excited.   The advance of
 the malady depends  a good  deal  on  the
 amount of sleep taken.  If he sleeps well, it
 is just possible he may recover ; but if not,
 he gets  more  restless, more irrational,  and
 more easily excited.  His  delusions, at first
 mere momentary 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 prob-
 ably moved to some place of refuge.  At this
 time the patient will 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 suckling.
 All these may be removed a'nd yet the pa-
 tient does not get well ; we cannot restore the
 mental balance.
   Treatment.—As a rule, the first thing is to
 remove the patient from home, and surround
 him with new attendants  who will  take him
 duly in charge in every way,  when he  will
 be removed from  the causes of aggravation
 be they what they way.  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
 'o secure good  digestion, and a due nutri-
 tion.  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, 30 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, in full  doses of 20 or 30
 grains, three times a day.  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 super-
 intendence, and as it is quite possible that the
 patient may get worse instead of better, when
 constant action may require to be taken,  it is
always better to select a place for the change
of air and scene where  there is a good prac-
 titioner 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 con-
 fused character, it will also assume the phase
 either of melancholia or of mania.   If melan-
 cholia, then the utmost depression overpowers
 the unfortunate  individual.  Everything that
 happens round  him seems to  be  connected
 with his evil fortune.   Very  likely he ihinks
 he has committed sins too  black for him to
 hope for forgiveness. 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 become thinner
 from want of  food and  sleep.   The pulse is
I slow and weak,  and the general condition of
 the patient indicates imperfect  nourishment
[ and bodily change.  Suicide  is  greatly to be
j apprehended in  a good  many cases, perhaps
i the majority ; and this  tendency may be so
i 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.  Of course,  in an asylum,  the means
 of  superintendence  are  much  more  readily
 available than in a private house, and the ex-
 pense  is  correspondingly  small.   Besides,
 take it all in all, a patient is better in a small
 asylum, or in a large one, if classified, than
 in most private homes.   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 nourish-
 ment in abundance may be  given.   Some-
 times these patients refuse their  food,  and
 when that is so  they must be made to take it,
 cither by the stomach-pump  or through the
 nose.  The bowels must be moved and kept
 open.  First had better be administered a tur-
 pentine  injection, after which  a  dose from
 time to time of castor-oil, or a small quantity
 of  aqueous  extract of aloes, daily at dinner-
 time, will suffice to keep them open.   The
 moral treatment of such  patients needs be be-
 gun 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  gener-
 ally do well ;  this  is the first step  toward re-
 covery.  At  this  stage, any sudden  event
 which necessitates or  ought to  necessitate
 exertion will  frequently suffice to complete  a
 cure ; but if there has been  no improvement
 it may do harm.   Perhaps the majority of 
INSANITY                                 INSANITY           255
 melancholic patients improve,  and a  great
 proportion  get quite well ; but sometimes it
 passes into a kind of melancholy called mel-
 ancholia altonita, which  rarely does well, or
 the patient may even become frenzied  as in
 mania.   Certain of the  peculiarities  above
 alluded to as characteristic of melancholy are
 much belter marked in the form of the malady
 known as acute melancholy. The patient be-
 comes actually frenzied  fiom fright.   Such
 patients have very strong suicidal tendencies,
 and  require the  most  caret ul   watching.
 These, too, are the patients who most  com-
 monly refuse food, and who require lo be fed
 forcibly.  They also  refuse to  lie  in bed at
 night, and  especially to  be covered by bed-
 clothes. This, too, must be forcibly combated.
 Patients,  the subjects of this form of disease,
 generally end  badly.   They  are  sure  to be
 badly nourished, and a very little superaddi-
 tion to their troubles in the way of acute dis-
 ease finishes them.  The lungs are especially
 liable to be fatally affected by low forms of
 inflammation.
   Mania,  accompanied by delirium, is per-
 haps 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 de-
 pend very greatly on the soil in which the bud
 is cast ; if there be 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 is it likely to be.   It is not always  de-
 sirable to  hurry these patients to an asylum,
 for, as said,  they may recover perfectly in a
 day or two  ; but  frequently it becomes  abso-
 lutely necessary to do so.
   Acutely delirious patients generally behave
 much in the same way.  They sing and shout,
 and will not rest a minute.  Commonly 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 means of treatment
greatly commended by some.  Its mode of
application will  elsewhere  be given.  (See
Packing.) As is well known to  those who
have experienced this mode of treatment, it
produces  a soothing calm which can hardly
be described, and at the same time it implies
as  absolute  rest in  being swathed  as a
mummy.  It acts, moreover, as a strait-waist-
coat, while acting medicinally ; but it is not
to be used overmuch, for too long  exposure
to its influence greatly weakens the patient—
a result we do  not desire  to obtain.  It is
chiefly with regard to these cases,  or to the
occasional outbursts 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 be-
tween 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  at-
tendant'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  sometimes an entire
absence of sleep for days and nights.   Wom-
en  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 procuting the  last  have
once more to  Le  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,
drug treatment had  been a good deal aban-
doned, and treatment by baths relied upon,
so general was the distrust 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 tem-
perature for the  bath is  about 92° or 93°  F.,
and the patient must be kept in it  for a con-
siderable time—half an hour or so.  Shower-
baths are  not  to be  given.   If the bowels be
confined,  a good  dose  of calomel may  be
given ;  but this had better  not be  repeated.
Frequently,during the acutely delirious period,
when many of these purgative drugs have
been administered, no action follows until the
patient begins  to come  round, and then  the
ac.ion  may be so violent as to occasion dan-
ger to  life, and under any circumstances will
occasion an important loss of strength.   For
similar and other reasons bleeding and blis-
tering are to be avoided.
  There is still another form of mania, which
may be acute, and yet there  is no  delirium. 
C5G
INSANITY
INSANITY
This  insanity may consist of delusions, but
more frequently manifests itself  in  actions
usually of a violent  and  dirty description.
Frequently they have their wits about them in
an almost surprising fashion, quite baffling the
medical man ivho endeavors to examine them,
so as to sign a certificate for their admission
to an asylum.   It may be as plain as a pike-
staff that they are mad, and yet it may hardly
be possible to obtain enough to place on  the
schedule to justify one in signing such a cer-
tificate.  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 mis-
taken 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 day they will dis-
turb the whole ward throughout  the  whole
night.   Sometimes they may go on like this
for long periods together, and, as they are
exceedingly troublesome, care must be taken
to get them  quieted.  This  was the class, and
they  constitute a goodly  proportion  of our
asylum folks, who used to be dealt with by
bodily punishments.  The plan did  not suc-
ceed.  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.   Much they do  is
like the acting of ill-trained children, and they
must be taught, if that be possible, the habit
of self-restraint.  Work in the field or garden
is the best means  of  keeping  such maniacs
out  of mischief.   Formerly  tartar-emetic
was given  freely  to such  patients,  and un-
doubtedly it kept them quiet for  the time
being ; but  it had no tendency to cure the
malady as work in the open air has.   Very
often these  patients  are allowed to run  on
without care or attention until  too late, pro-
vided 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 com-
monly 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
madness 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 charac-
ter, and  he probably  ends by becoming a
chronic maniac of the class just described, or
 a melancholic, but without the characters  of
 either division being very strongly  marked—
 that is to say, the patient being chronically
 insane, is  neither very excited  nor greatly
 depressed, when the health is ordinarily good.
 Such patients may, in most  respects, behave
 themselves  seemly enough, and  yet may on
 some particular point be as  mad  as  possible.
  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.  We have briefly alluded  to
 insane impulses, to what is called  moral in-
 sanity,  where there are no delusions—only
 acts which may or may not be  insane, and
 these need not further detain us ; but to this
 a few  remarks may be  well devoted.   This
 malady is one of the most fatal known, for no
 case has been known to recover, and though
 to the individual concerned there  is little pain
 connected with the disease,  yet the condition
 it produces  in him is such  as to create ex-
 treme disgust among his friends.  The malady
 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 exalted delusions,
 and the third one of complete dementia, with
 complete prostration of mind and body.  In
 the first  stage, or stage of  inert, a general
 paralytic is usually a prey to exalted notions
of his own importance and power.  If he has
 money he scatters it broadcast, 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 forgot-
ten.   The man mentaily  seems  falling  into
the dotage of old  age,  and yet he  is in the
 prime of life, most likely between thirty and
 fifty.  At this period,  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 character-
 istic.   Both these signs, are, however, much
 more marked in the second  stage, when the
 patient becomes fairly the subject of delusions,
These delusions, as already pointed out, are
 all of an  exalted character,  lie can do won-
 ders in every way.  But he has no fixed de-
 lusion ; that varies in degree, if not in kind,
 day by day ; but it ever goes on increasing,
 and that  too rapidly.   All his surroundings,
 though of the most trumpery kind, are inter- 
INSANITY
INSECTS (POISONOUS)     257
 preted as  being of the grandest character ;
 his power is immense, and his bodily strength,
 though like that of a a child, he thinks incom-
 parable.   As  to physical signs,  as already
 pointed out, they commonly begin with slow-
 ness 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 trem-
 ulous motion of the  upper lip which  is so
 peculiar  ; but in some there is in its stead a
 kind of  stiffness and swelling instead of the
 tremulous condition.  The tongue, too, trem-
 bles 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  they
 are generally men in the prime of life, and so
 they are  not easy to manage when they break
 out in fits of violence.  By  and by  they be-
 come  subject to fits of a peculiar kind, not the
 true epileptic convulsion, but most frequently
 epileptic  in form, and not seldom of the  kind
 resembling the slighter attacks of  epilepsy
 called petit vial.  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-writ-
 ing, too, becomes  imperfect, both as to me-
 chanism and material.  Words or letters  are j
 omitted or inserted  wrongly, the same word
 is repeated  over and over again.   The whole
 is nonsense.  The food is  eaten voraciously, !
 sometimes bolted,but in other cases, especial-
 ly 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 beddmg without
 knowing what  they are doing, and they dirty
 themselves  very  frequently  for  ornament.
 From  such a condition the patient may for a
 time partly  recover, and in all  cases there is
 great  variability of  the symptoms—well to-
 day and worse to-morrow—but there is only
 one end, that is dementia and death.
  By and by the patient gets worse ; he  can
 hardly walk or shuffle round  the  room ; he
 loses power over the bladder and rectum if
 not constantly attended to. His face has  lost
 all   expression, and yet  it  seems  fat and
 puffy.  He  can hardly hold anything  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, so then  there is
risk of suffocation if this is not seen to.   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 sur-
 vive a good long  time if care  be taken of
 them, and if  they are protected from cold, to
 which they are very sensitive.  Much, there-
 fore, depends on the care  taken how long the
 disease  may last, bufr the average duration
 from the onset to the end  does not exceed as
 a rule two years, while it may be much less.
   The causes of the malady are hard  to de-
 termine.  As already pointed out, it generally
 occurs  in the  prime of  life, and  most  fre-
 quently 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 not very easy to  make out,  but irregular
 lives have been noted in a considerable num-
 ber.  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 they are confined  to bed for a day or two
 their backs must be  carefully watched, and, if
 necessary, washed with some weak spirit with
 a little  corrosive sublimate in it.   Stimulants
 are usually necessary, especially in the later
 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 par-
 oxysm ;   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.
 As  the penalty of insanity is something con-
 siderable, it is rarely feigned  save  by crimi-
 nals before or after conviction ; before con-
 viction  to escape the consequences of  his
 crime, after it to  escape from the heavy  labor
 of penal servitude.   The means of detecting
 feigned insanity are not too numerous : 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.
  INSECTS  (POISONOUS).—It  may  be
 useful to point out the different classes of  in-
 sects  which   are venomous,  the  countries
 where they are found, and the treatment  to
 be adopted in  the event of injury.
  (a) Of the Invertebrata, the scorpion is per-
haps the  most formidable.  Its sting is the
claw with  which it is armed at the end of its
caudiform abdomen ;  this claw is perforated
and  connected  at  the  base  with poison-
glands.  The  symptoms  produced by its  at-
tack very much  resemble  aggravated forms 
258          INSOLATION
INTERMITTENT FEVER
of wasp-stings.  It is found  in  the  hotter
regions of  the globe, and a small species in
southern  Europe.  The  best  remedy  is the
external application of ammonia, as well as
its administration  internally.
  (3) Centipedes {Scolopendridof).  The poison
of these creatures is conveyed by some curved
fangs connected with the mandibles, which
are  perforated and probably  communicate
with poisoned glands.
  (<i) Spiders (.-/raneida).   Of these there are
a few  species deserving  of special  notice.
The tarantula (southern  Italy) has  long en-
joyed a reputation for the extraordinary effects
said to  be  produced  by its  bite.   Direct ex-
periment,  however, has shown  that nothing
beyond slight local irritation is produced ; in
fact, most of the tales connected with spiders'
bites are fabrications.   The bites of insects
are  comparatively   innocuous ;  but  it is
otherwise with their stings.  Stinging insects
belong chiefly, if not exclusively,  to the order
Hymenoplera, in  which the sting, in the sterile
females, represents the modified ovipositor.
The instrument consists essentially of two ex-
ceedingly fine sharp darts inclosed in a tubu-
lar sheath,  at  the  base of which is  placed a
special venom gland  or sac, whose contents
are injected into the wound  made by the ser-
rated or barbed darts.
  Treatment.—Ammonia  in the  form  of sal
volatile is the best application for allaying the
smarting and inflammation  produced by the
stings.   If a  person has been   stung suffi-
ciently to cause faintness, cordials and opiates
must be administered without  delay.  The
point of injury should  be examined minutely,
and the sting, which is frequently left  in the
wound,  removed  with a fine  forceps.  In
Sydney, a  poultice of ipecacuanha is consid-
ered to be a specific for almost any kind of
venomous  bite.   It sometimes happens that
a wasp  or  bee may be swallowed in fruit or
drink ;  the danger then is very urgent, from
the rapidity with which the fauces  swell up
the moment the  sting enters ;  leeches should
be applied  externally, and hot salt-and-water
gargle used  frequently.   The operation of
laryngotomy,  however, is usually  the  only
available remedy.
  INSOLATION.  (See  Heatstroke.)
  INSOMNIA.   (See Sleeplessness.)
  INSPISSATION is the process of thick-
ening any liquid solution by evaporating part
of the  water over a fire.  Its  object  is to
render an infusion or a solution stronger.  It
is best performed in a water-bath, to prevent
burning.
  INTERMITTENT FEVER, or AGUE,
is a specific fever occurring in paroxysms and
characterized by a cold, a hot, and a sweat-
ing stage, followed by a  period of complete
absence from fever.  The exciting cause of
this malady seems to consist in certain invisi-
ble  effluvia, or emanations  from the soi' of
marshy districts, to which  the  term malaria
has been applied.  The  malaria is, therefore,
a distinct and specific poison, producing cer-
tain  specific  effects  on the human constitu-
tion.   It is important, therefore,  to know  in
what countries and in what parts of a country
this malarious influence is liable to exert its
pernicious  qualities.   Of  the nature of the
poison we know nothing ; whether gaseous
or aeriform, it undoubtedly exists in  the at-
mosphere of particular districts, but nothing
as yet has been made out of its physical  or
chemical qualities.  (See Malaria.) Climale
seems to exert a marked effect upon,this mal-
ady ; in the Arctic circle it is not known  to
exist, nor is it found in the colder seasons of
more temperate climes.  Seldom met with
above the 56th degree of  latitude, it occurs
in its most pernicious and injurious forms  as
the torrid regions  are  approached.   Observ-
ers are not yet agreed as to the exact nature
of the  soil which breeds the mischief;  some
have thought that decaying vegetable matter
was a cause, but in vegetable markets, where
rotting  leaves are  abundant,  ague  is not
found ; and, again, others have  shown that
this fever is produced where there is no  vege-
table matter  to decay.   Heat  and moisture
together  are  not sufficient, for the  disorder
does not prevail among sailors at sea in what-
ever climate they may be ; the air and water
of affected districts have been examined, but
at present with no result.  It would seem that
those places are the most dangerous which
have been flooded and then become  dry ; so
the edges of swamps or the banks of drying
or half-dried rivers  become dangerous, ac-
cording to the season and the amount of water
in them.   It has often happened that  those
living in  the lower parts of a district are very
liable to the  fever, while those in  the  same
locality, but perched upon a hill,  escape alto-
gether.   Ague  and aguish fevers are, there-
fore, in temperate climates, more common  in
the autumn than at  any other  period of the
year, and follow after the  heat of summer.
Persons who live in marshy districts become
acclimatized to it, while strangers are readily
affected.  Although the natives in such places
are not so liable as new-comers to catch  ague,
yet they  seem to be  chronically affected by
the unhealthy atmosphere ; they are not  a
strong race, short in stature, of a sallow  com-
plexion, a melancholy and short-lived people.
It is a very  remarkable fact that the negro
seems  to enjoy a marshy swamp :  places
which to the white man are most pernicious
seem to have no effect on his darker brother,
while conversely the black  can find no enjoy-
ment on  the hilly lands where the white man
flees for health and safety.  Persons are  much
more liable to catch the disease at night than
during the day, so much so that many placis
which are safe during the day are pernicious at
night-time. Even now travellers at Rome are 
INTERMITTENT FEVER
INTERMITTENT FEVER    259
 warned against crossing the Pontine marshes
 after sunset.   Again, the  malarious poison,
 whatever it may be,  likes  to keep  near  the
 ground, so that those who live in  the upper
 rooms of a house  are safer than those who
 sleep on the ground-floor, and this  may be
 the reason why lying down in the open air in
 such places is so dangerous.   The malaria is
 movable by  the  wind ;  sometimes it hangs
 over a district like a thick fog or milky vapor
 near the surface of  the ground.   The malaria
 seems to  lose its  effect by passing over a
 sheet of water, so that while troops on shore
 are  having ague, those  in the ships a few
 hundred yards off may be perfectly free. The
 marsh poison seems to cling to the foliage of
 thick and lofty trees in those districts, so that
 it is very dangerous  to go under them, and
 still more to  sleep there ; and this fact has
 been made use of, for, in Guiana, where large
 trees abound, the settlers live  fearlessly and
 unhurt close  to the  most pestiferous marshes,
 and to leeward  of  them, provided that a
 screen or belt of trees be interposed.  Some
 curious notions were entertained in earlier
 times  about  the  salutary  effect  of  an ague.
 Dr.  James Sims, a London physician, when
 suffering from an  illness, which afterward
 proved fatal, felt convinced that he should re-
 cover if he could catch an ague ; for this pur-
 pose he went down into a marshy district, but
 came  back, complaining that  there was  no
 ague to catch, and that the country had been
 spoiled by  draining. -"The   superstitious
 Louis XI. prayed to  the Lady of Selles that
 she would confer upon him  a quartan ague"—
 a  request with which it  does not appear she
 complied.  There is an old English proverb,
 " an ague in  the spring, is physic for a king ;"
 in spite of this, James I. died of it.
   Symptoms.—The person who has been ex-
 posed  to  malaria  will generally suffer  for a
 few days from premonitory  symptoms. There
 is nausea and loss of appetite, with a slight
 feeling of  chilliness  ; often, too, there are
 muscular  pains in  the back and lower ex-
 tremities ; these symptoms may last only for
 a few hours or may be prolonged for several
 days.  Then  comes on the  regular attack, be-
 ginning with a cold stage,  in which the pa-
 tient lies shivering in the bed with chattering
 teeth, gathering the clothes round about him
 to keep himself warm ;  yet there  is only a
 feeling of cold, for in reality the patient is
hotter than usual, and the temperature in this
 stage will rise from  98.50  Fahr. to 101° or
 1020 Fahr.  This  is followed by a hot stage,
in which  all  shivering  has  ceased, while
the temperature goes on rising, so  that in
three or four  hours  from the  commencement
of the fit it may have  risen to  105 °  Fahr. or
 1060 Fahr. ; thus in that short time the whole
mass of the human  body has been heated  up
seven or eight degrees in many cases. When
this hot stage  is on there are flushes of heat
 about the face and neck ;  the coldness ceases ;
 the skin, which before was shrivelled and pale
 or even livid, now returns to its natural color,
 and the face assumes an ordinary appearance ;
 then a reaction takes place and the face be-
 comes red, the skin hot and dry ; there is a vio-
 lent headache and throbbing of the  temples ;
 the pulse is full and quick and strong,  while
 the breathing is oppressed ;  the patient feels
 very miserable and restless.   But presently
 the skin becomes softer  and breaks out into
 a gentle  perspiration on  the head and face ;
 this quickly increases, so that soon the  whole
 body is bathed  in  sweat, and great relief  is
 experienced ; the thirst ceases, the tongue  is
 clean again, the pains go away, and the heat
 and  discomfort pass  away,  so that in a few
 hours he will  feel as well again as ever until
 the next recurring fit.  During the  sweating
 stage the  temperature is falling, and at last
 reaches the  normal  line of 98.4" Fahr.   If
 any one draw on a chart  the state of the tem-
 perature  he will find  an  ascending and de-
 scending curve, rising at its highest  point
 seven or  even eight degrees above  the ordi-
 nary line of health (98.40 Fahr.).  During the
 first part of the ascent the patient shivers and
 has a rough skin—goose-skin as it is called—
 during the  second part  of the ascent he  is
 burning hot, but directly  sweating begins the
 thermometer shows a fall in the mercury, and
 this continues until the  third stage is over,
 when the patient  generally falls asleep and
 wakes feeling much  better.  But  the cold
 stage  may  occur and never be followed  by
 the hot, and again  there  may be  a hot stage
 not preceded by a cold one ;  those who suf-
 fer in this way often speak of it as dumb ague,
 and they generally have suffered from the
 ordinary ague previously. This set of symp-
 toms is exceedingly well  marked, and no one
 can mistake the  disease  ; yet there is  great
 misery endured by the patient during an at-
 tack,  although it is only temporary, and in
 this country very curable. A most character-
 istic  feature of  ague is  its  recurrence, and
 hence it is called an  intermittent fever ; the
 intervals  between the  attacks are marked  by
 a total absence  of fever ;  when these in-
 tervals are imperfect and  the patient remains
 ill between the paroxysms, the disease is called
 remittent; this form is met with, as has been
' said,in tropical climes.while the former is most
 common  here.   There   are three  principal
 types of ague.  When the paroxysm comes on
 every day,  it is called  quotidian;  when  it
 comes on at  the  same time every other day,
 appearing and remaining absent day by day
 alternately, it is called   tertian;  and  when
 two whole days intervene between the parox*
 ysms it is called quartan ; the two latter terms
 ought to be " secundan" and  " tertian" re-
 spectively, but old observers gave the names
 and they have been kept in the language.  As
 a rule, the quotidian ague comes on in  the 
2G0    INTERMITTENT FEVER                  INTERMITTENT  FEVER
morning, the tertian at noon, and the quartan
in the afternoon, although there are many ex-
ceptions, and it often happens that instead of
coming on  at the same hour  the fits may be
postponed  or accelerated , that is, they may
begin a little later or  a little earlier.   These
types differ from each other  somewhat, not
only in  their respective  intervals, but  in the
duration of the  paroxysm  and in the period
of the  day  at which the paroxysms  com-
mence.   In the  quotidian  form the fit lasts
ten or twelve hours, while  in  the  tertian its
duration is from  six to eight  hours usually,
and  in the  quartan it may be only four or six
hours.   Of these various forms the tertian is
the most common in this country, although
the others are far from infrequent.  Besides
these forms there seem to be others in which
two types are mingled ; thus a double tertian
or a double quartan may be met with, and a
patient may have two attacks in the same day.
  Treatment.—Ague is  a  very curable dis-
ease, and in this  country at least very simple
measures  may be taken.   During the  cold
stage the  patient will naturally prefer  to go
to bed,  and wraps himseif up  as  warm as
possible, and he  may be allowed to drink any
simple fluid that he likes, such as tea, barley-
water,  weak wine and water, etc., and no
more need  be done than that.  There is no
occasion to be over-fussy during a paroxysm,
as the patient will  come out  of it all right.
Of  all  the  remedies  in  the  Pharmacopoeia
none are  more   valuable than  quinine and
arsenic in the treatment of ague.   Expensive
as quinine is, it  is yet preferable  to arsenic,
because not  only is it more efficacious, but it
is not poisonous, and  can be  left about with
safety.  Given in large doses it is apt to pro-
duce giddiness, singing in the ears,  and deaf-
ness, but these effects  will pass away of them-
selves.  Four or  five grains of the sulphate of
quinine  taken every four or six hours during
the interval of an ague fit will generally cure
the patient.   Very often  the cure is immedi-
ate and  the patient has no more attacks ; more
often he has one or two very slight ones and
then becomes convalescent.  In hot countries
larger doses may be required, and  for travel-
lers in aguish districts nothing is more inval-
uable than a plentiful stock of quinine.   Bark
used to be given in  such cases, but when the
good effects of the bark were found to be due
to the  small quantities of  the alkaloid in it,
then physicians preferred giving the latter, as
it  was better borne  on  the stomach and is
much pleasanter to  take, besides  occupying
less compass. If a relapse take place, quinine
must again  be  taken.   Sometimes quinine
is disliked,  and then arsenic may be tried, but
it is very poisonous,  and must only be given
under medical advice ; the injurious effects
that should be looked for are a soreness of the
throat, vomiting, diarrhcea, pain in the abdo-
men, smarting and redness of the eyes and
nose.  Numbers of other remedies have been
tried, but no remedy is so powerful, effectual,
and simple as quinine.   The diet should be
liberal and  nourishing ; the patient,  being
much weakened by the attacks, will not bear
any  depressing influences  ; strong beef-tea,
milk, and some wine may be given  daily,
and meat or fish, etc., if  the patient care for
it.  After an attack, a nutritious  diet, abun-
dance of exercise, pure air,  and pure water are
very important : the individual,  if possible,
should leave  the neighborhood or live  at a
higher elevation. After repeated  attacks, the
liver and spleen are liable to become enlarged,
and  the latter  condition is known as ague-
cake.  An ointment of the  red iodide of mer-
cury has been strongly recommended for this
affection ; a portion the size of a hazel-nut,
may be rubbed into the left side and exposed
to the heat of the fire ; its application should
not be too often repeated, as it is apt to make
the skin sore.
  Brow-ague is another disease  allied to an
intermittent fever, and produced  by malari-
ous influences also ; it consists  chiefly  in an
intense pain confined to one side of the head,
lasting for several hours  and gradually pass-
ing off ; it comes on in paroxysms with vary-
ing intervals, and is chiefly met with in  sen-
sitive and  nervous people, and  more espe-
cially if they have had any mental trouble or
wrong previously.   From  affecting half the
head only, brow-ague has been  technically
called Hemicrania ; Migraine is also another
term for the  same  affection.  It  generally
occurs in the adult, and  is  more  common in
women than in men.  This form of headache
is very different to that which comes on after
a debauch or from eating too good a dinner,
and which is generally  accompanied by dis-
turbance of  the functions of the  stomach or
liver.  The  true sick  headache  is a purely
nervous affection  and quite independent of
excessive  eating or  drinking ; it occurs in
very temperate people and  is often hereditary
in families.  Any  cause which  produces a
strong impression  on the nervous system of
those who are predisposed  to it will bring on
an  attack.   Exposure to heat and fatigue,
breathing the hot and impure air  of a theatre
or concert-room, working late at night by gas-
light, working with a microscope, and any
special mental worry or excitement will cause
this painful  affection.  Those who suffer in
this  way wake in the morning feeling more
dead than alive, unable to  swallow any food,
and perhaps  actually sick ; the head throbs,
and any movement or conversation is avoided
as the pain is increased by  doing  so ; the pa-
tient begs to be left alone and to be kept quite
quiet, as the only means of obtaining sleep.
The sufferer looks ill and pale, has contracted
pupils, and a dark line under the  eyes.   The
head feels hot,  and the application of cold is
most refreshing.   The appetite is gone, the 
INTERNAL BLEEDING
INTESTINES           201
 mouth feels clammy, and there is a feeling of
 nausea.   Hot tea and coffee seem to allay the
 nervous system and give relief,  and a little
 wine or ammonia may be  given.  The only
 relief during an attack is to be found in a wet
 bandage round the head, profound quiet, and
 a darkened room.   Medicines have been over
 and over again tried and found useless, nor is
 it to be cured  by remedies  which act as  pur-
 gatives or on the liver and stomach.  Aconite
 and belladonna have been employed locally
 but with no good result ; sometimes relief has
 been obtained by giving  bromide of  potas-
 sium.  During the intervals the general health
 must be kept  up  by quinine and  tonics, but
 most good will be done by the  sufferer care-
 fully avoiding any of those causes which are
 found by his or her own experience  to bring
 on an attack. Very recently guarana has been
 recommended for  the cure of th's affection.
 This drug has  long been known, but it has not
 yet come into general use.   It consists of the
 seeds of Paullinia sorbilis, a tree growing in
 Brazil,  and belonging to the  natural order
 Sapindacea:  The seeds are ground into pow-
 der, and contain an alkaloid which is said to
 bs identical with that found in tea and coffee.
 The seeds, roasted, bruised, and pressed into
 cylindrical masses, form the guarana  paste,
 which,  when  finely  pounded, is then known
 by the name of Paullinia powder.  It is light
 brown  in  color, has  an odor faintly  resem-
 bling roasted  coffee, and a bitter astringent
 taste.  It contains tannic acid, and a principle
 called guaranin, which has much the same
 effect on the nervous system as tea or coffee.
 This drug has been much  used in  France for
 sick headache  and various forms of neuralgia,
 and  is given in doses of ten to fifteen grains
 once or oftener in  the day.
  INTERNAL BLEEDING.   (See Can-
 cer,  Gastric Ulcer, and Hemorrhage.)
  INTERTRIGO,  or Erythema   Inter-
 trigo,  is  the name  given  to  the common
 local condition known as a chafe or fret,  and
 which consists in redness and excoriation of
 a part of the skin.   This condition is caused
 by friction and prolonged contact of two  ad-
 jacent surfaces of skin, by  the friction of
 portions of dress, or by the contact of irritat-
 ing discharges.  It is met with generally in
 corpulent persons  and infants,  and in those
 who perspire  freely.   Its development is
 favored by the accumulation of sweat,  and
 occurs in persons who pay very little  atten-
 tion  to cleanliness.  The most frequent seats
 of intertrigo are  the  inner  surfaces of the
 thighs, the inner portions of the buttocks, the
 navel,  the armpits,  the back of  the neck,
 and about the  genitals.  It may be often  met
 with in  the folds of the skin of fat  infants,
 and  especially in  the flexures  of joints.  It
 occurs especially in warm weather.  It is often
produced in persons who take active exercise,
as in making walking tours during the sum-
mer or autumn, and thus causes much annoy-
ance and  distress.  The friction of the skin
induced by any of the above-mentioned causes
produces  a  raw and inflamed surface,  from
which there  is a thin discharge. The perspira-
tion also from the adjoining  portions of skin
is increased  and becomes very foetid.  There
is much itching of the affected parts, which is
increased by movement and friction.
  Treatment.—Intertrigo may in  most per-
sons whd are liable to be troubled  by the
affection be  prevented by frequent ablution,
followed by  careful drying, and  by occasion-
ally bathing the  most likely  stiuations  with
diluted  spirits of wine  or  weak lead lotion.
When a raw surface has been formed  the pa-
tient should  keep it at  rest as far as possible,
and prevent  further friction  of  applied sur-
faces of  skin.  The  excoriated  portion of
skin should  be kept very clean  and  be fre-
quently dusted with absorbent powder,  such
as  starch,  lycopodium, or  oxide of  zinc.
Fuller's earth and a weak  solution of lunar
caustic  or of alum are useful applications.
In  some cases,  where the patient is out of
health and has taken much exercise in  spite
of the development of very painful intertrigo,
the raw surface becomes much inflamed and
is covered by a thick ill-smelling discharge of
pus mixed with blood.   In some cases of this
kind  perfect  rest  of  the  patient  becomes
necessary, and the affected  parts should be
brushed over  with a strong solution of lunar
caustic, and  then be treated by zinc or chalk
ointment, attention at  the same time being
paid to the general health.
  INTESTINAL  WORMS are  parasites
which infest the intestines. (See Entozoa and
Parasites.)
  INTESTINES form a long, hollow channel
from the stomach to the anus, and allow the
passage of food along them.  Different names
have been given  to different portions  ; the
first part nearest to the stomach is called the
duodenum, and is about twelve inches long ; in
this portion  the liver and the  pancreas empty
their secretions and mix with the food which
has just left  the stomach.   The  next portion
is called the jejunam,  and is about two feet
long, and it  is abundantly supplied  with ves-
sels ; this leads on to the ileum, which is sev-
eral feet in length, and forms the greater por-
tion of  what  are  called the  bowels ; these
three parts  make up what is known as the
small intestines.  The next portion is of larger
calibre,  but made of similar materials, and  is
called the large bowel or the  large intestine ;
it commences in the right  iliac region of the
abdomen  as the ccccum, and  then, making a
large curve  round the  abdomen, it descends
by the left side of the abdomen into the pelvis
and ends at the  anus.   In its  course  it  is
called, respectively, the ascending, transverse,
and descending colon, while the lower twelve
inches are called the rectum.   Although hav- 
202           INTOXICATION
INTUSSUSCEPTION
ing different names, the intestines form one
continuous channel of great length, but they
are kept in position by a membrane called the
mesentery, so that the  different portions all
lie coiled together and can move freely upon
one another.  The coats of  the intestines are
three in number :  i. A serous smooth exter-
nal coat, called the peritoneum, which allows
the bowels to glide over each other smoothly
and  without pain.   2. A  muscular coat, by
which contractile movements go on in waves,
so that the food is propelled gently from one
end  to  the  other.   3.  Most internal is  the
mucous coat, a membrane lined  with  epithe-
lium and richly supplied with vessels, so  that
all the soluble parts of the  food can be ab-
sorbed as it passes along ; this  coat is really
much longer than  the  intestines, as it is ar-
ranged in folds,  like the tucks of a dress, so
that the surface available for absorption of
the food  is thus vastly increased.  In  this
coat are  numerous glands, which empty their
contents into the canal.  The movements of
the bowels caused by the  contraction of the
muscular coat are called peristaltic, and when
abnormally  increased in force  and frequency
they cause griping pains and diarrhcea.   At
the lower end of the caecum  is a curious little
tail or appendage, known  as  the appendix
vermiformis ; its function is not known, but
serious effecis have ensued from foreign bod-
ies, as  pins, cherrystones, etc.,  becoming
lodged there on their way down the bowels.
The intestines are  very liable to disease,  and
these affections  are treated of in the articles
on Cholera, Constipation, Diarrhoea,  En-
teritis,  Flatulence,  Hemorrhoids, Her-
nia,  Intussusception, Obstructions,  Ty-
phritis, Typhoid Fever, and Vomiting.
  INTOXICATION.   (See Drunkenness.)
  INTUSSUSCEPTION is the name given
to a condition in which a portion of the bowel
is protruded, something like the finger of a
glove half turned  inside out.  It is very fre-
quently met wiih  in children, and it seems
wholly independent of any symptoms of  dis-
order of the bowels during the patient's  life-
time ; sometimes only a single  intussuscep-
tion is found, but oftener  there are several;
and as many as ten or twelve have been found
in the same subject.  They are generally con-
fined  to  the small intestine, and are most
common in  the ileum.   The great frequency
of this occurrence, the absence of any symp-
toms during life, or of  any indication of  dis-
ease about the intestines after  death, lead to
the opinion  that this invagination may often
occur in the process of dying.  Although  this
form  of  intussusception is so common,  yet
there  are some rare cases in which a portion
of the large  intestine may become  invagina-
ted, and  cause a serious, if not fatal, obstruc-
tion.  This accident takes place generally in
infants under one year of age, and often  less
than six months old.
  Sudden and violent vomiting,  followed by
loud cries and signs of general uneasiness and
pain, recurring at uncertain intervals, accom-
panied  by  violent straining  and  effort to
empty the  bowels, are the earliest symptoms
of the mischief.  At first some faeces  may be
voided by these forced efforts, then mucus is
discharged tinged with blood, or  even pure
blood in considerable quantities.   If an in-
jection be given the fluid generally returns at
once, as its  passage  upward is obstructed,
and the obstacle may  be felt sometimes when
the finger is passed up the rectum.  Vomiting
commonly comes on, and is  renewed when-
ever any food or medicine is administered.
The  pain comes on  in paroxysms, alternating
with  intervals of quiet ; the  child  is often
thirsty,  and  will take the  breast or bottle
readily, although the sickness is  persistent.
It is  seldom  that anything can be  made out
from the external  examination of the abdo-
men.  As the obstruction continues there is
exhaustion of the infant's strength ; its pulse
grows more ajpd more feeble, the face becomes
anxious and sunken, and it falls in the inter-
vals  of pain into  a quiet, sleepy  condition.
In many  cases  convulsions  come on a few
hours before death, which takes  place within
a week, and often in  two or  three days.  In
some rare cases the symptoms abate, the pain
and the sickness may  cease, the bowels act of
themselves, and a speedy recovery of the little
patient occurs ; but this  is a state of things
which can be rarely hoped for.
  Treatment.—The treatment  must  consist
in stopping  the  use of any  purgative  or
active remedies to remove the constipation,
and in adopting soothing measures ; as soon
as the symptoms of intussusception occur, no
aperient  medicines  must be given  by the
mouth, as they will increase the action of the
bowels and make the  obstruction worse than
ever. Hot fomentations should be applied to
the abdomen, and a little opium may be given
to allay the pain ; but this drug must be given
with the greatest caution, as even the admin-
istration of two or three drops  may prove
dangerous to an infant under-twelve months
of age, and then the remedy will  be as fatal
as the disease.  If the symptoms do not dis-
appear within twelve  or  eighteen  hours,  in-
jections must be given by the rectum so as to
unfold the invaginated intestine,  just as the
introduction of a finger  will push  back the
above-mentioned glove.   Injections of warm
water may be used, and  even inflation with
air has  in  some  cases  been effectual ;  this
plan is useful in cases where the large intes-
tine is involved in the mischief, but not where
the small intestine  is implicated ;  however,
this last occurrence  hardly ever  occurs so as
to cause any symptoms, and nearly always it
is the large bowel  which is  the seat of the
obstruction. Surgical interference has in some
cases been successfully resorted to, and the 
INUNCTION
IODINE
263
 operation of gastrotomy has been performed,
 where the abdomen is opened by an  incision
 in front, and then search being made for the
 obstruction, the invaginated bowel is restored
 to  its proper  condition ; this is, of course, a
 very dangerous operation, but it may be re-
 quired when there is no other  chance to save
 life.  For  an  account  of  intestinal  obstruc-
 tions in the adult, see Obstructions.
   INUNCTION.—The remote and constitu-
 tional effects of certain  remedial agents may
 be produced by  rubbing into  some  parts of
 the surface of the body ointments containing
 these agents.   Thus   belladonna ointmenc
 rubbed into the skin of the forehead or temple
 will  produce enlargement  of  the pupil and
 relieve the severe pain attending certain forms
 of inflammation of the eye, and friction with
 sulphur ointment will in some cases rel.eve
 the articular pains of rheumatism and rheuma-
 tic gout. The agent which has been most fre-
 quently administered in this way is mercury,
 and  mercurial inunction is still with many
 surgeons a favorite way of treating syphilitic
 affections.   The patient is ordered to rub in
 half a drachm or a drachm of strong mercurial
 ointment every night, or on alternate nights,
 until it is thought  necessary  to  discontinue
 the use of  this powerful agent.  The most
 favorable parts to which the ointment can be
 applied are the armpits, the inner surfaces of
 the thighs  and arms, the hams  and calves,
 and the front of the abdomen.  The ointment
 ought not to be rubbed into the same part on
 two nights in succession. The patient should
 keep up friction for twenty minutes, and then
 put on  a thick  flannel shirt, or flannel draw-
 ers and retire  at once to  bed.  No  attempt
 should be made to wipe away any of the oint-
 ment which remains on the surface of the skin
 after the friction.  By this proceeding all the
 general effects  of mercury may be produced,
 and after  a period  varying in  different indi-
 viduals, the stomach becomes irritated and
 the gums sore.  The presence of the  latter
 result of the inunction treatment is an indica-
 tion that the mercury has commenced to act
 upon the system and that it is necessary to
 discontinue the frictions  or  to  perform them
 less frequently.  This mode of administering
 mercury is as effectual as any  other,  and for
 many patients more convenient, but it has the
 disadvantage of  being  dirty  and  causing
 much trouble.
  INVERSION OF THE WOMB is said
 to have taken place when that organ is either
 completely or partially turned  inside out ; it
 is of rare occurrence, but may come on after
 a labor, if there is an adherent after-birth and
 too forcible  attempts are made to remove it.
 The only remedy is to push it back again into
 its proper position.
  INVOLUTION is a term, opposed to evo-
lution, implying  the return of an organ or
tissue to its earlier state ; thus there  is said
 to be involution of the womb after a confine-
 ment, when that organ becomes small again,
 after having expelled the child.  The womb,
 as soon as the foetus begins to grow, devel
 ops  an immense quantity  of muscular fibres,
 and the various vessels and nerves also in-
 crease in size ; but  after pregnancy is over,
 these  muscular fibres  become  fatty, waste
 away, and are absorbed ;  the vessels also be-
 come much smaller, and  in the course  of  a
 month or six  weeks the womb returns to its
 natural size.  In  some cases,  however, this
 process does not take place properly, and al-
 though the womb contracts a great deal,  it
 may still remain much larger than it ought to
 be, so that the patient has a feeling of weight
 in the lower  part of  the  abdomen,  bearing
 down pains in the back, and inability for any
 exertion.   Menorrhagia or haemorrhage from
 the womb  is also a  very frequent symptom,
 and thus there is great debility.   When this
 takes  place,  sub-involution is  said  to have
 occurred.   It; is  liable to be met with  in
 women of delicate health, in those who get up
 too  soon after a confinement, in those who do
 not  suckle their children, and  in  those  who
 are  not  properly  attended  to  at  the time of
 the birth of the child.   Rest on a couch in a
 horizontal  position  should  be  enjoined, and
 especially when there is any bleeding ; no ex-
 ertion should be  taken, and even a carriage
 drive, unless   upon a very even road, will
 cause distress.  Tonics must be given to sup-
 port the  general strength,  and  the diet must
 be light and nourishing.  An abdominal belt
 will  often give great comfort, and enable the
 patient to  take a short daily walk.   Such
 cases are very troublesome to cure, and weeks
 may elapse before any marked improvement
 may take place ; but, although for a long time
 an invalid, recovery generally occurs sooner
 or later.
  INWARD  FITS are often caused in an
 infant by indigestion or by  flatulence, and are
 relieved  when the intestinal disorder is re-
 lieved, and a great quantity of wind has been
 passed. The child thus affected lies as though
 asleep, winks  its imperfectly closed eyes, and
 gently moves  or twitches  the  muscles of its
 face  ; this convulsive twitching, due to irrita-
 tion  in the  course  of the alimentary canal, is
 spoken of by poets as the " angel's whisper,"
 which makes  the  babe to  smile ; it is more
 correctly ascribed by nurses to the " wind."
  IODINE is  prepared from the ashes of sea-
 weed as collected on the west of Ireland  and
 Scotland.   It occurs  in the form of  scales
which have a metallic lustre, but have not the
 weight of a metal.  They readily  pass, when
 heated, into a beautiful violet vapor.   The
 solution of iodine strikes  a blue  color with
 starch, which  is very characteristic.   It may
 be dissolved up either by alcohol or in a solu-
 tion  of iodide of potassium.  The most im-
 portant preparations are  the tincture, oint- 
204             IODINE                                IPECACUANHA
 ment, and liquor, or strong tincture.  When
 applied externally iodine acts  as an  irritant,
 or if its vapor be kept in, even as a vesicant  ;
 at the same time, if well rubbed in, it is ab-
 sorbed and affects the system.  It is applied to
 the skin for a variety of purposes ;  but its ap-
 plication is painful and sometimes can hardly
 be borne.  The liniment or liquor is applied to
 the chest  as a counter-irritant  in  chronic
 pleurisy, and it is painted on the collar-bones
 for the chronic pleurisy of consumption, giv-
 ing rise to pain and cough.   But as a rule
 other counter-irritants are preferable.  It very
 often does good applied in the same way to the
 joints when enlarged and tender from chronic
 inflammation.  As an ointment iodine  is a
 capital application to chilblains, if applied be-
 fore the  skin is  broken.  So too  in  certain
 neuralgic or rheumatic pains of the chest the
 ointment often does great good, especially if
 the part be  tender  on pressure, and yet due
 to the kind of  malady above  alluded  to.  If
 the skin  be sore or tender On  pressure, bella-
 donna suits better.   Iodine, in some  form or
 other, is the great application for swollen and
 indurated  glands,  and  no remedy  applied
 locally certainly does so  much  good.   In the
 accumulation of fluid in the  scrotum, com-
 monly called hydrocele, it is usual to inject
 tincture  of iodine after the fluid has been with-
 drawn ;  some say plain  spirit  suits quite as
 well.   On similar principles, iodine has been
 injected  into the cavities of joints, the subjects
 of chronic inflammation.  So, too, it has been
 injected  into the cavity of the  chest after  fluid
 has been withdrawn, and even  into cysts of
 the ovaries. In all of these cases the solution
 must  be  rather weak or mischief may follow.
 In  chronic pulmonary consumption  an in-
 halation  of iodine of  the strength given in
 the pharmacopoeia night and morning  will
 give relief.  Similar inhalations have been
 commended in diphtheria and  chronic bron-
 chitis.  Chronic inflammation of the nostrils
 and upper part of the air-passages often yields
 readily to a little  iodine inhalation.   Iodine
 being readily volatile,  easily passes into the
 state of vapor with the heat of moderately hot
 water, and the steam which  escapes  at the
 same  time with the iodine seems to mitigate
 the violence of  its  action.  Iodine  is not
 nowadays given  internally.  As a  rule,  one
 of its  compounds, most likely the iodide of
potassium,  is prescribed.   This salt gives rise
 to all  the constitutional effects  of iodine, but
 is not nearly so irritating.  Nevertheless it
 does irritate, and cannot in many cases be
 given very long without indicating  some irri-
 tability of stomach.
  Both iodine and iodide of potassium taken
 in excess  give  rise to certain  peculiar  phe-
 nomena  called iodism.  Those are the pain in
 the forehead,  smarting of the eyes,  etc.,
 already  referred to.  The  disease in which
 iodide of potassium is most largely and  with
most benefit given is syphilis ;  but it is use-
less untif near the third or tertiary stage ; in
it the drug works  marvels, especially when
the bones are diseased and nodes have formed
on them.  Here the local application of iodine
to the swelling and iodide in full doses inter-
nally will often give  sleep and  rest  when
they have long been absent.   Other thicken-
ings of the covering of the  bone, not syphil-
itic, also yield to the same remedy.   Some
forms of  rheumatism do so rapidly,  others
not at all.   Those do best which are worst at
night, especially if  there be  any syphilitic
taint in the system.   Iodide of potassium is
the best remedy for chronic lead  poisoning
after the bowels have been freely opened, and
provided they are kept open.   Certain forms
of gout, too,  yield  readily to  its  influence,
though others are not affected  by it.  Iodide
of potassium given internally and iodide ex-
ternally are the great remedies for goitre of
the endemic kind.
   There are many other remedies  for which
iodide of potassium has been given, but these
are the  chief for which  it is nowadays pre-
scribed.   It requires to be given in very dif-
ferent doses.   In tertiary syphilis there is no
use playing with the malady,  and so  iodide
of potassium must be given  in  doses of 15 or
20 grains, or even more, three  or four  times
a day.  In other kinds of disease this would
do great harm.   In  rheumatic  gout, as  it is
called, similar large doses require to be given.
The ordinary  dose  for other  maladies  is 5
grains three times a day.  It  is best given
with a vegetable bitter; some like giving it in
milk.
  IPECACUANHA, or Ipecac, is the  dried
root of a plant, Cephtzlis Ipecacuanha, growing
chiefly in the Brazils.  It belongs to the same
valuable group of plants as yields us Cinchona
bark. The root itself looks as if marked with
rings, with a hard woody axis surrounded by
a dark brown woody substance.  Its powder
is pale brown, and is  the preparation chiefly
used.   Its  compound  powder, also  called
Dover's powder,  contains  opium, ipecacu-
anha, and sulphate  of  potash.  This   is a
powerful sudorific.   Ipecacuan wine,  which
consists of wine in  which a quantity of the
root has been soaked,  is also a good  deal
used, especially for children.  Given in large
doses, 20 or 30 grains, ipecacuan acts as an
emetic,  causing some sickness, but  not so
much as tartar-emetic.   In  smaller doses it
promotes  the  secretions  of the alimentary
canal and respiratory organs, and also  upon
the skin.   It  is therefore laxative—though
slightly—expectorant, and diaphoretic.   Do-
ver's powder has the last quality in the highest
degree. The drug has a peculiar odor, which
to some is unpleasant, and  causes  sneezing,
cough, and watering from the nose and eyes.
Ipecacuan is often of great value in allaying
irritability of the stomach, as in the vomiting 
IRRIGATION
IRITIS
265
  of pregnancy and imperfect menstruation.  It
  also seems to do good in many forms of con-
  stipation.  It is, however, mainly used,  so far
  as the alimentary canal is concerned,in dysen-
  tery, especially that of  tropical climates.   In
  some cases it acts like a charm, in others it
  does no good.  Large doses of 40 or 60 grains
  require to  be  given  in this form of  malady,
  and they may be given and repeated without
  any nausea being produced.  In some cases
  of dysenteric diarrhcea in children the wine
  given in small doses frequently repeated often
  cures the malady very speedily,  especially if
  the stools be slimy.  In asthma—hay or com-
  mon asthma—ipecauan wine often gives great
  relief.   Here it must be given in good large
  doses, not sufficient to give rise to vomiting,
  but enough to give rise to a certain degree of
  depression.  It must be used to cut short the
  paroxysm, and must therefore be given  at the
  onset of the attack.  In whooping-cough ipe-
  cacuan is a great remedy.  It  may be  given
  to lessen the  severity  of the paroxysms as
  well as their frequency.   Ipecacuan acts best
  as an  emetic given in small doses frequently
  repeated, and with plenty of water.
    IRRIGATION is a term applied  by sur-
  geons  to a mode of local treatment in which
  the temperature of  an injured  or inflamed
  part is kept reduced by the continual  drop-
  ping on its surface  of cold water or  some
 cooling lotion.   It is practised for the pur-
 poses of preventing or relieving inflamma-
 tion, and of cleansing wounds and ulcers.  It is
 especially useful in cases of severe sprains and
 injuries to joints, and for suppurating wounds
 in connection with fracture.   In the latter
 class of cases  the  discharge  is  continually
 being washed away,  and the wound  and its
 dressings are  kept clean and free from smell.
 The most ready way  of applying irrigation is
 the following  :  A wide-mouthed bottle  filled
 with iced water is suspended over the injured
 part, a long skein of cotton or an ordinary
 lamp-wick,  having been dipped in  water, is
 so placed  that  one  end rests  in  the wide-
 mouthed bottle  while  the other hangs  over
 and almost  in contact with the surface which
 is to be irrigated.  A kind of siphon is thus
 formed,  from the outer end of which there is
 a continual dropping of fluid. In cases where
 the injured  surface is extensive,  two or more
 skeins may  be used.
  IRIS  is  that  portion of the eye which, to
 outside view,  gives to  the  eye  its peculiar
 color ; anatomically, it  is a  structure, parLly
 vascular, partly  muscular,  and loaded  with
 pigment, which separates  the anterior from
 the posterior chamber ;  it may be  considered
as a prolongation of the choroid coat ; the
 pigmentary  element is  wanting in  Albinos.
The black portion in the centre of the  iris is
an  opening,  in   man,  circular,  called  the
pupil, which is capable of contraction or dila-
tation, according as light is required for the
  illumination  of the retina, acting  under the
  stimulus of reflex nervous action, and bearing
  pretty much the same relation to the optical
  structure of the eye that the diaphragm in the
  stage of a microscope does to that instrument.
  The muscular fibres are of the involuntary or
  unstriped variety, and are arranged in direc-
  tions both circular and radiating.
   IRITIS, or inflammation of the  iris,  may
  be  divided into  acute and chronic,  and its
  constitutional  modifications into syphilitic,
  gouty, rheumatic, and  scrofulous.  The  gen-
  eral symptoms  of iritis are  that, in  the  first
  place, the fibrous  texture of the  iris loses
  color, becomes confused, the pupil loses its
  movements  and becomes   contracted  and
  irregular ; next,  lymph is effused, in some
  forms' in small nodules, in  others as a  film
  over  the  pupil.   The  sclerotic redness  is
  marked in the  form shown by the vessels
  passing in straight lines, running  from the
  circumference toward the centre of the  eye,
  and possessing the  characteristic pink vascu-
  larity immediately round it.  There  is intol-
  erance of light, and  frequently deep-seated
 pain or aching about the brow and orbit, with
 great dimness of vision.  In  a typical syphi-
 litic case we notice  that it is distinguished by
 effusion of lymph on both surfaces of the  iris,
 in  reddish or  brown nodules,  causing the
 pupil  to become irregular ; pain most severe
 at night ; generally  associated with other  sec-
 ondary syphilitic affections.  In the rheumatic
 variety, there is less tendency to  the deposit
 of lymph on the iris, and what deposit there
 is is not nodulated,  and there is a haziness of
 the  cornea absent in  the  syphilitic  variety.
 The pupil  is contracted, and more or  less
 irregular,  in  consequence  of the effusion of
 the lymph  taking place between the edge of
 the pupil and the capsule of the lens.  The
 surface of the eyeball is often very much in-
 flamed and injected, so that the  well-defined
 vascular ring, seen  in syphilitic  iritis, is not
 so evident ; another great characteristic is its
 tendency to return.  Scrofulous iritis signifies
 either idiopathic iritis occurring  in a  scrofu-
 lous habit, generally combined with corneitis,
 or else a deposit of cachectic lymph in  the
 iris,  which leads to scrofulous suppuration of
 the eyeball or atrophy.  Traumatic iritis  sig-
 nifies an inflammation of the  iris set up by a
 penetrating wound of the eye.
   Treatment.—With regard  to the treatment
 of iritis, we must endeavor to subdue inflam-
 mation,  and  thus prevent the  effusion   of
 lymph ; endeavor to promote the absorption
 of what is effused, to preserve the form of  the
 pupil and allay pain.  The bowels should be
well  cleared out, the diet unstimulating, and
blisters,  which are  frequently of great use
when the most acute stage is over.  To arrest
the effusion of lymph, mercury seems of  the
greatest value, given  in the  form of calomel, 1
to 2  grains with £ or \ grain of opium every 
266
IRON
IRON
6 or 8 hours.   Better still is the administra-
tion of 2 or 3 grains of the hydrarg. c. creta
with  henbane four times in the twenty-four
hours.  If the  patient be very debilitated or
scrofulous,  iron  (the potassio-tartrate),  qui-
nine, or cod-liver oil is preferable.  The pupil
may be kept dilated by dropping a solution
of sulphate of atropine upon  the eye in the
strength of I grain to i oz. of distilled water.
Extract of  belladonna smeared round  the
orbit is of great use also in relieving pain.  In
gouty iritis colchicum should be administered
in small doses.  Pure  air  or  sea  air, good
animal food, and warm clothing, with general
attention to diet and the general mode of life,
are most important adjuncts to treatment.
  IRON is one of the most valuable remedies
we possess.  It is used in a great vari-ety of
forms, commencing with the metal  itself.   Of
metallic iron two forms are used in medicine
—namely, iron wire, soft, easily flexible, and
non-resilient, and reduced iron.   Iron wire is
used  for the preparation of the aromatic iron
mixture, a very valuable1 preparation, and the
wine of  iron  not the  less so.  Tne vinum
ferri, or iron wine, is made by macerating
iron  wire in  sherry.   Reduced  iron  is  the
metal prepared by passing hydrogen gas over
the peroxide of iron in a red-hot state.  The
hydrogen abstracts the oxygen, and  leaves
metallic iron in the form of a powder.  This
powder is steel gray,  inclining to black in
color, and is strongly attracted by a magnet  ;
by pressure it may be made to show metallic
streaks in a mortar.   Iron enters into  the
composition  of the living body in consider-
able quantity.  Especially is it present in the
red  blood  corpuscles,  into whose coloring
matter it  enters.   When,  from  whatever
cause, this proportion of  iron is deficient, or
the coloring  matter  itself  is not present  in
sufficient quantity, ill-health, accompanied  by
pallor, weakness, shortness of breath,  and
various other signs of imperfect nutrition, is
seen  to follow. And though it is by no means
clear that the giving of iron internally alters
this directly, it certainly does indirectly, favor-
ing  nutrition  and  the formation  of  more
healthy blood,  bringing back strength, color,
and mental and bodily vigor._  This iron acts
as a tonic  apparently directly  on the blood,
but indirectly on other tissues, especially the
nervous system, when deranged. Most prep-
arations  of iron  are  astringent, some more
so than others, hence  they do good by re-
straining discharges when these have grown
chronic, and the parts whence they are de-
rived flabby.   When, on the other hand, cer-
tain normal discharges, as the menstrual, are
in abeyance,  no remedy is so useful, provided
the stoppage arises from weakness, for bring-
ing them back as iron.  This, however, they
do not directly, but  indirectly, by improving
the quality and character of the blood.   Al-
most  all  preparations  of  iron  in  passing
through  the  bowels,  become blackened,  so
that the motions of one taking iron may seem
unnatural, where they are perfectly natural.
For the same reason the tongue and teeth are
colored black by them.
  Metallic Iron being tasteless,  is probably
one of the pleasantest forms in which to lake
iron.  It has no astringent effect in the mouth,
bi_t being dissolved in the stomach it is rapidly
absorbed, and acts splendidly as  a blood re-
storer.   It sometimes, however, gives rise to
unpleasant eructations.   It is best  taken in
doses of from 2  to 5 grains  during a meal, or
in the intervals it may be  given between a
sandwich.  It is tasteless, but unfortunately
rather expensive.  It is a very valuable prep-
aration when the stomach  is  irritable and
there  is anaemia. The wine  of iron is a favor-
ite  prescription  for children.   It contains a
combination  of tartar and tartrate of iron.
  Carbonate of Iron is another very valuable
compound ;  unfortunately, though easily pre-
pared, it will not keep, but passes rapidly into
the condition of rust.  The most important
preparation of this salt is the  compound iron
mixture, also known as  Griffith's Mixture.
This,  though it  contains certain ingredients
which might be dispensed  with, is perhaps
the most available and cheapest form in which
we  can prescribe iron to an  irritable stomach.
(See Griffith's Mixture.)
  Iodide of Iron, which is made by combining
iodine and iron directly, is a greenish  prepa-
ration.   It, too, keeps badly.   Its properties
partake  partly of those of  iodine,  partly  of
those  of  iron ;  but those of  the former are
predominant, so that it  is  commonly given
rather when iodine  is to  be  given without the
irritant effects of the simple substance or the
weakening influence of the potass.  Hence it
is commonly prescribed  generally as syrup
of the iodide of iron, in scrofulous diseases,
in some forms of rheumatism,  in syphilis hap-
pening in broken-down subjects, and perhaps
best of all in children of a  scrofulous ten-
dency, who are threatened with brain disease.
The dose of the syrup is for  adults 20 drops to
a drachm ; for children from  2 to 15  drops.
  Sulphate of Iron is made use of in two forms
as ordinarily sold—dried and granulated ; the
first of these being most commonly exhibited.
It is green in tinge, and crystalline, but the
ciystals  are  imperfect.   These also tend  to
break down and assume another hue from the
formation of a  persulphate.  This salt is a
powerful astringent, besides having the ordi-
nary action of iron salts. It is, therefore, use-
ful  in chronic discharges  and relaxed habits
of body.  Three or four grains may be given
for a dose.   It is usually given as a pill.
  Arseniateof Iron is a combination of arsenic
acid and iron ;  it is not often given, but when
so it is with a view to combine the effects of
arsenic and iron as a  tonic in skin diseases.
  Phosphate of Iron is of greater importance ; 
IRRITANTS
ISSUES
2C7
 it is a slate-blue preparation, and is  chiefly
 used as syrup.  This is a really valuable prep-
 aration, especially ^or  children, who readily
 take it.  It is not astringent, does not  bind
 the bowels, and it may be given usefully in
 certain maladies where the other preparations
 give rise to too much irritation.
   Magnetic Oxide of Iron is an oxide inter-
 mediate between the green and the red.  It is
 a brownish-black powder, and has not much
 taste.  It  has  been used  instead of reduced
 iron, but is not considered so good.  It is not
 much used.  Its dose is from  3 to 5 grains.
   Peroxide of Iron is used in two forms—one
 moist, the  other dry.  The moist peroxide is
 chiefly in  use  in case of strict emergency,
 which  rarely occurs—viz., poisoning  with
 arsenic, for which  it  is a kind of antidote.
 The dried  oxide is more irritating, and  is
 often given when not intended when the com-
 pound iron and other mixtures are long kept.
   Perchloride of Iron is the preparation most
 frequently  used as tincture or liquor.   It is
 a powerful astringent preparation, somewhat
 inclined to irritate ; but if astringency is de-
 sired, and the irritant  qualities not objected
 to,  no preparation  of  iron better fulfils its
 object.  It is used in poisons, bleedings, and
 discharges,  and applied locally for a similar
 purpose.   Internally it is given in water with
 good  effect in  erysipelas, pneumonia,  and
 other inflammations of a low type.
   Ammonio- Citrate of Iron is an exceedingly
 mild and very valuable preparation.  It exists
 in  beautiful red scales, and as it possesses
 little astringency, is often one of the best rem-
 edies of an  iron kind along with a vegetable
 tonic, when a patient is recovering from acute
 illness, especially if the stomach has  been
 troubled.
   Tartrated Iron is in many respects similar
 to the ammonio-citrate.  It may be given with
 effervescing alkaline  preparations.  The dose
 of these is from 5 to 20 grains.
   Citrate of Iron and Quinine  contains both
 quinine and iron in a palatable and digestible
 form.   It is unfortunately rather expensive,
 and cannot  be given with alkalies.  It  is one
 of the favorite  modes of prescribing iron to
 delicate patients.  In some cases of neuralgia
 this preparation is invaluable, though the  car-
 bonate is commonly prescribed for that mal-
 ady.  Other nervous maladies may be bene-
 fited in  the same way.
  IRRITANTS are substances which,  being
 applied externally or internally, give rise to
 marks of inflammation of a greater or  less
 degree  of  activity.   They  include all  sub-
 stances  called rubefacient or reddening, epis-
 pastic or blistering, and pustulant or produc-
 ing pustules.  The chief are mustard, turpen-
 tine,  cajuput, corrosive  sublimate,  iodine,
croton-oil, etc., which act both  externally and
internally, besides a great variety which only
act internally.  The blistering substances are
 mainly cantharides, or Spanish flies, in some
 form  or other, or  glacial acetic acid.  The
 pustulants  are croton-oil, tartar-emetic, and
 nitrate of silver.  They are used for various
 purposes, mostly for the relief of internal in-
 flammations, though sometimes of  pain of a
 different character.   They are  supposed  to
 have  what is called a derivative action, their
 effect being to neutralize  the  inflammation
 within ; more probably, however, their influ-
 ence is much more closely connected with the
 nervous  supply of the  part, especially with
 the nerves called  the vaso-motor.
   IRRITATION is a term employed in med-
 icine to denote a  variety of ill-defined  condi-
 lions and actions.  Health consists in a due
 balance of all our functions whereby they are
 carried on almost imperceptibly ; but for the
 performance of each a certain stimulus, vary-
 ing in different cases, is necessary to the action
 of the parts.  When this balance is lost, and
 the stimulus becomes excessive, we  call the
 action irritation.  Suppose we apply  an irri-
 tant substance, say an acid, to the surface  of
 the body, the consequence  is an  excessive
 irritation of the part which is out of all propor-
 tion  with that  of any  other in the system.
 The  condition is called irritation  if it stop
 short of that which we commonly call inflam-
 mation.   (See Counter Irritation.)
   ISCHURIA,  a technical  expression for
 suppression of urine.
   ISINGLASS.  (See Gelatine.)
   ISSUES are artificially-produced wounds
 which are kept raw and  open, so that  there
 may be a constant flow  of pus from the  sur-
 face.    It is  employed in  surgical  practice
 either as a counter-irritant in certain  local
 affections, as caries  of one or more bones  of
 the spine, joint diseases, and inflammation  of
 the eyes,  or to keep up a constant drain from
 the system in certain constitutional derange-
 ments.   It is often thought necessary, when-
 ever an old ulcer upon the leg has been dried
 up, to substitute for it a smaller wound, from
 which a constant,  though less abundant, dis-
 charge of pus may flow.  An issue may be
 made either by transfixing a pinched-up fold
 of skin with a knife and cutting through this,
 by blistering the  surface of the skin, or by
 making a slough by the  application  of strong
 caustics or  the red-hot  iron.   Whenever the
 surgeon has a choice  of  situation, he avoids
 regions where the  skin is thin and  stretched
 over prominent surfaces and angles of bone,
 and selects such parts as the outer surface of
the arm below the shoulder, the calf, and the
inner surface of the thigh immediately  above
the knee,  as here there is much muscle and a
thick layer of cellular tissue between the mus-
cle and the  skin.  The  wound made  with  a
knife is dressed for the first three  or four days
by a pad of dry lint, which  is lightly pressed
upon its surface by means of sticking-plaster.
 At the end  of this period a raw granulating 
268
ITCH
JALAP
 wound  is established which  resembles the
 issue-wound formed hy the detachment of the
 eschar after the application of a caustic or
 the red-hot iron. The issue is then kept open
 by keeping some foreign body in constant
 contact with its surface,  in order to irritate
 the granulations, and  to cause them  to dis-
 solve into pus instead  of forming scar-tissue.
 The bodies  used for this purpose are either
 peas or small solid glass beads.  The former
 cause irritation in consequence of their swell-
 ing ;  but  whenever  the wound  can be kept
 open without difficulty, the glass beads are to
 be preferred on account of cleanliness and the
 comparative ease and freedom from pain with
 which they may be  worn.  One or more of
 these beads, according to the size of the issue,
 are placed upon the  raw surface, and then
 strapped lightly down by sticking-plaster.
 When there is free discharge, they should be
 removed and  cleansed every day, and the
 edges of the issue should be frequently bathed
 with  some weak lead lotion, or  spirit and
 water.  Over the plaster  should be placed a
 thick pad  of ordinary  cotton-wool, or of the
 chloralum-wool.  When the beads or peas are
 removed and changed,the surface of the wound
 should be syringed  with  a weak solution of
 carbolic acid.    Sometimes, notwithstanding
 the presence  A a foreign body,  the issue-
 wound heals ; it then becomes  necessary to
 prevent this by applying some stronger  irri-
 tant to its surface in the form either of blister-
 ing fluid or of caustic potash, or by merely
 smearing the foreign body with  a salve con-
taining  iodine  or some  other stimulating
 agent.  (See Seton.)
  ITCH is a most troublesome skin disease,
caused by the  presence of the Acarus  Scabiei
or itch insect.   (See Ectozoa.)  These little
creatures burrow their way into the  skin and
the female deposits the eggs ; at night  time
especially they crawl very actively along the
skin and cause  intolerable  itching ; the pa-
tient to relieve the distress is sure  to scratch
the part, and  so  pustules  are  formed  and
numerous scratch-marks.  Close  by the pus-
tules may be seen an oblique line in the cutis,
which is the mark of the burrow.   This dis-
ease it  very catching, and is  a  frequent  ac-
companiment of dirt ; the little animals readily
pass from one body to another, so  that chil-
dren sleeping  in the  same  bed  or using the
same clothes will  readily transmit it  to each
other.   It is more  common in children than
in adults, as the insect prefers a tender and
delicate  skin ;  and while in  old people  the
rash is  generally confined  to the arms and
between the fingers, yet in children it may be
all over the body ; as a rule  the head and face
are rarely, if ever, attacked.
   Treatment.—A cure may  be readily effect-
ed if care be  taken to rub sulphur ointment
every night into the skin of the affected part :
this  must be  done so as to  make the part
glow ; next  morning  wash  the patient with
coarse soap and hot water, and rub the soap
well in  with a flesh brush.  At some places
sulphur baths  are  given with  advantage, but
this can only be done in hospitals or other
large institutions.   The clothing which the
patient has worn next the skin may be kept
on during the treatment, and then it should be
burned to stop the spread of  the disorder. Al-
though  devoid of  danger, this disease  is so
liable to extend to other people that when
one person is affected he should be  kept sep-
arate from others until he is  well.   When this
disorder appears in  a school, isolation should
be at once practised, although  those similarly
affected  may be  kept  together  and  placed
under similar treatment.  It is entirely a local
disorder, and no internal remedies need  be
given, although it  is a  popular  impression
that the  itching arises from some  impurity in
the blood, so loath  are people to admit the
faults arising from  uncleanlincss.   The treat-
ment should  be repeated every night lor a
week in  order to insure a cure.
J.
  JACTITATION, a term applied to the un-
conscious movements of a patient when in the
delirium of a fever.
  JALAP is the dried root of a  plant grow-
ing in Mexico, mainly near the city of Xalapa,
whence the name.  The roots are somewhat
egg-shaped and  pointed, unlinged, about -the
size of  an orange.  They are brown exter-
nally, and yellowish-gray internally ; some-
times they are sliced.  There is also in use a
resin procured from the jalap-root called jalap
resin.  This is dark brown in color, and very
bitter.  It is produced by means of rectified
spirit, in which it is  freely soluble, but is not
all soluble in water.   This is the jalap of the
shops.  Jalap itself,  as  powder,  has got  a
sweetish yet nauseous odor and taste.  Jalap
resin from the true plant contains a substance
called  convolvulin, which is strongly purga-
tive.  Jalapine is found  chiefly in  a false
variety of the root, but  is also found  in the
true one. The preparations of jalap mainly
used are its  powder  and compound  powder.
The latter consists of jalap, cream of tartar,
and ginger, and is a most valuable remedy in
many forms of dropsies, when it is desired to
pump the water out of the system.  Jalap it-
self is a brisk purgative, producing  watery
motions.  It is not so irritant as scammony,
and seems to act more on the small intestine
than on the large one.  It has a tendency to
gripe, and hence is seldom given alone.; usu- 
JAMES'S POWDER
JOINTS             2G9
 ally some substance like ginger is given along
 with it to prevent the pain.   Frequently  it is
 combined  with  calomel, the two constituting
 the favorite  purgative  powder of many  old
 practitioners.  It is frequently given to chil-
 dren to get rid  of worms.  The use of jalap
 as an habitual purgative is to be deprecated,
 as its use frequently gives rise to  subsequent
 constipation.  The dose of jalap powder is
 from 5 to 20 grains ; of the compound powder
 about half a drachm.
   JAMES'S POWDER is a secret prepa-
 ration long in vogue.   It has been a good deal
 employed  in fevers, but it is most serviceable
 in incipient colds.  It acts as a sudorific, and
 is suitable when Dover's  powder, on account
 of the opium it contains, is  not admissible.
 The preparation is generally understood to be
 oxide of antimony with phosphate of lime.
   JAUNDICE can hardly be looked upon
 as a separate disease, though as a symptom
 cf disease  it is so grave and important as to
 be ranked in nosologies as a distinct malady.
 The  one essential of  jaundice is a  yellow
 color of the skin, due  most frequently to an
 absorption of the coloring matter of the bile
 and its circulation along with the blood.   By
 some it is  also supposed that there are cases
 of jaundice due  to non-separation of the col-
 oring matter of  the bile from the blood and
 its accumulation there,  but this is not  gener-
 ally taken  as fact.  Whatever, therefore, ob-
 structs or  prevents the flow of bile  into  the
 intestine will give rise sooner or later to jaun-
 dice.  Chief among these are narrowing of
 the bile-ducts from whatever cause.  Thus
 inflammation of  the lining membrane  of  the
 ducts may  do so.  Still more likely  is press-
 ure to do  so, and this indeed is  the most
 common cause of jaundice.  In this way faecal
 accumulation in the  colon  may give rise to
 jaundice, tumors about the orifice of the bile
 and pancreatic  ducts, abdominal  aneurisms
 and cancer of the glands in the great  fissure
 of  the liver.  Again, we  may and  often do
 have obstruction from  gall-stones, plugs of
 thickened  mucus, hydatids,  etc., blocking up
 the ducts.  These same ducts may be blocked
 up by ulceration from gall-stones and  subse-
 quent contractions, or  in  a  variety of other
 ways. Within the liver any pressure on the
 main tubes containing bile may give rise to
 jaundice, so too  may inflammatory conditions
 extending  to them.   In  certain  degenera-
 tions  of the liver jaundice  is found, but by no
 means in  all.   It  occurs in acute  yellow
 atrophy, and in  cancer if  the mass happens
 to press on  a duct, but not  otherwise.  Yet
 again there are  certain maladies where  the
 liver need  not be specially affected in  which
jaundice prevails ; such is the case in relaps-
ing fever,  still more  in  yellow  fever and
ague ; while  in  not a few cases jaundice is
entirely due to emotional causes, as fright or
excessive anxiety,  or  the  sufferings  from
 wounded pride. The symptoms come on grad-
 ually or suddenly.  If gradually, then there is
 progressive  loss of appetite,  headache, and
 depression ; there is also some nausea and a
 sense of weight in the stomach.  If it comes
 on suddenly, the patient may make the dis-
 covery in the  morning that  he  is yellow.
 This color is most  marked in the whites of
 the eyes.  At the same time  the  urine  be-
 comes of a rhubarb  tint and stains  the  linen,
 while the faeces are  whitish or  clay-colored.
 The skin itches, and there is a bitter taste in
 the mouth.  Digestion is interfered with, and
 sometimes every object seen seems of a yel-
 lowish hue.   When  the malady lasts long the
 brain power is weakened, and there may be
 stupor or  delirium,  while the nutrition of the
 patient suffers and he becomes thin  and weak.
 Sometimes there is a tendency to bleed from
 various  parts, and  most frequently there is
 some bleeding.   All this may speedily pass
 away, or become more and more aggravated,
 till the patient becomes almost black.  At the
 same time there may be  excruciating pain,
 particularly  if a gall-stone  be the cause of the
 jaundice ; or pain may be  entirely  absent.
   Treatment.—The  treatment to be adopted
! for the jaundice will depend  entirely upon
I the cause of the obstruction to the flow of bile.
| But suppose we take a common case  of  ob-
 struction from catarrh of the bile-ducts, or ob-
 struction from some emotional  cause.  This
 last form of the malady will pass away sponta-
 neously, but both may be aided by medicine.
 Of  all remedies adapted  to the  complaint
 rhubarb and soda or potash seems best.  Then,
 as there is ordinarily some stomachic derange-
 ment, a little ginger added is  an improve-
 ment, and some spirit of chloroform aids  to
 make the whole sit easily.  Sometimes sul-
 phate of magnesia,  with  sulphate of  soda,
 does good ;  but the treatment must vary with
 each individual case.  The food  should be
 light and  nutritious, and  stimulants should
 be avoided.   If any are  lequired,  claret and
 water or very weak brandy and water is best.
   JAW, BROKEN. (See Fractures.)
   JOINTS (Diseases of).—The most com-
 mon affection to which  a  joint is  subject is
 inflammation of the  synovial or the thin deli-
 cate lining membrane.  This membrane con-
 tains and  secretes  the synovia  or joint oil
 which lubricates the joint.  Now, if,  from
 any cause, such  as  blows, strains, or  other
 local injury,  or from  exposure  to cold, iheu-
 matism, gout, etc., a  severe aching pain  in
 the affected joint comes on, and great  swell-
 ing very soon after  the  pain,  attended with
 redness of surface and constitutional fever, a
 condition exists called Synovitis.   The knee
 is the most frequently affected.   The shape of
 the joint is altered, owing to the effusion into
 the synovial cavity,which consequently bulges
 at those portions of the joint which are least
 protected by  the natural coverings,  ligament, 
270
JUNIPER
KELOID
tendon, or muscle.  In the case of the knee,
the affection can be distinguished from  the
inflammation of the bursa over the knee-cap,
from the fact that  in synovitis the knee-cap
can be distinctly felt floating as it were upon
the fluctuating swellings, which are situated
on  either side of  the  joint ; whereas  in  the
latter case  the swelling is in  front  of  the
knee-cap and of the ligament tying it down
to the shin-bone (tibia).
  Treatment.—Perfect rest is indispensable,
and  the joint must  be  confined  either by
splints or by a piece of gutta-percha or stiff
leather or card-board, made pliable in boiling
water, and moulded over the joint. It should
be lined with some soft leather, and capable
of being laced up or let out as the condition of
the joint requires it. Leeches may be applied
to the joint ; ice-evaporating lotions, hot fo-
mentations, or a linseed-meal or bran poultice
(sprinkled over with laudanum), are the best
local applications.   A dose of calomel, and
afterward a saline  purge,  with an opiate  at
night, form the constitutional treatment.   In
rheumatic  cases,  and when  the urinal sedi-
ment is red, ammonia  and potash, and after-
ward iodide of potash may be given.  If the
disease  has been  very acute, the joint may
become permanently stiffened. Chronic rheu-
matic inflammation of a joint  (arthritis) is
generally met with in old persons ; it is char-
acterized  by  racking,  gnawing,  rheumatic
pains  in the  joint affected, aggravated  by
changes of weather.   The joint  is  stiff and
swollen, very painful if touched, the muscles
become wasted, and on any attempt made to
use the joint  either actively  or  passively, a
sort of cracking or creaking sound is audible.
The joints most frequently affected  are  the
shoulder, hip, and articulations  of  the  hand
and the spine.  The treatment is to give iodide
potass, or ammonia,  or guiacum, with gen-
erous diet, anodyne embrocations, and vapor
or Turkish baths, but rarely  much relief is
obtained.
  JUNIPER (Juniperus communis) is a com-
mon enough plant.    It has berries, which.
being distilled when  green,  yield a colorless
or pale green oil, having in a high degree the
odor and warm taste of the fruit. The berries
themselves are about the size  of  black  cur-
rants, of a dark purple color, with a bloom on
the surface.  Their interior is  filled with a
brownish yellow plup.   Their odor somewhat
resembles that of turpentine,  but  is  more
agreeable.   The  oil  usually contains a little
resin from its own change by oxidation, and.
mixed with rectified spirit, constitutes Spirit of
Juniper.  This is largely used in medicine on
account of its action on the  kidneys, which it
stimulates and causes to pass through them a
larger quantity of urine than  natural.  This
property is  valuable  in  certain  forms  of
dropsy, and in these the  remedy is used.   It
is sometimes given alone, but most frequently
it is combined with other remedies, especially
broom-tops and cream of  tartar.   A capital
combination for country use is thereby  formed.
The same ingredient is found in Hollands, and
in  less  quantity  in ordinary gin.   For this
reason Hollands  may be  substituted  for  the
ordinary Spirit  of Juniper, and,  added  to
broom-tops  with cream  of tartar,  will  be
found a most efficient diuretic and  stimulant
in slow cases of heart disease.
K.
  EAMELA or Wurrus is a drug compara-
tively recently introduced into European prac-
tice  as  a remedy against worms.   It  is an
orange-red powder which adheres to the cap-
sules of the Rolllera iinctoria, an Euphorbia-
ceous  tree  growing  in  India.  The powder
hardly  mixes with water, but is almost en-
tirely soluble in alcohol.   It has  long been
employed in India as a remedy for tapeworm,
but has not been much used in this country.
It usually purges severely, and this may in cer-
tain  cases be an objection.   It is best given
in doses of 30  grains, or a drachm, in some
thick substance or in spirit.
  KELOID is the name given to a disease of
the skin in which there is hardening or  thick-
ening 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 dis-
order.   The word  "keloid" or  " kelis" de-
rived from a Greek word signifying a crab's
claw.  There seems to be two kinds or varie-
ties of this disease.  The one appears as hard,
shining tubercles or small nodules of a dusky
or deep-red  color, and  generally  attended
with itching,  pricking, shooting, or  dragging
pain in  the part.  These tubercular 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 be-
come 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 puck-
ering of the  skin.   Growth may  go on  for
months and even 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 uneasi- 
KERNELS
KIDNEYS            571
 ness ;  afterward  there is itching 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 yellow-
 ish, and may go on to ulceration.  If the
 affected  part  be  extirpated  it often returns,
 and no treatment  seems to be of any avail.
   KERNELS.  (See Glands.)
   KIDNEYS (The) are two in number, and
 lie in the back part of the abdominal  cavity,
 one on each side of the spine.  Each is about the
 same shape, but  nearly twice  the  size of  an
 ordinary  sheep's  kidney ;  each is supplied
 with a vessel (the renal artery) which brings
 the blood  from the aorta to the kidney, and
 with another  vessel (the  renal  vein) which
 brings the blood  to the inferior  cava after it
 has passed through the kidney.   Soon  after
 the artery enters the organ, it  breaks up into
 a great many small branches, and these again
 divide, so as  at length numerous fine tubes
 are formed  which have extremely  delicate
 walls and enable  the blood  to come into the
 closest contact  with the kidney tubes ; there
 are two  sets of these capillaries,  the  one
 being  arranged  in an  intricate  net-work
 around the tubes,  the other being arranged
 in clusters and surrounded by the  dilated com-
 mencement of a tube ; thus one set is out-
 side and the other  inside the kidney tubes.   In
 whatever way these different sets  are formed,
 they  finally  join  and form  the  renal vein.
 The rest of the kidney is  made up of tubes,
 or hollow canals, lined with epithelium, com-
 mencing at first in dilated extremities and in-
 closing fine blood-vessels ; then  they  pursue
 a tortuous course, surrounded  by capillaries,
 till, joining each other by degrees, the tubes
 open  into a  funnel-shaped opening  called
 trie pelvis of  the kidney ; this in  turn ends in
 a narrow  tube which conveys the  urine to the
 bladder.   The kidneys are, in  fact, so ar-
 ranged as to form  fillers, which abstract from
 the blood water  and  various constituents
 which make up what is known as  the urine.
 The kidney is the only organ in  the  body
 which  takes away materials from  the blood
 without giving anything in return, and hence
 the blood in  the renal vein is probably the
 purest to be found in the  body.  It is essen-
 tial for the proper performance of  the renal
 function  that  a certain amount of healthy
 blood should  pass  through this  organ  in
 twenty-four hours,  and so any alteration  in
 the quantity or quality of that fluid will cause
 some derangement of the kidneys.   In rases
 of heart disease, or of empyema, the circula-
ting stream is obstructed and the venous  sys-
tem becomes  too full ; the renal  vein  shares
in this fulness, and hence the kidneys become
over-distended with blood in their vessels, but
the blood  is more  or less stagnant and  not
removed as it ought to be, so that very little
urine is passed, and that excreted  is dark in
color and  deposits  some sand on cooling ;
often it contains also a trace of albumen,  be-
cause the serum of the blood escapes from the
tense vessels into  the tubes and so into  the
urine, and wherever serum is present albumen
will be found, for it is one of its constituents.
Now and then  blood will be seen also in  the
urine.  This state of things generally comes
on toward the end of the disease ; the patient
suffers also from dropsy  of the legs or abdom-
inal cavity, or from jaundice, and  shortness
of breath and palpitation of the heart, or from
a combination of these symptoms.  An alter-
ation in the quality of the blood will also in-
duce kidney disease ; this is the case in many
fevers, and more especially after scarlet fever,
when acute Bright's disease is by  no means
an uncommon complication.  Those who  are
scrofulous  or rickety,  and  those who suffer
from consumption, syphilis, or gout, and those
who have led intemperate lives, are liable to
get disorganization and destruction of their
kidney  substance, and  serious  mischief may
ensue, leading sooner or later to a  fatal ter-
mination.  For an account of these changes
and the symptoms which  accompany each
variety, the reader is referred to the article on
Bright's Disease.  The kidney is also liable
to various other diseases, which may here be
briefly mentioned.  A blow across  the loins,
a stab, or a gun-shot wound may cause rup-
ture of the  organ ; great pain over the seat of
injury,  with  sickness and faintness followed
by the appearance of blood in the urine, are  the
chief symptoms. (See Hematuria.)  Cancer
of the kidney may occur ; this is a rare form,
and is  generally associated with  cancer  of
other organs ;  a large tumor may be  devel-
oped on one or the other side of the  abdomen,
blood may appear  in  the urine, or albumen
may be present more  or less persistently ;
the  pain,  emaciation,  loss  of  flesh and
strength, are to be found  in these as in all
other cases of cancer, and  finally  lead to a
fatal result.   Death, however, takes place less
rapidly than  when the stomach or the liver
are the seat of this malignant disease.  Vari-
ous poisons, other  than  the fever-poisons
mentioned  above,  may cause  disease of  the
kidney ;  in  this way  phosphorus, arsenic,
turpentine, and cantharis  or  Spanish  fly
have  been  known  to   cause  blood  in  the
urine, and  even suppression of  urine.  The
inhalation  of arseniuretted  or  sulphuretted
hydrogen has  caused similar results ; these
gases are evolved in the process of separating
certain metals from their ores ; in their pure
form they are rarely met with, except  in  the
chemical laboratory.  A stone, or  calculus,
may exist in  the pelvis of the kidney without
bringing about any untoward result ; at other
times it may block up  the channel so as  to
prevent the flow of urine, and then the kidney 
 2i2           KING'S-EVIL

 will become distended into a large cyst and
 be rendered quite incapable of performing its
 functions ;  or, again, the  stone  may pass
 down the ureter, or the canal which conveys
 the urine from the kidney to the bladder, and
 cause great distress ;  intense  pain  in the
 loins and down into the groin and thigh, faint-
 ness, and vomiting are the  chief symptoms ;
 a hot bath  to  alleviate the pain, and  the ad-
 ministration of cholroform  to  diminish the
 spasm  of the  ureter,  are the best  means for
 relief ;  tea, water,  or any diluent drinks may
 also be given so as to wash the stone down
 into the bladder.  (See Obstructions, renal).
   Cancer of the bladder, or the presence of a
 tumor or stone in that cavity, may cause also
 disease of  the kidney,  by pressing on the
 ureter and  distending that tube, so that from
 this cause  the  kidney may become cystic or
 converted into numerous dilated cavities ; in-
 flammation, too,  of the bladder may exist in
 these cases  (Cystitis) and add to the mischief,
 for this process is very apt  to extend  up the
 ureter to the.kidney itself and cause the form-
 ation of pus and  a total destruction  of the
 kidney  ; this change is often a cause of death
 in those persons who have long suffered from
 a stone in the bladder.  Abscesses  may form
 in  the  kidney in  cases of  pyaemia, but no
 symptoms of any marked  importance  attend
 this change ; more frequently an abscess may
 form around the kidney and burst either in
 the loin or in the intestinal canal.  If the state
 of things is  known during life, and the abscess
 point in the loins, an opening may be  made
 by the surgeon and the matter be let out ; but
 these cases  are very obscure and very difficult
 to  make out accurately.   Lastly,  maltorma-
 tion of the kidney may occur, but give rise to
 no harm in  consequence ;  they may be joined
 together in  front of the spine by their  lower
 extremities  and so have the form of a  horse-
 shoe, or, more rarely,  both  are developed on
 the same side of  the  spine ; these peculiari-
 ties, however, do not seem to interfere in any
 way with the healthy performance of the renal
 function.
   KING'S-EVIL.  (See Scrofula )
   KINK-COUGH. (See Whooping-Cough.)
   KINO is  the juice of a tree belonging to the
 Leguminous group, the Pterocarpus marsu-
pium.   The trunk is incised, and as the juice
 flows it hardens in the sun, forming brownish
 or reddish  black  tears.   It is generally seen,
 however, in broken pieces, more or less angu-
 lar,  translucent,  and ruby-red at  the  edges,
 shining and brittle.  It has no odor, but its
 taste is  powerfully astringent and turns the
 saliva blood-red.   Kino contains   a kind of
 tannic acid, and another astringent principle
 called catechin, together with red  gum.  Its
 most important preparation  is the compound
 kino powder, which contains kino, cinnamon,
 and opium—one grain of  opium in twenty of
              KNEE-JOINT

the powder.  Kino is a very powerful  astrin-
gent, and may be given for the tannin  it con-
tains.  It is not so soluble as catechu.  It is
often, and perhaps chiefly, used in diarrhcea,
for stopping  which the compound powder is
a very excellent preparation.   It may also be
chewed for relaxed sore throat.  These are
the chief uses  of this substance.  It  mainly
differs from tannin in being less soluble.
  KIRSCHWASSER  is a  spirit  distilled
from cherries  in  Germany, and  resembling
brandy   From the quantity of prussic acid it
contains,  extracted from the kernels  of the
cherry, it is dangerous to take any amount of
it  inadvertently, but when mixed  with water
it forms an agreeable stomachic, and is  a good
substitute for a better stimulani.
  KLEPTOMANIA is a form of madness
in which stealing is a prominent and singular
feature.  (See Insanity.)
  KNEE-JOINT  is  the largest articulation
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  liga-
ments, and  the  movements of  the joint  are
controlled  by numerous muscles.   Like all
movable  joints, the articular surfaces are cov-
ered over with cartilage, and a large and com-
plex synovial membrane is insinuated between
the structures forming the  joint.   A remark-
able 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 ad-
justed, 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, its  size, and ex-
posed 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  out-
ward and inward.
  Diseases  of the Knee-joint.—The  several
affections to  which the knee-joint  is subject,
are—i. Fracture.   2. Dislocation.  3.  Syno-
vitis.   4. Bursitis.  5.  Scrofulous  disease.
6.  Rheumatic affections.  7. Loose cartilages.
8.  Malignant diseases.  9. Hysterical affec-
tions.  10. Deformities.
  Fractures connected with the knee-joint are
 treated in detail in the article Fracture.
  Dislocations of the Knee are  fully treated in
the article on Dislocations.
  Synovitis of the Knee-joint is treated of in
the article on Joints, Diseases of.
  Bursitis, or inflammation cf the bursae in
connection with the joint, viz.,  the  bursa
patellae, the bursa on the tubercle, of the tibia,
and those between  the condyles of the femur 
KNEE-JOINT                              KNEE-JOINT          273
 and the  gastrocnemian  muscle, have  been
 already  treated  of in  the articles  Bursa,
 Housemaid's Knee.
    Scrofulous  Diseases  of  the  Knee-joint,
 White Swelling.—This condition of the joint,
 or of the structures forming the joint, always
 occurs in those of scrofulous constitution.  It
 is probably more common in children than in
 adults, and it commences with  slight  lame-
 ness, swelling of the joint, and, from  the pain
 or  stiffness  of the articulation,  the  muscles
 are  not  brought into  play, and  so waste or
 atrophy.   The general train  of  symptdms is
 much as  follows :  In  the first place there is
 either history or evidences of scrofula ; occa-
 sional pains are noticed in the joint, becom-
 ing  gradually  worse,  especially  at night  ;
 swelling is  rarely noticeable at first, and the
 peculiar form  subsequently taken  by  this
 swelling—a  sort of globular enlargement—is
 owing to  the infiltration  of  the structure sur-
 rounding the joint, rather  than  of  effusion
 into it.   If the  disease  proceeds unchecked,
 some disorganization of the joint ensues, and
 from having been kept  so  long bent, or be-
 coming  bent by the  hamstring muscles, at
 last,  in  many instances,  dislocation of the
 tibia backward takes place.  The morbid con-
 ditions  occurring in  the knee affected with
 scrofula are identical with those of  other
 joints, and will be more  fully discussed  under
 the article Scrofula.  The  treatment in the
 early stages is, locally,  to  procure rest, and
 to endeavor to  prevent deformity, leeching,
 fomentation, and puultices, if  there be much
 pain.  Counter-irritation—blisters, iodine, or
 issues,  Scott's dressings,  are all of value.
 Constitutionally, cod-liver oil, iodide  of iron,
 quinine,  good  food, and sea air.  In severe
 cases, operative  interference  is necessary,
 such as excision of the joint, or even amputa-
 tion.  The  results  following excision of the
 knee-joint are  very satisfactory, provided a
 proper  case for  the  operation be selected.
 There are many instances  of a perfectly use-
 ful   limb  being  retained, and frequently a
 shapely one, and one on which an individual
 can follow his ordinary occupation  as well as
 formerly.
  Loose Cartilages.—The knee,  in common
 with  other  joints,  is  sometimes the seat of
 these bodies.  They are  usually of  an irregu-
 larly  oval form,  but  vary -in structure and
 density ; they vary also  in size from a pea to
 a  plum-stone.   Their surface  is  generally
 smooth, they seldom occur singly, usually two
 or three are found in the joint.  They are at-
 tached by means  of a  delicate pedicle to the
 capsule of the joint.  The symptoms  of  their
 presence are excruciating pain from their sud-
denly getting between  the ends of the bones,
 when the limb is  rendered rigid, and motion
arrested suddenly, and these symptoms will
continue until the substance has been manipu-
lated back again from  its  position.  If they
do not cause very much inconvenience, palli-
ative  treatment is  useful ;  thus,  an  elastic
bandage or  a  tightly fitting knee-cap  should
be applied, and the patient kept in a recum-
bent position.   Should this fail, an operation
for their removal must be had recourse to, and
it must be borne in mind that no operation is
expedient except in troublesome cases ; and
considerable precaution  must be  taken,  as,
even in the most skilful hands, it has been fully
shown that it is not altogether free from risk,
by setting up serious  inflammation  in  the
joint.
  Malignant Disease.—Occasionally the knee-
joint   is the  seat of  malignant  growths,
particularly  of cancer,  and  any soft tumor
springing from the lower end of the femur, or
head of the  tibia, is to  be viewed with anxi-
ety.   (Non-malignant growths, such as exos-
toses,  fibrous or enchondromatous tumors,
are sometimes met with.)
  Hysterical Neuralgia  of the Knee-joint  de-
pends  upon some  morbid condition  of  the
uterus, stomach, or rectum.  The term hys-
terical affection is taken rather in  a  general
sense,  and  it is  often the  custom to refer
anomalous  nervous  affections of  joints  to
hysteria.  The treatment in these cases ma)' be
both constitutional and local.  If there  be
emaciation and debility, iron, bark, and cod-
liver oil are of service.  In plethoric  persons
purging and low diet are indicated.   Locally,
hypodermic injection, aconite and belladonna
liniments  should be  rubbed  into  the part
affected.   Galvanism  in a continuous current
passed through the joint, and  the application
along  the  spine  of ice-bags,  are remedies
which  should  be tried.  Division of the main
nervous trunk is  not advisable, as, although
the relief is instantaneous, the attack speedily
returns as severe as ever.
  Knock-Knee.—This affection consists in an
inward projection of the lower extremities of
the thigh-bones, and a more or less consider-
able outward divergence of the legs and feet.
Great  deformity is thus  produced, and  the
patient experiences much difficulty in walking.
The  knees  constantly  strike against each
other,  and the foot  is turned  outward, so that
the inner  edge  is applied to the ground.
Knock-knee is caused by weakness  and yield-
ing of the  ligaments and sinews  about  the
inner aspect of the joint, and the affection is
increased by walking and standing.  It is met
with  in workmen  who carry heavy loads, or
in those accustomed to wheel heavy barrows.
It may also  occur in  youths who grow very
fast,  just  before  the  age of  puberty, but it
affects most commonly weak unhealthy chil-
dren of the poor  classes,  who live  in  towns,
and is  due in those subjects to  general weak-
ness and poverty of the  blood, engendered by
bad quality or insufficient supply of food.   It
then often shows itself while the child is still
in arms, but is  made much  more apparent 
274            KOUSSO
LABURNUM
and increases rapidly in extent after the child
begins to walk.  Knock-knee and rickets are
often associated together.  When undue use
is  made of one  leg, and  too  much weight
thrown upon it in  consequence of  disease or
injury in  the  other limb,  dne-sided  knock-
knee maybe produced.  This deformity when
it occurs in  rapidly growing and overworked
young people may be remedied  by rest and
cold douches.   If discovered early in infants
the best treatment is  fresh air and good and
suitable nourishment. The  patient should not
be allowed to move about  on the floor until
the unnatural  prominences at the  inner sur-
faces of the  knees have  disappeared.  In
severe cases,  in older children, it  will be
  LABOR is the common term for a confine-
ment or delivery.  It usually takes place at
the end of the ninth month, or at  the expira-
tion of 280 days from the time of  conception.
If the birth of the child takes place before six
months it is called an abortion, or miscarriage,
and when between six and nine months it is
known  as premature labor.   A  labor, as a
rule, is a perfectly safe and natural  process,
and attended with very little danger to either
mother or child, if  properly  conducted.   It
commences with pain in the lower part of the
abdomen, gradually  settling  down  in  the
back, and known as bearing-down pains  ; this
is accompanied by contractile movements  of
the enlarged womb,  by which  the  child  is
gradually expelled and brought into ihe world.
The duration of  a labor  varies froiii six  to
twelve hours, in most cases being longest in
those who are having  a child  for  the first
time ;  the pains  may begin  much  earlier and
may be of a grinding character, but in general
these are  not attended  by  any expulsive
effort;  they  are  caused by an error of diet
sometimes and are removed by giving a pur-
gative, followed by an opiate draught.   In at
least 99 cases out of every 100 the head of the
child comes down first and is the part which
emerges into the world the soonest ; the rest
of the body soon follows, and the main object
of care  is to see that the womb well contracts
as soon as the child is expelled.   In from  ten
to  twenty  minutes,   but  sometimes  longer,
after the child is born, the placenta or  after-
birth comes away, and then, seeing  that  the
womb is still well contracted, a wide binder
may be placed around the abdomen, and the
mother should be allowed to rest  quietly for
a time, after removing the  soiled linen around
her.  The child, when born, is generally for
the first few moments rather livid in the face,
but soon begins to cry out lustily ; after wip-
ing the mouth and nose, it should be wrapped
in warm and soft flannel until the nurse is
ready to wash it in warm  water and dress it.
necessary to apply to the outer surface of each
limb either a  padded  wooden splint  long
enough to extend from the hip to the foot, to
which  the  limb is to be bandaged ; or irons,
furnished with a ratchet screw, and  fixed by
means of buckles.  The treatment demands
much care and patience, and,  to be effectual,
must, in  severe cases, be continued for eigh-
teen months or  two  years.   The  deformed
limbs should be well rubbed and bathed with
cold water every  morning, and the child's
general health should be kept up by good liv-
ing, and, if possible, by a prolonged sojourn
in the country or by the sea-side.
  KOUSSO.  (See  Cusso.)
If the child do not breathe at first, it may be
gently siapped on the back or  held out for a
minute in the open air, or hot and cold water
may be alternately dashed over it, and efforts
made to keep up artificial respiration. Atter-
pains are usually the worst in  those women
who have had several children, and are very
troublesome the first twenty-four hours ; an
opiate is  the best remedy.  The mother's diet
must be  light and nourishing ; usually, the
first day, gruel or tea is preferred, but after-
ward a small  chop or a piece of  fish may be
taken.  The child should be put to the breast
as soon  as possible, but  it is seldom able to
suckle much the first day or two.  The mother
must be kept  in bed for nine or ten days, and
then may be  allowed to get up, still keeping
the  horizontal position for a few days longer.
  The details of management in a midwifery
case are  obviously out of  place in a book of
this nature.   Sometimes instead of the  nead
of the child  presenting, the  feet may come
down first, but this  is not of  much matter,
although it may prolong the labor.   If,  how-
ever, the arm or shoulder come down first  it
is a sign that the child  is lying  in a wrong
position, and there is then said to be a cross-
birth ; in such cases  skilled interference is at
once to be sought.  There  are  some cases of
such great deformity of the pelvis that prema-
ture labor has to be induced, but this must be
only done after consultation, as, if done with
a criminal intent, the  operator is subject to
severe punishment.  In other cases operative
interference is required to save  the life of the
mother or the child, or both, but for its proper
performance  great  skill  and  experience  is
required, and can only be attained by a  prop-
er education and  practical  acquaintance with
the  subject.   For a disease which may follow
a difficult or premature labor, see Pelvic Cel-
lulitis.
  LABURNUM,  a  beautiful  ornamental
shrub, known to the botanist as  Cytisus La-
burnum.   It yields seeds of an  acrid and poi- 
LACTATION
LACTEALS           275
 sonous nature which by possibility may be
 eaten by children,  and  produce  vomiting,
 cramps, purging, and all the symptoms of an
 irritant poison.   The remedies in such a case
 are to give  an emetic of mustard and warm
 water, or ipecacuanha, or white  vitriol,  and
 afterward  to support the patient with   am-
 monia and  brandy.
   LACTATION is the name given to the
 period of suckling a child after a confinement,
 After the birth  of  a child the breasts of the
 mother, which during pregnancy increase in
 size,  secrete a large quantity of milk  for the
 sustenance  of the offspring during infant  life.
 The process is a perfectly natural one, and it
 is  by far the best means of rearing a child ;
 for the  first day or  two, especially  after a
 first confinement, the milk flows in very small
 quantities, but after that time, when the secre-
 tion is well established, the production of milk
 goes on uninterruptedly in many cases.   It is
 the duty of every woman, if in good health,
 to  give  the child the breast,  yet there are
 many,  and  those  chiefly in high life, who
 from  indolence  or  apathy, or  some other
 cause, prefer their  children to be brought up
 by a wet-nurse or by  the bottle.   Many,
 again, are  incapable  of  suckling  their chil-
 dren from  ill-health, or  by the cessation of
 the secretion of  milk in the breast, and then,
 of course, other means must be taken to bring
 up the  child.  The  mortality of  infants not
 brought up  by suckling is vastly  higher than
 in those who are kept to  the breast for the  first
 nine or ten months  of life.  If the child die
 soon  after birth there may be some trouble in
 checking the distension  of the breasts, which
 may often be very painful.  The breasts may
 be  drawn by a  syringe, or by another child
 being put to them ;  a popular method is to
 apply a soda-water bottle previously warmed
 to the nipple ; on cooling, the air within the
 bottle is more rarefied than that outside, and
 the difference of the  atmospheric pressure
 will cause a flow of milk.  The secretion may
 in such cases be generally stopped in a  few
 days  by applying a large belladonna  plaster
 to each breast, and giving a saline purgative.
 Inflammation of  the breast may take place
 during lactation, and end in an abscess ;  the
 breast will be found  hot, enlarged  and pain-
 ful, and perhaps a  swelling,  tender  to  the
 touch, may be noticed at one part ; when it is
 clear that matter has formed, an incision must
 be made with a lancet to let it out ; the breast
 must  be slung in  a towel from the shoulder,
 so as  to relieve the patient of its  weight, and
 hot linseed-meal poultices should be often ap-
 plied.  Unless the opening be a free  one the
 matter is apt to accumulate again and require
 a second or even  third  incision.   When an
abscess  forms, the  health of  the  woman
 suffers ; she loses her appetite, becomes faint
and weak, and  loses color  and  strength.
Tonic medicines  must be given  her and a
 nourishing diet, and rest and quiet enjoined ;
 it is not always necessary to wean the child,
 as it can feed from  the  opposite breast.  A
 child should be  weaned  at the  end of nine
 months as a rule, but this is very seldom ob-
 served, and many poor  women go on suck-
 ling for a much longer period, until, perhaps,
 the child is eighteen  months or even two years
 old.  This  is bad for the mother as  well as
 the child ; to the former,  because it is  a great
 drain upon her strength, and to the latter, be-
 cause when the teeth have appeared a more
 solid food may be given.   Women who have
 a family fast, who wean their children at a
 late period,  and who. perhaps, live badly  all
 the  time, are  very  liable to suffer  much in
 their  health ; they  lose their  appetite and
 strength,  and become low and nervous ; they
 are very liable to headache,pain in the back and
 left  side, and very often  they suffer from leu-
 corrhoea.  The proper treatment for such cases
 is to wean ihe child  and improve the mother's
 health by tonics, good diet, and rest ;  stout
 is often recommended to mothers as being
 more nourishing than beer, but at such times
 all stimulants  should  be taken in moderate
 quantities, and reliance  should  be placed on
 a more liberal diet.  Over-suckling is a very
 frequent cause of ill-health in a  woman, and
 lays the foundation of future illness by bring-
 ing  on a state of debility.
   LACTEALS  are very minute vessels  or
 absorbents  which arise  in small conical pro-
 jections of the mucous or lining membrane of
 the  intestines ; joining together, they finally
 form larger branches, which pass up by the
 mesentery  into the mesenteric  glands, and
 then on to the  receptaculum chyli,  a  small
 chamber lying in front of the spine in  the ab-
 dominal cavity.  The function of the lacteals
 is to absorb various soluble portions of the
 digested food or chyme as it passes along the
 intestinal canal, and chiefly the fatty portions
 of the  food  ; the fluid, thus absorbed, is milkv
 in appearance, is called chyle, and this, pass-
 ing through the mesenteric glands, undergoes
 these various changes ; finally, it goes through
 the  receptaculum  chyli,  and then on  by the
 thoracic duct as lymph, to join  in the blood
 current at the root of the neck.   The lacteals
 are to  the intestines what the lymphatics are
 to the rest of the body.   They are often dis-
 eased in children, and many cases of maras-
 mus, or wasting away, are due to affections
 of the small glands and lacteals  of the  intes-
 tines ;  the  mesenteric glands  are also fre-
 quently associated in the change, and become
 swollen and enlarged, and add to the general
 mischief.   Such children waste  because the
 food cannot be  properly absorbed, and the
 blood loses in quality and quantity because it
does not  receive  its due supply of lymph.
 Diarrhcea, too, is a  common symptom, and
this, with  the emaciation and  general weak-
ness, often brings about  a fatal  result.  The 
276
LARD
LARYNGITIS
diet must be carefully looked to ; all solid or
thickened food should be avoided, while milk
and beef-tea or chicken-broth may be be given.
If there is any sickness, lime-water may be
added to the milk ;  but any error of diet may
again bring on diarrhcea.  Cod-livei oil is not
well borne by the stomach in such cases, and
therefore  it may be  rubbed into the skin night
and morning.   A  little steel  wine may be
given daily, but no  other medicine ; and  no
purgative should be administered.
  LARD is hog's  fat  deprived of its mem-
banes and  purified by  heat.   It is used in
making  ointments, and  is often  better tor I
application  to a blister or sore place than the
more skilfuily prepared and expensive oint-
ments.   A piece of ordinary  lard put into
boiling water and allowed to cool and  settle,
and then taken out free from all impurities
and kept in a stone jar, is a very useful and
pleasant application.
  LARDACEOUS DEGENERATION is
another term for waxy degeneration ; it may
affect the liver, kidney, spleen, and intestines.
(See Degeneration.)
  LARYNGEAL  PHTHISIS is a form of
consumption in which the patient suffers from
hoarseness and loss of voice ; it is very com-
mon  in the later  stages  of phthisis.   (See
Consumption.)
  LARYNGISMUS  STRIDULUS, also
known as spurious croup or child-crowing, is
a spasmodic form of disease commonly afflict-
ing children during the  period of their first
teething.  A considerable number of children
die of  the malady,  being mostly under one
year old.   This disease might be and often is
mistaken  for  croup ;  but there is no  fever,
almost the only symptom being the  interrup-
tion of the breathing.  The first attack may
often come on in the night, the child  having
been put to bed apparently well. There may
only be one or two  prolonged crowing inspi-
rations, and the patient fall asleep again.   In
other cases the child may have been been
irritable and restless for a  day or two, when
suddenly  it is seized with difficulty of breath-
ing, and kicks and struggles, unable to draw
a breath.   Presently,  however, it is enabled
to draw in a breath with  a long crowing or
shrill whistling sound, the  chink or opening
into the windpipe being much narrower from
spasm than usual.   This may end the  attack,
but it may return shortly in a few hours or
sometimes in a day or two.  In other cases
the  attack  resembles epilepsy more than
croup, the face being swollen and flushed, the
veins starting out with convulsive movements
of hands and feet.  The child may even seem
dead for  a few moments, until by  and by
there is  a gasp, and then  a thin  sounding
breath, the patient gradually recovering. This
is not always the case, for not unfrequently
the little patient does die in one  of these par-
oxysms.   The cause of  this spasm undoubt-
 edly lies in some irritation acting through the
 nerve  which  supplies  motor  power  to  the
 larynx.  It has  been supposed  to be  due to
 enlarged glands pressing on  and irritating
 this nerve.  In reality it may originate  in  i
 variety of ways, being most of them  reflex,
 but all unite in acting through this nerve.  It
 may originate in teething,  indigestion,  con-
 stipation, or the reverse condition, catharsis,
 which,  acting through  the brain and spinal
 cord in  subjects  whose  nervous system is
 easily put out of gear, is thus  manifested as
 spurious croup.
  Treatment.—Fortunately  much may  be
 done  by way of treatment, especially if  that
 is done at once ;  and there is  no disease in
 which  a general knowledge of  the principles
 of treatment are more important to the public.
 The best thing is promptly to put the child in
 hot water up to its chin, and pour cold water
 on  its head.  Some propose the same reme-
 dies as when a child seems still-born, such as
 slapping the  nates  or  even artificial respira-
 tion ; but the conditions are totally different.
 When the child is born so, the only difficulty
 is to induce its muscles of respiration to act;
 there  is no obstruction to the  entry of air.
 Here it is quite  the reverse ; the muscles of
 respiration  are ready to act, nay, are acting ;
 bu*. the air cannot enter, the way being barred
 by the closure of the entrance to the air pas-
 sages.   Before any good can be done, these
 must be relaxed, and  accordingly such treat-
 ment  as we  have  recommended, or  a  few
 drops of chloroform swallowed, will do what
 is necessary.   It is  useless to think of the in-
 halation  of  chloroform when  the  air  itself
 cannot make its way into the  lung.   After-
 ward the child's bowels should be carefully
 looked to, and the teeth and mouth examined.
Change of air is of  the utmost benefit.  Bel-
ladonna in very small doses sometimes is use-
ful, but the  great  thing  is careful nursing.
 The child should have nourishing food, but it
 must  not be overstuffed.  Overstuffing  and
 improper food are a very important cause of
 the malady.  The best food for a young child
 is its mother's milk, but sometimes they will
 not suck, and then  the  best substitute must
 be procured—a good wet-nurse, if possible ;
 if not,  asses' milk, or  the milk of a healthy
cow diluted with water.
  LARYNGITIS,  or  inflammation  of   the
upper part of the windpipe, is a troublesome
and even dangerous affection ; it may be pro-
 duced by exposure to cold, and  also by inhal-
 ing any irritant gases, as ammonia, chlorine,
 or hydrochloric acid.   There is  more or less
 of a croupy noise during inspiration,   the
 breathing is short and hurried, the patient can
 only speak in a hoarse whisper, and will point
 to his  throat  as  the  seat  of distress.  The
 symptoms are much the  same as if a foreign
 body were accidentally to  get  into the air-
 passages, and there is a feeling of impending 
LARYNGOSCOPE
LARYNX
277
 suffocation.   When occurring in children it
 is commonly called croup ; but every  case of
 croupy breathing does not show that laryn-
 gitis is present, as it may be only spasmodic.
 This disease is liable to come on in those who
 are subject to phthisis or bronchitis.  Steam
 must be at once inhaled ; hot sponges must
 be applied to the throat, and  a warm, moist
 atmosphere must be kept up.   In some cases
 it may be needful to perform the operation of
 laryngotomy or   tracheotomy ;  but  in all
 cases it is imperative to  have  medical aid at
 once.  (See  Croup, Laryngismus' Stridu-
 lus.)
   LARYNGOSCOPE is an instrument used
 by physicians to explore the larynx and upper
 part of the  windpipe.   In its simplest form
 it consists of a small reflecting mirror, which
 is mounted  on a long and slender stem so
 that it can be passed to the back of the throat.
 Upon this are thrown rays  of strong artificial
 light, reflected from another mirror, which is
 carried on the forehead or over the right eye
 of the surgeon.  In the latter case the  second
 mirror is perforated at its centre by a small
 hole, so that the rays reflected  from the mir-
 ror at the back of the throat may pass through
 to the physician's eye, placed at the centre of
 the reflection.   The physician sits in front of
 the  patient,  and  on  introducing  the  mirror
 into the mouth pulls the tongue well forward.
 The light is placed behind and  to one  side of
 the  patient.   The laryngoscope  is  used  for
 investigating the nature and extent of diseases
 affecting  the  larynx, and also as  an  aid in
 applying remedial agents directly to the lining
 membrane of this organ, and in removing by
 operation warty growths, polypi, and other
 tumors.
   LARYNGOTOMY  should  be performed
 only in cases where great urgency demands
 on opening of the windpipe, and  when  the
 proper apparatus for tracheotomy is at hand.
 The operation is  thus performed :  The  pa-
 tient is  seated in a chair, with  the head well
 thrown back and  kept  steady ; the finger of
 ihe  operator  is passed over the  front  of the
 neck, and the crico-thyroid depression felt
 for ; then a vertical incision, about an inch in
 length,  is made in the mesial  line over this
 spot, and the  crico-thyroid   membrane is
 divided sufficiently to allow of  the introduc-
 tion of a tube.   The operation can be per-
 formed  readily enough with a  penknife, and
 if  no tube be  at  hand, a quill or a thin piece
 of wood, turned on its axis, will  admit suffi-
 cient air to the lungs.  Care must be taken not
 to mistake the thyro-hyoid space for the circo-
 thyroid.   Laryngotomy  may be performed in
 cases of lodgment  of some foreign substance
 in the larynx.  The only casualty in the per-
 formance  of  the operation is the division of
the crico-thyroid  artery, a small  branch
which runs across the membrane,  and might,
if  large, cause considerable trouble.  In a
 young subject the chief difficulty of the oper-
 ation is the recognition of the parts, after the
 superficial wound has been  made, from  the
 smallness of their size, and this difficulty may
 be greatly increased if the skin and cellular
 tissue be inflamed and infiltrated with serum.
   When the operation has been performed, it
 is of the greatest importance that the proper
 aiter-treatment be adopted.   An experienced
 nurse or attendant, or at all events some one
 who can be trusted, shouid  be left with the
 patient.    He should  be  placed in  a  room
 where the  temperature is warm and equable,
 as the introduction of cold air into the trachea
 is  very liable to set up inflammation  of the
 air-passages.  The warmth should be a damp
 warmth, best so rendered by steam. The bed
 should  be surrounded with  curtains  or
 blankets, and a jet of steam admitted from
 the end of a tube connected with a tea-kettle.
 It  must be borne in mind  that blood and
 mucus  very readily collect  in  the tube and
 obstruct it  and  if  no  one be at hand to re-
 move  it the patient runs '"mminent  risk of
 suffocation.  The nurse or attendant should
 remove it carefully, as soon as any difficulty
 is noticed in the breathing, with a fine feather
 or camel's hair  brush.  This collection  of
 mucus is especially liable to occur during the
 first few  hours after  the   operation ;  and
 should the patient drop off to sleep, and the
 above precautions not taken, he may be suf-
 focated.   If the  patient desires to cough or to
 speak, he should  be told to a'raw in   a full
 breath, and then close  the orifice of the tube
 with his finger, when  expectoration can  be
 performed,  and  the voice  may be  heard.
 Care must  be taken that the tube be securely
 fastened round  the neck with tapes, but not
 too tightly.  The margin of the incision made
 in the neck very frequently becomes seriously
 inflamed ; a small poultice  should be placed
 over the affected part.  The  attendant  must
 be  cautious in the administration of the pa-
 tient's  food, to  give little at a  time, and to
 take care that, in the increased  difficulty ex-
 perienced in swallowing, no morsels pass into
 the trachea.
  LARYNX (The) is a complicated struc-
 ture, surmounting the  windpipe, serving the
 double purpose of being an  air-passage and
 of containing that mechanism which produces
 sound during expiration.  The note is formed
 by  the approximation  or  the divergence  of
two margins of membrane, which, in a  state
of quiescence, resemble in  mutual relation
the letter V.  These membranous margins
are called the true vocal cords, in contradis-
tinction to two somewhat similar folds placed
some way  above  them, called false  vocal
cords.   These  true  vocal  cords  are  acted
upon by a scries of muscles, which  place
them in the proper position  to  make either
sharp or grave tones.   In  order that  these
muscles may act upon  the  vocal cords they 
278            LARYNX                          LATERAL CURVATURE
 are themselves attached to the several parts
 of the  framework of the larynx, which are
 formed of cartilage.  The  prominent carti-
 lage in  the neck (Adam's apple) is the trian-
 gular front edge of the thyroid, or shield-like
 cartilage ; this cartilage expands behind, and
 at the inferior part of it are two little hinges,
 one  on each side, which turn upon another
 cartilage placed partly within the thyroid and
 partly  below  it.   This is very much like a
 signet ring, with  the signet part of it back-
 ward, and receives its name from this fact ;
 it is  called the cricoid cartilage.   Two mus-
 cles, one on  each side  (crico-thyroid), pull
 down the thyroid upon  the cricoid cartilage,
 at the  same  time  slightly   advancing  it.
 Within  the triangular voice box, formed at the
 sides by the thyroid and below by the  cricoid
 cartilages, and resting upon the upper  part of
 the signet of the  cricoid, are two little trian-
 gular cartilages called  arytenoid, from their
 supposed resemblance to an ancient pitcher.
 To these two arytenoid cartilages are  attach-
 ed the  legs of the  V,  and the point passes
 across the larynx to the inner surface  of the
 Adam's apple seen  in  front.   Now, as there
 are muscles  which  drag the  thyroid down
 upon the cricoid,  so there are  muscles which
 draw the arytenoid cartilages apart, and also
 approximate them.  The former, which are
 attached to the sides of the signet of the cri-
 coid and to the arytenoid, are called the crico-
 aryta-noidei-postici, and the latter, which are
 also  attached to the same cartilages,  but the
 fibres of which act in a contrary direction, are
 called   crico-arytanoidei-laterals.  The aryte-
 noid cartilages have special muscles of their
 own, called arytojnoidei,  which, according to
 some,  draw  their cartilages  together,  thus
 closing  the opening of the vocal cords (rima-
glottidis) ;  according to others, rotate them
 upon a  pivot and so open the chink.  Im-
 mediately underneath and external  to these
 true  cords are two muscles, one on each side,
 attached to  the thyroid and arytenoid carti-
 lages, which approximates the vocal cords  by
 shortening the distance between  the  aryte-
 noid and thyroid cartilages (thyro-arytenoid).
 These vocal cords are not only employed  in
 the production of sound for  the object  of
 speech or song, but can be completely  closed,
 so that  the air may be, as it were, imprisoned
 in the  lungs  during  the  phenomenon  of
 effort.   They, moreover, enter  into  vibra-
 tion,  in coughing, hiccough,  sobbing,  and
 laughing.   The sound is always produced  by
 the vibration  of  the lower  or  true vocal
 cords, whether the air enters the larynx from
 above downward, as in  hiccough, or whether
 it passes from below, as in other acts.  The
 larynx grows after birth, as do other organs,
both in girls and  boys.  But at  the time of
puberty,the larynx all of a sudden develops
 rapidly, more  especially so in boys.   In the
 male sex, in fact, the glottis is twice  the size,
both in length and breadth, and  the Adam's
apple (pomum  adami) becomes  conspicuous
at thia period.   It is  at  this age  that  the
voice  "cracks."  that  is to say, that  it be-
comes deeper, correspondingly with the mod-
ifications of the glottis.  But as  the muscles
of the larynx are not  as  yet accustomed to
this  disproportion of  the  vocal  organ, they
contract irregularly, with  inability,  so  to
speak, and producing those singularly inhar-
monious sounds which are  peculiar to  this
period.
  Foreign Bodies,  such  as  morsels  of  food,
sometimes get into the rima-glottidis, and by
sticking there may cause  death  speedily un-
less search be instantly made with the finger
in the pharynx to dislodge it, or the  opera-
tion  of  tracheotomy  be  performed.   (See
Foreign Bodies.)
   The diseases of the  larynx are laryngitis,
croup,  diphtheria,  cedema  of  the  glottis,
chronic inflammation and ulceration ; tumors,
warty excrescences, and epithelial  growths,
polypi of a fibro-cellular, fibroplastic, or  epi-
thelial  nature,  have been met  with  in the
larynx, epiglottis, and  trachea.   For the de-
tection  and treatment  of  these  diseases the
laryngoscope  is   necessary.  The glottis is
sometimes scalded, from the  effects of swal-
lowing  boiling  water,  such  as  in  the  case
of a child, in the nurse's absence, putting its
mouth to the spout of a tea-kettle.   Leeches,
ice to the throat, and opiates, or the admin-
istration of chloroform, are of use, unless the
symptoms are so urgent that tracheotomy be
necessary.
  LATERAL CURVATURE  is an  affec
tion of the spine in which there is a curvature
either to  the right or  to the left, so that
one shoulder is lower  than  the other,  and
more commonly it is  the left shoulder which
is the lowest.  It is often  due to girls carry-
ing children or any heavy weight at too early
an age.  Unlike angular curvature, which is
a grave symptom  of disease  of the spine, it
is a habit  which  may  may be overcome by
drilling and gymnastics.  As the  curvature
occurs in both  sexes  during the period of
youth and childhood, means must be taken to
remedy the defect, as it is  of no use trying to
alter it when the person is grown up.   The
carrying of any heavy  weight on one  arm
should be avoided, while daily drill should be
enforced at school, so  as  to  make the  indi-
vidual erect.  For boys dumb-bells may be
used,  or the elementary drill of a soldier ; if
able and strong enough, he should go through
the various gymnastic  exercises  so  common
now at all good  schools, whereby he will not
only gain in muscular strength, but he  will
expand his chest and improve in  health.  For
girls the dumb-bells should be lighter, or they
may use elastic bands, or even do gymnastics
on a small scale.  The great point in all these
exercises, is to  begin at first very gradually  ; 
LATERITIOUS URINE
LEAD
279
 never tire the muscles ; then every day a slight
 progress may  be made,  until, in the course
 of  a few  months, a marked improvement
 will be  found.   Too often, under the present
 system, such exercises are continued so as to
 lire the child, and even to give pain ; but this
 is a great mistake, and  such exercise ought
 to  be  made  pleasurable instead  of  being
 looked  upon as a punishment.   In this way
 girls would develop into much stronger wom-
 en, and there  would be  less need  of  stays
 and other articles of dress which are required
 by women, not  only to  improve what they
 term their figure, but to  prop up a too feeble
 spine.  (See Gymnastics.)
   LATERITIOUS  URINE  is   urine  in
 which there is a sandy deposit of lithates on
 cooling.  (See Urine.)
   LAUDANUM.  (See Opium.)
   LAUGHING GAS.   (See Nitrous Ox-
 ide.)
   LAUREL - CHERRY.    (See  Cherry-
 Laurel.)
   LAVENDER, the Lavandula spica,  is  a
 plant from which is distilled an oil which
 gives fragrance to the  plant.  This is either
 colorless or, if it has been long kept, pale
 yellow, and has a hot aromatic  taste.  This
 oil dissolved in water is much used  as a per-
 fume.  In  medicine  two  preparations are
 used, the spirit, which consists of the oil dis-
 solved in spirit, and the  compound tincture.
 This last, which is almost a liqueur, contains
 lavender, rosemary, cinnamon, and nutmeg,
 the  whole colored with   sandal-wood.   It is
 greatly used as a carminative and stimulant
 in hysteria and such like nervous affections.
 It is also  employed in  flatulence and colic.
 The oil may be given, a drop or two on sugar,
 for a dose.  The spirit  from half a drachm
 to  a drachm,  and  the   compound  tincture
 in about the same quantity.  The well-known
 lavender water is made  thus : »To a pint of
 proof spirits of wine, add one ounce of essen-
 tial oil  of lavender, and  two drachms of the
 essence  of  ambergris.   Put all  in  a  quart
 bottle, and shake it up well daily.
   LAXATIVES are remedies which gently
 open the bowels, so that they are inclined to
 be loose, but no more.   There is thus a dis-
 tinction drawn between such and purgatives,
 which purge,  and cathartics, which  are sup-
 posed to act still more   strongly.   As it  is
 highly desirable in  all cases that the least
 power should be employed,  laxatives should
 be employed when it is necessary to  open the
 bowels  artificially, if  this  will  suffice.  In
 many instances, however, they will  not, and
 something  stronger  will  be  necessary ;  but
 powerful opening medicines are apt to be fol-
 lowed by the very condition they have been
 used to get rid off, and so the  latter end is
something worse than  the first.   Somet'mes
a change of diet will act as a laxative.  Thus,
 if the food has been too concentrated, that is
 to say, if there has not been a fair amount of
 indigestible matter in it, the bowels  are  apt
 to become confined.   In this way the use of
 brown bread instead of white bread will often
 suffice to regulate the bowels and procure a
 daily motion.   Figs and prunes  are  inclined
 to be laxative, especially the latter.   Manna,
 tamarinds,  and cassia,  more  so.   But  the
 most convenient for use are flowers of sul-
 phur, castor-oil, and magnesia,  or  its car-
 bonate.
  LEAD in the metallic form  is not used in
 medicine, but as acted upon by water it  not
 unfrequently gives rise to slow lead  poison-
 ing.
  Oxide  of lead,  or  litharge,  consisting  of
 heavy orange-red scales,  is never given inter-
 nally : it is  oniy used  for the preparation of
 the plaster,  which is  so  commonly used  for
 fastening up wounds, etc.  Technically this
 is known  as lead plaster, but  much  more
 commonly is called mere sticking-plaster, or
 diachylon plaster.   It is  prepared by boiling
 together oxide of lead and olive-oil ; these,
 after boiling some  hours with constant stir-
 ring, form a thick  tenacious paste, which is
 applied to calico, and so  the plaster is  formed.
 The lead unites with  the fatty acids  of  the
 olive-oil, forming  a kind of soap.  It is due
 to the presence of the lead that this plaster
 blackens over putrid wounds.   Some prefer
 a plaster made of less  irritating materials,
 and certainly, were it not for its  tendency to
 harden, isinglass plaster  is infinitely superior
 to the litharge plaster.
  Lodide of lead exists as  a bright yellow pow-
 der, or in fine scales, which is soluble in boil-
 ing water, forming in it a colorless solution,
 which in cooling allows  the iodide to fall as
 crystals.  It alters and loses its brilliant color
 by exposure to  light.  Two preparations rre
 in use—a plaster seldom used, an ointment
 much more frequently  employed.  It  acts
 when applied externally as a very mild stim-
 ulant, and is used as an application to scrof-
 ulous joints. It gives to  these a yellow stain,
 which may be  objectionable  in  an exposed
 part of  the  body.  It is seldom used inter-
 nally.
  Acetate of lead, also known as sugar of lead,
 is prepared by dissolving oxide of  lead  or
 litharge  in vinegar or weak acetic acid, and
 afterward evaporating.  It  is generally seen
 in white spongy masses, composed of inter-
 laced needle-shaped crystals.  It has a sweet-
 ish vinegary smell and a  sweet metallic taste.
 It is readily soluble in water, and when ex-
 posed to the air tends to give off water, and
fall down in the form of powder.   The solu-
tion of sugar of lead in distilled water is clear,
or almost so.  Its main preparations are lead
and  opium  pill, a very valuable preparation,
consisting of acetate of lead, opium, and con-
fection of roses ; one grain of opium  in eight
of the pill mass.   In  small doses acetate of 
280
LEAD
LEAD POISONING
lead acts as a sedative and astringent, dimin-
ishing especially mucous discharges, drainage
from  relaxed vessels and surfaces, and the
like.   It  produces constipation and  thirst.
This,  as  well as other  preparations of  lead,
interfere with the normal condition  of the
blood, diminishing the number of red corpus-
cles, and so giving rise to anaemia.  It also
paralyzes the muscular coat of the intestines.
Lead  poisoning,  however  brought  about,
tends  to favor the production of gout, and
gout  in  such  cases is rather intractable.
Acetate of lead is used as a remedy in inter-
nal haemorrhages, and is one of the best we
possess.   It is also used in consumption, to
check diarrhcea and  perspiration.   It  is  a
capital remedy, especially as  lead and opium
pill, for diarrhoea accompanied by pain and a
tendency  to  dysentery.   It  is also largely
used externally as a sedative and  astringent.
Solution of the subacetate of lead is made by
adding litharge  to the ordinary solution of
acetate of lead and boiling.   It is a clear col-
orless liquid which tends to become tinted on
standing by the formation of carbonate on its
surface.  This  solution, under the name of
" Goulard water," has long been known and
valued.   It is  chiefly used  as an external ap-
plication, and is so used more than the ace-
tate.  A combination  of it with acetate of
morphia is a singularly soothing preparation
for inflamed spots, if the surface is not broken.
Its use with a broken surface might be dan-
gerous.  There  is also  an ointment which is
used in the same way.
   Carbonate of lead is mainly used in the arts ;
not much in  medicine.  There is,  however,
an ointment of  it which is applied to whole
surfaces as an astringent and sedative.  Some-
times also it is used  as  a powder along with
starch.   It is  the most poisonous form of
lead salt.
  Nitrate of lead is only  employed  in the
manufacture of iodide of lead ; it is not used
medicinally.
  With  regard to the general uses of lead
salts,  we  may say, first of all, that lead ap-
plied to a raw surface forms a kind of precip-
itate on its surface which protects it from the
air for the time being.  Hence, when surfaces
are raw or weeping, a  lead  lotion removes
the burning  and itching, and stops the dis-
charge.   It matters not where such a surface
is,  except  perhaps the eye,  for it has  been
found that prolonged  applications of Lead
lotions  to inflamed  eyes, especially if the
clear part or  conjunctiva is affected, tend to
form a deposit of the metal and to produce a
permanent opacity.  In  summer  diarrhcea
acetate of lead acts as a sure and certain as-
tringent, especially if a  few drops  of lauda-
num,  or, what is better, a fraction of  a  grain
of morphia is added.
   If the  acetate can  be looked upon as an
irritant poison at all, it must be considered
 as peculiar, inasmuch as it produces constipa-
 tion rather than diarrhcea.  Frequently ace-
 tate of lead may be given for weeks or months
 without producing any signs of lead poison-
 ing.  This is especially the case where lead is
 used to avert the wasting  diarrhcea of con-
 sumption.
   LEAD COLIC.  (See  Lead Poisoning.)
   LEAD POISONING  may be brought
 about in a variety of  ways.  Painters, and
 other workers in white lead are its most fre-
 quent  victims.  It  has been   produced  by-
 sleeping in a newly-painted  room ;  from tak-
 ing snuff  which has been wrapped in lead ;
 and  it used to prevail extensively in Devon-
 shire, its cause being the action of the apple-
 juice on the lead used in forming the cider
 presses.
   Lead Colic, which is the primary symptom
 of lead poisoning, is a variety of colic char-
 acterized by intense twisting pains about the
 navel.   Frequently,  too,  there is  retraction
 of the walls of the abdomen and pain in the
 back.  At the same time there is obstinate
 constipation, and if  the gums  be   examined
 there will commonly be found a blue line ex-
 tending along the gum at its junction with
 the teeth.  These are the  prominent symp-
 toms of the first stage of lead poisoning.   If,
 however, the malady is not arrested, but goes
 on, by and by the nutrition suffers.  First to
 so suffer are the extensor muscles of the fore-
 arm ; those, that  is,  which lift the back  of
 the hand, so  that if an attempt  is made to
i raise the hand that way, the wrist drops. The
} muscles themselves wasteland though at first
 they respond  to  the  stimulus  of  electricity,
 later on  they do   not.    By and  by the
 muscles of the upper arms also fail,  so that
 the muscles which raise the whole arm, and
 even those which are attached to the shoulder-
 blade, may waste and become useless ; the
 remedy for such  a state of things  is, first of
 all, to get rid of the poison, and, secondly, to
 restore  the  paralyzed  parts to their several
 functions.
   Treatment.—In the stage of colic with or
 without palsy, the bowels must be well moved,
 and for that purpose  nothing  is  so good as
 Epsom salts, with some dilute  sulphuric acid
 given freely until the bowels are opened well.
 Half an ounce of the Epsom or Glauber salts
 should be given for a dose,  and repeated in a
 couple of hours.  Jalap is sometimes given,
 but it is a mistake.   Castor-oil may do good,
 but the best means is  common Epsom salts.
 A warm bath frequently  gives great  relief,
 until the bowels have  acted, and  very likely
 aids in moving them.  If not speedily moved,
 an injection  of  soap  and  water  will  help.
 After the bowels  are  moved freely, a quarter
 grain  of  the  extract of belladonna may  be
 given to  relieve the pain, but  the salts must
 still be continued, though in smaller and less
 frequent doses.  The application of electricity 
LEAVENED BREAD
LENS
281
to the  bowels often  aids  in opening the
bowels,  and otherwise gives relief, but it is
not to be  trusted to solely.  Neither indeed
is Epsom salts, for as soon as  the bowels are
fairly open, iodide of potassium must be given
in good full doses (10 grains), hoping thereby
to remove the  lead still remaining in the sys-
tem.  This must be continued for some time.
If there is paralysis as well as colic, electric-
ity must be freely  applied to the weakened
muscles, so as to  exercise them, and aid in
recovering their contractility.  This should
be applied at least once a day, and undoubt-
edly is of  great benefit.  Sometimes the pa-
tients make use of sulphur baths, but this is
hardly needed, and is of questionable benefit.
  LEAVENED BREAD.  (See Bread.)
  LEECHES (Hirudo officinalis  and rnedi-
cinalis) are species of the class Annelida, or
worm-like animals.   They  are  elongated,
tapering to either  extremity, and either  ex-
tremity has a  muscular disc or sucker.  This
is larger in the hinder extremity.  The mouth
on the anterior extremity, is tri-radiate, and
contains three jaws, each furnished with two
rows of teeth.   These in cutting into the skin
leave a permanent  triangular mark, which is
characteristic  of their having  been used.
The intestinal canal  is straight, but  has a
number of chambers on either side, in which
blood may be  stored, and used up at leisure.
Hence these animals, if fully fed, do not re-
quire another meal  for a long period.  (See
Leeching.)
  LEECHING is the most useful and most
convenient method of local blood-letting,  the
blood being drawn from  the capillaries  or
small vessels  by the incision and subsequent
suction  of the leech.  (See Leeches.)  The
part to which leeches are to be applied should
be well washed with warm water, and, if hairy,
shaved. If the leeches will not stick, the skin
should be smeared with milk, sugar and water,
or some saliva, or should be pricked at two
or more points with  a sharp needle in order
that  a few drops of  blood may be shed.  If
the part to be  leeched is on the body or one
of the limbs  and  no delicate  structures or
natural  cavities are close at hand, each leech
may be taken by its  hind  part between  the
thumb and finger, and  its head or thinnest
part applied to the surface of the skin.  When
several leeches are to be applied over a small
extent.they should be covered with an inverted
tumbler or cupping-glass until they are fixed.
When  two or three  leeches are  used they
may be covered by  an inverted  chip-box.
When  the parts to be leeched  are situated
near to delicate mucous membrane, as on  the
face  near  the lips,  nose,  and eyelids, care
must be taken to prevent the leech from wan-
dering by  placing it in  a proper leech-glass
or in a cylinder formed by rolling up some
pasteboard or thick paper.  Leeches before
being applied should be well dried in a clean
cloth.   When  fully  distended  the leeches
usually  drop  off, but should  they remain
longer than is necessary the bodies may be
sprinkled with a little snuff or common salt.
A good  leech  will take about, two teaspoon-
fuls of blood.  After the leeches have droped
off the bleeding may be kept up for some time
afterward  by  applying linseed-poultices and
hot moist flannels.  In some instances, how-
ever this after-bleeding is too prolonged and
too excessive,  and with young children  and
weak and  delicate persons becomes a source
of danger.  In  a case of  persistent hemor-
rhage from one or more leech-bites the fol-
lowing plans may be successively carried out:
to cover the wounds with small pledgets cf
dry lint, taking care to apply the rough  sur-
face of the lint to the bleeding part, and then
to keep these pledgets in position by pressure
with the fingers ; to apply ice to the bleeding
surface  ;  to press  firmly  into  the bleeding
orifices  small  pieces of lint or cotton-wool
dipped into the tincture of perchloride of iron ;
to touch the wounds with a red-hot knitting-
needle ; to transfix the  base of each wound
with a sharp sewing-needle, and to surround
the skin  beneath  this by some stout  silk-
thread wrapped  lightly  round in four or six
turns.   The needle should not be removed
for twenty-four hours.
  LEG, BROKEN.  (See Fractures.)
  LEMON is the fruit of the Citrus limomtm
or lemon tree, growing in the more sheltered
parts of  Southern  Europe.   Its  bark, its
juice, and the  oil extracted from its  fresh peel
are all employed in medicine.   The rind con-
tains a valuable oil, which gives  the well-
known fragrance to the fruit.  The  juice con-
tains a considerable proportion  of citric acid,
which has  by some,  but  erroneously, been
supposed  to be the  principle  on  which its
value depends.   It also contains a consider-
able quantity of the salts of potass.  The prep-
arations properly  so  called  are the syrup
and tincture.  The peel is fragrant  and stom-
achic, while the juice is cooling and possessed
of  most valuable antiscorbutic powers.  The
lemon-juice has very frequently lime-juice,
the product of the Citrus  limelta, substituted
for it.   Lemon-juice may be given effervesc-
ing  along with  bicarbonate of potass,  and
constitutes a very valuable and very refresh-
ing  drink  for patients ill and  parched  with
thirst. Lemonade,  too, made from  the lemon
sliced into cold  or hot water and sugar, is ex-
ceedingly refreshing.
  LENS.—The lens is a transparent doubly-
convex,  crystalline body, placed immediately
behind the  iris  and in front of the vitreous
humor, and is separated from  both of them
by a transparent  capsule.  The use of the
lens is to enable one to distinguish the  form
or outline of objects, and act on the  rays of
light by concentrating them, or bringing them
to a focus after  they have  passed through it, 
282
LENTIGO
LEPROSY
exactly at the surface of the retina, which may
be regarded as a kind of sensitive screen upon
which they fall.  (See Eye.)
  LENTIGO is the name given to a disease
of the skin  in which  the freckles are more
permanent than usual.   (See Freckles.)
  LEPOID is  commonly  seen on  the face,
nose and forehead of elderly persons, usually
males of  a delicate, florid complexion, with
tendency to congestion of  the capillary ves-
sels, and  having light  eyes  and  hair.   It
generally  makes  its appearance  as a small
speck about as large as a mustard seed, and
of a dirty grayish color, soon becoming cov-
ered with a rough brownish scale resembling
the bark of  a  tree.  The first  scale or crust
falls off and is succeeded by another, and  so
the disease may go on  for  years.  At length
ulceration sets in, and a red glossy surface is
left, secreting a thin pus.   The disease is  at-
tended with itching, but not with pain.  It is
best not  to interfere with the growth ; the
crust  may be  softened by covering it with a
mixture of one part of castor-oil and two parts
of collodion.
  LEPRA is a dry skin  disease occurring in
circular red patches, and chiefly on the elbows
and knees.  (See  Psoriasis.)
  LEPROSY is  a malady of very great  in-
terest in  many ways.   Fortunately for  us,
however,  not because  it is common in this
country—though apparently some cases have
occurred.   Most  of the  cases seen in this
country have originated in  patients who have
at one  time lived abroad.   The  technical
name of the malady is Elephantiasis Grcecorum,
and it is of two kinds—one where the surface
is marked with tubercles,  and the' other in
which the surface is  smooth, but  in  which
there are ordinarily a number  of  spots in
which there is  no  feeling.  Leprosy does not
begin at any particular age—sometimes chil-
dren are its subjects, sometimes old people.
Of the two forms, the tuberculated and  the
anaesthetic,  the tuberculated seems to kill the
sooner, for  it is stated to  last but from nine
to ten years ; the anaesthetic between eighteen
and nineteen.  In both  varieties, but espe-
cially in  the  non-tuberculated,  the morbid
action seems to be sometimes stationary  for
years.   Many lepers die  from other diseases,
as  chronic diarrhcea,  dysentery,  diseases of
the lungs, like bronchitis and  pneumonia, or
kidney disease.  When the leprosy destroys
life it does so by attacking the  opening of  the
windpipe, or by deep ulcerations, laying bare
some important vessel, and causing hemor-
rhage, or  yet again by convulsions or coma.
   Leprosy  is   generally considered  heredi-
tary, but sometimes jt overleaps a generation
as in  other  hereditary maladies.   What  the
maladies are which prevail in the intermediate
generation are not noted.  As usual, the  in-
fluence of the mother seems greater than that
of the father  in  giving  a hereditary  taint;
and it seems more inclined to spread among
those of  the same family, than from parent
to offspring.  It does not seem, notwithstand-
ing the loathsome sores it produces, to be
able to spread by direct contagion.   It pre-
vails most among the lower classes of society,
being greatly  fostered  by  dirt,  insufficient
food, badly  ventilated  and  damp dwellings,
and especially by malarial districts.   Gener
ally the sufferers are most wretched in every
way.  The disease sometimes approaches very
gradually, sometimes more rapidly.    Theie
appear, with or without  fever, one or more
pinkish or purplish-red spots, which may be
isolated or in patches.   These may go, and
nothing be seen for a time, but again there is
a feverish attack, and the red spots again ap-
pear more  extensively  than  before.   This
may happen several times ;  but at length the
spots begin to harden and to  become promi-
nent, so that they appear as hard semi-trans-
parent tubercles.  The skin at the same time
becomes  brawny  and  coarse-looking, while
swelling of the tissues beneath makes it pit
on pressure.   Patches  of brown  appear here
and there on  the skin,  and by and by some
of its tissues waste, so that white  patches ap-
pear as if a wound  had formerly existed on
the spot.   The face,  too, alters ;  the cheeks.
lips, and  ears become swollen and bloated,
and there is a  copious watery discharge from
the  nostrils ; the eyes look watery, and little
nodules form on the edges of their lids, which
are  turned  outward.   The  hair  changes in
color to a dirty white, and often falls in con-
siderable quantity. The membrane lining the
mouth and nostrils  swells and looks  flabby,
pimples often  forming on it.   The glands in
various parts of the body swell, especially in
the groins, and a peculiar greasy sweat comes
from all parts  of the body.  As the tubercles
enlarge and spread over  the body, the mind
becomes   torpid,  and   the  extremities  are
swollen and useless.  This is the period of
complications, which often carry off the suf-
ferer.
  The non-tuberculated variety  commences
with a few small patches on the hand or face.
These  are shining, wrinkled, and paler than
the surrounding skin.   On these not even a
red-hot iron can be felt.   Ulcers  often form,
and heal  after a time ;  but the affection con-
tinues  to spread.  The  mental faculties are
dulled, the surface is cold,  and the  appetite
voracious.   By and by  frightful ulcers form,
without any pain, sloughs form  and fall off,
exposing the interiors of joints till bone after
bone  drops  off,  leaving  behind  only the
stumps of the arms and legs.  These by de-
grees become  useless, the patient being only
able to crawl.  The temperature falls,  and
the whole surface exhales a loathsome smell,
which  is more troublesome to the spectator
than the  miserable patient.
  Treatment.—Cases  of recovery from lep- 
LETTUCE
LIGATURE           283
 rosy are not unknown ; but  they are rare.
 However, the first thing to be done to insure
 anything like a successful treatment  is to re-
 move the patient from an unhealthy  to  a
 healthy locality ; if  a European abroad,  to
 send him home.  The diet, too, must be im-
 proved ;   high-seasoned or   long-preserved
 meat, especially  salted provisions  and fish,
 are to be carefully avoided, and a plain nu-
 tritious diet, containing a due supply both of
 fresh meat and  fresh vegetables, must be in-
 sisted on.  Personal cleanliness is of the first
 moment, and so baths must be used regularly
 and frequently.  As for  internal remedies.
 these  have been used  of almost every kind
 —none  seem  very  decidedly  to- do good.
 Some have  given aperients,  some  altera-
 tives ; arsenic has been largely used, and  is
 now employed by the Arabs, especially in the
 form of yellow sulphuret.  Cupping-glasses
 all along the line of the spinal cord have been
 used and recommended, but their use is more
 than doubtful.
    The latest treatment which has  been re-
 ported on as moderately successful, or even
 more than moderately so, is one invented by
 Dr. Beauperthuy, and by him  applied first in
 the West Indies, and after that in  Guiana.
 One imporant part of it, if not the  most im-
 portant, is the  application of the stimulant
 cashew-nut oil to the tuberculated parts on the
 lower extremilies. At the same time the diet
 was attended to, and  made more than usually
 nutritious.   The results  are  reported  as
 good.   Unfortunately Beauperthuy died be-
 fore he had time to fully test the value of his
 supposed discovery.
   LETTUCE,  the  Lactuca saliva,  is  well
 known as a spring and summer salad, and is
 very wholesome and good in  diet.   It is re-
 markable, however, for  yielding, when fully
 ripe, a quantity  of sticky, milky juice, which,
 on exposure to the air,  becomes of the con-
 sistency of cobbler's wax and possesses a
 narcotic principle resembling  opium in its
 effects, and known as lactucarium or lettuce
 opium. Dr. Duncan, of  Edinbufgh,  first dis-
 covered this drug, and for some time it was
 constantly used  in practice as  being less ex-
 citing than opium. It is now, however, sel-
 dom  employed, being superseded by  mor-
 phine.
  LEUCORRHCEA, commonly known as
 "the whites," is a disorder frequently met with
 in women.  It is  met with either as a thin,
 watery discharge, and is then  merely an in-
 creased flow of the ordinary secretion of the
 vagina, or as a thick,  yellow discharge which
 generally comes from the womb, This state is
accompanied by  debility,  pain in the back and
 loins, pain and difficulty in passing water, and
anaemia, or pallor of the skin.  It often occurs
during  pregnancy,  more  often  when  the
mother is  weakened from having had a large
family, and from over-suckling. Any disease
which has a debilitating effect on the system
may cause this complaint, so that it is not un-
common after a fever or a protracted illness.
There are also local as well as constitutional
causes ; many diseases of the womb, growths
in the vagina,  stone in,  or disease of. the
bladder, and many  affections of the recturr.
will cause this symptom.
  Treatment.—The treatment must consist
in keeping up the general health, and in  re-
moving any irritating cause ;  the  object in
the first  case may be maintained  by giving
tonics, of  which iron and quinine are the
most  valuable ;  moderate exercise, fresh aii.
and a generous wholesome diet are also re-
quired.   The removal of any irritating cause
will in each case depend on the nature of the
mischief, and for each  a special course may
have  to  be  adopted.    Astringent  lotions
should be  injected  two or three times a day
with a syringe ; lotions containing tannin or
alum  or sugar of lead are  the best. The parts
affected may also be freely bathed with cold
water night and morning.
  LICE.  (See Ectozoa.)
  LICHEN is a skin eruption  consisting of
a number of small pimples cr papules arranged
together  in clusters, and occurring anywhere
on the surface of the body ; the frequent rub-
bing in of zinc ointment is the best thing to do.
but the rash is often very troublesome to heal.
The patient should not scratch  the heads off.
or he may produce  an irritable sore  which
may become eczematous ; when the  rash is
due to syphilis,  the  treatment will consist in
taking iodide of potassium  in conjunction
with some tonic infusion, as gentian or sarspa-
rilla.  The prickly heat of tropical countries
is really an aggravated form of lichen.   This
disease is  not  contagious ; it is more com-
mon in women than  in men, and in those of
a nervous and  excitable temperament.  It is
more  common in spring and summer than in
autumn or winter.
  LIEBIG'S   EXTRACT.    (See  Meat,
Extract of.)
  LIFE, CHANGE OF. (See Menstrua-
tion.)
  LIGATURE is a cord or thread employed
in tying a  blood-vessel or tumor,  consisting
either of  milk or strong  hempen twine,  cat
gut, horsehair, or other substance.   In  ap-
plying a ligature to a bleeding artery, its ori-
fice is first laid  hold of, and pulled out from
the surrounding  tissues, either with a pair of
forceps or  a tenaculum, so that a loop form-
ed  by  the  ligature may embrace  it and
it alone.   The length of the ligature for ease
of application should be  about a couple of
feet.  The  knot used for  an artery is what is
known as a reef knot, and, in  bringing the
bight  tight, care must be taken to run the
cord over the tips of the  forefingers, so that
all pressure is made at  the bottom of the
wound, and that the  vessel be npt  " tugged" 
284
LIGHT
LIME
at, to the imminent danger both of  tearing it
through and of pulling the ligature away from
the vessel.  One end of  the ligature, in the
case of tying an artery, should be cut off, and
the other lett hanging  out of the wound, so
that when the sloughing of the arterial coat
has taken place, it may be readily withdrawn.
The time  that ligatures require to separate
varies from a week to three   weeks  or  a
month.
  LIGHT is as important to health almost
as air.  Its want is  noticeable in those who
work in  dark  workshops  and  underground
kitchens.  These have complexions as devoid
of color as a piece of blanched celery or aspar-
agus, and  for exactly the  same  reason, both
have  been deprived of light.   In  the vege-
table  kingdom light is  absolutely necessary
to convert the white shoots into green leaves
and branches.    So, too, in the human being
the circulating blood requires an exposure to
light  to give  it its  true vivifying  qualities.
Such  individuals, therefore, who have not a
due exposure to light are what is technically
called anaemic, and though in some the health
seems tolerably good, in others there is  a
tendency to passive dropsies, owing to what
is called thinness of blood,  and a  want of
breath when called upon to undergo exertion.
The exact nature of the constitutional change
is not known, but probably is connected with
some change in the intimate  structure of the
red corpuscles or the chemistry of their color-
ing matter, hemoglobin.
  LIGHTNING STROKE, or a flash of
lightning, will generally strike the most prom-
inent object near it, and  if this  chance to be
a conducting  body, it  is carried off to the
earth and  may do no harm ; in other cases it
may strike the chimney of. a house  and  do
serious harm to the  walls  and   inmates, and
especially if there is a conductor, the supports
of which are made of metal and inserted be-
tween the stones or bricks of which the wall
is made.   Lightning  is  the dazzling  light
emitted by the electric spark when it shoots
from clouds charged with electricity ; some-
times the flash is  zigzag, and moves with
great velocity  and sharp  outline ; sometimes
the flashes, instead  of  being linear, fill the
whole horizon without having  any  distinct
shape.  There is also the so-called heat light-
ning, which  illumines  the summer  nights,
without the presence of any clouds above the
horizon,  and  without  producing any noise.
The lightning  discharge  is the electric dis-
charge which strikes between a  thunder-cloud
and the ground. The latter, by  the induction
from  the  electricity of  the  cloud,  becomes
charged with  contrary electricity, and  when
the tendency of the two electricities  to com-
bine exceeds  the resistance  of  the air, the
spark passes, which is  often spoken of as a
thunderbolt having fallen.  The  discharge
generally  falls on  the nearest and  best con-
ducting objects, and, in  fact, trees,  elevated
buildings, and  metals are more particularly
struck by the discharge.   Hence it is impru-
dent to stand under trees  in stormy weather,
especially if  they are good conductors, such
as oaks and elms.  The lightning discharge
kills men and animals, inflames combustible
matters, melts  metals, and breaks  bad con-
ductors in pieces.  After the passage of light-
ning, a very singular odor is often produced.
This  odor  is  attributed to the  formation of
ozone, a peculiar modification of oxygen, first
discovered  by  Schonbein in 1840.  The re-
turn shock  is  a violent and sometimes fatal
shock.which men and animals experience even
at a distance  from the place where the light-
ning discharge has passed.  It is caused by the
inductive action which the thunder-cloud ex-
erts on bodies placed within the sphere of its
activity.   These bodies  are then,  like  the
ground, charged with the opposite electricity
to that of the cloud ; but  when  the  latter is
discharged by the recombination of its elec-
tricity with that of the ground, the induction
ceases, and the bodies reverting rapidly from
the electrical to the neutral state, the concus-
sion in question is  produced.   A lightning
conductor consists of a rod and a conductor ;
the rod is a pointed bar of iron, fixed verti-
cally to the roof of the  building to  be pro-
tected ; it is from six to ten feet high, and its
basal section is about two or three inches in
diameter ; the  conductor is a bar of iron or
copper which descends from the  botton of the
rod to the  ground,  which  it  penetrates to
some distance.   Strands of iron or copper
wire may be  used instead of a  rod.  A con-
ductor, to be efficient, must satisfy the  fol-
lowing conditions :  1st, the rod ought to be
so large as not to be  melted if  the discharge
passes ; 2d, it ought to end in a point, to give
readier issue to the electricity disengaged from
the ground ; 3d, the conductor must be contin-
ued from the point to the ground, and the con-
nection between the rod and the ground must
be as intimate  as  possible ; 4th, if the build-
ing which is  provided with a lightning con-
ductor contains metallic  surfaces of any ex
tent, these ought  to  be connected with the
conductor, or else lateral discharges may take
place between the conductor and the edifice,
and the danger may be increased.  Death by
lightning is instantaneous, and leaves nothing
to be done ; there is generally a mark as of
being burned, and articles like a watch or coins
may be partially destroyed.
   LlME, the oxide of the metal  calcium, is
used for a variety of purposes.   Quicklime is
prepared by burning chalk or  limestone,  and
so driving off the carbonic acid, quicklime is
left behind, retaining something of the shape
of the original blocks. If, however, water be
added, the whole mass heats and breaks down
into a fine powder, and this, which is  slaked
lime, dissolved in water to saturation consti- 
LIME                              LIPS, WOUNDS OF       285
 tutes  lime-water.   If sugar  be added to the
 water the lime is taken up much more freely,
 and a stronger solution—saccharated solution
 of lime—is produced.  Lime given as lime-
 water acts as a powerful  antacid both on the
 alimentary canal and after absorption.  It is
 also astringent  and tends to diminish secre-
 tions, and so is very useful in  many forms of
 diarrhcea.  Lime-water is also used with ad-
 vantage to check abundant  discharge in the
 skin disease called eczema.  In some forms
 of vomiting, especially in children, lime-water
 is a most valuable remedy.   It  is,  perhaps,
 of most use  in  chronic vomiting.   It is best
 given mixed with milk.   It prevents cow's
 milk from coagulating, and so  obviates fertile
 risks of stomach-ache and diarrhcea.  If the
 bowels  be constipated bicarbonate of soda
 should be used  instead.
    Carbonate  of lime  as precipitated from  a
 solution of a lime salt, or  as prepared  thus
 as well - washed  chalk,  is  a  useful rem-
 edy.   Two preparations are available : chalk
 mixture and aromatic  powder,  or  aroma-
 tic powder  and  opium.  Chalk  is an ant-
 acid  and  astringent.   It is mainly used in
 diarrhcea, seldom  alone, but generally  with
 other remedies astringent and aromatic.  If
 given too long it is apt to cause concretions
 in the bowels  which  may  be  troublesome.
 Chalk is also often used as a dusting powder,
 when  sores form, as in the creases of fat chil-
 dren.   Sometimes these are better dealt with
 by using greasy preparations, but in a goodly
 number chalk does well.
   Chloride of calcium is  a  remedy  which is
 very variously estimated by different observ-
 ers.  It is  introduced into the pharmacopoeia
 mainly as a  drying agent, and as concerned
 in  the manufacture of chloroform and ether.
 Some, however, esteem it highly because it is
 supposed to exercise a special influence on
 the glandular system in scrofula.
   Chloride of lime.  (See Chlorine.)
   Phosphate  of lime, or  bone earth,  is a very
 important salt in the animal economy,  consti-
 tuting the  main  basis of our  bones.  It is
 obtained from  bones by a slight process of
 purification.  This salt is  necessary  not only
 to the growth of bone, but also to the growth
 of  other  tissues.   It is most  useful  in the
 anaemia of young and rapidly-growing individ-
 uals, and women weakened by frequent child-
 bearing.  It is also a very good thing to give
 to women  while suckling, if they have been
 previously weakened  in the  same way.   In
 rickets it is a most valuable  remedy, giving
 hardness to the softened bones.  The time
 best adapted for its use is  just alter the acute
 stage of the  malady when the  pain and ten-
derness of the  bones has ceased.   Not too
much should be given for a dose, as  given in
excess  it hinders digestion. Most of it passes
into the intestines, where, if  much be given,
it  is apt  to  form concretions.  In  various
 forms of chronic diarrhcea, especially in chil-
 dren, this remedy is of value.   It may be
 given along with iron in the form  of  syrup.
 Most of the phosphates necessary for the wel-
 fare of the body are taken in the food.
   LINIMENTS, from  the  Latin,  lino,   I
 smear,  literally mean those remedies which
 are smeared on the skin and left there.  Now-
 adays we commonly include in the term those
 also which have to be rubbed  in—really em-
 brocations, and the common  idea  of  a lini-
 ment is something to be rubbed in.   Lini-
 ments are made use of for all sorts of pur-
 poses, and many are included in tne pharma-
 copoeia.
   LINSEED, as commonly used, consists
 of the  pounded seeds  of  the common flax
 plant.  These seeds contain a valuable oil
 obtained by expression, the linseed-oil, which
 is also  officinal.   Not infrequently the sub-
 stance  which remains after this oil has been
 expressed  is  ground down and  the  powder
 made use  of as linseed for  poultices.   It is
 not, however, so good  as the pounded seed,
 being depiived of its oil.  Linseed is mainly
 employed  for poultices, and  it furnishes one
 of the  best  materials for  these  (see  Poul-
 tices),  and in this form is commonly applied
 to open and  suppurating sores.  Internally
 linseed  is given  as  linseed tea or  infusion of
 linseed.  This is an old-fashioned and useful
 remedy, being employed when there is  irrita-
 tion about the bladder or urethra.  It has also
 been employed  with  less benefit  in diarrhoea
 and dysentery.
   LEPOMA.  (See Nose, Diseases  of.)
   LIPS, WOUNDS OF.—The  most  com-
 mon cause of wounds of these structures is a
 blow or fall.   The lip  is driven  backward
 against the teeth, and laceration of its soft tis-
 sues produced.    These injuries may  vary,
 from a slight  wound  on the  free margin or
 posterior mucous surface of the lip to a large
 cleft, involving  its whole thickness, so as  to
 expose  the teeth and corresponding portion
 of the jaw.  The lips are sometimes bitten by
 sudden  closing of the lower jaw, and  when
 any of the incisor teeth  are sharp  or  broken
 at their free ends the wounds may be deep
 and  serious.   Wounds of the lips  generally
 bleed profusely, as their structures  are trav-
 ersed by large blood-vessels, and the internal
lining of red mucous membrane  is  very vas-
cular.  As there is usually much gaping, even
in small wounds of the lip, it is almost always
necessary to apply sutures.   When the whole
thickness of  the lip has been involved, the
separated  parts should  be brought together
by sutures twisted round long needles,  as  is
done by most surgeons in operating for the
relief of hare-lip. Care must be taken to bring
the corresponding portions  of the  wounded
lip into  contact, and to preserve the  line of
red margin.  For the simple stitching together
of the margins of superficial labial wounds, 
rVOW
LIQUEURS
LITHOTRITY
thin silk or thin silver wire are the best ma-
terials to use.
  Cracked Lip.—The most  common form of
this troublesome  affection  is  a  superficial
crack at about the middle of the red portion
of the lower  lip.  This is raw  and painful,
bleeds readily when touched, and is generally
associated with a sensation of dryness in the
whole lip.   It is met  with  in  weak and un-
healthy individuals during the winter months.
The upper lip may be affected, but cracks are
much  more  common  on  the  lower one.
Deeper and larger cracks are occasionally ob-
served  on  the lips  of scrofulous  children.
The best and simplest treatment consists in
applying blue-stone or sulphate of copper to
the base of the ulceration, and then to keep
the sore and surrounding portion of lip moist
with glycerine, and to protect these parts from
cold and external irritation  by means of cot-
ton-wool.
  Ulcers.—Non-cancerous ulceration  of the
inner surface of the lips is generally due to an
extension of some  similar  disease affecting
all parts of  the lining mucous membrane of
the cheeks  and gums and  the surface of the
tongue.  Ulcers on the lips are in most cases
superficial grayish patches  surrounded by a
zone of inflamed and  swollen mucous mem-
brane.  The following are the  most frequent
causes of oral and labial ulceration : denti-
tion ;  rough and  broken  teeth ; action  of
mercury ; disordered stomach ; venereal dis-
ease.   The white spots called  aphthae, which
are so frequently observed on the tongues of
unhealthy and badly fed infants, may also
attack the lips.  In the  management of cases
of ulceration of the mouth and lips, the med-
ical  man  directs his attention, in the first
place,  to the constitutional  origin of  the dis-
ease.   The best local treatment in most cases
consists in the application  of  blue-stone to
the surfaces  of  the  small ulcers, and in the
patient's sucking frequently during the day
small pieces of alum.  Borax and honey is a
well known   and very useful  application.
(See  Aphthve ;  Cancrum  Oris ;  Chaps ;
Harelip ; Salivation.)
  LIQUEURS.  (See Distilled Spirits.)
  LIQUOR  SANGUINIS  is the  opaque
straw-colored  fluid  or  plasma  in which the
blood-corpuscles  float  when  in  the  living
body.   (See Blood.)
  LITHARGE.  (See Lead.)
  LITHATES or Urates, form the red  or
pink deposit which settles from  the urine on
cooling ; it is often  found  in  cases of dys-
pepsia, or when too little water is passed, or
when the urine is very acid.   (See Urine.)
  LITHIA  is  an  alkali closely allied in  its
properties to  potass.  It  has recently been
brought into practice as a remedy in gout,  it
being supposed to favor the  passage of uric
acid from the system more than potass.  Its
preparations are the carbonate and the citrate.
It is somewhat expensive, and is not much
better than potass.
  LITHOLYSIS means an attempt at solu-
tion of the stone within the  bladder, which
may be  endeavored in two ways—by medi-
cines given by the mouth, and by injections
into the bladder of the former class of reme-
dies.   The  alkalies are the  most useful,
especially the carbonates of soda and potash,
given in copiously diluted  doses.   Of the
natural waters, Vichy appears to be the best.
The oxalate of lime calculus, however, resists
its influence.   The.uric formations, however,
are benefited in two ways by their administra-
tion ; alkalies thus given tend to correct the
diathesis  whereby the  calculus has arisen,
and at the same time they have an undoubtedly
sedative and corrective  effect on the  urinary
organs.  These remedies  should be contin-
uously given,  and in small  doses copiously
diluted.   In the case of the phosphates, they
seem to have the effect of gradually  disinte-
grating the stone by solution of the animal
matter  whereby  its  particles cohere.  Sol-
vent injections into the  bladder have been in
use since 1792, both acids and alkalies ; acid
injections appear to be not without their effi-
cacy, especially in  phosphatic stones.  Car-
bonate of  lithia has been proposed  for uric
concretions, and  the salts of lead  in phos-
phatic.
  LITHOTOMY, the  operation of the re-
moval of a calculus, or stone,  from the blad-
der, has created the greatest interest  from the
earliest  ages  ; but its history, though one of
the most interesting in the annals of  surgery,
would be manifestly out of place in a work
of this character.  The instruments  required
for the  operation of lithotomy in our own
time are remarkably few and simple—a knife,
a grooved staff, forceps or a scoop.   The pa-
tient having been previously  prepared,  and
placed under the influence of  chloroform, the
method at present in use—usually the lateral
operation—is  by  a skilful operator  a matter
of a few seconds.   After the  stone has been
extracted, a morphia  suppository may be ad-
vantageously administered,  and the patient
should lie  on  his back with the shoulders ele-
vated, a napkin applied to the perinaeum to
soak up the urine, and the bed protected with
mackintosh drawsheets. Pain is to be allayed
by opium, the bowels kept open with castor-
oil,  the wound  perfectly clean,  nourishing
diet, and the wound  made by the surgeon,
generally  speaking, heals entirely in four or
five weeks, the urine commencing to  flow by
the urethra in about a week.  The  cases in
which  lithotomy is preferable  to  lithotrity
are in case of children, or when the  urethra
is strictured, irritability of the bladder, great
enlargement of the prostate,  and  great  size
of stone to be  removed.
  LITHOTRITY is the proceeding  whereby
a stone in the bladder is crushed or broken 
LITMUS
LIVER
287
 by means of  some instrument  introduced
 through the urethra,  so that its debris may
 either be extracted by the said instrument, or
 may pass with the urine in the act of micturi-
 tion.   As may be surmised,  lithotrity is. an
 operation requiring, in  the  first  place, great
 perfection in diagnosis, so  as to determine
 when  this operation is to be preferred to that
 of lithotomy or cutting ; secondly, it requires
 immense practice, and  a peculiar  attention to
 detail.  The operator  must  have originally
 great  nicety of touch, so as to discriminate
 the tissue between the  jaws, and  to  this gift
 must be added great experience. Each opera-
 lion has its advantages.  The advantages of
 lithotrity (which,  of course,  are  determined
 by the surgeon), or rather the cases in which
 lithotrity should  be resorted  to  instead of
 iithotomy, are, when the patient  is an adult
 with a full-sized urethra, when the  prostate
 is not enlarged, when the stone is small  and
 friable,  when  there is  good  general health,
 and the bladder healthy and free  from irrita-
 bility, and cases  where the stone is single,
 not large, or very hard.  It must  be borne in
 mind  that the  greatest benefits are likely to
 be derived from this operation at  the  earliest
 possible period after the descent of the stone
 from the kidney into the bladder.
   LITMUS or Lacmus is  a peculiar blue
 coloring matter extracted from a variety of
 lichens.  It  is prepared extensively  in Hol-
 land.   As it is readily affected by acids and
 alkalies—turned red by acids and blue by alka-
 lies—it is used as a test of  acidity or alka-
 linity.   It is used  for no  other  purpose.
 Litmus paper is made  by spreading the sub-
 stance on a piece of ordinary paper, and after-
 ward cutting it up into  slips.
   LIVER (The)  is the largest gland in  ihe
 body,  and weighs  generally between fifty and
 sixty ounces, being greater on an average in the
 male  than in the female. It  is seated on the
 right side of the abdomen, just below the dia-
 phragm, in  the right hypochondriac region.
 (See Abdomen.)  It stretches across to  the
 left also, crossing  the  epigastric region, and
 reaching as far as  the spleen in the left hypo-
 chondriac region.   It commences  as high as
 the fifth rib  in  the line of the nipple on the
 right side, while its lower border comes down
 as low as the lower margin  of the rib.  Its
 length, however,  varies a good deal even in
 health, and in women who wear tight stays it
 may come  down  an inch or two lower.   In
 front  of the liver, in the erect position, is the
abdominal wall : behind is the right kidney  ;
while   above  there is  the arch  of the dia-
phragm. The organ is covered all over with a
thin,smooth, serous membrane,called the peri-
toneum,  by which  it is held in its place.  The
liver can move up  and down  slightly with
each movement of respiration, for during in-
spiration, when the diaphragm descends,  the
liver is pushed down also, returning to its  old
 position when  the diaphragm ascends during
 expiration.   It is of firm consistence and of a
 dark red color, smooth and convex in front ;
 the hinder surface is flattened and irregular ;
 the upper border is thick  and rounded, while
 the lower edge is thin, and can be felt in thin
 people.  The liver is divided into two main
 lobes or divisions,  called the  right and left
 lobes ; the division is marked by a deep notch
 in the lower border ; looked at from behind,the
 lobed arrangement  is very evident, but  from
 a front aspect  the two lobes seem, and are,
 continuous.  The  right  lobe  is  by far the
 larger of the two, while the smaller, left  lobe,
 occupies  chiefly the  epigastric  region  ;  its
 lower border,  too,  does  not come  down  so
 low as that of the  larger lobe.   This gland
 contains various vessels,  and also a secreting
 structure formed of myriads of  cells.  The
 portal vein brings the blood to the liver, and
 then breaking up  into  numbers  of  small
 branches the bloodstream is carried through
 very fine tubes known  as the hepatic capilla-
 ries ; here  the current is brought into  the
 closest proximity to the liver cells, and  they
 take from the blood the  elements necessary
 to form bile and  glycogen.   These hepatic
 capillaries next join together again and finally
.form the hepatic vein, which carries the blood
 into the inferior  vena cava,  and so on to the
 right side of the heart.   The portal vein col-
 lects all the venous blood  just  after it has
 passed  through  the  stomach,  spleen,  and
 large and small intestines, so that this blood,
 highly  charged with nutrient  material  from
 absorption of the elements of food in the ali-
 mentary  canal, is at once  carried  on to the .
 liver.   The hepatic artery is a  branch  from
 the  aorta and  sends several branches to the
 liver, and probably  is the nutrient vessel of
 that gland.  The hepatic  duct is a tube which
 conveys the excreted products  of  the  liver
 away into  the alimentary canal, and enters
 that channel in the duodenum.   It  has  been
 said above that hepatic capillaries form a very
 close network  of   thin-walled vessels, and
 among the meshes lie the  liver-cells ; these
 communicate  readily with  the commencing
 branches of the hepatic duct, which, uniting
 together, finally  form branches  of  consider-
 able size ;  along the ducts the bile flows in
 health  and  runs down  into  the intestine.
 Thus there are two currents, each in an op.
 posite direction ; the blood is  brought  from
 the  intestines  to the liver ;  the bile,  then
 formed, flows from  the liver down to  the in-
 testines.   In addition  the  liver is supplied
 with  lymphatics  and nerves, which play an
 important part with regard to the functions
 of the organ ; branches of the vagus or pneu-
 mogastric are the chief nerves  which  supply
 the liver. Opening out from the main hepatic
 duct  is a  dilated reservoir,  called  the  gall-
 bladder ;  it forms a large  oval sac, and varies
 in size according to the amount of its contents. 
 28b              LIVER

   The  liver removes  from the blood certain
 substances, and also supplies that fluid with
 new compounds ;  it is thus a source of loss
 as well as a source of gain.   The blood loses,
 because bile is being constantly formed, and
 passing down the hepatic duct,  and experi-
 ment shows that there is a difference in the
 blood which enters the liver and in that which
 leaves  it, in consequence of this loss.  The
 total quantity of bile secreted in  twenty-four
 hours  varies,  according  to different authors,
 the probable average being between two and
 three pounds.   It is a greenish-yellow fluid,
 slightly alkaline, and of  an extremely  bitter
 taste.  It consists chiefly of water, holding in
 solution from 10 to 17 per cent of solid sub-
 stance.  The  solid matter consists  chiefly of
 bilin,a resinous substance composed of carbon,
 hydrogen,  oxygen, nitrogen, and sulphur, in
 combination with soda.   Chemists have sepa-
 rated this bilin or biliary matter.into two acids,
 the taurocholic and  the glycocholic, each of
 which  exists combined with  soda.   In addi-
 tion to  this constituent, the bile contains also
 a substance called cholesterine, which  is very
 soluble in  alcohol,  and  crystallizes  out in
 thin quadrangular plates ; it forms a great
 part of what are known as  gall-stones.  Of
 these bodies,  the  water, saline matter, and
 cholesterine have been  found in the blood,
 and probably the  liver-cells  simply abstract
 them from the stream as it flows along, and
 certainly the  blood in  the  hepatic vein is
 poorer  in water than that in the  portal vein.
 Bilin  has not yet been  discovered  in  the
 blood,  Land  thus  this  substance  must be
 formed in  the liver itself.  But  the liver is
 also a  source  of  gain to the blood.  If the
 blood in the hepatic vein be  examined it will
 be found to contain a large  quantity of glu-
 cose,  a kind  of sugar  formed in the  liver,
 while the blood in the portal vein, or hepatic
 artery,  contains a very  much smaller quan-
 tity, and sometimes none at all.   Experiment
 has shown that an amyloid substance called
glycogen is formed in the liver ;  this substance
 is made up of carbon, hydrogen, and oxygen,
 and much   resembles  starch,  dextrine, and
 gum in chemical composition.  Further, this
 glycogen, like starch, can be acted  upon by
 ferments, and so is converted into hepaose or
 liver-sugar.   This ferment exists,  under ordi-
 nary circumstances in  the liver.   So that it
 would  appear that the  liver forms glycogen
 from the blood with which is  is supplied, and
 also a ferment which, at the ordinary temper-
 ature  of the body, will  convert the slightly
 soluble glycogen into very soluble sugar, and
 this is carried away by the hepatic vein on to
 the vena cava, and so through the right side
of  the heart into the lungs.
  The  bile, as has been said, enters  the duo-
denum, or that portion of the small  intestine
next to  the  stomach, and here it mixes with
the chyme,  or partially  digested food ;  the
                   LIVER

 bile neutralizes any free  acid, and, perhaps,
 aids in digesting any fatty matter ;  it also in-
 creases the peristaltic action of the bowels,
 and thus acts  as  a purgative.   If from any
 cause the flow of bile down the hepatic duct is
 obstructed, the bowels often become consti-
 pated  and  the motions  are of a pale clay
 color.   At the same time the liver becomes
 rather larger than usual, because  the ducts
 are full of the retained bile, and the patient
 feels pain over that region, which is worse on
 pressure.  Since the bile cannot flow in its
 usual course, some  of  it  is absorbed  by the
 blood, and  thus some kinds  of jaundice are
 produced.    Then  the  urine becomes much
 darker in color and has a dark olive-green hue,
 the conjunctivae also are tinged yellow, and
 in a short time the whole skin assumes a yel-
 lowish  tint.   Exposure to cold, indigestible
 food, and sedentary employment may set up
 .an inflamed condition of the  bile-ducts and so
 cause temporary obstruction, but this form is
 very amenable to  treatment  ; any great emo-
 tional disturbance or fright also causes jaun-
 dice.  Sometimes the jaundice is more per-
 manent, as when  a growth or tumor presses
 on the duct,  and such cases may prove fatal.
 Or a gall-stone may  become lodged in the
 canal and cause intense pain in the right hy-
 pochondriac region, with sickness  and faint-
 ness ; these symptoms are relieved when the
 stone has passed  into  the  intestine.  (See
 Jaundice  and  Ohstructions.)   Excessive
 drinking  and the immoderate use of ardent
 spirits cause  congestion of the  liver and
 finally  produce  profound   changes  in that
 organ, as in cases of cirrhosis and fatty liver  ;
 inflammation of the liver,  ending in abscesses,
 is uncommon in this  country, but it is fre-
 quent in  tropical  climates ;  abscess of the
 liver in  this country is generally associated
 with pyaemia, or ulceration of the bowels.
   The liver, like the kidney and other organs,
 is liable to various acute and  chronic diseases.
 Among the  acute  changes  may be  classed
 catarrh,  or  inflammation of the bile-ducts,
 acute atrophy of the liver, congestion and in-
 flammation of the liver, and the presence  of
 gall stones in  the hepatic duct.  Catarrh of
 the bile-ducts  has  been briefly mentioned
 above ; there is, in addition to the jaundice,
 a  loss of appetite,  a  coated tongue,  slight
 sickness,  and  a  feeling of  retching ; the
 motions are pale, the urine dark, the skin and
 eyes become yellow,  and there may be,  in
 some cases, a troublesome itching of the skin.
 Pain is not a very troublesome symptom, and
 it is generally felt  in the right shoulder-blade
 and along the lower edge  of the liver, being
 often worse on pressure.  The best treatment
 is to open the bowels freely by means of pur-
 gative medicines ;  a dose  of calomel at bed-
 time with a rhubarb draught twice a day will
[ generally suffice.   The diet  must  be  very
 light, and capable  of  being  easily digested  ; 
                  LIVER

 all rich food  should be  avoided, while milk,
 broth, beef-tea, toast, and biscuits, or a light
 pudding may be taken ;  no stimulants  need
 be given, as they would only tend to increase
 the congestion of  the  liver.   Effervescing
 solutions may be given with benefit, as they
 allay thirst and sickness ; those containing
 soda salts are the best, and those also which
 have an aperient action ;  for this reason effer-
 vescing Carlsbad waters  often prove bene-
 ficial..  In three or four days a mixture con-
 taining extract of  dandelion, hydrochloric
 acid, and gentian, may be  given three times
 a day, and the bowels must  be kept  open
 daily ;  active exercise should be taken daily,
 if  the  patient can bear it, and for some time
 care must be taken to avoid indigestible food.
 This disease  is not a dangerous one,  and
 with early and proper  treatment is  easily
 cured.
   Acute atrophy of the liver is a very formida-
 ble disease, and fortunately is of rare occur-
 rence.   The patient becomes hot and  fever-
 ish, vomits often,  and  the skin assumes a
 deep yellow  tint ; the liver rapidly shrinks
 inside so as sometimes to lose  half its weight.
 Headache comes on quickly, followed by de-
 lirium  and  insensibility ;  the patient  lies in a
 prostrate condition, and there is picking of
 the bed-clothes and low muttering delirium ;
 bleeding may take  place from the nose or
 mouth, and small hemorrhagic spots may be
 seen in the skin.  Death generally occurs in
 four or five days,  and  treatment is  not of
 much avail.
   A  '  sluggish"  or congested liver is gen-
 erally  associated with  catarrh of the  bile-
 ducts,  and arises often from  want of exer-
 cise and eating or  drinking too  much ; but
 congestion  may go on  to inflammation in
 tropical countries and end in the formation of
 an abscess.   This may be known by the pain
 over the region of  the liver, the swelling of
 the abdominal wall on that spot and the  fre-
 quent  shiverings ;  the patient loses  flesh,
 strength, and  appetite, and his  skin becomes
 of a sallow  tint ; such people generally come
 back to this  country  invalided, and  if  they
 get over the illness they seldom recover their
 former  state of health.
  A gall-stone in the hepatic duct will cause
 great pain over the  liver, chiefly referred to
 one spot, much sickness and distress, and a
 feeling of faintness ; a hot bath and  the ad-
 ministration of chloroform will  ease the pain,
 while purgative medicines may be taken, and
 all  means used  to get the stone to pass on-
 ward to the bowel.  Jaundice will come on
 from the obstruction to the flow of bile, but
 this will  disappear when  the  stone  has
escaped.  Sometimes the stone will  remain
in the canal for weeks and become imbedded
there, but generally there is a passage left by
the side for the escape   of  bile.  In  some
cases of hysteria very analagous  symptoms i
                  LIVER              289

 are  met with, but in such  cases  there is no
 jaundice ;  the  disorder  occurs in  nervous
 young women,  and there  is a dark  areola
 under the eyes.
   Among  chronic changes  may be enumer-
 ated cancer, cirrhosis, fatty  and waxy degen-
 eration,  passive congestion, syphilitic depos-
 its, and the presence of hydatid cysts.
   Cancer of the liver is a most fatal and seri-
 ous disorder, carrying the patient off within a
 year or  a  year and a half from the first ap-
 pearance of any symptoms.   There is at first
 loss of appetite and pain over  the abdomen ;
 the  latter  begins  to swell  as  the cancer in-
 creases in size, and becomes extremely  ten-
 der ; rapid emaciation goes  on, but the tem-
 perature is generally no higher than usual and
 there is no attendant fever.  The loss of flesh,
 the hollow temples, the great prostration, the
 pain and swelling or enlargement of the liver
 are the chief symptoms, and these gradually
 become  worse and finally  cause a lingering
 and painful  death.  Jaundice  is not often
 present, nor does the patient suffer from shiv-
 ering.  Cancer of the liver may occur in both
 sexes and be met with at any period of life ;
 more frequently, perhaps, between thirty and
 fifty  years of age.  This terrible disease  is
 not often confined to the liver, but may attack
 the stomach or parts adjacent,  and so add  to
 the  distress ;  sometimes the  peritoneum  is
 also implicated, and  then  there is more  or
 less dropsy ;  oedema or dropsy of  the feet is
 also of common occurrence.   The treatment
 must be directed  to the  relief of the patient,
 as no cure can be looked for.   The pain may
 be alleviated by the administration of opium
 or morphia, and this may be given internally
 as a draught, or a small  quantity may be in-
 jected under the skin with a  syringe. Chloral
 is of much use in  easing the pain.  The diet
 must be light  and nourishing, and must be
 varied from day to day to please the fancy  of
 the patient, whose appetite will be  but small
 and  capricious.
   Cirrhosis of the liver comes on  more gen-
 erally in middle life ; at first it may be mis-
 taken for cancer, as there is loss of flesh and
 appetite  and pain in the abdomen, but the
 symptoms  come on more gradually, the liver
 does not increase in size, but rather shrinks,
 and dropsy of the abdomen  soon comes on ;
 jaundice also is very common, and the  dis-
 tended abdomen becomes marbled over with
 blue veins as the stream of blood through
 them is impeded.  (See Cirrhosis.)
  Fatly degeneration of the liver is common  in
 many disorders, and there is hardly any affec-
 tion  of the  liver in which more fat than usual
is not found ; to a slight extent it occurs  in
health, and especially after a meal.  The liver
may. be  very fatty and give  rise to no symp-
toms, as in cases of consumption, and in those
who drink a great  deal of beer.  Fatty livers
may attain  a great age and become  double the 
290
LIVER
LIVER
ordinary weight ;  they occur often in scrofu-
lous people.  Not only is the liver larger than
usual, but  the  abdomen may swell  from the
presence of dropsy, which is very common in
these cases ; often, also, there is a similar
affection of the kidneys, so that albumen is
present in  the urine, and there is less of that
fluid  passed  than  usual ;   frequently,  also,
there is dropsy of  the legs.   The patients do
not lose much  flesh, at any rate at  first,  nor
is the appetite  much impaired ; there  is no
pain, or if present, it is very slight, seldom
any jaundice or shivering  ;  the  symptoms
come on very gradually, and the liver is gen-
erally much diseased before any notice is taken
of the mischief ;  the disease is  often very
chronic and will last for years, unless there
be much mischief  in other organs ; dropsy is
a bad symptom, and, when  general, will  fre-
quently point to disease in the kidneys.  Con-
stant rest in bed is not  required, unless  the
patient  be  too  weak to go  about ; attention
must be given to the diet, and any indigesti-
ble food should be avoided.  Stimulants need
not be given, but a pint  of  beer a day, or a
glass or two of sherry or  claret, will do no
harm.   If dropsy be present purgatives must
be given, so as to remove  the fluid, and  the
general health must  be kept up  by  tonic
medicines,  as iron and quinine.
   Waxy degeneration of the liver is a less  fre-
quent disease ;  it rarely, if ever, occurs alone,
and  is generally associated with  similar dis-
ease in the kidneys, spleen,  and  intestines.
It occurs in persons who have long suffered
from  diseased  joints and chronic  abscesses,
in the scrofulous, and in those who have suf-
fered from  syphilis or ague, and  some other
wasting disorders.  As in the case of the fatty
liver, there is seldom pain or jaundice, or loss
of flesh  ; in each the appetite is good, or but
slightly  impaired, and  in each the  mischief
may go on  for a long time and cause no
symptoms.  In waxy change, however, dropsy
seldom occurs,  diarrhcea is often present, the
spleen on the left side  enlarges,  and the pa-
tient passes a  large quantity of pale,  limpid
water, in which is contained a good deal of
albumen. The liver, also, attains larger dimen-
sions than in the case of a fatty change, and its
lower border comes lower down,and can usual-
ly be easily felt.  The treatment will consist in
improving  the general health by  liberal diet,
and by the  administration of tonics ; and at-
tention must be directed  to  any other disease
on which the waxy change may depend.
  Passive congestion of the  liver often  occurs
in heart disease, and some disorders  of the
lungs, and  depends upon the fact  that since
the course  of the  circulation  is disturbed at
those points, the veins  become too full all
over the body ; now the hepatic vein  shares
in this fulness, and so the liver is stuffed with
blood and  the  stream  flows through slug-
gishly.   From a similar  cause the veins in
the leg and  kidney are full, and so there re-
sults dropsy of the lower extremities and  a
scanty flow of urine, which will  contain  a
variable amount of albumen.  There will be
pain over  the liver,  but not  of marked in-
tensity, and frequently there is some yellow-
ness of the skin from the presence of  jaun-
dice : after a  time  dropsy of the abdominal
cavity  will come on, and  then a  fatal  result
often follows.  Since this  state  of liver de-
pends upon the disease of the heart or lungs,
the treatment must be directed to allaying any
tumultuous  or irregular  action of the  heart
and removing any dropsy  by purgatives or
small punctures  in the leg ; then  by dimin-
ishing  the quantity of fluid  in the circulation
relief may be temporarily given.
  Syphilis will produce various changes  in the
liver, and cause  a hardening  of that organ
and thickening of the capsule ;  sometimes
rounded  masses, something resembling can-
cer, are met with  in that organ ; the health in
such cases must be improved by a visit to the
sea-side, if possible, or a sea-voyage, by  lib-
eral diet and regularity of  living  ; prepara-
tions containing  iron and quinine are  valu-
able, and may be given  in conjunction with
iodide of potassium.   In such cases the  pa-
tient is generally of sallow  complexion, feels
low and  nervous, and is  in a  feeble state of
health ; to improve,  therefore,  the  general
condition of the constitution is the chief  in-
dication.
  Hydatid cysts occur more commonly in the
liver than in any other organ, although they
are by  no means  very often met with.  They
may occur in the liver either as small, round
and firm tumors,  formed of a fibrous capsule.
with putty-like contents ;  these  are  hydatid
cysts which  have undergone  spontaneous
cure, and can do no more harm ; or as cysts
with a  tough,  fibrous  capsule, inclosing much
fluid, and a greater or less number of smaller
cysts floating  about.  The  fluid  is  limpid,
clear, of low specific  gravity, and is, in fact,
chiefly made of water holding common salt
in solution.   These cysts play attain a great
size, from a walnut to a child's head ; they
form a rounded,  abdominal tumor, firm  yet
elastic, and giving a peculiar thrill  when tap-
ped.  They are seldom  attended with  pain,
unless there is inflammation outside setting
up  adhesions ; the  general  health  is seldom
affected, so that the nature of the disease is
chiefly recognized by the presence of a tumor
in the liver, and the absence of any constitu
tional symptoms.   The treatment will consist
in having resort to surgical aid, whereby  the
contents  may be  evacuated  and  the cyst
allowed to shrink ; in most cases this is very
successful  treatment, and,  with  certain pre-
cautions, it is not difficult to perform.   If
allowed to grow,  such cysts may  cause  death 
LOBELIA INFLATA
LUCIFER-MATCH       291
by bursting into the abdominal cavity, or into
some neighboring organ.   (See  Hydatids.)
For an excellent liver pill, see COLOCYNTH.
   LOBELIA INFLATA is a plant growing
in North America, where it has long been in
use among the native tribes.  The whole herb
is employed  in  medicine.  It has a peculiar
odor and  a burning taste, not observed until
after the medicine has been chewed for a time.
Two preparations are in use, a tincture and an
ethereal tincture.  In small doses it is expec-
torant and diaphoretic ; in larger, emetic and
cathartic.   In  still  larger  doses it causes
death. This has not unfrequently followed its
use  by a medical  sect appropriately  called
Coffinites. It closely resembles tobacco in its
action.   It has been chiefly used for asthma
and other diseases of the respiratory passages
accompanied by spasm.   It is sometimes
smoked.  If it  is to  do any good, lobelia
must be  given  in large  doses,  and very
carefully'  watched.  Sickness and  vomiting
are often  so  produced, put pass  away.  It is
also useful in whooping-cough.
   LOCK-JAW.  (See Tetanus.)
   LOCOMOTOR  ATAXY.   (See  Pro-
gressive Locomotor Ataxy.)
   LOINS.    (See Lumbar Abscess.)
   LONG-SIGHTEDNESS. (See Eye and
Vision.)
   LOTIONS are medical preparations used
as outward applications for bruises, burns, or
hurts of any kind, for allaying local inflamma-
tion,  or for  stimulating  indolent  sores  or
ulcers.  They are of various kinds, such  as
astringent, sedative, stimulating,  evaporating,
or refrigerant, according  to  the effect they
are  intended to  produce.   Arnica  lotion
(made by mixing one part arnica wth five to
eight parts of water) is an example.
   LOUSE.  (See Ectozoa.)
   LOW FEVER.  (See  Typhoid Fever.)
   LUCD7ER-MATCH MAKER'S  DIS-
EASE. — Lucifer-match-makers  are   fre-
quently affected with necrosis  of  the jaw-
bones,  especially  the lower, owing to the
action   of  the  fumes  of  the  phosphorus
used in their  trade.   Thus " Phosphorus
disease" was not known to have any existence
until the  extensive use of the modern style
of match so much prevailed,  and there can-
not be  the slightest  doubt that  it is due to
the introduction of  phosphorus  in  some
form, and that is  " applied to the perios-
teum, or what is equivalent,  some  raw sur-
face in immediate connection with the  nutri-
tion of the bone, and that its application must
be prolonged, and be  under peculiar circum-
stances of  temperature, and probably of  oxidi-
zation."   If the pulp of a carious tooth is ex-
posed to the  influence of the  poison, the re-
sulting necrosis is that of the jaw bone.   It
is a matter of speculation in what manner the
phosphorus-oxide may be absorbed, but the
iact of phosphorus itself entering so largely as
it does into the formation of the skeleton is
a suggestive circumstance ; and perhaps if it
be  accumulated by the periosteum, it may
generate upon the bone's surface a condition
of chemical superphosphate inconsistent with
osteal  vitality.    Efficient sanitary measures
should be adopted to prevent the disease,and it
has been suggested that " there should be a
periodic and rigid scrutiny of the mouths of all
those employed.  Those whose teeth are bad
should be excluded from the rooms where the
obnoxious fumes are being developed (the
dipping and drying rooms). All carious teeth
should be extracted or stopped, and a simple
and effective  respirator,  having its  centre
composed  of a porous diaphragm, such as a
sponge or some woven fabric, linen or cotton,
which should be daily dipped in a solution of
one of the fixed alkalies or  of  their car-
bonates,  should  be worn  over  the mouth by
those employed, or the respirator devised by
Mr. Graham for persons exposed to carbonic
acid vapor,would be probably as efficacious. It
consists of a mixture of fresh-slaked lime and
sulphate  of soda, through a cushion of which
it is easy to breathe.  The acid vapor might
be  neutralized  or  rendered  innocuous by
keeping  the  atmosphere  of  the  apartment
ammonuretted."   (S. J. A.  Sailer.)   The
symptoms of this disease do not differ in any
essential particular . from ordinary necrosis
not  produced  by phosphorus.   They usually
commence with a feeling of toothache, and
the pain is referred  to a decayed tooth, by
which channel the poison enters. The disease
takes a slow course at first, the gums become
red  and  sore, and there is general  pain and
extreme tenderness.  The mucous membrane
of the cheek becomes involved.   The teeth
become  loose,  appear elongated, and cause
intense pain  when brought against those of
the  opposing  jaw.   After a  great  deal  of
suffering, matter-forms, and points either in-
ternally  about the fangs of the teeth,  or ex-
ternally  on the  outside  of the  jaw.  The
matter is peculiarly letid,  and  a probe intro-
duced into the opening made either naturally
or artificially, is long, tortuous, and burrow-
ing, leading to portions of dead bone,  or se-
questra.   It is worthy of remark here, that
in necrosis of  the lower  jaw-bone, whether
from phosphorus or any other cause, we have
a wonderful exhibition of the  vis medicatrix
natures,  in fact that  there  is  an immense
amount of repair, which does not exist in the
event of a similar affection of the upper jaw.
In  milder cases, if  the disease  progresses
favorably, the dead bone loosens and becomes
detached, and the teeth  fall out, and in very
severe  cases, and when the extent of the dis-
ease is  very great, the patient  may have in-
tense  constitutional   disturbance,  the local
condition being peculiarly distressing from
the secretion of fetid matter and loss of  tis-
sue ; oedema of the face and neck may super- 
292           LUMBAGO
LUNAR CAUSTIC
vene,  probably  accompanied  by erysipelas,
and terminating in an agonizing and long de-
layed death.
  Treatment.—With regard to the treatment
of this form of necrosis, the first indication is
obviously in the early  stage, or where  it is
anticipated to remove the individual from his
work,  pure  air,  cleanliness, attention  to
bowels and secretions, and all bad teeth taken
out.  If the disease  has  made any progress,
and the extreme pain, swelling and thicken-
ing of  the soft parts, show themselves, active
measures for the relief of the periosteum and
bone should be resorted to, leeching and gen-
eral antiphlogistic  treatment, free vertical in-
cisions into  the tender, soft  places  in the
gums,  carrying it clear down to the bone, so
as to afford relief to  the loose overloaded peri-
osteum.  In advanced cases the treatment is
that generally adopted in necrosis from other
causes. (See Necrosis.)  With regard to the
peculiar region affected, which of course dis-
ables the powers of mastication, and so con-
sequently interferes  in  great  measure with
digestion, and the  great length in duration of
such cases,  suitable  food, such as mashed
meat, cod-liver oil, etc., are to be abundantly
given,  and iron.
  LUMBAGO is  a  form of chronic rheuma-
tism specially affecting  the lower part of the
back and loins.  The pain is sometimes mus-
cular, but sometimes also seems situate in the
broad and strong ligament situate in that re-
gion.   Chronic rheumatism is rarely a malady
of youth ; it  is a totally different  complaint
from acute rheumatism, and mainly affects old
people who have been exposed much to cold
and wet. The pain sometimes  called lumbago
which  may  affect  young people  who stoop
much at their work, or who  have to  raise
heavy  weights, is merely the pain of tired
muscles, and  demands the same remedy, rest.
True lumbago is quite different ; there is no
feverishness with it,  as in acute rheumatism,
and it is not relieved by rest, as tired muscles
are. The individual moves stiffly, as if he
were tired, but night and day  the pains con-
tinue.  Sometimes the   malady gets  better
from the application  of cold, much more fre-
quently it is improved by heat, so that a roll
of flannel means  to such positive  comfort.
There is not much difficulty in  the  diagnosis,
nothing, in fact, can  well be  confounded with
it, but the making of  the diagnosis is no great
comfort, for the malady is often a most in-
tractable one.   Broadly  it may be said that
internal remedies  are of little use.  Hot or
tepid baths, applied even locally,  do good,
especially if salt water is used  ; local applica-
tions are, in point of fact, the best  remedies
in true lumbago, and as  a rule they are  best
applied hot.   Turpentine, ammonia and oil,
blisters, iodine paint lightly used, belladonna,
and chloroform with opium, may all be tried.
In a considerable number of cases, but these
are neuralgic, the subcutaneous injection  of
a small dose  of  morphia will act as a charm.
Sulphur is by many praised as a local remedy,
wrapped up in flannel, which should be hab-
itually worn. All exposure to damp and cold
should be  avoided,  and the diet should  be
carefully regulated.
  LUMBAR ABSCESS.—In the region  of
the loins acute abscesses are not met with  so
frequently   as  slowly-growing  and  almost
painless  purulent  collections, which  in the
course of  time acquire  large proportions.
The former resemble acute abscesses in other
parts  of  the body  in being due either to in-
jury or to  acute inflammatory action.  The
chronic  lumbar  abscess generally has   its
origin in disease of  the vertebrae of the back
and loins, or  in  suppuration  in  the  loose
areolar and  fatty  tissue  about the kidney.
The former, however, is the frequent cause,
and  the presence of a  slowly-growing and
fluctuating tumor in  the right or  left lumbar
region, paleness and debility, and a peculiar
sickening pain on tapping the sharp posterior
spines along the lumbar portion of the spinal
column, are almost sure  indications of verte-
bral caries. When angular curvature is present,
together  with the above symptoms,  there can
be no doubt as to the  cause of the  lumbar
abscess.    Occasionally,  though  rarely,  a
chronic abscess forms in the loins of patients
whose spine and kidneys are both  quite free
from  disease.  It seems to be due, then,  as
most  spontaneous chronic  diseases are,  to
general debility, and  a slow  inflammatory
action in the areolar tissue of  the region
affected.   A  lumbar abscess generally term-
inates, after it  has  been growing for some
time,  and has attained a certain size, in point-
ing and subsequent outward discharge of the
contained purulent fluids.   In  some few in-
stances the pus contained in the abscess be-
comes converted into a shrunken semi-solid
or cheesy  mass and the external mass sub-
sides.   Occasionally the pus contained within
the lumbar abscess  makes  its  way into the
thorax and lungs, and is discharged through
the air-passages.
  Treatment.—The  treatment of lumbar ab-
scess  differs  very slightly from that usually
carried out in  cases of  chronic abscess  in
other  parts of the body ; and whenever there
is  a suspicion of disease of the  spine, it  is
thought  advisable by most physicians not  to
open  the swelling until there  is  advanced
pointing, and the  integument over the most
prominent part of the  abscess has become
very red and thin.
  LUNACY.  (See  Insanity.)
  LUNAR CAUSTIC, or nitrate of silver,
is much used by surgeons for cauterizing pur-
poses.  By melting with it a certain propor-
tion of chloride of silver the "  stick" is now
rendered flexible  instead  of  brittle.   (See
Caustics.) 
LUNGS
LUNGS
293
   LUNGS are the organs by which the pro-
 cess of respiration is  carried on, and where
 those  changes occur by  which the carbonic
 acid is removed from the blood while oxygen
 is supplied to that fluid.  The lungs are two
 in number, the right and the  left ; they are
 seated in  the  closed cavity of the thorax or
 chest and occupy most of the space ; the  right
 lung is subdivided into three lobes, while the
 left has only two  ; each is surrounded  by a
 smooth  thin  serous membrane  called  the
 pleura, which  is  reflected at  certain points
 from  the  surface of the  lungs  and lines the
 chest  wall ;  this  surface  is kept constantly
 moist  by the secretion of a small quantity of
 fluid,  so that  the lungs  can glide upon the
 thoracic wall with the greatest  ease  and the
 least amount of friction.   Each lung consists
 of a bronchus, which allows of the passage of
 air to  and  fro,  of an artery, which brings the
 venous blood from the  right side of the heart,
 of capillaries,  which surround  the air-cells,
 and of veins which carry  the purer blood  on
 to  the left side of the heart.  (See Air  Pas-
 sages.)    The trachea  divides  into  two
 branches,  called  bronchi, and  one bronchus
 goes to each lung ; as  soon as  it enters that
 organ,  it  divides into four  or five  main
 branches, and then again  into very numerous
 sub-divisions, too  fine tObe seen by the naked
 eye ; finally, these very small branches end
 in  dilated  extremities with extremely  thin
 walls,  called  the  air-cells or  vesicles of the
 lung.  At  first the bronchus  has pretty thick
 walls,  which consist of an internal mucous
 coat lined by epithelium,  of a middle coat,
 made partly of muscular fibres  and partly of
 cartilaginous plates, and  lastly, of an outer
 fibrous coat ; these various coverings become
 thinner by degrees, until at last, when the
 ultimate ramifications  are reached, nothing
 is seen but a nearly homogeneous membrane
 of extreme thinness and lined by epithelium.
 The artery? which supplies each lung  is a
 branch of  the  pulmonary  artery, which is a
 vessel  of great  size and arises from the right
 ventricle of the heart  ; in this  way, all the
 blood which has passed through  the various
 vessels of  the  body is carried to the lungs ;
 the artery,  like the bronchus, breaks up into
 a vast  number  of  branches which at length
 end in a fine network of capillaries surround-
 ing the air-cells ;  so  that, although there is
 no  direct  contact in health  between the air
 and the blood,  yet the two are by this means
 brought  as nearly together as possible, and
 all  the necessary changes can  take place
 through  the moist and thin-walled air-cell.
 The wall of the artery in the first part of its
 course  consists of  an  inner epithelium  coat,
of a middle coat chiefly made of elastic fibres
and partly containing involuntary muscular
fibres,  and  thirdly of an outer coat of ordi-
nary white fibrous  tissue ;  in  its smaller
branches there  is less fibrous tissue and' the
muscular coat is relatively the thickest, while
in the smallest branches of all, these various
structures disappear, and only a thin homo-
geneous membrane  is left  with a few oval
nuclei  in its walls.  The veins are formed by
the union of the capillaries, and these uniting
to form still larger branches end  by forming
four large trunks which carry the blood to
the left auricle of the heart.  In addition to
these various important structures, the lungs
are supplied by various  nerves and lymphat-
ics, while the aorta gives off numerous small
branches, called the bronchial  arteries,  which
supply the lung-tissue with nourishment.
   It will  thus be seen  that  the lungs are
spongy, elastic bodies, and  they are capable
of much distension, as may be seen by inflat-
ing a lung after death. During life the chest-
wall is constantly moving up and down with
each inspiration and expiration, and  corre-
sponding  movements at the same time take
place in the lungs, which closely follow the
chest-wall, so  that there is  always a varying
amount of air in the lungs.   Inspiration and
expiration follow each other  in  health with
the greatest regularity, and the two actions
make up what is known as respiration  ; each
movement is repeated fifteen to eighteen times
in a minute on the average when the individ-
ual is  sitting  quietly, but  they  occur  much
faster during a period of active exercise, as in
running or rowing, etc.  The structure of the
lungs is such as to  admit of a very large
amount of blood being exposed to the air, and
the movements of the chest in  respiration are
to enable fresh currents of air to be constantly
brought while the impure air is also removed.
The expired air  differs from the  inspired air
in these particulars :  i. Whatever maybe the
temperature of the external air,  that expired
is nearly as hot  as  the blood,  or varies be-
tween 900 Fahr.  and  100 °  Fahr.   2. The ex-
pired air  is quite or nearly  saturated with
aqueous vapor,  however dry the  outer air
maybe.   3.  Ordinary air consists of 79 parts
of nitrogen and  21 parts  of oxygen, with a
trace  of  carbonic acid gas,  in  every  100
parts ;   expired  air contains  more  than  4^
parts of carbonic acid gas, between 15 and 16
parts of oxygen, and about 80 parts of nitro-
gen ; so that while the quantity  of  the latter
gas is not materially altered, there is, on the
other hand, a great loss of oxygen and a great
gain of carbonic acid gas.   But carbonic acid
is very prejudicial  to health,  and hence the
need of a movement of the  chest-wall to ex-
pel it from the lungs  , in ordinary expiration,
the normal elasticity is enough  for the pur-
pose, and very little  muscular force is used.
From three hundred and  fifty  to four hun-
dred cubic feet of air are passed  through the
lungs of an adult man, taking  no active exer-
cise, in the course of twenty-four hours, and
this amount must in that  time  become de-
prived  of five per cent of oxygen and be 
294
LUNGS
LUNGS
 charged with five  per cent of carbonic acid.
 Thus  it has been calculated that " if a man
 be shut up in a close room, having the form
 of a cube, seven feet in  the side, every par-
 ticle  of air  in  that  room will  have passed
 through his  lungs in twenty-four hours, and
 a fourth of the oxygen it contains will be  re-
 placed by carbonic acid."  But carbonic acid
 is a compound of carbon and oxygen in  the
 proportion of  32 parts  of the  latter to 12
 parts of the former, and  hence the  quantity
 of carbon eliminated  every twenty-four hours
 and calculated from  the  amount  of carbonic
 acid given off  is equal to a piece of charcoal
 weighing eight ounces. The amount of water
 given  off varies very much in the twenty-four
 hours  ; about half a pint is the average quan-
 tity, but it may be much more or less.  The
 lungs during life can never be emptied of air,
 however forced  an expiration we make ;  the
 amount of air which  cannot be got rid  of is
 called  residual air, and varies from 75 to  100
 cubic inches  in amount.   After  an ordinary,
 but not  forced, expiration,  about as much
 more remains, and this is  called supplement-
 ary air.  In  ordinary breathing,  from 20 to
 30 cubic inches of air pass in and out of  the
 lungs, and  this is called tidal  air.  Thus
 about  230 cubic  inches of air are contained in
 the lungs after an ordinary inspiration,  but
 this may be  increased by  another 100 cubic j
 inches, if a  very deep inspiration  is made ;
 this extra-supply is called  complemental air.
 Since  the lungs can  contain 230 cubic inches
 of air and the tidal air amounts to only 20 or
 30 cubic inches, it follows that only 7 or £ of
 the air in the lungs is renewed with each in-
 spiration, so  that the  remaining air acts as a
 buffer  between the incoming fresh air and  the
 blood  in the  capillaries ;  it plays, as  Profes-
 sor Huxley has  shown, the part of  a middle-
 man between the two parties, the blood and
 the fresh tidal  air, who desire to  exchange
 their commodities, carbonic acid  for  oxygen
 and oxygen for carbonic acid.
   Experiments have been made by means of
 an instrument called a spirometer, with refer-
 ence to the power of persons taking air into
 the lungs.   The person  first inspires to  the
 full extent, and then breathes into the instru-
 ment as much air as he can, and it seems that
 the height of the individual has  much to do
 with the result.   On  an  average a person of
 5 feet breathes 174 cubic inches ;  one of 5 feet
 1 inch  will breathe 182 cubic inches, and  for
 every inch of height up to 6 feet  will breathe
about  8  cubic  inches additional.    Weight
seems  to have  much less influence  than
height, and tends to diminish the  respiratory
power when beyond a certain limit.  In males
of the  same height the respiratory range  in-
creases from  15 to 35  years of age ; but from
35 to 65 it decreases  nearly ij- cubic inches
per year.  The activity of  the  respiratory
process is far greater  in children than in old
 age, and this  activity is  also modified by
 other circumstances.   Cold greatly increases
 the quantity of air  which  is  breathed,  the
 quantity of oxygen absorbed, and of carbonic
 acid expelled ;  exercise and  the taking  of
 food  have  a very similar  effect.   There is
 more carbonic acid excreted during the day
 than during the night ; during the day also
 much more  oxygen is  given out than is  ab-
 sorbed,  while  at night-time  much  more
 oxygen is absorbed than is excreted as car-
 bonic acid during the same period.   Air may
 become  unfit to  breathe  therefore  in two
 ways, viz., by the deprivation of oxygen and
 the accumulation of carbonic acid ; both will
 give fatal results, but when acting  together,
 death is of course much hastened.  Asphyxia
 will take place when the  proportion of car-
 bonic acid in tidal air reaches 10 per cent,
 provided  that the oxygen  is  diminished in
 like proportion ; life could be carried on with
 10  or even  15 per cent of  carbonic  acid, so
 long as the  supply of oxygen is simultane-
 ously increased ;  hence it  will appear that
 carbonic acid is not of itself  so poisonous,
 but that its  fatal  effects are due  in a great
 measure to its taking  up the room that ought
 to be occupied by oxygen.   Thus it is most
 essential for health that every human being
 should  have  fresh  air and plenty of air ;
 every man ought  to  have  at least 800 cubic
 feet, a cubic space of  rather more than 9 feet
 to the side,  and this air should be constantly
 renewed from the external atmosphere.  Las-
 situde, uneasiness, and headache come  on
 when the due amount of oxygen is by any
 means diminished, and there is in time a great
 loss of vital  energy.
  Lastly must be  considered   the  changes
 which take place in the blood  in its passage
 through  the  lungs.  The blood in  the pul-
 monary artery is venous, as has already been
 stated, and  is of a dark purplish color ; the
 blood in  the pulmonary veins, on the con-
 trary, is of a bright scarlet  color and arterial
 in character. Now it is known by experiment
 that when venous blood is mixed with oxygen
 it  becomes  brighter in color and  resembles
 arterial  blood, and when the latter is mixed
 with carbonic acid it becomes darker in color
 and resembles venous blood.  Now  in the
 lungs the interchange can only take  place in
 the  thin-walled pulmonary capillaries, and
 here the carbonic  acid is removed  from the
 blood and fresh oxygen  is supplied ;  this
 oxygen in its turn  combines with the carbon
 from the  tissues to pass away again as car-
 bonic acid.   It must not be supposed that all
 the carbonic acid is removed from the blood
 during its passage through the lungs ; on the
contrary,  arterial  blood always contains a
certain amount of carbonic  acid and  all ven-
ous  blood  contains  a little  oxygen.  The
cause of  the change of color during the pro-
cess of respiration is not yet well made out; 
LUNGS
LUNGS
295
 the blood contains myriads of rounded bod-
 ies, called corpuscles ;  these are  rendered
 somewhat flatter by oxygen, while they are
 distended by carbonic acid ; in  this way, by
 reflecting more or less light according to the
 convexity of the surface, the changes may be
 due ;  on the other hand, it has  been shown
 that  solutions of blood-crystals  free  from
 blood-corpuscles change in color from scarlet
 to purple according as they gain or lose oxy-
 gen.  In this way, those changes are constantly
 going on in the  blood  by which  effete ma-
 terials are carried away  in  part by the lungs,
 and  other organs of the  body, while  fresh
 oxygen   is  constantly  being  absorbed and
 carried  by that fluid to nourish every tissue
 and organ in the individual.   (See Blood,
 Consumption, Pleurisy,  and  Pneumonia.)
   LUNGS  (Wounds of.)—Wounds  of the
 lung are, of course, common enough in mili- j
 tary practice, though somewhat  rare in civil.
 When arising  from external wound they may
 be  either incised, punctured, lacerated,  or
 gun-shot, or they may be  produced by frac-
 tured  rib, which generally causes a lacerated
 wound.   The simplest form of a wound of the '
 lung is a punctured one, such as a stab ; next j
 in severity  are the lacerated, the lung sub- j
 stance having great power of retractibility  ; i
 and the  most dangerous are the incised, onac- j
 count of the hemorrhage and escape of air. ]
 When a lung is wounded three conditions are i
 observed :   (i) Hemorrhage ;  (2) escape  of j
 air from divided vesicles and tubes ; (3) col-
 lapse  of lung.   The symptoms indicative  of j
 wounded lung are : (1) The escape of blood i
 through  the external wound of  a pale red
 and frothy character'; (2) the issue of blood J
 mixed with  air and  mucus from the mouth j
 during the efforts of coughing ; this is always
 to be regarded as a dangerous symptom,  as
 the blood accumulating in the tubes produces
 a.choking sensation which may suffocate the
 patient ; (3) a deeply fixed pain in  the chest,
 and a  good  deal of irritation of  the larynx,
 producing a constant desire to  cough ;  (4)
 dyspnoea and  difficulty of respiration.   The
 constitutional  symptoms are, at  first,  col-
 lapse,  though, unless  this  extend  over any
 considerable time, it need  not excite alarm ;
 inflammation,  pleurisy,  and pneumonia are
 next to  be  apprehended.   In all  cases, the
 prognosis of wounds of the lung is unfavor-
 able.   Wounds  from projectiles (gun-shot) are
 exceedingly dangerous.  They are fatal from
 hemorrhage, causing exhaustion and suffoca-
 tion ; from pleurisy, irritation, fever, or from
 accumulations of blood, pus, or serum in the
 pleural cavities.   In the  case of  gun-shot
 wounds,  the usual train of  symptoms  above
enumerated as characteristic of  this  injury
must not be always constantly expected to
exist, and it  is by no means easy  to decide
whether the lung is wounded in  perforating
wounds of the chest-walls.   Serious bleeding I
 rarely occurs from any vessels external to the
 cavity  of  the chest.   Although haemoptysis
 indicates injury to the lung, it does not prove
 penetration.  Dyspnoea is a frequent accom-
 paniment  of penetrating wounds.  It was
 formerly thought  that escape of air by the
 wound necessarily indicated laceration of the
 lung tissue, but it  must be  remembered that
 external air may pass into the external wound
 during contraction of the lung, and be expelled
 during inspiration, but, as was above stated,
I if  air with frothy blood and mucus be ex-
j pelled, there is  no doubt that the lung itself
 is  perforated.
   Treatment.—All hemorrhage  from super-
 ficial vessels in  the chest-walls should be first
 arrested ;  these vessels are cutaneous, mus-
 cular,  or  most  frequently intercostal,  which
 lie under the lower margins of the  ribs, and
 are very liable to be lacerated by some splin-
 ter of bone from an adjacent rib.  All foreign
 bodies, dirt, pieces of clothing,  or wadding,
 should be  carefully  removed,  and  the  ex-
 ternal wound closed  as quickly as possible
 with some  light  dressing.    The  natural
 motions of the chest should be restrained by
 broad strips of adhesive plaster, or by broad
 bandages  passing round  it.  The patient
 should be left where he is found, or very care-
 fully carried to some more  convenient place.
 In the first stage, that of collapse, no consti-
 tutional treatment need be  attempted,  but
 haemoptysis, dyspnoea, or chest complications
 must be carefully  watched for, and  total ab-
 stinence frcm food or stimulating drink must
 be enjoined for  the first few days.  Ice  to the
 chest, or iced-water  to drink, are useful in
 checking  the  hemorrhage, and in  severe
 haemoptysis, venesection, with a view of pro-
 ducing  artificial collapse.   Dr.  M'Leod  re-
 marked that,  during the Crimean  war,  he
 noticed that those cases of gun-shot wound
 of the lung did best in which early, active, and
 repeated  bleedings were had  recourse  to.
 Dilute sulphuric acid or acetate of lead is fre-
 quently useful in checking violent haemoptysis
   Complications.—There are frequent com-
 plications  associated  with  wounds of  the
 lung  which   demand  particular attention.
 These are : (1)  Emphysema, or  an escape of
 air into the subcutaneous cellular tissue ; (2)
 Pneumothorax, when  air  has escaped  into
 the cavity of the pleura (usually associated
 with  the  foregoing) ;  (3)  Hcemothorax, or
 hemorrhage into the pleural cavity ; (4) For-
 eign bodies, such  as bullets, buttons, cloth-
 ing etc. Emphysema comes from  a broken
 rib penetrating  the pleura  and entering the
 lungs, thus allowing air to  escape ; or from
 penetrating wounds of the bronchi or lungs,
 when, on  inspiration,  the air received into
 the lung escapes from  its wounded part into
 the chest, and  on  expiration  is forced out
 through the external wound, thereby getting
 into the cellular tissue.  The symptoms of 
296
LUPUS
LUPUS
emphysema are a swelling of the integument,
beginning at the seat of injury, and increas-
ing in all directions.  There is no change in
the color of the skin; the swelling crepitates
or crackles  under pressure, and  there is no
pain. The prognosis is generally favorable,
except in cases  of extensive wounds.   With
regard to treatment :  If it be found that mod-
erate pressure  with the hands on the seat of
injury affords relief, a roller-bandage should
be applied ; and in  cases where  the air has
diffused itself over a large surface, punctures
are useful.  Constitutionally for the relief of
dyspnoea in such cases, antimony and ipecac-
uanha appear lo be the most useful remedies
given in full and repeated  doses.  Bleeding
may be resorted to  if  there  is lung conges-
tion  and oppression  of the circulation.  In
Pneumo thorax the symptoms would be dis-
tressing dyspnoea ;  on percussing the chest a
tympanitic resonance, and a ringing metallic
resonance  on  auscultating  the  chest,  sup-
posing the lung is not too much compressed.
The treatment consists either in enlarging the
external wound so that the air may escape, or
in puncturing the cavity with a small trocar
or canula  (as  in paracentesis).   In Hawno-
thorax  the  symptoms  present depend in a
great measure on  the  quantity of blood
poured  out in  a definite period.  If  large
quantities are effused suddenly, as in a wound
of a large vessel, death speedily follows from
loss  of blood and pressure on the lung.   The
treatment consists in  closing the  external
wound, and thus allow  the  effused  blood to
coagulate if possible, so as to form a plug to
prevent  further bleeding.   Paracentesis  is
sometimes necessary.    Some  surgeons  re-
commend the  external  wound  to  be kept
open, so that  the blood may escape, while
others prefer enlarging the external wound to
let the blood escape speedily,-and in several
recorded cases  this has  been successful.  If
the difficulty of breathing be very urgent, the
trocar and canula may be used, and the wound
dressed with carbolic acid dressing.
  LUPUS is a name  given to several forms
of obstinate  inflammatory  and ulcerative
affections of the nose, cheeks, and lips, which
give rise to much disfigurement, and often to
destruction  of   soft parts,   and   deformity.
Some of these diseases  are known by  the
name Noli me tangere.
  The following are some of the chief  varie-
ties of lupus : In the affection called erythe-
matous lupus, which  is the least troublesome,
the skin of the  nose or  face  presents numer-
ous deep-red or livid patches slightly elevated
above the general surface,  and smooth and
shining.  These increase in size  and run to-
gether, forming large purple patches, which,
if not treated, become covered by thick crusts
of scarf-skin. This form of lupus is attended
with but little pain  or itching, and does not
result in ulceration or loss of substance.  It
is, however, very obstinate, and often resists
for a long time all kinds of treatment.
  In another form of  the disease, called lupus
non-exedens, numerous  small reddish-yellow
and  waxy  nodules are  set  upon a  dark-red
base of thickened  skin.  These nodules in-
crease in number and size, and  become cap-
ped by small horny-like  scabs. No open sores
are formed, but the disease leaves  behind a
very distinct scar,  which  is tense  and  de-
pressed below the level of the sound skin.
This  disease has  a tendency to heal  at  the
centre of the patch whilst fresh nodules are
formed about the circumference.
  The most severe form is  that called Lupus
exedens, or Noli me tangere.  This generally
commences at  the  tip or edges of  the nose,
and often attacks simultaneously the  skin and
the  internal mucous membrane.   Red or
brownish-red nodules are first formed, which
increase in number and run together,  and then
crack down into a jagged ulcer, which is cov-
ered by a thick adherent  crust, under which
pus  collects.  This ulcer, after  a time, com-
mences to heal at one part of its circumfer-
ence ;  but at the same time fresh nodules and
ulcers are  formed, and the disease,  if  not
arrested by treatment, spreads slowly and in-
sidiously, until a considerable part, or even
the whole  of the  nose, with its bones and
cartilages, has  been  destroyed.   The  subse-
quent  disfigurement  is made worse by  the
presence of large pale-red scars, traversed by
tough  bands of a white  color, which are very
contractile, and cause by their shrinking con-
siderable displacement  of parts  of the face.
In Lupus exedens there is generally a  tend-
ency to an early relapse.
  Lupus is seldom  met with in patients over
thirty  years of age, and  occurs more fre-
quently in  the  country  than in large towns.
It is mare common in females than in  males.
Lupus in all forms is generally associated with
scrofula, and occasionally with advanced or
tertiary syphilis.   The patients in the ma-
jority of  cases have  fair, delicate skin, and
light eyes  and  hair.  Like other local  affec-
tions dependent upon a scrofulous or syphi-
litic  taint, it is met with chiefly among  the
poor.
  Treatment.—In  the treatment it  is neces-
sary first of all to attend to the general health,
to support the strength  by tonics, good diet,
and wine or malt liquor ;  to  keep the diges-
tive organs free from irritation  and disease,
and to improve, if it be  possible, the  hygienic
circumstances of the patient.   In   this dis-
ease, especially the form of  Noli me tangere,
the remedies used in cases of  scrofula  are
especially useful ; of  these  the best are cod-
liver oil and the citrate  of iron  and quinine.
In some cases it is necessary for the patient
to take arsenic or .mercury ; but those agents
ought not to be administered except by medi-
cal advice.  In Lupus erythematosus and Lupus 
LYMPH                                 MAGNESIA            297
non-exedens the safest  local applications are
sulphur ointment, tar ointment, and tincture
of iodine, which may be applied by means of
a camel's-hair brush.   Obstinate and severe
cases of these two forms of  lupus, and the
slowly spreading ulceration of Lupus exedens,
are treated by the  application  of caustic pot-
ash,  chloride  of zinc,  Vienna  paste,  lunar
caustic, and the actual and galvanic cauteries,
powerful and very painful  remedies,  which
necessitate in many instances the administra-
tion of chloroform, and, in all, delicate surgi-
cal manipulation and careful control.
  LYMPH is an alkaline fluid which fills the
absorbents or lymphatics ; it differs from the
blood in containing no red corpuscles, and in
having a very small  proportion of solid con-
stituents ; lymph  may be  looked upon as
blood diluted with water and deprived of the
colored corpuscles.
  LYMPHATICS  are  vessels distributed
throughout  the  body, generally closely ac-
companying blood-vessels,  but also pursuing
a solitary course.  They are intended to re-
tain  that porticn  of the nutrient fluid which
has poured out from the smaller blood-ves-
sels, and which does not return by the veins.
This fluid is  colorless, and  is called lymph.
These vessels are of great importance in the
spread of some  maladies.   Thus it is fairly
established that cancer spreads  from  one
organ of the body to another mainly by these
means, and it is very likely that tubercle does
so likewise.   The lymphatic system is  espe-
cially liable to invasion by inflammation when
that seizes upon any part to which  they are
richly supplied, and especially if the inflam-
mation is of a bad kind.  Thus a fresh wound
of the hand, into which putrid animal matter
has entered, speedily gives rise to an appear-
ance resembling  a number of irregular red
cords running up the arm.   These  seem all
to run to the armpit, and there enlarged lym-
phatic  glands soon  are felt, as hard painful
knots are soon to be felt.   Most  likely these
will suppurate, and may constitute a new form
of disease.   If  the lower extremities are
affected, the glands in  the gums  are affected
in like manner.
  LYMPHOMA or LYMPHADENOMA,
is a name given to a disease in which there is
great enlargement of most or all of the lym-
phatic glands of the body.  The growth takes
place gradually and without much,if any,pain;
the patient becomes pale and weak.   Children
and young people are most commonly affect-
ed ;  the  glands do not soften and form an
abscess, as they do in scrofulous cases, but are
firm and retain their rounded  outline ; they
are most  easily seen at the  root of the neck
on  either side, and sometimes large promi-
nent tumors arc in this way formed.
   MACARONI is a well-known Italian food
 made of the best wheaten flour, and formed
 into long thin pipe-shaped lengths about the
 size of a quill.   Macaroni is  a highly nutriti-
 ous and digestible article of  diet, and if pro-
 perly cooked may be eaten by an invalid with
 a delicate digestion with  advantage.   It is
 pleasant  either well boiled  till it becomes
 quite soft, and served with gravy from roasted
 meat, or plainly boiled in milk and eaten with
 salt or sugar.
   MACE is a well-known spice, the product
 of  a tree  growing in the Molucca Islands,
 known  to botanists as  Myristica  officinalis.
 The fruit  of the tree is of  the size and  form
 of  a peach, and when ripe  the fleshy part
 bursts in halves exposing the kernel, which is
 the nutmeg, surrounded by an arillus or scar-
 let net-work sort of fibre, which is  the mace.
 It is a valuable and powerful spice, and re-
 alizes a high price.  It contains a large  quan-
 tity of aromatic oil, the taste of which is pun-
gent and sharp.   It is  used in medicine as a
stimulant, and is imported into this country
for that purpose in considerable quantities.
  MADEIRA.  (See Wines.)
  MADNESS.  (See  Insanity.)
  MAGNESIA, or oxide of magnesia, occurs
in two forms, one more bulky than  the other.
It is obtained by burning the  carbonate, and
then appears as a white powder with  hardly
any  taste, almost  insoluble  in  water, and
slightly alkaline in  reaction.   When  intro-
duced into the stomach magnesia acts as an
an acid, and its antacid properties are consid-
erable.   If not all neutralized, what remains
passes on  into the  stomach, where, if given
incautiously,  it is apt to accumulate.  In the
small intestine it acts as a gentle laxative, in
very large  doses having considerable  power.
It also passes into the blood and tends to ren-
der the urine clear if previously turbid from
urates.   It is given as an antacid in heart-
burn, and is still more useful for the acidity
of the  intestines which gripes, and so is use-
ful along with rhubarb in the early stages of
diarrhoea.  It is also  useful when there is
acidity with a tendency to constipation, as in
gouty subjects.  In these patients it does re-
markably well.   On  account  of alkalinity,
too, magnesia is often  given as an antidote to
poisoning by mineral or vegetabfe acids, and
for  this  it is well suited.  It neutralizes the
acid and protects the  stomach from  injury.
Many metals are also precipitated by it and
rendered nearly  insoluble. Magnesia has also
been given as a remedy for vomiting when
that has seemed to depend on excess of acid,
but other remedies are more powerful.
  Carbonate of magnesia also exists in two forms 
298          MAL-DE-PAYS
MALFORMATION
 —heavy and light.  It is prepared from the
 sulphate of magnesia by precipitating by car-
 bonate of soda.  The powder so thrown down
 is a white almost tasteless substance, insoluble
 in water, and nearly neutral in reaction.  A
 solution of the bicarbonate  of magnesia has
 long been  in use under the title of fluid mag-
 nesia ;  it is an admirable preparation.  This
 may  effervesce slightly; when  opened the
 liquid is clear and is not bitter.   Carbonate
 of magnesia acts in much  the same  way as
 magnesia  itself, only, when introduced into
 the stomach, and it meets  with  an acid,  it
 gives off its carbonic acid, which  may be un-
 pleasant.  Sometimes, however, the carbonic
 acid gas so set free is pleasant to the stom-
 ach.  The great disadvantage these remedies
 labor under is their bulk, so much requires to
 be taken ;  but the objection does not apply
 to the fluid magnesia.
  Sulphate of magnesia,  or  Epsom salts, is a
 well known remedy.  (See Epsom  Salts.)
  Citrate of magnesia, the effervescent prep-
 aration popularly used  as  a laxative,  con-
 tains, besides the magnesia, citrate or tartar-
 ate of sodium or potassium.   It is pleasant
 to take and mild  in its operation.
  MAL-DE-PAYS is a condition of mind
 which assumes the form  of  a disease  in peo-
 ple, who, having  been born  in  mountainous
 countries are removed  from  the scenes of
 their  early  childhood.   It is especially  fre-
 quent among the  Swiss, and is sometimes so
 uncontrollable as to  prevent them ever set-
 tling in distant regions.
  MALARIA is a term  used for those badly
 defined agencies  which give rise to fevers of
 the remittent and intermittent type.  There
 are commonly supposed to be certain effluvia
 or miasms given  out  from marshy grounds,
 especially from salt marshes, which entering
 the system give rise to the well known phe-
 nomena of ague.  What, however, these ef-
 fluvia are no one knows ; the air has been ex-
 amined and nothing found, and as  the malady
 is equally rife in  the dry regions  of Central
 India and the Sahara, it is plain that they do
 not depend on marshes.  True they are most
 powerful in tropical regions, especially  near
 the mouths of  great rivers, or among man-
 grove swamps where decaying vegetable mat-
 ter  and  heat most  abound, but  the same
 phenomena are frequent far north, in temper-
 ate regions especially, in certain seasons  of
 the year.  Some have been constrained from
 the  phenomena, and  from the situations in
 which they are  produced, to infer that these
 extremes of heat and cold are the main causes
 or constituents of malaria ; that is to  say,
great heat during the day and cold during the
 night are the concomitants of severe attacks
of aguish maladies.   Certain  it is that  the
individuals who are attacked are more readily
attacked during the night than  during  the
day.   Thus people can work in the Roman
 Campagna during the day, but cannot remain
 in  it all night without suffering.   The  poi-
 son lies low, too, for a man standing up-
 right may escape it while one lying down will
 not.  Another peculiarity of it is that it does
 not prevail at any distance from  the  shore,
 and even blowing over a wide river will in-
 terfere with the malarial influence, be it what
 it may.  A row of trees, too, has been found
 to  give  protection  when planted  between
 marshy districts  and inhabited places.  All
 these facts seem to point to  the  conclusion
 that the poison after all is something material
 that is closely connected with the ground, and
 water of any extent interferes with its spread.
 (See  Intermittent Fever and Remittent
 Fever.)
  MALFORMATION.—During the  devel-
 opment of the foetus  in  the womb it some-
 times happens that  some parts are  not  pro-
 perl y formed, and there is an arrest of growth
 or else an union of parts which ought to be
 separate.   In this way many of those  mons-
 trosities are formed which excite the wonder
 of  the ignorant.  The  Siamese twins were
 two individuals who were united together by
 a band of skin, and this change took place in
 the womb at an  early period of foetal life ;
 sometimes the union is  more  complete  and
 may  extend  along the whole  length of the
 spine, as in the  case  of the  " Two-headed
 Nightingale," twin  sisters  who were  exhib-
 ited some time ago ; of  course this  peculiar
 malformation can  only exist when there are
 twins, and  the union  takes place along the
 middle line of the body, either in front  or be-
 hind.  There are, however, other cases of
 malformation which affect  only one  child,
 and these are always 'congenital,  that is to
 say, are met with at birth  and produced at
 some period of fcetal  life.   Malformations
 may result in various ways.
  A.  Those resulting from incomplete  devel-
opment or growth of parts,   i. Of the body
generally.  The head may be absent or rudi-
mentary, and the foetus  is then said to be
acephalic ; it  is either  born dead  or lives a
 very short  time ; the arms and legs may be
defective,  or  the  hands  are  joined to the
shoulder-blade, and the feet to the thigh-bone,
so that the arms and legs are absent ; the fin-
gers may be too many or too few in number.
2. Of the nervous system.  The  brain  and
spinal cord  may  be absent,  or  exist only as
 rudimentary formations.   3.  Of the organs of
 special sense.  The  eyes may be absent or
 imperfect, or the eyelids may remain united ;
 the  ear may suffer in a similar way, and deaf-
 ness is the result ; sometimes the nose is ab-
 sent or deformed  and resembles a proboscis.
 4. Of the vascular system.   The heart may
 be absent, or the cavities of the heart may be
 deficient in number ; sometimes two or more
 valves are  joined together,  or they are  too
 numerous ; at other times the orifices between 
        MALIGNANT DISEASES

 the different cavities of the heart are closed
 or unduly large, or the vessels which carry
 the blood from the heart into the system are
 wrongly  placed.   Such cases generally die
 early and the infant often  suffers from cyan-
 osis or bluenessof the skin in consequence of
 the impaired  circulation.  (See  Cyanosis.)
 5. Of  the  respiratory  system.  The  lungs
 may be absent or  only one may be present,
 or the lobes may be deficient in  number, or
 the air passages may be absent or imperfect.
 6. Of the digestive system.   The intestines
 may be deficient in various regions or imper-
 vious, or the liver may be unduly small.  7.
 Of the urinary system.  The kidneys may be
 (one or both) absent or united together so as
 to form a horseshoe shape.   8. The organs
 of generation.  These may be absent or mal-
 formed so as to cause a doubt in some cases
 as to the sex, thus giving rise  to hermaphro-
 ditism.
   B. Malformation resulting from the incom-
 plete union of lateral  halves of parts which
 should -become  conjoined.   The  ordinary
 cases of hare-lip and cleft palate are deform-
 ities of this kind ; sometimes there is a fissure
 of the abdominal walls so that the  bladder is
 visible, or there  may  be a  fissure of  the
 uiethra,  producing the conditions known as
 epispadias and hypospadias.  On the posterior
 surface of the  body, there may be a fissure of
 the  skull, or of the spinal cord, causing spina
 bifida,
   C. Malformation resulting from joining to-
 gether of the  lateral halves of parts  which
 should  remain distinct.   Examples of this
 class occur when the fingers or toes are joined
 together so as  to give a web-like appearance
 to the  extremities, or the lower extremities
 may be joined together.
   D. Malformation resulting  from duplica-
 tion of parts in an infant.   Examples of this
 variety are seen when the child has extra fin-
 gers or toes.   In addition to these varieties,
 there are  other occasional malformations, as
 transposition   of  the  internal organs  and
 hernias  of the  intestines, brain, heart,  and
 lungs.  Some  of these malformations cause
 the  death of the fcetus in the womb, others
 are of such  a nature as to prevent it coming
 to maturity, while some are so slight as not
 to give rise to any symptoms during life.   It
 is, in fact, a matter of surprise,  when the com-
 plex structure  of the organism is taken into
 account, how seldom any deformities occur,
 but when  malformations do happen, they are
 due to some defect of devlopment in early life,
 and such monstrosities are capable of explan-
 ation on ordinary scientific grounds, although
 to the ignorant and uneducated they  form
 food for awe and superstition.
  MALIGNANT  DISEASES  are  those
which are very rapid in their  course, which
always end fatally, and  for which all human
aid seems powerless.   In  an epidemic of
               MANDRAKE           299

 typhus or scarlet fever it  may  happen that
 some  cases will be  attacked much  more se-
 verely than others, and be knocked down or
 prostrated from the virulence of the poison ;
 thus, a person  may  die of malignant  scarlet
 fever  in  twenty-four or forty-eight  hours.
 Either the individual has received an unusual
 quantity of the poison of the fever, or he may
 be in a bad state of health at the time, which
 has rendered him  more susceptible to its in-
 fluences.   Such cases seem hopeless from the
 very commencement, but fortunately they are
 rare ;  the usual symptoms of a disease are in-
 tensely exaggerated ; there is great prostra-
 tion, low muttering delirium, and sometimes
 bleeding from the nose and gums, or petechial
 spots over the body.  Scarlet fever is the most
 likely  one to become malignant, but it may
 occur  in measles, typhus, and typhoid fevers ;
 it generally is noticed at the commencement
 of an  epidemic.   The term " malignant" is
 also applied to those  tumors of which cancer
 is the best-known example, where there is
 very little hope when the  disease is internal,
 or has once made  much inroad upon the con-
 stitution ; such cases go on for some months,
 and finally die of exhaustion and emaciation.
 (See Tumors.)
   MALLOW is  a plant known to botanists
 as Malva sylvestris, belonging to the natural
 order Malvacece.   The whole plant, but espe-
 cially the root, yields, when boiled, a plentiful
 tasteless mucilage, which is useful  in some
 cases of internal irritation.  Decoctions of the
 leaves are employed in dysentery, and they
 are used in fomentations,  poultices, etc.
  MALNUTRITION is  said  to take place
 when the body is badly nourished, and sup-
 plied  with impure air  and food.   The un-
 healthy state of  the children  in our large
 towns  is largely  due to this cause, and may
 be seen in the stunted and rickety condition
 which  they present.  The evils thus taking
 place in early life influence the  future devel-
 opment of the individual and are more likely
 to render  him susceptible to some forms of
 disease than those  who  are more  healthy.
 For the prevention of such mischief the diet
 should be regulated according to the rules laid
 down in the article on Diet, and our sanitary
 officials should see  that there  is a plentiful
 supply of good  water and air.  In this respect
 it  is very important that  all adulteration of
 milk,   bread, and other necessaries of  life
 should be severely punished ; that the water-
 supply should  be  abundant  and wholesome,
 and that in every large town open spaces or
 parks  should exist for  the  children  to play
 about in.
  MALT LIQUOR. (See Beer.)
  MANDRAKE  is  a  powerfully  narcotic
 plant belonging to the genus Atropa, known
also  as Mandragora.  It  was  at one  time
thought to have a sort  of supernatural  effi-
cacy, and was gathered with great solemnity, 
300         MANGANESE
MATICO
with incantations.   From the forked appear-
ance of its roots, and its fancied resemblance
to a man, it was in superstitious times sup-
posed to have an influence on the health of a
person against whom it was used, so that, as
the root withered away, the life of the doomed
victim  would gradually wane also.
  MANGANESE can hardly be said to be
used in medicine.  The black oxide is largely
employed for  the  production of oxygen gas,
and the  sulphate has been given internally.
In very large doses it gives rise to purgation,
and in  smaller  does it has been supposed to
act in  a  fashion somewhat similar to iron.
It has been given in anaemia, therefore, but it
is not a standard remedy.
  MANIA  is  that variety of insanity char-
acterized by delusions of exaltation, with  or
without delirium,   Sometimes such patients
become very greatly excited, very destructive
and dangerous, but not so much so as do cer-
tain others.  Mania has  also been used as a
generic word to imply all forms of  insanity.
(See Insanity.)
  MANNA is  the hardened exudation from
the incised bark of, various species  of Frax-
inus.   These trees are cultivated for the pur-
pose of producing this substance in Calabria
and Sicily.  Manna of the best description
forms pieces not unlike stalactites, about six
inches  long  and one or  two broad, hollowed
out and  discolored on  one side where at-
tached  to the  tree.   This is called flake
manna, and  is  porous and  friable.  It also
occurs  in smaller  masses,  or in broken and
colored fragments.   This substance,  when
pure, has a  sweetish odor  and taste, but is,
withal, bitter.  Manna is soluble in water and
alcohol, and consists almost entirely of a kind
of sugar  called mannite,  -which differs from
ordinary sugar  in not fermenting with yeast.
Manna itself is  a very mild laxative, generally
given to children or added to other purgatives,
as senna, to  sweeten them ;   sometimes  it
gripes.   The dose  is from  a drachm  to half
an  ounce.
  MARASMUS is a technical name given
to the wasting disorders  of children.   It oc-
curs as a symptom in cases of bad feeding,
malnutrition diarrhcea,  constitutional  taint,
and in  diseased conditions of the intestines
and mesenteric glands.  The term marasmus
corresponds to  the word  emaciation or wast-
ing.   (See  Lacteals and Tabes  Mesen-
terica.)
  MARJORAM,  the Organum vulgare  of
botanists is  an  indigenous  plant, yielding a
voltatile oil,  and possessed of properties very
similar to rosemary.  It is not officinal, but
is sometimes  employed.  Formerly  it was
contained in the Pharmacopoeia, but has been
expunged.
  MARRIAGE.—The marriage-rate of the
country  is to a great extent an index of the
prosperity of the  nation.  When the neces-
saries of life are cheap, and when there is a
great demand for labor and when high wages
are given, the number of marriages in a yeai
is much greater than when the  opposite con-
ditions  exist.  Generalizing  from this  fact,
the historian, Buckle, laid down the proposi-
tion that the marriage-rate in any country  is
in  exact proportion to the price  of corn.  The
statistics gathered for a series of years by the
English Registrar-General  seem  to  prove
that married people live somewhat longer than
the single.
  MARSH-MALLOW, the root of Althea
officinalis, is no longer officinal.  The outer
covering is usually removed, so that the sub-
stance looks yellowish externally, and white
internally.  The syrup of  marsh-mallow had
at  one time a great reputation  for allaying
coughs, etc., and even  now in France, under
the title Guimauve, it is greatly  used.  Speci-
fic properties it has none.
  MASTICATION is the process by which
the food when taken into the mouth is chewed
into small pieces by the teeth and thoroughly
mixed with the saliva.  Pieces of meat, etc.,
are thus finely divided, and  are so rendered
more easy to be  acted upon by the  gastric
juice when they are swallowed  and enter the
stomach ;  farther, since starchy  foods,  as
rice, potatoes, bread, etc., when mixed  with
the saliva, become converted into sugar, it fol-
lows that if mastication is properly performed,
all the insoluble starch  will thus be changed
into the soluble  form of sugar and made
ready for absorption.  It will  thus be  seen
that it is a very important thing to eat a meal
slowly, and not swallow the food hastily, as
some are apt to do ;  the latter fault is very apt
to  cause indigestion, and be a source of much
distress if the habit be persevered in.  (See
Digestion and Diet.)
  MASTICH is  a resinous exudation flow-
ing from a plant  of  the turpentine family, a
native of the countries  bordering the Eastern
Mediterranean.   The best  mastich  consists
of  small masses called tears, which are light
yellow and friable,  but  becoming  soft and
ductile  on  chewing.  The   surface  of the
masses is often covered with a whitish  dust,
produced by rubbing one  against the other.
Larger masses  are  formed by the agglutina-
tion of  several tears.   It has  an agreeable
odor.  Mastich is not much used save to give
a pleasant  odor to  the breath  when  chewed
and to stop teeth.
  MATCHMAKER'S DISEASE.  (See
Lucifer-Match  Maker's Disease.)
  MATICO is the leaf of a kind of pepper
plant growing in  Peru.   The leaves  are ob-
long and pointed, marked on the upper sur-
face, downy and  reticulated beneath.  Their
colors are green,  their  taste  aromatic, warm,
and slightly astringent, the odor is pleasant.
Matico  contains some  tannic  acid, and  a
peculiar substance called aranthic acid.  The 
MATTER
MEASLES            301
 only officinal preparation is an infusion ; but
 a tincture is also  in  use.  The leaf, in sub-
 stance or in powder, applied to small bleed-
 ing surfaces, as leech-bites  and the like, acts
 as a powerful styptic.  Given internally, it is
 said to act as an astringent in the  urinary
 ways and  on  the rectum,  but this is by  no
 means clear.
  MATTER  in a medical sense is synony-
 mous with  pus, and  means the fluid humor
 which is contained   in  an abscess  or sore
 tumor.
  MEAD.   (See  Distilled Spirits.)
  MEASLES is  a contagious febrile disor-
 der, and forms one of the group of the exan-
 themata.  It is nearly  always more or less
 prevalent in this  country ; but at  times  it
 spreads with great rapidity, and carries off a
 large number of victims.  As a rule, children
 and young  people are  attacked, but the ex
 emption of adults  and older people probably
 depends on the fact  that they have  had the
 complaint in early life, and so are not subject
 again to the influence of the poison ;  yet in a
 few rare  cases persons have suffered twice
 from this disorder. This disease is more fatal
 in the autumn and' early winter  than in the
 spring and  summer.  Measles  varies much
 in malignity ; in some years, although many
 are attacked, the mortality is moderate ; while
 at other times  the disease is fatal in  a much
 larger ratio.  Measles is essentially a contagi-
 ous disorder, and  often attacks  all the mem-
 bers of  a  family one  after  another.   In
 measles, as  in other contagious disorders,
 there is a period of incubation ;  and by incu-
 bation is meant the  time which elapses be-
 tween the exposure to the contagion and the
 first appearance of symptoms.   This period
 varies  in different fevers ; in the case  of
 measles it seems to be ten  to  fourteen days.
 Such a question as  this is usually very difficult
 to answer, as there are many sources of falla-
 cies when the disease  is prevalent in  a town,
 and  a person  may be exposed to contagion
 unawares.
  Symptoms.—Before the appearance of the
 rash there are  some  precursory symptoms ;
 the patient feels languid and hot, and there is
 shivering, followed by a rise of temperature,
 a quick pulse, thirst, loss  of appetite, and
 sickness.  Such, in fact,  are the usual symp-
 toms which precede most febrile  attacks. But
 in addition to the above signs, there is super-
 added an inflamed  condition of  the  mucous
 or lining membrane of the air-passages ; and
 this state is so marked as as to be very char-
 acteristic of  this disorder.  The eyes become
 red and watery, and give the appearance of a
 patient having cried ; the  membrane  which
lines the nose,  throat, larynx, and trachea  is
 red  and swollen, and pours forth a watery
secretion ; thus the affected person seems to
have a severe  cold, with running from the
eyes and nose ; hence there is generally much
sneezing,  with  a slightly sore throat  and a
dry, harsh cough.  In addition there may be
diarrhcea, with pain in the stomach, and  a
good deal of vomiting ; but these cease when
the eruption appears.  Convulsions occasion-
ally occur in  children, and the  younger the
patient the more liable is it to have a fit.
  After these uncomfortable symptoms have
lasted about three or four days, the rash ap-
pears.  Although the rash may come  out as
late as eight or even ten days from the first
appearance of  the symptoms,  the fourth day
is by far  the most usual for it to come out.
The* rash begins  in very small papules or
minute pimples which rapidly multiply, and
then run together into  patches which have a
tendency to a  horseshoe or crescentic shape,
while the portions of  skin between  are of  a
natural color.   Commencing on the face and
neck, it spreads to the arms, then the trunk of
the body, and  gradually  reaches the  lower
extremities ; this process takes  two or three
days.   The same order is observed when the
rash fades ; it is generally out fully for three
days on the face, so that the whole duration
is at least six or seven days, and it disappears
on  the upper part of the body, while  a  few
faded spots may still be seen on the legs.  At
first the eruption has a dark pink or mulber-
ry  color,  but  toward  the end it  becomes
browner.   The face is generally bloated  and
swollen, and if the finger be  passed gently
over the surface of the skin, the rash may be
felt to be slightly elevated. When the erup-
tion has  disappeared, the part  of  the skin
affected becomes covered with  a dry  scurf,
and seems covered with a branny powder ;
the cuticle  does not come off  in large flakes,
as  in scarlet fever.  The fever does not dim-
inish on the appearance of the rash, as in
cases of small-pox, and there is no proportion
between  the abundance  of the rash and the
danger to the patient ; indeed  in some cases,
where the rash is  late  in appearing  and  not
very plentiful, the individual may Le in much
danger.
  This disease is known, then, by  the  ca-
tarrhal affection, or appearance of a cold with
which  t is ushered in, and by  the peculiarity
of  the rash.  Scarlet fever mostly begins with
a sore throat, and the rash comes out earlier ;
and in  small-pox there is more vomiting  and
much pain across the loins ; these are the two
disorders with which measles is most liable to
be confounded, but if any doubt exist, the case
will be cleared up when the rash is seen.   Of
late years  cases  have  been seen where the
eruption has appeared without the fever and
catarrh, and to this variety the name of rube-
ola sine catarrho has been given ; but it con-
fers no protection from  measles,  and often
the latter  disease appears in its regular form
a  few  days afterward.   In  some  cases a
measle-like eruption comes out in  the early
stages of small-pox, and may give rise to mis- 
302             MEASLES
MEASLES
takes ; but in two or three days the regular
rash of variola  will appear.   A rose-colored
rash sometimes  appears  in  children  while
they are  teething,  but  it is  more diffusely
spread over the body, and there are no signs
of running at the eyes and nose, and the fever
is but slight.
  The temperature in measles rarely rises to
more than 103°  F., and in mild cases may not
be more than  ioi°F. or  102°  F. ; this is a
guide to the severity of the  disease, for the
higher the temperature the more danger there
is to the patient.  To find out the tempera-
ture, a delicate thermometer should be placed
in the arm pit, and the arm held closely to the
side, so that the skin  perfectly surrounds the
bulb of the instrument ;  it should be kept in
this  position  for at least five  minutes,  and
then the point to which the mercury has risen
in the graduated tube can be read off.   The
patient should be  in bed,  and have his arms
covered up half  an hour  before the  ob-
servation  is made, or otherwise the skin of
the arm-pit will be unduly chilled.  Since the
ordinary temperature of the body is 980 F. or
98 50 F., it follows that any degree of heat
observed higher than that  indicates a state of
fever.
  The pulse at  the  wrist beats quicker  than
usual, but is usually not so high as in scarlet
fever ; from 120 to  140 beats in a minute is a
common occurrence.  The tongue  is gener-
ally furred, and  has a moist,  white appear-
ance ;  in  very  bad cases it may become dry
and brown ; it begins to clean at the tip and
edges from the fourth to the eighth day of the
disease, and the rest of the tongue is clean in
twelve or  fifteen days, unless  some other dis-
ease arises.  Small superficial ulcerations may
in some cases be  seen  on the lining  mem-
brane of  the mouth and  gums.  The throat
may be red and swollen, and the act of swal-
lowing rendered in  consequence rather pain-
ful ; but this symptom  is of  very slight im
portance.   Still  more rarely, there  may be
some difficulty of hearing.  In some cases the
glands behind the jaw, or down the neck, and
even those in the groin, may become  large,
swollen, and painful ; but this varies in  dif-
ferent  epidemics, is rarely severe,  and is far
more common in scarlet fever.
  Vomiting is frequent enough at the outset of
the attack, but is very seldom met with after-
ward if care be taken  with the diet.  Diar-
rhcea, now and then, is very troublesome ; in a
modrate amount it is not injurious, but some-
times it is very exhausting, and blood may
be found  in the stools ; it is worse in those
cases where the  children are weak and sickly
previously.  The urine  is generally scanty,
and in fact in most febrile disorders less urine
is passed than usual. On standing and allow-
ing to cool, a light, yellow, sandy sediment is
deposited  ; this deposit  need never cause any
alarm, as  it is merely due to  certain salts in
the urine being less soluble in the cold, while
when the water is first passed at the ordinary
heat of the body they are soluble.
  More characteristic symptoms are the cough
and expectoration.   The cough is at first dry
and hacking, very frequent and  annoying ; in
a few days it comes on in occasional par-
oxysms or fits, which give much distress, and
even cause retching and vomiting ;  it gener-
ally  disappears when the rash  fades, but in
some cases it  may remain for some time.
At first there is not much  expectoration, and
it is clear and viscid ;  in  a few  days it is
more abundant and frothy, or even of a green-
ish-yellow color.
  Complications.—These are  very  liable to
occuf», but they vary in their nature, in their
severity,  and  in  various  epidemics.  The
rash generally disappears when the  finger is
pressed upon it, but in some malignant cases
the spots  turn a dark purple and will not dis-
appear ; hence the  name of black measles has
been given to this  variety,  and this  form is
usually fatal.  Or the rash may suddenly dis-
appear instead of gradually fading away, and
this  may  indictate  some  internal mischief ;
this also is a serious symptom.   Convulsions
at the commencement are usually without
danger, but if they come on at the end of the
disease theyr may lead to  a fatal issue.  In-
flammation of the larynx or upper part of the
air passages may give rise  to  harsh, croupy
breathing, and sometimes the inflammation
becomes chronic and very  obstinate, being
always liable to return whenever the patient
takes cold.   Inflammation  on  the  lungs is
very  common  in measles, and unless great
care be taken may prove very dangerous ; the
breathing is hurried and the temperature and
pulse rise ; the patient may lie in great dis-
tress, and in children there is often dilatation
of the nostrils at each inspiration.  Children
under ten years of age rarely expectorate, and
so the bronchial tubes often become choked
with  phlegm.   Wheezing sounds   may  be
heard  all  over  the  chest if the ear is  placed
there,  and may  be felt  when ihe hand is
placed over the back or front of the chest.
Bronchitis often  proves  fatal to very young
children, and in aii  cases adds  to the danger.
Whooping-cough is very frequently an accom-
paniment of measles ; indeed, an epidemic of
each is generally prevalent at the same time.
Any  children who  have just  suffered from
measles, and are living in a house in which or
near which whooping-cough is  prevalent, are
almost sure to  take it.  Consumption some-
times follows measles, and especially in those
who are liable to be subjects of it.  Inflam-
mation of the ear now and then occurs ; the
child then cries a great deal and puts its hand
to the side of its head ; at first nothing may
be seen, but afterward a discharge flows, and
this will then give great relief.
  Measles, as a rule, is a  mild disease, and 
MEASLES
MEASLES            303
the great majority of cases recover ;  if  at-
tacking children in previously good health, the
result is  nearly always favorable.  In those
who have bad health, and chiefly in those who
are liable to diseases of the chest, the danger
is greater. Cold and damp weather increases
the mortality by favoring the development of
affections of the lungs.
  Treatment.—Since there  is no drug which
can  cure  the  disease,  attention  must  be
directed to those means by which we can re-
lieve the  patient  and avoid  any complica-
tions.  In the first place he must be kept in
bed, as in this way a more equable tempera-
ture can be kept up, draughts can be avoided,
and so any  liability  to  inflammation of the
lungs maybe lessened.  The room should be
airy and well ventilated, but great care should
be  taken  that the patient  is not exposed to
any draught    All offensive excreta or dirty
linen should be removed and disinfected, and
the way to do this has been already fully dis-
cussed under the article on Fevers. A temper-
ature of 60" F. or 65 ° F. may be kept up by hav-
ing a small fire in the room, but the heat should
never be oppressive,   It is as well to keep
down  the blinds and  to allow the patient to
lie with his back to the light, as the e\res  are
generally inflamed, and a strong light causes
much  discomfort.  Any feeling of dryness
or  tingling of the skin may be relieved by
bathing the part with tepid water, but for this
purpose do not expose the patient all at once,
but  bathe and  then dry one part  at a time.
 In all cases it is advisable to give the patient
a hot bath at the very onset of the disease,
then dry the surface of the body and put him
to bed directly  ; no chill need be feared, and
it may help to bring out the rash ; if the chil-
dren are  dirty it is all the more needful, not
only for the sake  of seeing the rash clearly,
but to aid the skin in performing its proper
functions. All sources of annoyance or irri-
tation and all noises should  be avoided, and
the patient should  be kept quite quiet so as to
try and induce sleep.   Food of the simplest
nature should be given, and this point is im-
portant, as a favorable result  much  depends
upon it.  In all cases of fever, care should be
taken to give food which is  at the same time
nourishing and easily absorbed.   At first  no
solid food will  be cared for, and the thirsty
patient may drink milk, or milk and water, or
tea,  chicken-broth, beef-tea,  or  toast and
water.  The quantity given should be moder-
ate, and  the  child should only drink enough
to quench its thirst. A pint and a half of milk,
with half a pint of  beef-tea, free from fat, will
suffice for a child  of  three  to five years old,
and if requiring more drink,  some simple fluid
as barley-water or tea may  be  given.  The
quantity, however, will vary with the age of
the patient.  As too much food should not be
given at once, the meals must be given every
two  or three hours,  and  something  should
 always be ready in the night or early morning
 when the child  awakes, as it is often much
 required then.  Acid drinks are very grateful
 and agreeable : lemonade with a little sugar,
 or raspberry vinegar,  may be given in mod-
 eration, but should  not  be taken  at the same
I time as milk is taken, as they apt to make the
 latter curdle in  the stomach and  be vomited.
 Stimulants are rarely  needed in children, and
 should only be given under medical  advice.
 When the fever  subsides, a small piece of
 chicken or mutton may be taken ; toast or
 bread and butter, with  a  fresh egg may also
 be given, and as the tongue  cleans and the
 appetite returns, the patient may  return to his
 ordinary diet.  If there is any inflammation
 of the lungs,  a hot linseed-meal poultice may
 be applied to the back and front of the chest,
 and in all cases the chest may be  kept covered
 with  cotton  wool and  all exposure to cold
 avoided.  But  in all  cases of any complica-
 tions arising, medical advice should be taken,
 as it is  impossible to lay  down any rules for
 the treatment of what  may occur in  any in-
 dividual.
   Although children  generally  recover rap-
 idly,  yet there  are  times when much  debility
 ensues and the general health becomes im-
 paired,  although  the fever has  quite left.
 Such children as are in  bad health are liable
 to lumps  or  glandular  swellings of the neck
 and  under the  jaws, or they  may  remain
 weak for a long time or be subject to some
 skin eruptions.  Steel wine and similar tonics
j may here be given with great advantage.   If
• the child be  growing fast, too much exercise
| should be avoided, and plenty of  rest allowed.
 Should the weather be warm and genial, out-
 door exercise is beneficial, but the child should
 wear flannel  next the skin and  be protected
 from cold and  wet.    Regular  hours, plain
 nutritious food,  and a very moderate  amount
 of stimulant should  be given.   A cold bath
 may be given every morning, but it should be
 discontinued if, after being well dried, the
 child should not feel a healthy glow ;  salt
 water is the best for this  purpose, but if not
 procurable, a handful of  sea salt may be put
 into the bath.  Nor should the  child  remain
 long in the water,  as depression  and chilli-
 ness may ensue ; generally two or three min-
 utes willsuffice.  A visit to the sea-side is to
 be recommended if possible,  and if  there is
t any tendency to enlarged glands or discharge
 from the  ears,  a moderately bracing place
 should be chosen.  If  a  child is timid and
 afraid to bathe  in the sea, sea-water  may be
 procured  for  its  morning bath ;  no  child
 should be forced into  the water, but should
 be coaxed and encouraged to bathe, and a
 sea-bath  should be given to delicate  chil-
 dren about two or three  hours after breakfast,
 and not before that meal.  Baths, to do good,
 should act as  tonics ; if they depress and make
 the patient feel worse they are doing  harm. 
304     MEAT,  EXTRACT  OF
MEAT, EXTRACT OF
  Morbilli and Rubeola are techincal names
which have  been given  to  measles.  The
disease is contagious  when the  rash is out,
but other children are probably safe to mix
with affected patients a  week  after the rash
has disappeared.  Isolation is the only way
to stop the spread of this affection ; if by leg-
islative measures a quarantine could be estab-
lished round an infected house or district, the
disease might become-stamped out,  or  its
spread  vastly diminished.  We cannot  do
much in  the way of curing  measles, but a
great deal might be done  to prevent its com-
ing among the people and pursuing its rav-
ages.
  MEAT, EXTRACT OF.—The substance
commonly sold  as Extract of  Meat is also
known as Juice of Meat and Liebig's Extract.
The name of the late  Baron Liebig, the great
chemist, is  especially connected  with  this
compound, as he undoubtedly was one of the
first to call attention to it as a valuable article
of diet.  In his " Familiar Letters  on Chem-
istry"  he devotes a  letter to  vegetable  and
animal  food, and gives an account of their
various chemical components.    He  shows
that all animal flesh contains, besides fibrine,
albumen, gelatine, and fat, certain  other con-
stituents which may  be  separated from the
rest by a simple process of infusion, straining,
and evaporation.  The substance thus obtained
is extract of flesh.  This compound was not
unknown  to chemists  before   Liebig drew
special attention to it, but they regarded it only
as a remedy for disease and exhaustion, and
recommended it as a resource for extremities
of nature, and especially for  the sick  and
wounded soldier on the  field of battle, with
sinking and ebbing powers.  That  which at
one time was considered  to be a last resource
i s now an article  of daily consumption in our
hospitals and households, and  is  almost as
commonly used as tea, or any other beverage.
A frequent  inquiry is, in what consists the
efficacy or advantage of Liebig's extract? and
the popular idea is, that being a concentrated
extract of pounds of flesh, it cannot fail to be
extremely nutritious.   But it is not so, and it
will be surprising to those who believe in this
doctrine to hear that the extract of meat con-
tains little or nothing  of what may be said to
be at all  nutritious.  The substances which
go  to  form nourishment for  the  body  are
fibrine, albumen, and  fat ; but  these are not
present in the extract  of meat.   One hundred
parts of beef contain  the  following constitu-
ents :

   I. Fibrine..................................  4
   2. Albumen................,...............  4
   3. Gelatine...............................  7
   4. Fat.....................................30
   5. Mineral matter..........................  5
   6. Water.................................. 50

                                     100
  Let us contrast  with  this the composition
of a  hundred  parts  of Liebig's  extract  of
meat :

  1.  Creatine, Creatinine, Inosic Acid, Osmazome.. 51
  2.  Gelatine....................................  8
  3.  Albumen....................................  3
  4.  Mineral matters............................. 21
  5.  Water...................................... 17
                                       100

  The difference will be at  once seen.   The
water has diminished by half,  the albumen is
less, and there is four times the quantity  of
mineral matter, and  a set of substances is
introduced which occupy half  the bulk of the
compound, which are not noticed in the com-
position of beef  itself at all.  If, then, the ex-
tract of meat differs from beef, and all other
nutritious articles of diet,  it  is not in con-
taining nutritious matters, but in the fact that
chemical compounds and mineral matters just
mentioned are  found in large quantities.   It
is to these,  therefore, that we must  ascribe
the  marvellous  powers which  the  extract of
flesh  exerts  on the human  system.   The
chemical  action of  these   products on the
human body are imperfectly understood ; but
it is  certain that when  albumen or fibrine is
partaken of  alone it will not digest or sup-
port life ;  but when in combination with these
mineral matters found  in the juice of meat,
and of course present in every pound of meat,
they are  digested and appropriated  to the
nutrition  of  the body.   It  therefore  follows
that Liebig's extract of meat, if partaken of
alone,  would in no  way support  life ; but,
if in combination with bread or eggs  or any
ordinary  food,  it enables  the  stomach  to
assimilate all the  nourishment contained  in
these articles and provides sustenance for the
failing powers  at a  much  less cost  to the
digestion than if it had unassisted  to extract
what nourishment they  contain.
  The juice of flesh or extract of meat, it will
be seen, contains  no new  product after its
manufacture, but  simply those constituents
in a concentrated form, which are  ordinarily
present  in the  flesh  of animals.   The great
advantage it confers is, that  it is already fit
for  use.   A teaspoonful of the extract in a
pint of hot water is a stock for any  soup, and
admits of  any variety of flavoring.  For the
dyspeptic, whose stomach cannot bear tea or
coffee, it  is an excellent beverage and assists
materially in the digestion of any solid food
that may  be taken with it.  Hence  it is a
most valuable adjunct to the  invalid's table.
or to  the  menage of the ordinary cook," in
whose hands it may be made to form the basis
of many rich and well-flavored soups.  A mut-
ton  chop eaten alone, or  even wth  tea  or
coffee, will  frequently prove most  indigesti-
ble, and the dyspeptic who seeks for nourish-
ment will  give it up as impossible.  Let him, 
MECONIUM
MELANOSIS           305
 however, try with it, instead of  tea or coffee, |
 a  cupful  of  Liebig's extract, with salt and
 pepper,  and he will find his chop  nutritious
 and pleasant and usually  require  no other
 addition besides a little bread to his excellent
 meal.  A portion of this preparation partaken
 of at proper times will often render recourse
 to alcoholic stimulants unnecessary and sup-
 ply the needful refreshment to the system.
   MECONIUM is a  word used for the in-
 spissated juice of the poppy) a  substance re-
 sembling treacle.   It is also, and more fre-
 quently, applied  by medical men to the first
 dark slimy discharge from the bowels  of a
 newly-born  infant, which  generally passes
 within an hour or two of birth, but is not en-
 tirely  expelled till the  babe has partaken of
 the mother's first milk,  which is in itself of a
 cleansing and slightly purgative nature, and
 is adapted to remove all these impurities from
 the infant's body.
   MEDULLA OBLONGATA is the name
 given to an important and central part of the
 brain which is situated  at the lower and pos-
 terior part of the skull, just where the spinal
 cord joins the brain ;  it is the centre from
 which emanate most of the principal cranial
 nerves ; an injury here  causes sudden death.
 (See Brain.)
   MEDULLARY CANCER is one variety
 of cancer.   (See Cancer.)
   MEGRIMS means a variety of headache
 to which  women are often liable, especially if
 they have  been subjected to weakening influ-
 ences, such as prolonged suckling or profuse
 menstrual flow.   It is also common in badly
 nourished  women   from   whatever cause.
 Occasionally it will come and go almost like
 an  aguish  complaint  ;  more   commonly,
 however,  it  persists for a  time.   The best
 means of getting rid of such headaches are
 stimulants,  especially ammonia, for the time
 being,  but they invariably return. Good food
 and tonics are necessary, therefore, for the
 relief of such headaches, and without these
 and the removal of the cause of the weakness
 little good need be expected.   Perhaps the
 remedies best adapted are bark and ammonia,
 followed by  iron.  But  if  these  headaches
 have lasted a long time, something more is
 necessary.   In such cases we have found the
 chloride of ammonium (sal ammoniac), com-
 bined with the perchloride  of iron, both in
 full doses, the best remedy  attainable.  The
 sal ammoniac must be  given in doses of 20
 or 30 grains, and  the  iron in doses of  30
 drops.   At the same  time  the bowels must
 be attended to. (See Headache.1
  MELiENA is the name  given to hemor-
 rhage from  the bowels.   It  may occur under
 various conditions sometimes from bleeding
into the  stomach,'when  some  of the blood
naturally finds its way  down the intestines.
(See Haematemesis.)  Cirrhosis of the  liver
occasionally causes it, because the circulation
I through that organ is  so  obstructed, and the
 bleeding in such cases is  a source of relief to
 the distended vessels ; more frequently piles
 are produced in the course of this disease of
 the liver.   (See  Piles.)  Melnena is not  un-
 common in the course of typhoid fever, and
 when very  profuse may cause a fatal result ;
 yet when the  quantity is but small the danger
 to the patient does not .seem to be greater in
 consequence.  Turpentine in small  doses is
 valuable at such times, but it should be given
 with great care ; iced milk, but no solid food,
 may be given.  (See  Typhoid Fever.)   In
 some forms  of Bright's  or kidney disease,
 melaena may  occur in the early stage, but it
 seldom  is  profuse,  and  does  not   call  for
 special  treatment.  (See  Kidney.)   Ulcera-
 tion of the  intestines is often accompanied by
 melaena, and  may occur  in cases of  phthisis
 or in scrofulous disease.   Rest in bed, cold
 drinks,  light  and nourishing food should be
 given, and  also some astringent medicine, as
 iron,  tannin,  or  gallic acid, sugar  of lead,
 and turpentine ; but the quantity to be given
 and the choice of the remedy must depend on
 the special peculiartiies of the case.  When
 the melaena proceeds from the upper parf of
 the bowel,  it  passes away mixed with the ex-
 creta, and  has  a brown or  coffee-ground
 color ;  when  from the rectum  or the lower
 part of the  bowel, it has the usual appearance
 of clotted blood ; in these latter cases injec-
 tions containing iron or tannin, are very use-
 ful, as  then the astringent fluid can be  ap-
 plied directly to  the part.  When  admissi-
 ble, opium  is often of service  in keeping the
 patient quiet and  in allaying nervous excite-
 ment, and also  in  preventing any undue
 movement  of the bowel  itself.   In  cases of
 melaena it  is very rarely advisable  to  give
 purgatives, and they should always be taken
 with much caution,  as their  presence  may
 give rise to irritation and increase  the flow
 of blood.
   MELANCHOLIA  is  that variety of  in-
 sanity which is characterized  by delusions
 of depression.   Sometimes the patient  be-
 comes excited over these, but not very  fre-
 quently.  There are several  varieties of mel-
 ancholia, but the  above definition applies to
 almost  all  of them.   (See  Hypochondria
 and Insanity.)
   MELANOSIS is a disease characterized by
 the deposition of black or dark-brown color-
 ing matter  in various textures and  organs.
 Almost any form of tumor may become  mel-
 anotic, but one variety of  cancer has a special
 tendency to  do so.  True melanosis has its
 site most frequently  in the  skin and tissue
 just below  it  ; but it is also frequently pres-
 ent in and  beneath mucous membranes.   In
 certain parts of the body pigment of this kind
 is  normally  present ;  thus  there is always
 some in the skin even of a European, much
 more in those  of the darker-colored races. 
30G          MENINGITIS
MENINGITIS
So, too, it  is present in certain parts of the
eyeball, the lungs, and other internal organs.
In general  melanosis we have usually a num-
ber of  masses  scattered  through  different
parts of the body.  These are of very various
sizes, from a pin's head to that of a walnut,
and may invade even the tissues of the heart
and the  bones.  It is  commonly supposed
that these melanotic masses are malignant in
their nature—cancerous, that is to say—and
tend to shorten life ; but this is by no means
certain as  yet.  There  are certain forms of
false melanosis of importance.  Thus, there is
the lung of those who inhale large quantities of
carbonaceous  matter.   These  individuals
often suffer from a form of consumption char-
acterized by certain peculiarities. After death
their lungs are  found  quite black ; the  bron-
chial glands, too, are  blackened, though  that
is nothing unusual. Most lungs of those  who
live in  cities tend to acquire,  in course of
time,  more  or less  pigmentation.   Blood
may be blackened.  Thus  the action of the
gastric juice on the blood in the vessels of
the stomach after  death may give the  stom-
ach an appearance of mortification.   Blood,
too,  which has been extravasated into  the
gut becomes quite black before it passes from
the bowel,  if it is allowed to remain  in  it
long enough.  As to treatment little can be
said.   In true melanosis, if the mass can be
reached it  should  be removed ; but if truly
melanotic  it is  most likely  multiple, and  rep-
resented elsewhere.
  MENINGITIS signifies inflammation of
the membranes of the brain.   Under article
Brain it has been shown that this organ has
three coverings, in the following order, from
without  inward : i. A  dense,  fibrous  struc-
ture the dura mater ; 2  A thin delicate mem-
brane,  the  arachnoid ; and 3, a tissue full of
vessels, the pia mater.   The last two  mem-
branes are  those usually affected in the pro
cess of  inflammation.   There are several
varieties of inflammation of these coats, de-
pending  chiefly on the cause.   I.  Traumatic
meningitis,  or  meningitis  dependent  on  a
blow or injury to the head, which may be
also accompanied with fracture of the skull.
In the course of two or three days after the
accident, severe pain will be felt over the  seat
of injury, and the patient will be feverish and
thirsty ; constant sickness and a moist  white
tongue are also very prominent symptoms.
The pain increases in intensity, the head  is
hot,  and the face often flushed, and the pa-
tient restless and disliking  the  light ; gener-
ally, convulsions  come  on, or the limbs are
affected wiith convulsive starts ; delirium at
night is  generally present, and the patient
may lie on his back in a prostrate condition,
moaning at times, and picking at the bed-
clothes.  By degrees he becomes drowsy and
stupid, with sometimes  a  flushed  face  and
suffused  eyes, taking little, if any, notice of
i what is going on around him.  As the drowsy
 state deepens, the  pain is not felt, and grad-
 ually he passes into a state of  coma or deep
 insensibiliy, from which he cannot be roused ;
 the pupils,' at first small, generally become at
 this stage larger than usual, and squint may
 be.also present ;  now the face is pale,  and
| the pulse frequent and often irregular.  Very
 few cases  recover  when  the disease has  ad-
 vanced so far,  and, in fact,  the greatest dan
 ger  always  exists  whenever  these  serious
 symptoms  come on after an accident or in-
 jury to the head ; nevertheless, death may
 not take place  for weeks in some cases,  the
 patient lying meanwhile in an  unconscious
 state.  The treatment will consist in perfect
 rest after ihe  injury, however slight it may
 seem to be at first  ; he should  lie in bed  or
 on a sofa in a cool and rather darkened room,
 and avoid all kinds of excitement.  No stim-
 ulants  should be given, nor are any required,
[ as they only tend to flush and excite the  pa-
 tient ;  the bowels should be kept open, and the
 forehead may be cooled by means of vinegar
j and water, or an evaporating lotion,  in which
: small pieces of ice are melting, or an ice bag
 may be applied to the head.  Medical advice
 should always be sought for early, as very
 little hope can exist when the  disease has
 made much progress.
    2. Tubercular meningitis is another variety
 which  is very fatal  to children, and equally
 so, but not so commonly met with, in adults.
 The same tissues or covering are affected as
 in the  preceding variety, but  the nature  of
 the inflammatory  process differs somewhat
 in this kind.   Acute hydrocephalus is another
 name for this disease, but it should be avoid-
 ed, as  persons  are  apt lo  confound this dis
 ease with  chronic  hydrocephalus,  whereas
 there is no connection between the two. Some
 have also styled  this brain fever.  Children
 are usually attacked between  two  and five
 years of age.  The symptoms begin by their
 feeling listless and disinclined to play about ;
 they are  fretful, and  wish to  lie  in their
 nurse's or mother's lap ; generally they com-
 plain  of pain in  the head.   In a day or two
 these symptoms are more marked  and  the
 pain increases, accompanied by very constant
 vomiting and generally convulsions,  although
 in some cases this latter symptom is  wanting.
 The tongue is white and moist, the abdomen
 generally concave instead of convex, and the
 thumb of  each hand is turned inward.  The
 child dislikes  the  light,  and the pupils  are
 smaller than  usual.  At times squinting is
 met with ;  the face  may be  pale or occasion-
 ally flushed, and if the finger be lightly drawn
 across  the forehead, a red blush or wheal
 will at once appear.   The bowels are usually
 confined, the pulse  quick, and the heat of the
 body greater  than  usual.   Gradually and in
 the course of a few days  the  child becomes
 semi-unconscious, lies in its bed, taking little, 
MENORRHAGIA
MENORRHAGIA        307
if any, notice of what is going on around, and
the symptoms become  still  more marked.
The stupor generally goes on increasing, the
pupils dilate, the pulse becomes irregular,
often  the child utters a low moaning cry, and
by degrees it  passes into a state of complete
insensibility  until death puts an  end to its
sufferings.  No  case  recovers after  the dis-
ease  has  once clearly developed  itself, but
many cases may be mistaken for it ;  thus, a
child  when teething may present  at first many
symptoms similar to  those met with in the
early  stages of this disease, and much alarm
may at first  be created in consequence.  To
accurately distinguish these cases requires a
good  deal of  experience  and  knowledge.
The children most liable to  be  affected with
tubercular meningitis are those  of a  nervous
and excitable temperament, and such as are
percocious for their age ; those  also who are
suffering from diseases of joints  and enlarged
glands are subject to it.  Death  usually takes
place  in the course of  three or four weeks from
the onset of  the malady.  The treatment will
consist in following  the same  plan  as has
been  mentioned above for traumatic menin-
gitis.  A pleasant way of applying cold to the
head  is to pound ice in small pieces, and place
them  in a bladder ; this can then  be suspended
from  the  head of  the bed, and placed on the
child's head for a couple of  hours at a time ;
in this way the pillow and bed-clothes are pre-
vented from getting  wet.  Very little nour-
ishment, can be taken  in these cases, and usu-
ally a little iced-milk  is  most grateful to the
patient.
  3. Meningitis may come on as a result of
exposure  to  cold or  to great heat, or in the
course of many febrile disorders, as pyaemia, j
septicaemia,  etc.,  or  from the  presence of I
tumors in the brain,  or  from disease of the
bones of the  skull as a result of  scarlet fever
and  syphilis.   The symptoms  are  such as
have  been mentioned above, and show a seri-
ous disturbance of the functions  of the brain.
Nearly  all such  cases commence  with pain
in the head,  sickness, fever,  intolerance of
light,  and are followed by convulsions, which j
lead  on  to  stupor, coma, and  insensibility, j
In nearly all these instances,  too, a  fatal re-
sult may be  expected  in consequence of the
serious injuries which ensue to such important
structures.  They all  depend probably in the
first place on some altered and poisoned con-
dition of the blood, and the  treatment to be
adopted, in addition  to what has been above
recommended, will  consist  in  the   various
remedies  appropriate to the special cause
which gives rise to the disease.
  Another form of meningitis also affects the
spinal membranes  as well as  those of the
brain  ; it occurs in an  epidemic  form, and is
very fatal.  (See Cerebko-spinal Fever.)
  MENORRHAGIA is a profuse discharge
of the catamenia at  the menstrual  period,
attended with more or less debility,  pallor,
and discomfort.  It generally occurs in those
who are out of health, and who have been
weakened by having had a large family, by a
difficult labor, or in whom there is some dis-
ease of the womb, or ovaries.  The flow may
be more profuse than usual, but  only last the
usual number of days, or it may be more or
less persistent for several days or weeks, but
not very  great in amount.   After  delivery,
the womb does  not always return to its usual
proportions,  and this  will often be a source
of menorrhagia, as the vessels are then con-
gested and  readily bleed.   A  tumor in the
womb, or a polypus growing from it,  or can-
cer of that  organ, or displacement of it,  will
all  cause  this  malady.   Those who  have
suffered from lactation, or who have had mis-
carriages, are also  liable  to this affection.
The patient will also have pain in the lower
part of the back, and perhaps down the thighs,
pain or difficulty in passing water or in evac-
uating the bowels,  and a general inability to
walk or undergo any exertion.   The amount
of  pallor will  be great  in proportion to the
loss of blood, the health of  the patient is but
indifferent,  there is very little appetite, no
fever or thirst, but a general feeling of languor
and prostration.  It is sometimes difficult to
distinguish  between  this affection  and an
abortion,  but in the  latter case  there  will be
the fact of pregnancy, and  the  expulsion of
undeveloped portions of the fcetus.
  Treatment.—The  treatment must  consist
in rest in  the horizontal  position on a couch,
and this may have to be enforced -for several
days or even weeks.   Astringent medicines,
especially containing iron or  tannin, gallic
acid or ergot, may be given with much bene-
fit.   Cold applications  and the injection of
cold water are very useful, and must be given
when the  hemorrhage proceeds from a tumor
in or cancer of  the womb.  The  latter disease
generally comes on in women over forty-five
years of age, and generally produces a fatal
result  in  a year and a half or two years.
Emaciation, great pain in the back and abdo-
men, a sallow,  cachectic appearance,  a foetid
discharge and occasional menorrhagia are the
main symptoms of this disorder.  In all cases
of menorrhagia rest must form a chief part of
the treatment,  the  diet must  be light  and
nourishing,  constipation must be avoided ; a
gentle  drive may be taken in fine weather by
those who are  able to do so ;  if not,  a short
walk should be taken daily, so as to obtain a
little fresh air, but if it bring  on a  fresh dis-
charge of blood this must be discarded for a
time.  The malady is very apt to recur, and
the more  so after every succeeding confine-
ment.   Patients so affected should not get up
too soon  after a labor, as an  erect  posture
tends to cause  congestion of the womb, and
to induce a fulness  of  the vessels which  pre-
disposes to menorrhagia. 
308        MENSTRUATION
MERCURY
  MENSTRUATION  is  a function  per-
formed by women 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 func-
tion : it is  spoken  of  as the  menses,  the
period, the catamenia, etc.  When not per-
formed at  all,  the  patient is said to have
amenorrhcea, when the function  is performed
with difficulty  or pain it is called  dysrnenor-
rhcea, and when the discharge is very profuse,
the individual is suffering from menorrhagia.
Each of these is treated of in its proper place.
The appearance of menstruation is generally
accompanied by more or less pain in the back,
headache, and  lassitude ; often,  also, the pa-
tient 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
irrregular  at  first,  and some months  may
elapse before  the function is carried on with
regularity.  When well established, an inter-
val of about four weeks elapses between each
period, but  sometimes  only three weeks in-
tervene.  The  blood that flows differs from
ordinary blood in being acid instead of alka-
line, 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
causes 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 dis-
eases 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  or change of life, and
the cessation of the function is often accom-
panied by more or less distress ; the  patient
becomes nervous and  is easily worried, suf-
fers from lowness of spirits, pain in the back
and between  the shoulders,  pain also fre-
quently 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  troublesome, are not  attended by dan-
ger, and subside when the function of men-
struation 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.   Tonic  medi-
cines, such as iron, and quinine, may be given
with advantage, and if there is much nervous
derangement, assafoetida or valerian may be
given in addition.  (See Emmenagogues.)
  MENTAGRA,  or Tynea  Sycosis,  is  a
disease of the beard, moustache,  whiskers,
and inner part of the nostrils, in which a little
fungus or vegetable parasite  finds its  way
into the root  of the hair.   Its piesence sets
up  inflammation of the hair follicle, and  a
little matter forms around  the  hair ; the part
around  becomes  hardened,  and  brownish
thick scabs form among the hairs.  It may be
mistaken for  acne  or impetigo, but the pres-
ence  of  the  parasite under the microscope
will clear up the doubt. The scabs should be
removed  by  moistening them with  oil and
then applying a hot poultice, or the part may
be  washed  with  hot  oatmeal  and  water.
Each hair should be pulled out  and some sub-
stance  applied which will destroy the  life of
the  parasite, as acetic acid, perchloride or
pernitrate of  mercury.  The general health
must at the same time be  kept up  by  a light
and nourishing diet, daily  exercise, and the
administration of tonic medicines.
  MERCURY,  in  Latin  Hydrargyrum, is  a
remedy about which many doubts  have been
raised.  Of its power none can doubt,  but
of the appropriate cases in which to allow its
power to be exerted there is still much hesita-
tion and doubt.
  Metallic mercury  is mainly obtained from
its red sulphide, cinnabar,  which, being dis-
tilled,  yields mercury.  This requires  re-dis-
tillation, however,  and washing with dilute
hydrochloric  acid.   When pure, metallic
mercury is a  brilliant white, metallic-looking
liquid, becoming solid at 400 below zero F.,
and volatilizing  at a  heat below redness.
Rolled on paper, pure mercury forms globules
which leave no stain ; if amalgamated  with
other metals it generally does.   Liquid mer-
cury is seldom used in medicine ; it has been
given in obstinate constipation, with the idea
that its weight would force a passage, but in
vain.   There  are, however, several prepara-
tions of mercury where the metal is only in  a
finely  divided state, and these are very effi-
cacious.  Thus there is mercury with chalk or
gray powder,  consisting of  metallic mercury
rubbed with chalk till the globules disappear.
Mercurial pill or blue pill is prepared  in the
same way, by rubbing metallic mercury with
confection of roses till globules can no longer
be seen. Mercurial ointment or blue ointment
is prepared in like fashion, by rubbing mer-
cury with lard and suet.  These are all admi-
rable  preparations.   Mercurial plaster, mer-
curial  liniment, and mercurial suppositories
all have metallic mercury as their basis.  The
vapor  of mercury  acts powerfully, as  used
to be  seen in its effects on  the makers of
looking-glasses.   By rubbing  metallic mer-
cury into the  skin till the  exceedingly small
globules make their way  through its pores,
the full effect  of the metal  may be  produced.
Given in repeated small doses, mercury first
of all  increases the  various secretions—the 
MERCURY
MERCURY            309
 saliva, the bile, the intestinal juices, etc.  The
 increase of the saliva is well marked, and sali-
 vation is  one of the best established actions
 of mercury.   The saliva increases, the gums
 become sore and  tender, till they can hardly
 close on a morsel of  solid food.  Round the
 bases  of  the  teeth they seem swollen, red,
 and spongy, and the whole  yield an exceed-
 ingly  disagreeable fcetor ; the inside of the
 lips may  suffer also.   This  is, as a rule, the
 first indication of the full effects of mercury.
 On the liver mercury seems to have the power
 of  increasing  the flow of bile for the time
 being, or, at all events, of emptying the gall
 bladder.  The metal  ordinarily acts as a pur-
 gative, producing copious high-colored soft
 motions,  the increased fluid coming partly
 from the intestinal canal.  Frequently, too,
 the kidneys act better, getting rid of  a larger
 quantity of urine than usual.
   Mercury, in producing  its effects,  always
 finds its way into the blood,  and may also be
 detected in  various secretions.   It influences
 the  nutrition  of  the blood for  the  worse,
 especially if long continued or given in weak
 subjects.   Given  in  over-doses  or too long,
 mercury  produces serious  mischief.   The
 body wastes, and a kind of  fever may be  in-
 duced.  This is sometimes  marked  by skin
 eruptions.  There are also tremors or shak-
 ing, beginning in the hands and arms, whose
 movements  lack  precision ;  gradually they
 extend to the whole body.  They cannot  be
 controlled, and being excited last some time ;
 even the respiration may become spasmodic.
 Salivation may be absent with tremors.  Sul-
 phur baths  and iodide of potassium are the
 remedies  for the  condition.   In  other cases
 there is terrible salivation, the tongue  swol-
 len  so that  nothing  can be  taken into  the
 mouth ; the  teeth may fall out  and the jaw-
 bones die.  Occasionally pints of saliva flow
 per day.  In these cases there may be exces-
 sive purging.  Salivation  is most likely  to
 follow the  swallowing or inunction of mer-
 cury.  Mercurial  tremors  more frequently
 occur  after inhalation.  Children are rarely
 salivated.   Mercury  used to be given  in  all
 cases where acute inflammation existed, with
 a view to arrest its effects.   Its preparations
 were constantly given to salivation with this
 view ;  now  they arc seldom so used, except
 in inflammation of the  iris and  deep-seated
 parts of the eye, and in inflammation of some
 serous membranes, as the peritoneum, which
 lines the abdomen.  They are also used with
 a view to  the removal of the deposits caused
 by  inflammation, as  in effusions  into  the
 pleura, in pericarditis, etc., but  assuredly in
 some of these its effects are  not  only useless
 but injurious.  In acute rheumatism mercury
 is still  given  by some practitioners, but they
are not numerous.  The general opinion is
that few  remedies, if  any, affect  the cause of
the disease,  which must be watched for com-
plications.  In these, mercury may be of use ;
in the ordinary disease,  never.   In certain
forms of dropsy mercury may be of great use,
especially if from antecedent inflammation,
but in  the majority  it  is  worse than  use-
less.  In syphilis mercury used  to  be given
invariably ; now, not in all,  but  in a certain
number of cases.   On the whole, a case  of
syphilis is better for mercury, provided the
health of the  individual will bear the course,
but not otherwise.   It  is best, too, perhaps
to give it  by vapor, as a mercurial vapor-
bath,  or by injections, as  that will not inter-
fere so much with digestion.   Its use should
in no case be continued too long,  or harm
will follow.   It is a common  practice, and on
the whole a satisfactory one, to  give a blue
pill and a slightly purgative  draught for bil-
ious headache, cr when there are the usual
symptoms of biliousness,  furred tongue, foul
breath, etc.   Gray  powder is much given in
the affections of children ;  in  many it requires
caution, especially in rickets.  The same prep-
aration  is  extremely  valuable  in  certain
forms of diarrhcea, where the  motions are
green and  slimy, frequent and  offensive,  as
occurring in children.  In  other cases, cor-
rosive sublimate, especially  in  adults, does
better.  The gray powder is  usually given in
doses of from a grain to five grains.   The
blue ointment is rubbed into the  skin at the
groins and arm-pits to produce the effects of
a mercurial preparation.
  Calomel, also known as  the sub-chloride of
mercury, is one of the  best  known  prepara-
tions  of mercury.  It is  prepared from the
sulphate of mercury, and is a  heavy white
powder,  insoluble in water,  ether, or spirit,
but volatized  by heat : it is quite tasteless.
Added to lime-water,  calomel yields  the well-
known black-ivash(lolionigra), which consists,
however, of the suboxide  of mercury mainly.
The compound calomel or Plummer's pill is
another well-known preparation  ; it contains
calomel,   sulphurated  antimony,   guiacum
resin, and castor-oil.  Calomel ointment  con-
sists of lead and calomel.  Internally, calomel
does not irritate, but  generally gives rise  to
nausea, and purges  if given in sufficient dose.
It acts apparently on  the liver and intestines,
and is largely used in the treatment of certain
of these maladies.   In children  it produces
green stools. The compound pill is mainly used
as an "alterative" in chronic skin disease,
especially of a syphilitic origin.   Black-wash
is used for sores of a syphilitic character.  As
a purgative calomel is given  in doses of from
2 to  10 grains.  Its chief advantage is  its
tastelessness.   If given to affect the system,
only small doses, i or  \ a grain, are given
every four hours.  Calomel may also be given
as a fumigation.  Calomel ointment is often
used for the relief of the itching of some forms
of skin  disease, and is blown into the eye in
certain forms of ophthalmia. 
310           MERCURY
MESENTERY
  Corrosive sublimate is  the perchloride of
mercury.  (See Corrosive  Sublimate.)
  White precipitate of mercury, or ammoni-
ated mercury,  is obtained  by  precipitating
corrosive sublimate by ammonia.  It contains
ammonia  itself, and  is a white amorphous
powder, capable of  sublimation.  It is never
used internally, and its only  preparation is an
ointment which is chiefly used for destroying
vermin ; for this it  is well fitted.  It  is  also
used for unpleasant-smelling discharges from
the  nostrils.
  Green iodide of mercury is obtained by caus-
ing  iodine and mercury to combine directly.
It does not keep very well.  It acts similarly
to calomel, but  does not  purge  nearly so
much ; it  is  therefore  chiefly used  for the
constitutional  effects  of mercury,  and with
many is the favorite preparation for syphilis.
It is also used as  an ointment  for skin erup-
tions.
  The red iodide of mercury is  of  more im-
portance.   Internally it is usually combined
with some other  substance, iodide of potas-
sium and corrosive  sublimate being mixed to
form it.  It is largely given in the advanced
stages of syphilis,  with excess of iodide of
potassium.  It should not  be given in any
substance containing an alkaloid.  Goitre and
enlarged spleen have been successfully treated
by its ointment, especially in India.
  Red oxide of mercury, also  known as red
precipitate is usually seen as red shining crys-
tals, entirely volatilizing by heat.   Its oint-
ment is only used externally, as an irritant to
the  eyelids in ophthalmia, to destroy  vermin,
and the like.  It is also applied to indolent
ulcers of a specific kind.
  The acid nitrate of mercury, or its solution,
is made by dissolving mercury in  nitric acid.
This is  a colorless  and  highly acid solution,
of which the only preparation  is an onitment
which used  to be  called citrine  ointment.
The solution itself  is  a powerful caustic, and
has been applied  to arrest the disease called
lupus.  It is not given internally.  This oint-
ment, too, is irritant or stimulant, and is used
in some eye diseases, especially inflammation
of the lids, and in  chronic scaly eruptions
about the hands, especially from syphilis.
  The sulphurct of mercury (artificial cinna-
bar), better known  as vermilion, is not now
officinal.  It may be employed for local fumi-
gation, and  also  as an inhalation off a hot
brick,  or  from a lamp  specially contrived,
for syphilitic sore throat.  It is useless in the
earlier forms of sore throat,  but may do good
when there  is ulceration ;  dilute solution  of
corrosive sublimate applied  as spray is, how-
ever, better.
  Sulphate of mercury  is only used as the
basis of these preparations.
  MESENTERY  (The) is  a  double fold
of peritoneum which retains the small intes-
tines in their place  in the abdominal 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 arc 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 intestines ; these are called themes-
enteric  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 : 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, hav-
ing passed through  the mesenteric  glands,
they convey the  chyle, altered by that  process,
to the receptaculum chyli, a  dilated lube lying
in front of the spine, and  serving as a kind
of reservoir  for that  fluid, which, afterward
passing up the thoracic duct, enters the blood
at the left side of the root of the neck.  The
mesenteric glands become much  enlarged in
typhoid fever and in some cases of consump-
tion ; very frequently  also they become dis-
eased in  children, and this may occur very
early in  infant  life ;  when  this occurs, the
nutrient material of the food which  ought to
be absorbed in the intestine is diminished in
quantity,  and so the chyle, being altered per-
haps in quality as well as in amount, and ob-
structed  by the disease in  the glands, is
unable  to pass  on into the blood as usual,
and  thus  emaciation  and  death may ensue.
Mesenteric disease is most  common  in scrof-
ulous children ;  such infants have large stom-
achs, a doughy skin,  perhaps the enlarged
glands  may  be  felt through the  abdominal
walls, as a hard,  firm mass in front of the
spine ;  sickness and  emaciation  attend the
disease, and  frequently diarrhcea  and consti-
pation alternate ;  at times  dropsy comes  on
and adds to the suffering.   In such cases  great
care must be taken  in giving the child alight
but nourishing diet, consisting chiefly of  milk,
with an occasional egg and some beef-tea or
good mutton broth ;  solid  food should  be
avoided, as it may irritate too much  the deli-
cate mucous membrane of the stomach and
intestines.  Preparations containing iron, as
iron wine or the syrup of the phosphate of
that metal, are very valuable, and  may be
given in small doses twice a day.  Lime-water
should be mixed with the milk in  the propor-
tion of one part of the former to three or four
parts of the latter,  if there  is much  sickness
or  diarrhcea present.  Great benefit will be
derived  from rubbing cod-liver oil  into the
skin night and  morning ;  it often  happens
that a child dislikes or cannot take cod-liver oil 
MESMERISM
MESMERISM          311
 by the mouth, and this plan of rubbing it into
 the skin is very efficacious, and  prevents any
 sickness or distress arising from taking it by
 the mouth ; its  action is increased in value.
 if about one tenth  part of strong solution of
 ammonia is added to the oil ; the skin is there-
 by stimulated and absorption takes place with
 greater  ease.   Children suffering from this
 disease often  derive benefit from going to the
 sea-side, and  although they are seldom in  a
 condition to bathe in  the sea, yet a daily bath
 in sea-water  in the nursery is  of much ser-
 vice.  Should dropsy come on in these cases,
 an operation for removing the fluid from the
 abdomen may be resorted to.  The procedure
 is simple enough, and consists merely in  in-
 troducing  a small  hollow tube  through  the
 skin, and allowing the fluid to run through it.
 The  after-treatment  will consist in  a soft
 flannel bandage being passed round the abdo-
 men, in rest  in bed  for a while, and  a diet
 similar to what has  been mentioned above.
 Disease of the mesenteric glands attended by
 wasting is called tabes mesenterica.  (See Tabes
 Mesenterica.)
   MESMERISM is a term  usually applied
 to the phenomena of  animal magnetism, after
 the name of its  first propounder, Anton Mes-
 mer, a German physician, born at Baden in
 1739.   Perhaps the time has not yet  come
 when the combined physiological, pathologi-
 cal, and  psychological phenomena  of mes-
 merism can be rationally explained.   At any
 rate it involves  a series of facts  in relation to
 the human system which historically have  a
 high interest.   Many of these are new since
 the time of Mesmer,  but he first gave a sys-
 tematic  character  to the  phenomena  and
 sought to refer them  to  scientific  principles.
 Since the death of Mesmer animal magnetism
 has had directed toward  it a great amount of
 attention, and has been investigated by physi-
 ologists of eminence, and used  as a curative
 agent by some  medical men.   A great im-
 pulse was given to  the theory of mesmerism
 by a series of letters  to the Athenwum from
 Miss Martineau, who attributed her cure from
 a long-standing ailment  to the influence of
 animal magnetism. A correspondence on the
 subject took place at that time in the pages of
 the Alhenojum,  in  which Miss  Martineau's
 conclusions were shown to be mistaken to the
 satisfaction of the majority of readers.
   Writers on  animal  magnetism distinguish
 many stages.  The following classification is
 by  Kluge, a German writer, on the subject:
  First Degree.—Called waking,  when the in-
 tellect and senses retain their ordinary powers
 and susceptibility.
  Second Degree.—Half sleep,  or imperfect
 crisis.   Most of  the senses retain their activ-
 ity, that of vision  only being impaired, the
eye withdrawing itself from the  power of the
will.
   Third Degree.—The magnetic, or mesmeric
sleep.   The organs of  the  senses refuse to
perform their respective  functions, and the
patient is in an unconscious state.
   Fourth  Degree.—The  perfect crisis, or sim-
ple somnambulism.  In this stage the patient
is said to "wake  within himself," and his
consciousness returns.  He is in a state which
can neither be called sleeping nor waking, but
which  appears  to be something  between the
two.
  Fifth Degree.—Lucidity or lucid vision. This
is called in France and mostly in this country
clairvoyance ; in Germany,  hcllsehen. In this
state  the  patient is said  to obtain a  clear
knowledge of his own  internal, mental, and
bodily  state ;   is enabled to  calculate with
accuracy the phenomena of disease which will
naturally  and  inevitably occur, and to deter-
mine what are their most appropriate and
effectual  remedies.  He is  also said to pos-
sess the same  faculty of  internal  inspection
with regard to other  people who  have been
placed  in mesmeric  connection (en rapport)
with him.
   Sixth Degree.—Universal  lucidity.  In this
state  the lucid vision  becomes greatly  in-
creased, and extends to objects whether near
or at a distance.
 .  Such is the  system as recognized by mes-
merists, and many  volumes have  been writ-
ten, on each phase and  condition.   Many
who practise mesmerism are themselves scep-
tical with regard to the real existence of the
last two degrees, although such cases are re-
corded.   Many theories have  been  pro-
pounded in order to embrace the facts of ani-
mal magnetism, and numerous aspects given
to the  question by inquiries both in confirma-
tion  and  refutation  of the  supposed  facts
elicited by  inquiry.  The whole   series of
phenomena known as electro-biology, table-
turning, spirit-rapping, and odylic force are
based  primarily  on  this  condition of mes-
meric sleep or influence.  There can  be no
doubt  that the  condition  of mesmeric  sleep
does exist, and that some persons are much
more susceptible to this condition than others.
When  under this influence  they are readily
open to obey the will of another, and become
as it were the  slaves  of suggestion and the
victims of the operators. They exercise their
volition unconsciously,  and attribute it to the
existence of a mysterious force.  The known
fact of the great increase of force  that takes
place  in  normal conditions of the system
when the whole attention  is concentrated  on
one  idea, serves  to  explain the  feats of
strength performed by persons in the sleep-
waking state.  Although so many of the phe-
nomena of mesmerism admit now of a rational
explanation, it is still  practised as a mystery,
and large numbers  of persons give credence
to its  marvels.  Exhibitions are  constantly 
312         METACARPUS
MILK
 made before the public, professing to be tests
 of the power of mesmerism or electro-biology,
 which are, in fact, but the feats of clever con-
 jurors, and present no remarkable phenomena
 at all.  Such attempts do but injure the repu-
 tation of those who  may be earnestly  inquir-
 ing into natural and curious conditions of the
 nervous system with a view to discover truth.
   METACARPUS is  a name  given to the
 bones which lie between the wrist or carpus
 and the fingers or phalanges.
   METASTASIS means change, transposi-
 tion.  This is a medical  term used by physi-
 cians to express that change which sometimes
 takes place in the seat of a disease, as when,
 in gout  or  rheumatism, the heat and  pain
 suddenly leave the foot and take up their abode
 in the hand or fingers, or go  from an exter-
 nal to an internal organ ; such a  condition of
 a disease is called a  metastasis, and is always
 to be apprehended, as  a disease migrating
 from an external to an internal part may be
 more or less dangerous.
   METATARSUS is the name  given to the
 bones which lie  between the tarsus or ankle
 and the toes ; it corresponds to the  metacar-
 pus of the hand.
   MEZEREON BARK is the  bark of the
 Daphne mezereon, a shrub well known.   Two
 plants, however, yield the bark of commerce.
 This  bark,  is thin,   flat,  or  curled,  tough,
 brown outside and white within.  It  is  not
 easily broken.  When boiled, an acrid vapor
 is given off.   There is an ethereal extract of
 the bark, which, however, is seldom given
 internally in this country.  It is  a powerful
 local  irritant, and even blisters.   Internally,
 it causes vomiting and purging.  It has been
 used in chronic rheumatism, syphilitic pains
 and  skin diseases.   It is contained in  the
 compound decoction of sarsaparilla.
   MIASM.   (See Malaria.)
   MIDRIFF is another  term for  the  dia-
 phragm, or  muscle which is attached  to the
 sternum or breast-bone just above the stom-
 ach,  entirely  dividing that  portion of   the
 trunk into two   cavities.   The  upper,  the
 thorax or chest, and  the lower, the abdomen
 or belly.  It is this muscle which  is liable  to
 a  spasmodic affection known  as hiccup,  or
 hiccough,  occasioned by some slight derange-
 ment of  the stomach,   and  usually  very
 transient.
   MIGRAINE, or Brow-ague,  is a painful
 disorder generally seated on one side of the
 forehead, and causing,  while it  lasts, great
 distress to the patient.   (See Intermittent
 Fever.)
  MILIARIA are minute vesicles or little
blisters,  which at first are transparent, but
soon become opaque and purulent in appear-
ance.   They are often seen on the trunk and
extremities in cases of rheumatic fever. They
differ from sudamina in being pointed, in their
 opacity soon after they appear, and in the nar-
 row red halo around ; however,  some  look
 on the two as identical.  They usually come
 on in summer time,  and are connected with
 profuse perspiration.
   MILK is the liquid formed in the breasts
 of all the mammalian tribe of animals, the ob-
 ject of which is the support of their young ti 1
 the time comes that they can  take other food.
 From the earliest time man has used the milk
 of the  domesticated mammalia for the  pur-
 pose of supplying himself with food.  The
 milk of all forms of mammalia is more or less
 alike, and contains substances necessary for
 the nutrition of the whole body.   Milk is, in
 fact, the type of all food (see Food). Although
 man in various countries has recourse to the
 milk of the  horse, the ass, and the goat, the
 milk which is  most frequently used as man's
 food is  that of the cow..  For this purpose the
 cow is  extensively' fed  and  pastured in the
 various countries of Europe.  The following
 is an analysis, of the milk of the cow in 100
 parts :

    Water...:..............................  86. o
    Casein................................  5.0
    Butter..................................  3  5
    Sugar of milk ...........................  4.5
    Mineral matter..........................  1.0
            t                v
                                     100
                     or
    Water................................. S6.0
    Flesh and force producers...............  5.0
    Heat and force producer,................  8.0
    Mineral matter..........................  1.0

                                     103
 Not only does milk contain food in an easily
 digestible form, capable of  becoming the food
 of infants, but its easy digestibility does not
 interfere with its  being  used as the food of
 strong men.   The value  of milk as an article
 of diet may be stated  in an abstract manner,
 in the  ascertained  fact  that  one  pound of
 cow's milk, when digested and  oxidized, is
 capable  of producing a  force which would
 raise 390 tons  one foot high.  This force, if
 it could  be exactly  realized,  would enable a
 man to raise 70 tons one  foot, or to perform
an amount of work with  his brain and mus-
cles equal to the act of raising 70 tons a foot
high.   This is done through  the  agency of
the oxygen of  the air acting upon  the carbon
and hydrogen  contained in  the heat and force-
producing constitutents  of the milk.   The
flesh-forming constituents in a pound of milk,
the casein, if all digested and appropriated,
is capable of making eight tenths of an ounce
of dry muscle or flesh. Although cow's milk
contains the same  general  constituents as
human and other milks.there  is a considerable
difference in the  quantity  of these constitu-
 ents.  The following table presents the differ-
 ent quantities of the substances contained in
 100 parts of woman's, cow's, and ass's milk : 
MILK
MILK
313
	Ci o 5?	X c 3 3	>
Casein, or flesh and force producers c u er > heat and force producers \ Sugar j v \	86 5 3J/2 4l/2 i	89^ 3 3 4 J*	90 2 6 54
			
	IOO	IOO	IOO
 It will be seen from this table that cow's milk
 contains less water and more casein, butter,
 sugar, and mineral matter than mother's or
 ass's milk.  Hence, when cow's milk is.used
 for the feeding of young  children, it is usual
 to add a certain quantity of water ; one table-
 spoonful  of water to two  tablespoonfuls of
 milk is usually recommended.   This is, how-
 ever, not needed when the milk presents less
 than 8 per cent of cream by the lactometer.
 When, however, a third of water is added to
 the milk, the sugar of the cow's milk is re-
 duced below  the quantity in  human milk,
 hence it is desirable to add a little sugar,  say
 half a drachm, or half a teaspoonful, to three
 tablespoonfuls of the watered milk. A better
 substitute for mother's milk than cow's milk
 is undoubtedly ass's milk.  It  should  be re-
 membered that  ass's milk  is  altogether a
 feebler milk than mother's milk.  It contains
 more water, less casein and less butter.  It
 contains,  however, more sugar, and this may
 make up for the  deficiency in  butter.   The
 milk of the goat is very like that of the cow,
 and is extensively employed in the moun-
 tainous districts of Switzerland, where  the
 goat is more easily grazed than  the cow.  In
 Sweden and Denmark the milk  of the  sheep
 is used as an article of diet ; in Lapland  the
 people use the milk of the reindeer, and in
 Tartary mare's milk is employed.
  Cow's milk varies in its quantity and com-
 position, according to various circumstances,
 so that no standard can  be given  by which
 genuine   milk may be ascertained.    Thus,
 milk is  known  to vary according to the age
 of the cow, the age of  the calf, and other cir-
 cumstances in the life of the cow.   The time
 of the day at which the cow is milked makes
 some difference.   It is found to be richer in
 solids in the morning.  The kind of feeding
 also produces a difference, beet-root and car-
 rots, for instance,  are  known to increase the
 sugar.  There are different varieties of cows
 which are known to  give milk of different
 quality.    Thus, Alderney cows give more
butter,  and  long-horns  give  more casein.
 Milk as sold in the large towns of this coun-
try is frequently adulterated.  The most com-
mon and  frequent, because the  easiest, form
of adulteration, is that  of the  addition of
water.  Although  when in large quantities
water may be easily dectected, yet within the
limitations of the natural varieties of milk it
is difficult to  detect the addition.  The easiest
way of detecting adulteration by water is to
take the  specific gravity  of the suspected
milk.  Instruments are sold in  the shops by
which the specific gravity of the milk may be
easily  ascertained.   The quantity  of  cream
afforded by  milk after standing, is  a good
rough test of  the presence or absence cf added
water.  The percentage of cream, which may
be  ascertained by the  use of  a long glass
divided into one hundred parts, varies from
5 per cent to  40 per cent, the larger percent-
ages having  been known  to  be  given  by
Alderney cows.  The  average  quantity  of
cream found to be given by cows at Aylesbury
is 13 per cent.  The milk  may be as low as
5 or 6 per cent of cream and yet not be adul-
terated, but if this low percentage is attended
with low specific gravity, then the milk is un-
doubtedly adulterated.  Starch  is sometimes
added to milk to give consistency to the water
which has  been added.   This may easily be
detected by the microscope 01 the addition of
iodine.   Salt is added to keep up the specific
gravity, and may easily be detected by nitrate
of silver, throwing  down chloride  of  silver.
The brains of  animals  have been  added to
thicken with, but this lraud is easily detected
by the microscope.  It may be said, however,
that the adulterations of milk otherwise than
with water are very infrequent.
  Milk, after being allowed to stand for some
time,  is very liable  to decompose  and be-
come acid.  In this condition it is quite unfit
for  the food of  young infants.  Much of the
diarrhoea that prevails in the summer among
children in large towns seems to be  due to
this condition of the  milk.   Boiling the milk
before allowing it to stand will  to a certain
extent prevent this  tendency.   To prevent
this, as well  as to  render adulteration with
water impossible, milk has been evaporated,
and sold under the name of  " condensedmilk:"
This article is now  manufactured on a large
scale, both in this country and  in  Europe,
Condensed milk is easily  converted to the
condition of ordinary milk by the addition of
cold or hot  water.   The only difference is,
that the condensed  (such  as is sold in cans)
contains proportionately more sugar  than
ordinary cow's milk.  The addition of sugar
is rendered necessary in order to prevent de-
composition.   This really  proves a  recom-
mendation of condensed  milk for Infant's
food, as the addition of the sugar brings the
milk in  point  of sweetness up to the condi-
tion of mother's milk.  Condensed milk, we
think, may be confidently recommended, not
only where new milk cannot be had,  but in
all cases where the milk sold is suspected of
adulteration.   It can also be converted into
milk for use at  any  moment,  and conse- 
31-4         MILK FEVER

quently is free from  the suspicion of any in-
jurious decomposition.   New milk has  also
been the means recently of conveying typhoid
fever by means of the water used in adultera-
tion, or for cleansing the cans.   This evil  is
entirely prevented by the exposure to heat in
the preparation of condensed milk.
  MILK FEVER, known also as Ephemera,
often comes on two or three days  after a con-
finement,  but generally  passes off  in a  few
days, leaving no evil effects.  The symptoms
are languor, heat of skin, furred tongue, rest-
lessness, pain in the stomach and breasts, and
loss of appetite.   The secretion of milk does
not take place regularly, and  the breasts may
have to be  drawn.  Any  febrile symptoms
coming on  soon  after a  labor,  are apt to
cause alarm, as in many cases danger may be
apprehended.   Milk fever comes  on  very
soon, while  puerperal  fever, a very serious
disorder, does not  generally  appear for  a
week or ten days after delivery.  The treat-
ment of milk fever consists in giving cooling
saline medicines, a diet  of milk, gruel, and
broth,  etc.,  and  keeping the bowels  open.
The child  may be kept to the breast,  and
these must be drawn if the milk does not  flow
freely.
  MILK LEG. (See Phlegmasia  Dolens.) j
  MINERAL WATERS are such as con-
tain an unusual amount  of mineral substan-
ces in  solution, from which  they derive im-
portant healing properties not possessed by
ordinary water.  All water, except that which
has been  distilled,  or which  falls  from the
clouds in wide open spaces far removed from
towns, contains  a certain amount of mineral
matter in the shape of salts of various kinds,
to which they owe in great measure the pleas-
ant taste which characterizes good drinking
water.  (See Water.) Such a water becomes
a mineral water when these saline ingredients
are present in excess.  Wells yielding  medi- i
cinal waters derive, as do most other springs,
their water  orginally  from  rain-fall.   This
water  permeates the soil,  carrying  with it a
greater or less quantity of the salts  which it
encounters in its passage, until it reaches the
surface of the soil at some lower level, or is
artificially raised  to  the  surface  of  the  soil,
there to be made use of.   According, there-
fore,  to the qualities  of the strata though
which the water percolates will be its qualities
when  the surface is reached.  Various  salts
of sodium,  especially  the  chloride, the  sul-
phate,  and carbonate, salts of lime, iron and
magnesia, with  various   other  less widely
distributed ingredients, are found. Very often
these are held in solution by  the help of  car-
bonic acid gas,'which gives the water a spark-
ling quality, or they contain  sulphur in the
shape of foul-smelling sulphuretted hydrogen.
Different kinds of water  have different  uses.
For the most part they are used either exter-
nally or internally, very often in both fashions.
          MINERAL WATERS

Those usually applied externally are as a rule
above the temperature of the surrounding at-
mosphere ; what are commonly  called hot
springs.    They  increase  the   circulation
through the parts, and favor the  removal of
any effete material which it may be needful
for the  general  health to  remove.   Given
internally, their action varies with their con-
stitution, some acting as tonics.others as elim-
inatives, as the case may be. One very pow-
erful  agency in  effecting  cures by means of
mineral waters is the regimen laid down, and
the total change  of air  and scene, as well as
of habits of life, necessitated by  removal to
the spot where they are to be obtained.   The
existence of these subsidiary  influences ac-
counts for the failure which commonly fol-
lows  any attempt to secure the benefit of a
particular water  at home, arid to procure the
full benefit from them they must be taken on
the spot.
  Mineral waters are of use only in chronic
disorders, and certain forms of these seem to
be much more benefited than  others.  Skin
complaints, scrofulous  disorders of  various
kinds, stiff joints, gouty and rheumatic affec-
tions, and neuralgic pains of certain descrip-
tions, diseases of the liver and kidneys, dis-
orders of the bowels,  and certain abnormal
conditions of the womb, are those most likely
to receive benefit from a  " course," as  it is
called,  of mineral waters.   It is important
for the invalid very clearly to understand that
immediate relief does not follow the change.
Very  likely he  feels  worse in the first in-
stance, for he has been dislocated as to his old
habits and has not become accustomed to the
new ; but by and by he will reap the  benefit
of the change, and  this will follow him even
when he has returned  to his wonted way of
life.  Broadly  speaking,  no invalid  should
go to a  watering-place  without consulting a
medical  man of skill ; and having selected
the spot most suitable, it is  generally desira-
ble to place one's self under the care of a local
practitioner who is acquainted with the specific
property  of  the waters and how they  are
taken with most advantage.  Very often  the
rules laid down  by these local men seem friv-
olous, and we  are not prepared  to say that
they never are so, but following them in a good
many instances  means reaping the full benefit
of the waters, abandoning them no advantage
at all.  It is a  notion, unfortunately, but a
mistaken one, that the greater the quantity of
water drank the greater the advantage reap-
ed ; no notion could be more erroneous.  In
all cases the patient should begin with  a mod-
erate quantity of the water, say two or three
glasses  in the morning before  breakfast, and
one or two  in  the evening before  supper.
The patient, if  strength will permit,  should
rise early, walk  to the springs or pump-room.
swallow slowly a  tumbler  of the water in a
luke-warm state, neither too hot nor too cold, 
           MINERAL WATERS

 walk for a  quarter  of an hour, return for
 another glass, renew the walk gently ;  a third
 glass should follow, if  permitted, and a gen-
 tle saunter  home to breakfast.  If there is
 bathing, that is  generally done  in the fore-
 noon, about two hours after breakfast.  Din-
 ner should  be early and light ;  an excursion
 may be made in the afternoon ;  in the even-
 ing,  drink  as before  a  tumbler or two of
 water, and to bed before ten, a  light  supper
 having  been partaken of some hour or so be-
 fore.  A little  attention to diet is necessary,
 and, as a rule, during the period that the pa-
 tient is  drinking the waters his stimulants
 should  be restricted to some light wine or
 well-fermented bitter beer. Above all things,
 regularity and persistence are to be cultivated
 at  such water-cures ; regularity  in rising, in
 eating and sleeping ; persistence in the object
 of  the  cure.  Taking twice  as  much of the
 water one  day  will not make  up for total
 neglect on  the next, and so indiscretions in
 the way of diet or stimulants may at particu-
 lar periods  of the course undo the work of
 weeks.   The grand  rule is festina lente, for
 loo great a  hurry to get well may undo  the
 whole good  acquired or acquirable.
    Mineral waters are commonly divided or
 grouped  according  to their  constituents.
 Chief among these are the saline, the chaly-
 beate or iron,  the sulphurous, and gaseous.
 Some are faintly acidulous,others are alkaline.
 The  saline  waters are  the most numerous.
 Some contain mainly purgative salts, like sul-
 phate of soda or sulphate of  magnesia ; such
 are Leamington,  Cheltenham, Seidlitz,  Ptillna
 Carslbad, etc.  Others, again, contain more
 common salt and so act less  on  the bowels ;
 such  are  Wiesbaden,   Baden-Baden,  Hom-
 burg, and Kissengen.  The chalybeate  waters
 are sometimes also slightly  laxative—a val-
 uable combination.   Most,  however, retain
 the iron  in  solution by means  of carbonic
 acid.  These are especially useful in cases of
 debility, where the patient seems bloodless
 and weak.   The sulphurous  waters are a
 tolerably numerous  class.  They are  largely
 patronized for a variety of chronic disorders,
 skin  eruptions,  liver and  womb diseases,
 gouty and rheumatic  ailments.   In many of
 these the efficacy is increased by  the warmth
 of the waters.   Gaseous springs can  hardly
 be recognized as a distinct group,inasmuch as
 both saline  and chalybeate waters frequently
 obtain their  palatable character owing  to  the
 carbonic acid gas they contain.  The thermal
 waters of Vichy are salines of this class.  The
 waters of Kreuznach are peculiar in contain-
 ing both iodine and bromine  in  considerable
quantity.  Hence they  possess  considerable
efficacy in dealing with scrofulous disorders,
but, being weakening, require to be prescribed
with caution.  We shall now proceed to give
a short account of the most important springs
          MINERAL WATERS      315

in this  country and in  Europe, with  their
most important properties.
  The most famous group of mineral waters
in America  are the Saratoga Springs, in
New York State,  comprising 28 springs in
all ; some  chalybeate,  others  impregnated
with iodine,  sulphur, and magnesia, and all
powerfully charged with carbonic  acid gas.
High Rock Spring  is the  oldest of the group,
and its medicinal properties  were known to
the Iroquois Indians at the period of Jacques
Carder's visit to the St. Lawrence in 1535.
Toward the  end of the eighteenth century its
curative value began to be appreciated by the
whites ; the first hotels were erected in 1815 ;
and since then  the  fame of the springs has
spread so widely that, in addition to the hosts
of visitors, immense quantities of the waters
are bottled and sent to all parts of the United
States  and Europe.  The High Rock water
contains 69.5 grains of  miperal constituents
and 51 cubic  inches of carbonic acid to each
pint,  and is strongly cathatrtic and  tonic.
Perhaps the  most popular  of the  Saratoga
waters is that of the Congress Spring,  which
contains 75 grains of mineral constituents and
49 cubic inches of carbonic acid gas  to the
pint, and  is  carthartic and alterative.  The
Columbian Spring is  strongly  impregnated
with iron, and  acts as a diuretic and  tonic.
The Washington  is  less  ferruginous  than
the Columbian, but is  an excellent tonic and
pleasant to take.   The Hathorn is a powerful
cathartic, and acts also as a tonic and diuretic.
The Hamilton is mildly cathartic and altera-
tive, and the  Pavilion is one of die best of the
cathartic waters, the Star being also  excel-
lent.  The Putnam is chalybeate, and is used
for bathing.   The  United States is  tonic and
alterative, and  agreeable to drink  ; and  the
Empire closely  resembles the Congress. The
Saratoga, the Excelsior, and  the  Eureka are
mildly cathartic.  The Red Spring contains
an  unusual  proportion Of  iron ;  and the
Eureka White Sulphur, strongly impregnated
with sulphuretted  hydrogen, is chiefly used
for bathing.  Of the " spouting springs," the
most famous are the Geyser, which is so highly
charged with carbonic acid gas that it foams
like soda-water  when  drawn from  a faucet,
and exhilarates like champagne ; the Glacier
Spring, which spouts high above the pipe and
is strongly cathartic ; and the Seltzer Spring,
which closely resembles the celebrated seltzer
of Germany,  and is a sparkling and invigorat-
ing drink.
  Other  celebrated  springs in  New York
State  are the Ballston Spa, near Saratoga ;
the Chittenango White  Sulphur, iron and sul-
phur ;  the Clifton, sulphurous in  character
and remedial in bilious and cutaneous disor-
ders ; the Richfield, a  numerous group, con-
sidered especially  efficacious in diseases of
the skin ;  the Sharon group of four springs, 
31G       MINERAL WATERS
MINERAL WATERS
comprising a chalybeate, a magnesia, a white
sulphur, and a blue sulphur ;  the  Vallonia,
whose waters are impregnated  with sulphur,
iron,  and magnesia,  and  are  beneficial in
cutaneous diseases ;  and the Avon,  saline-
sulphurous,  and good for rheumatism, indi-
gestion1, and cutaneous diseases.
  After the Saratoga Springs, the most famous
group in America are  the Virginia Mineral
Springs, which are also the most numerous
in the world. The region through which they
are scattered covers the entire northwestern
part  of the State,  and  comprises nearly a
hundred springs of every quality and variety.
The most famous of the Virginia Springs are
the Greenbriar White Sulphur, which  have
been  resorted to for more  than a hundred
years.  The water  is alterative and stimu
lant and is  beneficial for dyspepsia,  affec-
tions  of the liver, nervous diseases,  cutane-
ous diseases, rheumatism, and gout.   The
Blue  Sulphur is near the White Sulphur, and
is said to be beneficial in chronic hepatitis,
jaundice,  chronic irritation of  the  kidneys
and bladder, and  diseases of the skin.  The
Old Sweet Springs  are situated in  Monroe
County, and are said  to be the oldest water-
ing-place  in Virginia.  The  water derives a
peculiar briskness  from  the carbonic  acid
which predominates in it, and is recommended
for dyspepsia, diarrhcea, dysentery, and gen-
eral disorder of the system.   The Red Sweet,
near  by, is  chalybeate and  tonic.  The Salt
Sulphur is also in Monroe  County,  and the
water is prescribed  for  chronic  affections of
the brain, for chronic  diseases of the bowels,
kidneys, and bladder, and for  neuralgia and
the various nervous diseases.   The Red Sul-
phur,  near the  Salt Sulphur, is strongly
charged with sulphuretted hydrogen,  and is
remedial in  cases of  scrofula, jaundice, dys-
pepsia, and chronic dysentery and diarrhcea.
The Rockbridge Alum  Springs are situated in
Rockbridge County, and are highly esteemed
for chronic  dyspepsia,  diarrhcea,  scrofula,
gastric  irritation, and diseases of the skin.
The Rockbridge Baths are impregnated with
iron and as a tonic bath are  useful.  Jordan's
Alum Springs possess similar properties.
  The thermal baths of Bath  County,  Va.,
are a remarkable group,  unrivalled  by any
yet discovered either  in Europe or America.
The Warm  Springs were discovered by the
Indians, and have long been a popular re-
sort.  The water is  used chiefly for bathing,
and so used is  beneficial to gout, rheuma-
tism,  swellings  of  the  joints  and  glands, !
paralysis,  chronic cutaneous diseases, and
calculus  disorders.    The Hot Springs are
said to  be the hottest  baths in the  world,
the temperature reaching no° Fahr.   Their
most  marked effect is  in cases of rheumatism
and torpid liver.  The  Healing Springs closely
resemble the famous  Schlagenbad and  Ems
waters of Germany, and are excellent for skin '
diseases, scrofula, chronic thrush, neuralgia,
rheumatism, ulcers of long  standing,  and
chronic dyspepsia.  The  Bath Alum waters
are  tonic  and astringent,  and  are recom-
mended  for scrofula,  dyspepsia,  eruptive
affections, chronic diarrhcea, nervous debility,
and various uterine diseases.
  One of the most famous and popular of the
Virginia  watering-places are the  Berkeley
Springs,  situated in Morgan  County,  West
Virginia.   The waters are not remarkable for
their curative properties, being  but slightly
impregnated with  mineral  ingredients,  but
the bathing is highly invigorating. The water
of the Capon Springs is more valuable, and
benefits  gravel,  diseases  of  the  intestinal
canal, various forms  of  dyspepsia, chronic
diarrhcea, and affections of the nervous sys-
tem.   The Rawley Springs  are a compound
chalybeate, alterative and  tonic in their effects.
The  water of Coyners  Springs  is  recom-
mended  for imperfect  or painful digestion,
indolent liver, chronic disease of  the bladder
or kidneys, and an enfeebled condition of the
nervous  system.    The Blue  Ridge Springs,
in Botetourt County, have  a  special reputa-
tion  for the cure of  dyspepsia.  The  Alle-
ghany water is cathartic,  diuretic, and tonic,
and is  considered remedial in  costiveness,
dyspepsia, scrofula,* jaundice, and  incipient
consumption.  The Montgomery  White  Sul-
ptiur are a strong sulphur,  acting as a mild
cathartic. The  Yellow  Sulphur possesses val-
uable tonic properties.
  The foregoing are the most  prominent and
popular of the Virginia springs, but there are
others which deserve  mention, as the Bed-
ford Alum, the Sharon Alum,  the Pulaski
Alum the Grayson  White  Sulphur, in Carrol
County, the Fauquier  White Sulphur, Eggles-
ton's, a powerful  sulphur, Jordan's,  in Fred-
erick County, the Shannondale, in Jefferson
County,  the Holston, in  Scott County, and
the Huguenot Springs,  in  Pinkerton County.
  The  Warm  Springs, in  western  North
Carolina,  have  a wide  reputation.   They
are sulphurous, with traces of  lime and mag-
nesia, and  in the form  of  baths are  excellent
for  dyspepsia, liver-complaint,  diseases of
the  kidneys, rheumatism, and chronic  cuta-
neous diseases.
  There  are no  mineral  springs in South
Carolina  or Georgia  which  have  more
than  a local reputation, but some,  perhaps,
deserve to  be better known.   In  South Caro-
lina are  Glenn's  Springs, a strong sulphur,
the Limestone Springs,  a  chalybeate, Chick's
Springs,  a  mild  sulphur, and   Williams ton
Springs,  a valuable tonic.   In Georgia  there
are several which  are better known.   The
Warm Springs,  in Meriwether County,  are
an excellent sulphur.  The Chalybeate Springs,
in Talbot County, have fine tonic properties.
The Lndian  Springs,  in  Butts  County,  are
highly  esteemed  sulphurous  waters.   The 
MINERAL WATERS
MINERAL  WATERS      317
 Madison, in Madison County, is a fine chaly-
 beate.  The  Red  Sulphur  are  in  Walker
 County, and the Powder,  sulphur and  mag-
 nesia, in Cobb  County. The Catoosa Springs,
 in  Catoosa County, Rowland's, in  Bartow
 County, and Gordon's in Murray County, are
 chalybeate.
   In  Pennsylvania  are  several  valuable
 springs.   Bedford Springs  have  long been
 popular. The waters are a saline-chalybeate,
 and are'beneficial in dyspepsia, diabetes, in-
 cipient  consumption,  and  skin  diseases.
 Cresson  Springs -are a saline and  an alum,
 situated nearly  on the summit of the  Alle-
 ghany Mountains.   The Gettysburg water re-
 sembles Vichy, and is considered remedial in
 gout, rheumatism,  dyspepsia, and  affections
 of the kidneys-  The Ml. Holly Springs, near
 Carlisle,  are mildly sulphurous in character
 and tonic in effect ;  and  the Perry Warm
 Springs, also near Carlisle, are aperient and
 diuretic when taken internally, and as a bath
 help diseases of the skin.  The Doubling Gap
 Springs comprise two springs, a sulphur and
 a chalybeate.   The Minnequa Springs are
 impregnated with iron  and hence  tonic in
 effect.  The  York Sulphur Srings  were once
 famous, but have declined in popularity.
   Some of the most celebrated mineral spings
 in the country are in Vermont. The  Sheldon
 and Missisquoi Springs are  alkaline in  char-
 acter and  are  very efficacious in cutaneous
 diseases.   The Highgate  Springs are also
 alkaline, and are thought to be  beneficial in
 dyspepsia and cancer,  as well as in  eruptive
 diseases.   The Alburgh water is  prescribed
 for cutaneous diseases. The  Clarendon Springs
 are  alkaline, highly charged  with  carbonic
 acid gas,  and much resorted to.   The Mid-
 dletown Springs are impregnated with  iron,
 and  are highly  esteemed.
  The Stafford Spring, in Connecticut, is
 one  of the best chalybeate  springs in the
 United States.   The Sand Springs  and the
 Berkshire  Soda, in Massachusetts,  have
 some reputation.
  The Arkansas  Hot Springs are  among
 the most famous of the kind in the world, and
 a  great  sanitarium has grown up  around
 them.   There are  66 springs in all, varying
 in  temperature from  930 to 1600 F.,  and
 the waters are used chiefly as a bath.  Taken
 both  internally  and as  a bath,  they  have
 worked many wonderful cures of rheumatism,
 rheumatic  gout, stiffness of the joints,  mer-
 curial  diseases (arising  from the  effects of
 mercury in the   system),  malarial  fevers,
 scrofula, and diseases of the skin.
  The Hot Sulphur Springs, in Middle Park,
 Colorado, are rapidly growing  in  reputa-
tion, and the Manitou Springs are perhaps the
most famous  in the West.   The waters con-
tain  sulphur, soda, and iron, and are recom-
mended for their tonic effects in all diseases
of which general debility is a feature.  The
Idaho Springs (hot and cold) have fine tonic
properties and are frequented both  in sum-
mer and  in  winter.   The  Boiling  Springs,
near the foot of  Pike's Peak, are 6350 feet
above the sea.
  In California are several springs enjoying
considerable  local repute.  Among  the best
of these are  the Hot  Sulphur, near  Santa
Barbara, which are said to cure rheumatism
and various diseases  of  the skin.  The Paso-
Robles Hot Springs are a famous bath, and are
considered remedial in gout, iheumatism, and
chronic diseases of the skin.  The' Congress
Springs, near Santa Clara, contain carbonate
and  sulphate  of  soda,  chloride of  sodium,
lime, iron, silicate of ammonia, and magnesia,
and  are  regarded as  a specific for  rheuma-
tism.  Harbin's, the White Sulphur, and the
Napa Soda Springs, in the northern part  of
the State, are  valuable.  The  Geyser Springs
are rather a curiosity than  a sanitarium, but
a properly-directed course of the waters is said
to afford an  almost certain cure for gout,
rheumatism, and  skin diseases.
  Well-known springs in Canada are the St.
Catharine's, which  are used chiefly in  the
form of warm baths, and  are  remedial in
rheumatism,  neuralgia, and gout ;  the St.
Leon, on the Riviere  du Loup ; and the Cale-
donia, the water of which is largely exported
under  the  name  of  " Plantagenet Water,"
and  is  recommended for rheumatism and
skin diseases.
  Of the English mineral springs the oldest
are those of  Bath.   The Bath waters  are
thermal, their temperature being always over
ioo°F., sometimes as high as 120° F.  They
contain sulphates of  lime and soda,  chloride
of sodium and magnesium, some carbonate of
lime, .silica and iron, all held in  solution by
carbonic acid  ; other gases are contained in
the waters,  chiefly  oxygen and nitrogen.
The waters are sparkling in appearance, owing
to the  presence of these gases, and  they are
generally drank in  quantities of  half a pint
morning and  afternoon.  They usually raise
the temperature and  quicken the circulation,
increasing certain of the secretions, especially
those of  the  kidneys.   The waters are also
largely used for bathing purposes, all kinds of
baths being  provided.  Bath is chiefly fre-
quented  in  late  autumn, winter,  and early
spring, for. situated as it is, in a hollow, it is
warm,  though, as a rule, damp, owing  to the
steam of the hot waters permeating  the soil.
The main diseases for which the Bath waters
are adapted are rheumatic and  gouty affec-
tions of a chronic character, neuralgic affec-
tions, especially  lumbago, rigid joints, and
some forms of paralysis.   Certain skin dis-
eases, too, are benefited by them.
  Cheltenham is perhaps more of  a health
resort than a watering-place.  The waters are
cold and  all  saline,  except  one,  which  is
chalybeate.  The chief spring is the Mont- 
318      MINERAL WATERS
MINERAL WATERS
pelier Spa,  whose  waters contain chlorides
and sulphates, with a little iron.   These are
used both internally and externally, but chiefly
internally.   They are  supposed to be espe-
cially valuable in torpidity of the liver and
bowels,  and in  gouty disorders.   Patients
commonly  resort to the waters at the time
when the regular inhabitants are absent, that
is to say, in the summer months.
  Leamington,  in  many  respects, resembles
Cheltenham, but is  more beautifully situated.
The  composition of these waters resembles
that of the Cheltenham springs.   They con-
tain chlorides of sodium,  calcium, and mag-
nesium, with sulphate of soda.  They contain
also carbonic acid and  nitrogen and oxygen.
On the whole they are more powerful than
are  those  of  Cheltenham,  and  so better
adapted for those who  suffer from torpid liver
and bowels, in the first instance at least.
  Tunbridge Wells,  situated  in one of the
most beautiful districts in  England, is largely
visited, not so much on account of its waters,
which are almost neglected, but because the
air is mild  yet  bracing, the walks are fine,
and the  place one  well fitted for a pleasant
sojourn.  The waters are chalybeate, but only
feebly so, and require to be taken for a good
long time ; nevertheless, drank regularly, and
combined with exercise taken in the open air,
they may be relied upon as being  most effica-
cious in cases of anaemia, such  as occur in
young females of sedentary habits.
  One of the most  important of the  English
watering-places,  certainly the  one which is
most visited  for  its waters,  is Harrogate.
The soil is sandy, the  air pure and bracing.
The  waters  are all  cold,  but are  usually
warmed  before being drank.  Springs of the
most  various kinds are  found here, some
strong sulphurous, some  mild  sulphurous,
with alkali combined, some saline chalybeate,
and some purely chalybeate of a  most un-
usual kind.   The strong sulphurous waters
are the typical waters of Harrogate, for which
it has received its reputation. They are taken
internally in doses of about a pint, in divided
doses, every morning  before breakfast,  and
are also used as baths.   These  are mainly
used to stimulate the liver and bowels ; used
as baths, the skin ;  they also favor the secre-
tion of urine, and are especially useful in cer-
tain  forms of skin disease,  and  gouty and
rheumatic  affections.   The   mild  sulphur
springs contain  less sulphuretted  hydrogen
and chlorides of sodium and magnesium, but
they have carbonate of magnesia  in addition,
These  are  antacid as well as  alterative.
The saline  chalybeate  contains carbonate  of
iron, so that these waters  are tonic as well as
alterative.  Again,  some  are  purely chaly-
beate, one especially, of a  very rare kind, con-
taining aprotochloride of iron.
  Buxton is totally different from any of the
preceding.   The springs are situated among
the Derbyshire  hills,  and  are exceedingly
bracing.   The  climate  is only adapted  for
summer and autumn ; at other times it is often
cold and  badly adapted  for invalids.   The
salts contained  in  the  waters are small  in
quantity,  and are  mainly salts  of  sodium,
magnesium, and calcium, with a trace of iron.
They contain much carbonic acid and nitro-
gen.  The waters are chiefly used for  bath-
ing, and douche-baths are perhaps the favor-
ite form of applying them.  The waters are
useful for  stiff  joints, especially when  these
are due to  gout or rheumatism, to old sprains
or muscular contractions.
  There are a few  other places in England
where waters are  drank, and  also a few in
Scotland ;  most,  however, have been aban-
doned for their more fashionable continental
rivals,  and indeed some of those here de-
scribed are not in much better case. It would
be impossible to give in this slight sketch any
full  account of  foreign  watering-places, but
equally so  would it be impossible, while pre-
tending to deal with the subject  of mineral
waters, to  conclude this sketch  without refer-
ence to these.
  Spa in  Belgium,  whose title has become
generic, being applied to almost all watering-
places, is situated in a valley of  the Ardennes.
The waters are of a temperature of 50° F.,
and contain much carbonic acid.   This  holds
in solution salts of  soda, magnesia, lime, and
iron, so that these partake of the qualities of
alkaline and ferruginous waters.  The dose
given is considerable, as much  as three  pints
a day in divided doses,  but  beginning with a
couple of  glasses.    They  are valuable  as
chalybeates.  The  season is from  May  to
September.
  In the Pyrenees are a multitude of  springs
which  we  cannot  describe   individually.
Chief among these  are  the Bagneres  de Big-
orres, Barege,Bagneres de Luchon, Cauterets,
Eaux Bonnes,  and  Eaux  Chaudes.    The
Bagnere de Bigorres are saline,  sulphurous,
and ferruginous.  The Barege waters are sul-
phurous,  and are of three  kinds—hot, tem-
perate, and tepid.  A peculiar pellicle  floats
on  their  surface, which  is  supposed  to  be
peculiarly  beneficial in  chronic rheumatism.
It is called glairine, zoogene,  or baregine.
These waters are highly esteemed.  St. Sau-
veur, four  miles off, has waters similar, but
less active.   Cauterets is more  sheltered than
Barege, has many  sulphuretted springs,  the
warmest having a  temperature of 1220 F. ;
baregine  is  also  present  in  these  waters.
These are manly used for skin diseases of an
obstinate  kind, scaly and pimply, in  chronic
rheumatic  and gouty affections, stiff joints,
etc.  Some maladies of the womb are also
greatly benefited by them, so, too, is scrofula
and threatened phthisis.  Bagneres de Suchon
and Eaux Chaudes are also sulphurous waters.
The latter contain or  deposit a substance 
MINERAL WATERS
MINERAL  WATERS
 called sulfuraire.  Eaux Bonnes  are  mildly
 sulphurous waters, of which  the  supply is
 scanty.  They are supposed to be  specially
 efficacious in threatened consumption.  They
 are situated 2400 feet  above the level of the
 sea, and the air is exceedingly fresh and pure.
   Vichy affords  perhaps one of the most im-
 portant  mineral  waters known to us.   It is
 situated in central France, in a wide open
 valley.  The air  is temperate, and the season
 lasts from May till September.  The springs
 are nine in number, they are all warm, alka-
 line, and gaseous.  They contain mainly car-
 bonate of soda and carbonic acid.  They also
 contain, however, some potash and ammonia,
 and baregine.  The springs mostly employed
 are  the Grande  Grille, the  Celestins, and
 L'Hopital.  They are used for diseases of the
 lungs,  especially catarrh, for irritability of
 the  digestive organs, gravel, catarrh  of the
 bladder, diabetes, chronic gout and rheuma-
 tism, etc.  The Grande Grille is supposed to
 be most useful for liver complaints ; the Cel-
 estins is mainly given for  urinary disorders ;
 the Hopital spring for gastric catarrh.   Their
 taste is someth ng like soda-water. They are
 largely exported, and are  given in doses of
 half a pint to two pints.
   Aix-la-Chapelle lies to the westward of
 Cologne, between  the  Rhine and the Maas.
 Its waters are partly warm  sulphurous, partly
 cold  chalybeate.   The waters are extremely
 disagreeable, though less so than some of the
 Pyrenean sources ; there is abundance of the
 rotten egg flavor, but the baregine is wanting.
 They are not much given internally, but are
 chiefly used in baths,  douches,  shampooing,
 and  kneading, and in these cases are of great
 use in curing old Standing sprains, stiff joints,
 contracted muscles, and the like. Other mal-
 adies, like skin diseases, may also be benefited
 by them.   The season is from  June to Sep-
 tember.
   Kreuznach is a spa of singular value.  The
 waters  are bitter and  contain  chlorides  of
 sodium, calcium,  and magnesium, bromides,
 iodides,  and  some iron.   The waters  are
 chiefly used wth a view to procure the absorp-
 tion  of tumors.  It is drunk at  first in small
 quantity, sometimes  mixed  with  hot  milk.
 The  baths  are taken tepid, and quantities of
 the substance which remains behind when the
 salts have been crystallized from  the waters
 are added according to circumstances.   The
 waters  of  Kreuznach  have obtained  their
 chief reputation  in maladies of the womb,
especially in chronic inflammation, with hy-
pertrophy and induration.   Scrofulous ulcers
and glands, too, are frequently relieved.
  Neunaiir is situated in  the  valley of  the
Ahr, not far from Cologne. It contains much
carbonic acid,  with carbonates of lime and
magnesia,  some  sulphate  and chloride  of
sodium, with a little iron, alumina, and silica.
The waters are useful in rheumatism  and a
I tendency to the formation of gravel, in mala-
 dies of the throat and lungs connected with
 these.
   Ems lies in the valley of the  Lahn, not far
 from Wiesbaden.   It has  long been a noted
 place of resort, and the beauty of its situa-
 tion, is in itself almost a sufficient attraction.
 The waters are warm or hot—86° to  1330  F.,
 and are saline,  alkaline, and gaseous.  The
 waters contain chloride of sodium, carbonate
 of soda, and magnesia, with smaller  quanti-
 ties  of  lime,  iron, manganese, potass,  and
 lithia.   Hence they  are  alterative,  mildly
 diuretic, and  laxative.   They  are   recom-
 mended in catarrhal affections  cf the lungs
 and air passages, and in dyspepsia when there
 is a tendency to  consumption ; also in   the
 form of skin disease known as eczema.   For
 gouty subjects they are also valuable, but less
 so than Vichy.
   Wiesbaden lies  on the southern  slope of
 the  Taunus mountains, and is greatly  fre-
 quented.  The season extends  from June to
 September,  but the climate is good much
 later.  The water contains chloride of sodium
 in large quantity,  with potass, lime, iron,
 magnesia, some arsenic, and bromine.  The
 carbonic acid is in very large bulk. The taste
 has  been  compared to weak chicken broth
 slightly salted. The waters have to be cooled
 before being  taken, and  then  three  or four
 glasses produce a slight diuretic and  laxative
 effect.   These waters do  good  in  gout or
 rheumatism, with congestion of the liver and
 piles, and also in some skin diseases.
   Homburg, too, has derived its attractions
 from other sources than its waters ; neverthe-
 less these are  worthy of mention. This place
 lies not far from Frankfort, and its air is in-
 vigorating  and  bracing, but variable.  The
 waters are  cold, and contain chlorides along
 with  carbonic acid.   The  flavor  is  fairly
 agreeable,   though  saltish  and  somewhat
 bitter.
   Baden-Baden is another of the  German
 watering-places  where a gambling table and
| the French demi-monde offered the chief at-
 tractions.   It  is  situated in the  Black Forest,
 in a delightful valley.   Its mineral waters
| are weak, but  they are said to contain a good
 deal of lithia.  This place, now  that gambling
 is suppressed,  has a doubtful future.
   Kissingen,  in Bavaria,  stands  in a totally
 different category.  It is  one of the  favorite
 bathing-places of  Germany, and is  situated
 about thirty miles from Wurzburg.  Its waters
 are  cold and  gaseous.  The .chief salts  are
 chloride of  potassium, sodium, lithium,  and
 magnesium, carbonate of lime and sulphate
 of magnesia, with iodine,  bromine, and iron.
 The waters are useful in habitual constipation,
 with congestion  of the liver,  in dyspepsia
 with  flatulence, and  in tubercular  disease.
 Gout and gravel are also benefited.   Baths
 are also used. 
320
MINERAL  WATERS
MINERAL WATERS
  Gastein, in Austrian Tyrol, not far from
Salzburg, is another favorite place of resort
for the sake of its waters.  It is situated 3200
feet above the level of the sea, and the air is
extremely bracing.   The season is limited to
July and August.  The  springs  are thermal,
but weak ; sulphate of soda is the chief in-
gredient.  The waters are used for baths after
cooling, and some derive great benefit from
them ;  the prematurely  old, the hypochon-
driac, and paralytic  are said to be most so.
The  waters of Toplilz, in Bohemia, resemble
those of Gastein, but  the  town  lies  much
lower,  in a situation of  great  beauty,  the
climate being exceedingly agreeable.
  Friedrichshall and  P'u'llna both supply
a water which is highly laxative. The waters
are bright and clear, with a slight tinge of
yellow, and are largely exported, previous to
which, however, they are  somewhat concen-
trated. They contain sulphates of soda, lime,
and magnesia, with chlorides, carbonates, and
bromides.
  Carlsbad is situated  in  Bohemia,  some
distance from Prague.  The season extends
from May to September.   It is  1200  feet
above the sea.  There  are several springs ;
the principal rises  some feet in  the air, and
gives off clouds of vapor ; its temperature is
165°.  It  contains  sulphates of  soda and
potash,  chloride of sodium  and carbonate of
lime, with some iron,  alumina, and silica.
The  waters are mainly given for abdominal
complaints,  as in  diseases  of  the  liver, en-
gorgement,  and the like, dyspepsia, hypo-
chondriasis, constipation, diabetes, gout, and
rheumatism ;  also in  jaundice  from gall-
stones.
  Still higher up is Marienbad, in the same
valley  as  Carlsbad. The waters are mixed,
saline  and chalybeate,  with some carbonic
acid  ; by standing they become turbid.  The
waters are valuable for chronic diseases of the
digestive  organs,   combining  laxative and
tonic influence.   The water,  made  into  a
paste with peat soil, is used  as a mud bath or
poultice,  which  is useful  in healing chronic
ulcers and  dispersing  glandular  swellings.
Gas  baths, consisting of carbonic acid with a
little sulphuretted hydrogen, are also used to
remove pains from the muscular and nervous
systems.
  In the same district is Franzensbad, whose
waters are cold ; they are acidulous, and con-
tain  mainly alkaline salts.  Here, too, besides
being used in the ordinary way,  the mud and
gas baths are high in favor.   Various chronic
skin diseases, indolent ulcers, gouty deposits,
etc., may be thus removed.  The water taken
internally improves digestion and  the nerv-
ous system.
  Aix-les-Bains,  in Savoy, is a  watering-
place well worthy of the attention of the in-
valid.  Its greatest  fault is its remoteness.
The springs  are warm,  one containing sul-
phuretted hydrogen, the other none.   The
waters are chiefly used externally as douches.
The climate is very mild, and admits of a stay
from April to October.  Chronic rheumatism
and stiff joints are the forms of disease most
benefited by the treatment.
  Zoneche stands high in  the valley of the
Rhone.  The waters are hot, and contain
mostly sulphate of lime  and  other sulphates.
Scrofulous enlargements,  eczema, and  gout
and rheumatism are chiefly  benefited by the
baths here.
  Pfeffers is also high above the sea, in the
Grisons.  Its waters are conducted in wooden
tubes down the heights to Rogatz, in the valley
of the Rhine.   Sometimes,  however,  the
waters can  only be obtained  at Pfeffers.
Baths are  chiefly used, but the  waters are
also drunk.  They are useful in hysteria and
nervous excitability.
  Tarasp, in the Grisons, has springs some-
thing like those of Marienbad, cold and gase-
ous.  The springs  are  4300 feet above the
sea;  they are said to be  useful in early
phthisis,  and when  the abdominal organs are
out of order.  Doubtless, the elevated regions
and the pure  mountain air have  much to do
with the  benefit.  This is still more markedly
the case with St. Moritz, in the Upper En-
gadine, which lies  5863  feet  over the sea
level.  The waters,  which  are situated on a
still higher level than the village, are chalybe-
ate, with free  carbonic acid.  They are used
both  internally and  externally.   The place
seems of most value in the early stages of
consumption.
  Schinznach and its neighborhood contains
many springs, those of  Schinznach resem-
bling  those  of Zoneche ; those of Wildegg,
close by, being  more like  those of  Kreuz-
nach.
  MINERAL WATERS, ARTIFICIAL,
are imitations of  mineral spring waters, made
by dissolving the salts which  constitute the
basis of the natural  mineral waters in distilled
water impregnated with gases, especially car-
bonic acid gas.  They are prepared according
to analyses which represent the natural min-
eral waters when in their best condition ; and
consequently, if  properly made,  have some
advantages over natural waters.  The supply
of  the latter exported  from  the European
springs is inadequate for the demand, and
they are  apt  to be diluted ;  and most natural
waters lose  materially by bottling.   The
springs,  too,  are subject  to many changes,
and frequently vary in the quantity or the re-
lative proportion of their mineral ingredients.
Artificial waters, on the contrary, are always
the same in  composition, in consequence  of
the techincal perfection of their manufacture,
and they produce the same general  effect  as
the  natural  waters.  They  are   also  more
highly charged with carbonic acid gas than
the latter,  which insures their keeping in any 
MISCARRIAGE
MORTIFICATION
climate, and  renders  them more pleasant to
the taste.
  MISCARRIAGE.   (See Abortion.)
  MIXTURES are perhaps the most favorite
forms  of  remedies—one  or  two substances
intended  to aid each other's action  being
combined and given in some pleasant vehicle.
It is  not  desirable  that  too  many  objects
should be aimed at in any mixture, so that its
composition should be as simple as possible.
  MOLES, called also  liver stains, mother's
marks, pilous and pigmentary naevi, are con-
genital marks  of  a  light or dark brown or
black color; situated  on the surface of the
body.   They are formed by circumscribed
thickening of the  scarf skin with excessive
deposit of organic coloring-matter,  and are
covered by numerous thick, stiff hairs. They
vary  much in  shape,  size, and situation.
Most frequently one or two small marks
of  a rounded  form  are met  with, either
on  the face or on  the back of the neck,
but in some cases a mole covers several inches
of surface, and is very irregular in form.  The
usual seats of moles are the face, the back of
the neck, and  the back.  Moles, in conse-
quence of friction, often become sore,  and
sometimes ulcerate.    It is believed, too, by
many surgeons that they are  often the start-
ing-points of cancerous growths.   For these,
as well as for  cosmetic reasons, it is advis-
able  to have a small and isolated mole cut
out.  If the surgeon's knife be carried in ihe
direction of the folds of  the skin, the scar will
cause very little if any disfigurement.   For
large moles very little can be done ;  removal
of the hairs by tweezers is soon followed by
renewed  growth,  and  the use  of   depilla-
lories, or  hair-destroying applications,  does
much more harm than good, in  consequence
of their irritant and caustic action on the skin.
  MOLLUSCUM is a disease of the skin,
characterized by 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 de-
pression.   These  little  tumors may  increase
slowly in size without undergoing any change,
or they may ulcerate and discharge their con-
tents.   There  seem  to be  two kinds :  (i)
Molluscum fibrosum, which consists in an in-
creased formation of the fibrous tissues round
the hair  follicles ; and (2) Molluscum conta-
giosum, 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  molluscum are  the  back or
front of the trunk, the  neck, face, and scro-
tum.   Its presence is not attended with any
constitutional disturbance ; it may  exist at
any  age,  but is most frequent  in  children.
There are generally  several  of these small
tumors present at the  same time.  The treat-
ment 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 scissors, and the
cut end touched with caustic.
  MONKSHOOD.  (See Aconite.)
  MONOMANIA.   (See Insanity.)
  MORPHINE.  (See Opium.)
  MORTIFICATION means the death of a
part  of the living  body.  There are several
varieties  of this process, styled  by surgeons
gangrene, sphacelus,  sloughing, mummifica-
tion. Gangrene is that stage in which the part
is hot,  swollen, and  livid, but not yet quite
dead. The term sphacelus expresses that con-
dition in  which the part is cold and black, and
utterly deprived of life.  Mummification^ is
dry gangrene, a condition in which a portion
of an extremity is dry and  shrunken.   By
sloughingis meant a limited death of skin and
soft  structures at  the surface  of  the  body.
Death of bone is called necrosis, and destruc-
tion  and breaking down  of  brain tissue is
called " ramollissement" or softening.  The
following  are the  most  common exciting
causes of mortification :
   1.  Mechanical or Chemical Action.—Severe
injuries  of the  extremities,  and especially
compound  fractures, associated  with  much
crushing and contusion,  occasionally  result
in death  of the injured parts, the blood sup-
ply of which has  been cut off.   The applica-
tion of actual flame or of hot fluids to the sur-
face  of the body  may also cause destruction
of  the skin and subjacent soft parts.   The
contact of  sulphuric, nitric, and other  strong
acids, and  of the caustic alkalies, as ammonia
and  potash,  will also produce mortification.
Under this head may be included the action
of living  and putrid animal fluids, as  the
poison of  snakes, and the  fluid causing the
bad result  of certain dissection wounds.
   2.  Stagnation of the blood in a limb due to an
obstruction to the circulation through the veins.
—If a limb be tightly constricted at any part
by a bandage or handkerchief, and this  con-
striction be kept up  for eight or ten hours,
the extremity of  the limb will swell, become
cold, senseless, and livid,  and at last mortify.
These changes sometimes take place  after a
limb has been tightly bandaged for fracture
of one or more bones.   A common instance
of mortification produced by  compression of
some part of  the surface of the body and ob-
struction to  the  circulation  of  the blood
through  the veins is the bed-sore, the forma-
tion of which, however, is  much favored by
other conditions, as the exhausted state of
the patient, and the  prolonged contact of the
skin with  urine, sweat, and  other irritating
fluids.
   3. Arrest of the Supply of Arterial Blood.—
When a  large artery is torn through by a frac- 
322        MORTIFICATION
MORTIFICATION
tured bone or ruptured by external violence,
mortification of the parts supplied by  this
vessel will often result, though not always,
as a sufficient amount of  blood  may still be
supplied by smaller collateral vessels.  When,
in addition to division of a large artery, there
is much effusion of blood and  contusion of
soft structures, mortification will certainly
take place.  Mortification  occasionally results
from the blocking of an artery with a clot of
fibrine detached from the lining membrane of
the heart,  and carried along with the current
of blood.  In feeble old persons, spontaneous
mortification sometimes attacks the toes or
fingers ; this affection, which is  called  senile
gangrene, is generally due to  a  combination
of two or more of the  following causes :
weakness  of the heart's  action, ossification
and contraction of the arteries,  sluggish cir-
culation, diminished nerve force, exposure to
cold and wet.
  4. Injury or  destructive  disease of  ner-ves
sometimes causes mortification.  In a case
under the  care of Sir Benjamin  Brodie, mor-
tification of the skin of one foot was observed
within a few hours after injury to the  spinal
cord.   Opacity and ulceration of the cornea
or transparent  membrane  of the  eye, occa-
sionally follows division  or  compression of
the fifth cerebral nerve.
   5. In France  and other countries on  the
continent  where rye is an article  of food, mor-
tification has been observed to follow the use
of this grain  when  diseased,  in  consequence
of the growth of a fungus  in the  ovary.  The
grain  when  in  this  state  is  called  ergot,
spurred rye, cock-spur rye, and.  by botanists,
Secale cornutum. It then contains a poisonous
active principle called  ergotine,  which gives
rise, when black bread made  of  the diseased
rye has been eaten, to  severe cramps, itching
of the skin at some parts of the  body, numb-
ness and  loss  of sensibility  at  other  parts,
deafness,  and  dry  mortification  of the  ex-
tremities of the limbs.
   6.  For mortification  resulting  from the
effects of  cold  and moisture,  (see  Frost-
Bite.)
   The predisposing causes  of  mortification
are general debility  due  to senile  decay, to
insufficiency or bad quality of food, and to
exhausting and severe diseases—to disease
of the heart, and diabetes.  To these may be
added the  local predisposing causes, such as
inflammation and congestion of a part of the
body.
   Moist mortification generally  occurs when
the circulation of blood in  a part ceases  sud-
denly ; the dead tissues are then mixed with
the stagnant blood and serum.  Dry mortifi-
cation, or  mummification, results from slow
death of a part, due to deficient  or obstructed
arterial supply.   When  moist  mortification
attacks a limb, or a superficial part  of  the
body,  the skin  becomes distended and livid.
 Blisters containing a dark fluid then form on
 the surface, and the epidermis becomes moist
 and can be readily detached.  Large black and
 purple patches then appear, and these increase
 in size and run into each other.  The affected
 part is cold and insensible ; it is much swol-
 len, and crinkles under the finger in conse-
 quence of the  presence of gases.   The soft
 parts  under the skin  are  black, putrid, and
 rotten, and soaked in  a thin, ill-smelling fluid.
 After a bad  compound  fracture or gun-shot
 wound  of a  limb,  the   mortification often
 spreads very  rapidly  toward the trunk, and
 its course is not arrested before it carries off
 the patient.   In less  severe cases, and when
 but a small portion of an extremity mortifies,
 in consequence of a deficient supply of blood,
 the edges of the gangrenous  patch become
 sharply defined, r.nd  are separated  from  the
 surrounding and living integument by a bright
 red  groove,   moistened  with purulent dis-
 charge.  This  gioove is the so-called line of
 demarcation,  and when present  always in-
 dicates an arrest of the mortification.   It in-
' creases in width and depth, and ruddy granu-
 lations  are  formed, from  which  there is  a
 healthy discharge.  The deeper portions  of
 the mortified part then become detached from
 the tissues beneath, which are also covered
 by granulations ; before the dead portions are
 detached, the  blood-vessels  are  closed  by
 coagulation of  the blood  at their extremities.
 After the  whole of the  mortified  tissue  has
 been thrown off, the  resulting wound  closes
 rapidly by granulation  and  scarring.  The
 tissues, which are less readily detached, and
 which generally remain when dead for a long
 time after the removal of  other soft parts of the
 gangrenous patch, are tendon and bone.  Py
 the formation  and subsequent extension of
 this line of demarcation, a foot  or hand, or
 even the greater part  of a limb, may undergo
 spontaneous  amputation.    This process of
 separation is generally attended by a profuse
 and  exhausting discharge  of pus.  The in-
 tensity of the constitutional disturbance varies
 according to the extent and the cause  of ihe
 mortification.   In cases of rapidly-spreading
 death of a limb, in consequence of injury, the
 patient falls  into  a very serious  condition,
 and presents all the symptoms of low typhoid
 fever.   If the  mortification be limited to  a
 small part only of a limb, there will generally
 be heat of skin, thirst,  headache,  nausea, a
 rapid pulse, and other symptoms of high in-
 flammatory fever.
    Treatment.—The  general  treatment  of
 mortification should consist in husbanding the
 patient's  strength by giving  very  nutritious
 and easily digestible food, with port wine and
 brandy and  water as  drinks  ; opium  is ad-
 ministered in  most cases for  the purpose of
 relieving pain and  allaying  nervous  irrita-
 bility.  When the symptoms  are those of a
 low  typhoid condition of  the system, bark, 
MOTHER'S MARKS
MOXA
323
 ammonia, and chloric ether  are  indicated.
 The local treatment, in cases where the morti-
 fication is limited to one or more fingers or
 toes, or to a small part of the surface of the
 body or of a limb, ought  to be such as would
 favor the speedy separation and throwing off
 of the dead tissues, and prevent as much as
 possible putrefaction.  Loose  shreds of skin
 should be at once removed, but care must be
 taken  not to  pull away with force  any dead
 tissue that may still adhere at its deeper parts.
 By  rough proceedings of this kind trouble-
 some bleeding may be caused.  The mortified
 part may be covered or surrounded by strips
 of lint dipped in a weak  solution of carbolic
 acid or of permanganate  of potash, and then
 enclosed in a thick  layer of prepared oakum
 or of cotton wool dusted with carbolic acid
 powder.  This dressing ought to be frequently
 renewed during the day, and the gangrenous
 tissues and  surrounding line of demarcation
 be well syringed with a  solution  of carbolic
 acid, permanganate of potash, or chloralum.
 In  some cases of  mortification,  where the
 pain is very great and the discharge from the
 seat of disease very profuse and  foetid, cold
 charcoal poultices may do good.  For further
 information  concerning  the  varieties  and
 special modifications of gangrene, the reader
 is referred to  the articles on Bed-Sores, Can-
 crum   Oris,   Frost-Bitf, Hosiptal Gan-
 grene, and Phagedena.
   MOTHER'S MARKS.  (See N^vus.)
   MOTES IN THE EYE.   (See  Musoe
 VOLITANTES.)
   MOUTH, Diseases of.—Under  this title
 it is proposed to deal with some of the chief
 affections of the structures contained within
 that cavity which is bounded in front by the
 lips  ; behind by the soft  palate and  fauces ;
 above  by the  hard  palate ;  below  by  the
 tongue ; and on the sides by the cheeks and
 parts of the upper and lower jaw bones.
   Contraction of the Opening of ihe Mouth.—
 This is  met with very rarely as a congenital
 deformity, but often results  from the effects
 of injury or disease.  In the  latter case the
 opening may  be much reduced  in  size, the
 lips  distended, and the  interior surfaces  of
 these structures and of  the cheeks  closely
 united to  the mucous membrane covering the
 jaws.  This  condition  not only produces a
 most unpleasant deformity,  but often,  in
 consequence  of the contraction of  the open-
 ing of the mouth and of the restriction of the
 movements of  the  jaw, leads  to serious dis-
 turbances of digestion and  nutrition.   The
 most frequent causes of this unfortunate con-
 dition are cancrum  oris, lupus or epithelioma,
 ulceration of the cheeks and gums from mer-
 cury, deep burns of the face, and sloughing
wounds.   For affections of this kind there is
no treatment  short of a well-planned  and
carefully-performed plastic operation.
  Spasmodic Contraction cf the Masseter, or
 large muscle  which closes the jaws, is occa-
 sionally met with  in connection with painful
 cutting of a wisdom-tooth.   In consequence
 of the ulceration of the gum and the irritation
 about the crown of the appearing tooth, the
 masseter muscle falls into a state of painful
 and persistent spasm.  The  jaws are kept
 closed  and cannot  be separated except by
 using a wedge.  A similar spasmodic condi-
 tion is sometimes associated with caries of a
 molar tooth.  The only treatment  for this
 affection, and one which is  always effectual,
 is removal of  the offending tooth.
   Tumors.—Cysts are frequently met with on
 the  floor of the mouth.  They may be con-
 genital or  the resut of obstructed and dis-
 tended ducts.   These  growths are described
 under the head of  Ranula.  Solid tumors are
 not often observed on the floor of the mouth.
 A fatty growth occasionally makes its appear-
 ance under  or within the tongue.  Large cal-
 careous masses, which  are supposed to be
 salivary calculi, seated within the ducts, some-
 times form  under the mucous membrane  at
 the floor of the mouth.  The most formidable
 morbid growths to be met with in  this cavity
 are  those which spring  from  the  upper  or
 lower  jaw,  in most cases from the former.
 These generally grow rapidly, involve impor-
 tant organs, and necessitate sooner or later
 some capital surgical proceeding.
  For other  affections  of the mouth see
 articles  on  Aphth/E,   Gums,  Hare-Lip,
 Quinsy, Ranula,  Salivation.
  MOUTH-WASHES.  (See Gargles.)
  MOXA is a method of applying actual fire
 to the surface  of the body for  the purpose  of
 producing   counter-irritation,   blistering,   or
 cauterization, or to form an issue.  It is an
 old and  common  plan of treatment in the
 East, but is seldom applied in this  country.
 The affections for the treatment of  which it
 is generally employed are diseases of the
 spine and  joints,  and muscular  rheumatic
 pains.  A moxa is composed of some material
 which will burn readily, as cotton wool, lint,
 German tinder, dry rotten wood made into
 a paste with spirits of wine, blotting paper,
 etc.  The most convenient  plan is to take a
 cylinder of cotton-wool, previously dipped in
 a solution of nitrate of potash, and then well
 dried, and  to  place this in a  small pill-box
 without the  lid and the bottom of which has
 been removed.  This box should then be held
 over the  selected  part of the surface of the
 body by means of  a loop of thick  wire, and
 the wool ignited.  If it be intended to produce
 only redness of the skin  or  slight blistering,
 the moxa should be held at  some distance
from the skin and be left to itself to burn out,
but when a slough  is to be formed and a deep
wound to act as an issue,  the ignited  wool
should be applied  close  to  the  surface and
combustion  be kept up by blowing upon the
flame through  a long tube, or  by working  a 
324           MUCILAGE
MUSCjE volitantes
small pair of hand-bellows. The surrounding
skin must be protected by layers of lint dip-
ped in cold water.  When the moxa has been
consumed, the patch of burned skin should be
covered by a fold of  moistened lint,  which
after twenty-four or thirty hours is to be re-
placed by a bread poultice.
  MUCILAGE is a solution of gum in water,
used as a medicine sometimes.  (See Acacia.)
The mucilage of gum-arabic, so commonly
used for household purposes, is made by dis-
solving gurn-arabic (the best is nearly color-
less) in either hot or cold water till the whole
is of the consistency of  cream.   It must  be
kept from contact with the air.
  MUCOUS MEMBRANE  is the interior
lining of the human bod}', which, commenc-
ing at the lips, nostrils, eyelids, and ears, and
after lining the several organs from which  it
starts, unites at the back of the mouth or in
the pharynx.  One portion descending through
the wind-pipe and bronchial tubes, finally ter-
minates in the air cells  of the lungs ; while
another proceeds down  the oesophagus,  or
gullet, lines the whole length of the aliment-
ary canal, and finally ends  in  the  outlet of
the bowels.  This  membrane  is extremely
delicate, and when irritated or inflamed gives
rise to many troublesome ailments.
  MUCUS is a thin glairy fluid  secreted by
the mucous membrane of the body, and always
present in a certain quantity, which is greatly
increased by inflammation,  and  altered in
character  if  it be deposited  from unhealthy
tissue.
  MULBERRY CALCULUS is a name
given to a stone in the bladder, which has a
rugged surface and is a deep purple color like
a mulberry ;  such stones give great pain and
distress from their rough outline ; they are
formed principally, if not wholly, of oxalate
of lime.  (See Stone.)
  MUMMIFICATION.  (See Mortifica-
tion.)
  MUMPS, also known as  Parotitis  or
Cynanche Parotidea,  is an  inflammatory
affection of the salivary glands, especially  of
that one lodged between the jaw and the ear,
called the parotid. It seems to  be contagious
or infectious, and often spreads through  a
family or  district.  It  begins with some de-
gree of fever,  and  soreness and  swelling
about the angle of the jaw.  This swelling
gradually extends toward the ear and toward
the chin, so that the whole side of the face is
swollen.   The swelling  interferes with the
movements of the  lower jaw,  so  that the
mouth can  hardly be opened, and even the
slightest attempt at opening gives  rise  to
acute pain. From accumulation of the saliva,
etc., in the mouth itself, it decomposes and,
as a consequence, the foetor of  the breath is
very troublesome.  The appetite at the same
time is  usually good, and much pain  is ex-
perienced in  endeavoring to  satisfy it.  The
disease docs not last long, in about four days
it  reaches  its  height and then  gradually de-
clines, rarely going into suppuration.   Occa-
sionally it is said that, during the abatement
of the disease  other organs  may be affected,
especially  the testes  in male subjects ;  but
this is by no means necessarily so.  It is true
that these  organs  are so affected sometimes.
but the attack is rather simultaneous or fol-
lowing close upon the mumps than any true
metastasis, that is, passage of inflammation
from  one spot to another, leaving one  organ
and attacking  another. Such a change of site
is  rare, and this  can hardly be said to be an
example of it.
   Treatment.—The remedies  to be used for
mumps are simple.   The bowels should be
well opened, best  by some  saline medicine,
say a dose of  Rochelle salts, in the form of a
Seidlitz powder.  The patient had better be
kept in-doors and kept warm,  with a piece of
warm flannel round the  throat.  The diet
should be milk as nearly as possible.  Warm
opiate fomentations  or   dry  heat  may be
used to relieve the pain of the inflamed parts.
   MURIATIC ACID. (See Hydrochloric
Acid.)
   MUSC2E VOLITANTES, or MOTES,
are the small dark bodies and beaded  strings
which appear to  some individuals  floating
across the field of vision, and give rise to
much trouble and often to unnecessary alarm.
Sometimes but one or  two small bodies, like
specks of dust, are  observed rising and fall-
ing, and then when the person's  attention is
directed to some external object these sud-
denly disappear.  At other  times, by a sud-
den movement of the eye, the field of vision
is  crowded both by  specks and by beaded
strings, which  glide about for a time and then
slowly sink.  These bodies are analogous to
the highly-refractive globules which are ob-
served both singly and arranged in  strings
when one  looks through a microscope, the
field of which is brightly illuminated. Muscat
are generally  observed for the first time at
about the age of twenty-five, or between  this
and the age of thirty or thirty-five.  At first
they are few in  number but soon  increase.
They  are  usually observed by  myopic or
short-sighted persons, but do not indicate, as
is  too  often supposed, any  deep-seated and
progressive disease  of the eye.  Although
these  floating  bodies increase in number as
the patient gets older, and give much trouble,
they are generally associated  with  a normal
continuance of good, and in  many cases even
acute  sight.  Muscae, however,  must not be
confounded with  the  mistiness of vision  and
the floating opacities  which are among the
symptoms  of  advanced disease of the mem-
branes and humors of  the eye, or of hemor-
rhage into  the interior of  the  eyeball.  The
floating muscae or motes, are loose portions of
the delicate filamentous tissue of the  trans- 
MUSCLE
MUSTARD            325
 parent  and  apparently structureless viscid
 material which fills up the interior of the eye,
 and which is called  the  vitreous  humor.
 Muscae volitantes cannot  be completely re-
 moved  by  treatment.   If  at any time  they
 should become unusually numerous and  give
 rise to  much irritability,  the application  of
 a solution of atropine dropped  into  the eye
 will give temporary relief.
  MUSCLE forms a very important tissue
 of the body.  There are two kinds of muscle
 —i. That which is found in the  muscles  of
 the trunk and arms and legs, and by which
 we have  the  power of moving  about ;  this
 kind is made  up of bundles of  fibres and by
 the contraction  of these fibres, under the in-
 fluence of the will, movement is performed.
 The biceps,  for instance,  is a muscle of this
 class ; it forms the well-known prominence in
 front of the upper arm  ; it is attached above to
 ihe shoulder-joint, and below to the humerus
 or bone of the upper arm ; now, when it  con-
 tracts, the two  ends tend to approach  each
 other and so the arm becomes flexed or bent.
 In  the body,  therefore, there is an immense
 number of muscles, by means of which, when
 they  act  either singly  or in combination,
 every movement can be performed. All these
 muscles are supplied by nerves  which are in
 direct communication   with the brain  or
 spinal cord, and by which the will can act upon
 any part of the system.  Since these muscles
 are under the influence of  volition, or the
 will, they are called voluntary muscles.  These
 muscles  may become  hypertrophied,  or in-
 crease in bulk from active use, as is well seen
 in the limbs of an athlete, and in the arms of
 a blacksmith  ; or they may waste from  dis-
 ease, or become atrophied, as in  cases of par-
 alysis, or in cases of long-standing  disease,
 as cancer or consumption.   Local wasting of
 the muscles of the  fore-arm may come on  in
 some cases  of lead  poisoning, and a general
 and gradual wasting of  these muscles is an
 important part of the  disease known as  pro-
 gressive  muscular  atrophy.  Spasms,  or ir-
 regular muscular contractions, which occur in
 the course  of  tetanus and some other nervous
 disorders, are due to an altered  condition  in
 the nerves which supply them.   2. The other
 class of muscles is known as the group of in-
 voluntary muscles,because  although they are
 supplied  by nerves and have the power  of
 contracting, they are not under the influence
 of the will ; they also are formed of bundles
 of fibres,  but  of different  structure and ar-
 ranged in  a different  way.  The heart, the
 womb, and the muscular coats of the stomach
 and intestines are made  up of this involun-
 tary muscle ; in  the heart,  the blood  is pro-
 pelled through the body by the muscular con-
 traction,  and  it may increase in frequency
from disturbed nervous influences, as  is seen
by the palpitation which comes on from fright,
etc.  This tissue may become hypertrophied
 in some cases of heart disease, and cause that
 organ to increase vastly in  size.   In the
 womb,  hypertrophy  of  the  muscular  coat
 takes place in pregnancy,  and it is by the
 contraction  of this tissue that  the  infant is
 finally expelled from  the  womb ; the muscu-
 lar fibres  afterward become fatty and waste
 away.  In the intestines it is by means of the
 gradual wave-like  contraction of the muscular
 coat that the food is propelled  along the in-
 testinal canal ; if the coat is torpid  and will
 not contract,  constipation ensues ;  while if
 its  action  is irregular and excited,  diarrhcea
 and griping pains  may come on.
  MUSHROOMS are  one of many species
 of Agaricus, of which few are usually eaten ;
 and although much has been written  and said
 to prove that many more  may be safely used
 as food, we are inclined  to  think that such
 experiments are better left to  those  who are
 botanically acquainted with the peculiar struc-
 ture of  each species, for of late many serious
 accidents  have occurred to unskilful judges,
 who have eaten poisonous mushrooms instead
 of those which are really  edible.  The  com-
 mon   mushroom,  Agaricus campestris,  is
 readily  known by  its fragrant odor,  which is
 its  chief characteristic,  and  the absence  of
 which is very  suspicious.   When  in a very
 young  state it  resembles  little snow-white
 balls which  are  called buttons ; afterward it
 acquires a stalk,  separates  its cap,  and  be-
 comes shortly conical with liver-colored gills,
 and a white thick  fleshy cap,  marked wth a
 few particles of gray.  At a more advanced
 age the cap is concave, the  color gray, and
 the  gills  black ; in  this  state it is  called a
 flap.  As a ruie, the colored varieties  of mush-
 room are  unfit; for food, and  such  as have a
 milky juice should be  avoided.  In case  of
poisoning  by  spurious  mushrooms,  take a
 liberal dose of any  emetic that may be  at
 hand, and after the stomach has settled  take
 2 or 3 tablespoonfuls  of castor-oil.
  MUSK is the  peculiar secretion  of  the
 musk deer,  a  native  of Thibet and Central
 Asia.   It occurs  in  irregular reddish-black
 grains, bedded together and soft to the touch.
 The odor is powerful,  diffusive, and persis-
 tent.  This substance is described as stimu-
 lant and antispasmodic.   No physicians care
 to prescribe it.   Most of the musk commonly
 encountered is  spurious.   There is a  root
 known as Sumbul or Musk Root which has a
 similar  odor.   This  comes from  Siberia—
 otherwise its  origin is unknown.   It seems
 to act something like valerian, and  has been
 used in Russia for low fevers.  Its use has
 not been attended by much  success in this
 country.
  MUSTARD  is the seed of two  kinds of
 Sinapis, one of which yields the black,  the
 other the  white mustard.  These yield an oil,
 which is also officinal.  The black seeds are
 smaller than the white.  The two together, re- 
32G            MYALGIA                                   NyEVUS
duced to powder, constitute the officinal sub-
stance.   The  composition of these seeds  is
peculiar.  The black give off  a  volatile oil,
which it does  not  contain ready made, but
which is formed by the union of two substan-
ces contained in mustard if water be present.
This volatile oil  is light yellow and very
pungent, while mustard does  not yield the
oil, but  contains a non-volatile crystallizable
compound exceedingly irritant.
  There are two  preparations of mustard :
first, the well-known poultice, which should
be made with lukewarm water, and no spirit
or vinegar should be added.  In  the officinal
preparation, linseed-meal is added.   One  of
the best plans is to spread a  little mustard
paste over a  moderately hut linseed-meal
poultice, with  a thin piece of cambric over
that.  Second,  the compound  mustard lini-
ment, a new preparation.  Mustard seeds and
flour act as a  powerful  stimulant.  In good
large doses it causes speedy vomiting, useful
in narcotic poisoning ; in smaller doses, as a
mild stimulant, it aids digestion.  Externally,
  N2EVUS, called  also  erectile tumor, or
commonly, mother's  mark, is, anatomically,
a tumor  composed of dilated blood-vessels,
and those small ones ; or generally it is a dis-
eased formation,  in  which the vascular tis-
sue bears  the most  prominent part.  The
simplest  form, a congenital one,  is an affec-
tion of no danger, rather  a deformity than a
disease.  It is very  superficial  and hardly
projects above the level of the skin consist-
ing of a patch of dilated capillaries.  Although
usually congenital, it  may develop later  on ;
frequently  the patches disappear  of  them-
selves, but more  generally increase in size,
and vary in shape.  The most common local-
ities are the true skin of the face, head, neck,
back,  and buttocks.   Another form of naevus
is found  in  the subjacent tissues, consisting
of dilated  veins, causing  an elastic,  livid
tumor.   The true erectile tumor is  one com-
posed  of capillaries  and  arterial  branches
largely  dilated, with  strong,  thick, vascular
walls.  There is free communication between
these vascular tubes, which are attended with
large tortuous veins.   The growth is usually
congenital, and its most  common  situations
are beneath the integuments of the face, head,
neck,  back, and buttocks, orbit, bones or vis-
cera.   Pathologically considered, there  is no
aneurism in the proper sense of the term in
this growth, as there is  no degeneration of
coats, but dilatation  with hypertrophy,  and
increased function as  well.  A bruit is heard
in it, sometimes associated with  a  vibratory
thrill, and though it pulsates  synchronously
with the action of  the heart, this pulsation is
less distinct and has less expansion than true
mustard acts as  a powerful  stimulant, useful
in local pains of various  kinds, especially
slight inflammations.  It is frequently used
in foot-baths.  Various  plans  are employed
for applying  mustard to the skin ; the best
are those hinted at above, but by far the most
convenient is  in the shape of Rigollot's mus-
tard leaves.
  MYALGIA.   (See Rheumatism.)
  MYOPIA, a condition in which the vision
is altered.   (See Eye and Vision.)
  MYRRH is a green  resin, exuding from
the Balsamodendron Myrrha, a tree  of  the
turpentine group, growing in the East.   It
occurs  in  irregular  reddish fragments,  the
surface often covered with powder.  It has a
peculiar odor and taste.   Myrrh is contained
in a variety of pills,  for the sake of its warm-
ing  and   stimulant  properties.   It  is  fre-
quently given along  with  iron  and aloes
especially.   Occasionally also as an  expec-
torant.   The  tincture of myrrh may be used
for that purpose, as well as for an application
to spongy gums, aphthous mouth, etc.
aneurism (Sec Aneurism).  It is worthy  of
note, that in the female  adult these tumors
may be the  seat of vicarious menstruation,
the tumor becoming dense and full at the re-
turn of each period, and the blood slowly
distills from  some fissure  or sore on its sur-
face.   The treatment of  erectile tumor may
be conducted on three principles :   (i) Re-
moval  ; (2) Diminution of arterial supply ;
(3) Effecting change of structure.
  1. By Removal.—In cases where the skin is
involved, the removal by  the application  of
ligature is  the most successful.  The tumor
is  transfixed by a stout  needle carrying a
hemp or silk ligature, which is left in by with-
drawing the needle ; the loop is then cut, and
both sides of the mass included in  each por-
tion of the thread, which is tied up as tight as
it will bear ; by this  means the nrcvus  is
strangulated or killed, and brought away.  In
complex  nacvi several  such loops must be
used.  In  some instances transfixion with
hare-lip pins, and  ligatures  twisted round
them, suffice to destroy the tumor.   In large
naevi, where the integument is uninvolved, it
may be dissected from  off the mass and re-
flected, so  that  the  naevus may  be strangu-
lated subcutaneously, and the flaps being re-
placed, there will be an  avoidance of  the
puckered scar frequently  left after ligaturing
these tumors. A method of ligature devised
by Professor Wood, whereby skin  is saved
and  scar prevented,  is thus  performed :  A
slightly curved needle on  a handle, with  an
eye near  the point,  is armed with a  fine
smooth hempen thread ;  "it  is  first passed
under the skin round half the circumference
N. 
NAEVUS
NAILS              327
 of the morbid tissue, entering and emerging
 through the skin at the opposite pole of the
 tumor.  The short end of the thread is left in
 ihe  puncture and  the  needle  withdrawn,
 carrying the long end.   Next it  is  passed
 under the base of the tumor across its diame-
 ter, entering and emerging at the  punctures
 first made.  The loop at  the eye of the nee-
 dle is then caught and held while the needle
 is withdrawn, carrying the free end of the
 thread.   Lastly, the  needle is passed round
 the remaining half of the circumference, under
 the skin,  through the same  two punctures,
 and the ligature  thread detached.   There are
 now a loop and two free ends emerging from
 the farther puncture, the thread being entirely
 sunk into the puncture nearest the operator.
 The ends are then made each to pass through
 the loop, and tied very tightly in a loop knot,
 so as to leave the power of tightening  it as
 the parts enclosed shrink under the ulcerative
 process.   As the thread is tightened the loop
 recedes into  the  puncture, but is held there
 by the ends passing through it, and the pres-
 sure  exercised   throughout  is  everywhere
 equalized.  By this  method the suppuration
 and slough formed by the naevus escapes  by
 the punctures along the thread.  The small
 spots of cicatrix  remain as the only evidence
 of the  operation."   Extirpation by the knife
 u only advisable when the tumor is small,
 and can be lifted up from the parts  beneath
 i:,and its shape and size accurately determined.
 Two  elliptical   incisions  should  be  made
 so as to include  the whole of the diseased
 growth and a little of the sound tissue sur-
 rounding it.
   2. By diminution of the  arterial supply.—If
 the tumor is so situated that it is inaccessible
 Ijy  the knife or ligature, the main  arterial
 trunk may  be ligatured ;  as, for example, if
 within the  orbit, by ligature of  the common
 carotid,  or, in some instances,  the  feeding
 vessels  can be  obliterated with a  twisted
 suture.
   3. By effecting change of structure.—Con-
 solidation of the contents, converting the tex-
 ture into a compact mass, or by converting it
 into abscess.  The means adopted to this end
 are : Pressure, potassa fusa applied  lightly,
 so as to induce ulceration, thus imitating the
 process  of spontaneous  cure.  A  red-hot
 needle  or  galvanic cautery introduced  fre-
 quently and freely through the mass.   The
 injection of some coagulating fluid through a
 fine syringe.  The seton.   If very small and
 superficial, the repeated application of nitric
 acid will destroy it, taking  care in applying
 the acid that the parts immediately surround-
 ing the naevus are not implicated.  Vaccina-
 tion is sometimes  of use,  in children, in the
 site of the  tumor.  By obstructing both the
 arterial  and venous supply, the contents of
 the tumor may be caused to suppurate,  and
after the evacuation of the pus the naevus will,
 in   some   instances,  entirely   disappear.
 Amputation  has  been  necessary  in  some
 instances, as for example, where the greater
 part of the foot or hand,  or a  finger or toe,
 have been involved.  There is likely  to be
 considerable hemorrhage in such a case.
  NAILS,  Diseases of.—Acute  inflamma-
 tion of the soft structure  into which the root
 of the nail is implanted frequently occurs  in
 the  toes, in  most  instances the  great toe,
 after much walking in tight or short boots.
 The whole toe becomes red and swollen, and
 even slight pressure upon the free edge of the
 nail causes acute pain.  The crescentic mar-
 gin of skin at the root of the nail is retracted,
 and in the course of three or four  days  there
 is from  this part and from under the nail a
 scanty discharge of dark-colored and ill-smell-
 ing pus.   The whole nail then becomes thick-
 ened, and is finally loosened from its attach-
 ment to  the top of the toe, and is thrown off,
 leaving a new short and  delicate  nail which
 grows slowly and is for several months over-
 hung by the  structures forming the swollen
 extremity of the toe.   The usual treatment
 for this affection is  absolute rest, and the fre-
 quently-repeated application of lint dipped in
 cold water or lead lotion.
  Psoriasis of the nail is not often met  with.
 It attacks  the nails both  of the fingers and
 toes, and is in most instances observed in pa-
 tients who  have had  the venereal disease.
 The affected nail becomes brittle,  thickened,
 and very rough on its surface.  It is also very
 convex on  its upper surface, and has been
 said to resemble in  miniature the outside of
 the concave shell of an  oyster.   The free
 edge is rough and broken, and the skin at its
 root and along its sides is swollen and red-
 dened.   The nail is finally thrown off, and
 leaves a raw and inflamed surface upon which
 a small and malformed nail finally  grows.  In
 severe cases the inflammation extends and in
 volves the whole of the finger.   In acute and
 severe cases, warm fomentations or poultices
 may be applied with advantage. The chronic
 form is usually treated by the internal admin-
 istration of  mercury, arsenic, and bark, and
 by the local  application of glycerine  or tar
 ointment.  The roughness of the  surface of
 the nail may be removed or reduced by fric-
 tion  with a small file or with sand-paper.  The
 affection in most cases is very obstinate.
  Onyicha  maligna is  an unhealthy ulcera-
tion of the bed of the nail affecting one of the
 fingers or toes of a scrofulous child.  The end
of the digit  is much swollen,  and of a deep
 ied color.  The nail is expanded  at its free
edge and is in-curved laterally  ; it also loses
its color and is lifted from its  bed by a layer
of a dark thin and very foetid discharge.  The
fold of skin at the root of the nail is retracted,
and at last the nail itself is thrown off, leav-
ing a deep irregular  ulcer with jagged edges.
This  ulcer increases in extent, and the sur- 
32S              NAILS
NECK
rounding  skin  becomes redder  and  more
swollen.   The  progress of the ulceration is
attended with severe pain.   This disease is I
often excited by a slight injury to the digit.
The simplest  local treatment for this very
obstinate disease is the application every sec-
ond or third day of a strong solution of lunar
caustic or blue-stone.  Arsenic also is a use-
ful agent,  but ought not to be employed ex-
cept with great caution.  The nail should be
removed as soon as it is loose.  The general
treatment should consist  in  placing the pa-
tient in good air, giving plenty of nourishing
food, and  in the internal administration of
chlorate of potash with small  doses of bichlo-
ride of mercury or gray powder.
  In-growing toe-nail, or growth of nail into
the flesh, occurs in almost  all cases on the
outer side of the great toe.  It is a very trou-
blesome  and painful affection, due to over-
paring of  the  nail, or  to compression of the
foot and  toes  caused by  walking in tight
boots.  The soft and delicate integument at
the outer edge of the nail,  in consequence
cither of  compression or of irritation, swells
and becomes  inflamed.  The swelling does
not subside  but is kept up and increased by
the contact  of  the  sharp edge of  the nail,
which, as this  structure  grows, is imbedded
into the overlapping fold of skin,  and at last
causes ulceration and a  discharge of pus.
From the raw surface thus formed there often
springs a prominent mass of proud flesh or
exuberant granulation, which is so extremely
tender that  the patient cannot wear a boot.
Exercise,  or even an  attempt to walk,  will
often produce  redness and  swelling of the
whole toe.  When the  end of the toe is much
inflamed,  and  the edge of the nail is over-
hung by a large fungous mass of proud flesh,
the foot should be kept at rest and uncovered
by shoe or stocking, and  the inflamed parts
be bathed wth some cooling lotion, as a solu-
tion of muriate  of  ammonia in water  and
spirits of wine or lead lotion.  In slight cases,
and when there is little or no inflammation
present, the nail, after having been softened
in warm water, should be  scraped very  thin
with  a sharp  pen-knife, and under its outer
edge should be then pressed in a small quantity
of scraped lint, so as to form a soft and yield-
ing pad between the irritated  skin and the in-
growing nail.   The scraped  lint  should  first
be oiled and then introduced little by little
with the end of a small probe. This treatment
should be repeated every second or third day,
until the edge  of the nail no longer presses
against the side of the  toe.   In severe cases
where the ulcer is large and very  tender,  and
the margin  of  the nail is  deeply imbedded,
removal of the  outer  half of the nail is the
most effectual mode  of treatment.  This is a
very painful operation, and should always be
preceded by the administration of chloroform,
or by what acts quite as effectually, the local
application of ether-spray.
  NARCOTICS are remedies which procure
sleep.  There  are  usually other  remedies
associated  with  these which may  procure
sleep in  another  way,  by  relieving pain.
These are technically known as Anodynes,
and  include such substances as belladonna,
stramonium, and aconite, which have directly
no influence in procuring sleep.   The only
real  narcotics,  however, are opium and  its
chief alkaloid, morphia, and  chloral.   The
latter substance has only been recently intro-
duced, and had better be given in the form
of the syrup of the  hydrate of chloral.   Bro-
mide of potassium and Indian hemp are com-
monly included in the list, but have no direct
influence in giving sleep.  Sleeplessness may,
however, arise from various causes, and so a
remedy which is useless at one time may be
of value at another.  In the main,  however,
if we desire to procure sleep,  we must have
recourse either to opium or to chloral. Opium
seems to have this  inconvenience : it  is apt
to be followed by headache, and it constipates
the bowels ; it also disorders the  digestive
organs generally ; and so it is better to avoid
its use in a good many cases.  Chloral was
introduced with the  notion that,  being ab-
sorbed, it would in the  blood become con-
verted into chloroform, and so produce a kind
of anaesthesia.  Experience, however, shows
that  it acts rather as  a simple narcotic, than
as an anaesthetic, and its effects seem to be
less felt afterward than those of opium.
  NASAL HEMORRHAGE.  (See Epis-
taxis.)
  NAUSEA is  a common symptom of dys-
pepsia and disorders of the stomach.   When
occurring in women  in  the early  morning
during the child-bearing period, it is one of
the signs of pregnancy.   In diseases of the
liver and  kidney, as  well as in those of the
stomach, nausea may be a prominent and dis-
agreeable symptom.   It may  be  produced
also  by  nervous and emotional influences.
(See Indigestion.)
  NAVEL.  (See Umbilicus.)
  NECK  (Stiff)  is  nothing  more  than a
cramp or rheumatic affection of the muscles
of the neck, and is caused by sitting in a
draught ;  but its persistence and the delicacy
of the part affected  make it necessary to treat
it with care.  Relief may generally be ob-
tained by warm fomentations and  the warm
bath ;  warmth  should also be applied  by
means of  hot  flannels wrapped round  the
neck.  This will usually effect a cure in a few
hours at furthest, and in the mean time it is
best to keep quiet and especially to avoid any
sudden starts or wrenches to the neck.  Any
attempt to place the neck in its proper posi-
tion by manual force is attended with dan-
ger. 
NECROSIS
NECROSIS
329
   NECROSIS means the death of bone, an-
 alogous to gangrene of the soft parts, by
 which  the  shaft of  a long bone (generally)
 dies from injury or inflammation, and is en-
 closed  in a case of new bone.   Exfoliation is
 a form of necrosis, but it is the death of a
 thin  superficial  layer not encased  in  new
 bone.  The dead portions of  bone are called
 sequestra.   Necrosis may be  divided  into
 simple and complicated ; the  former when it
 is unaccompanied  by any disease, the latter
 when associated with fracture  or caries.  It
 is further divided into idiopathic, when  aris-
 ing without any assignable cause ; traumatic,
 when the  result  of injury.  Necrosis is also
 acute and  chronic ; the  first act, so to speak,
 the local death, being acute, and the subse-
 quent process of the throwing off of  the old
 and formation of  the new,  being chronic.
 Necrosis varies very much in  extent, its  sim-
 plest form being.as above-mentioned,exfolia-
 tion, which is an external form  ; the internal
 form is where the inner portions of bone die,
 and the external  retains its vitality.   General
 necrosis is where both internal and external
 portions of the bone perish  simultaneously.
 Necrosis generally stops at the articulating
 extremities of bones, and thus the cancellous
 structure is less liable to necrosis than the
 compact, being, however, at the same time,
 more liable to  caries  (see  Caries).  The
 bones most liable to suffer are those most ex-
 posed ; viz., the  tibia, femur, humerus,  cra-
 nium, lower jaw, clavicle, ulna, etc.  Acute
 necrosis is more  prevalent in the young  than
 in  the  old.  The peculiar form of necrosis
 affecting the jaws has often, as  its  specific
 cause, the phosphoric fumes of lucifer-match-
 making ; this  disease has been  discussed in
 the article on Lucifer-Match-Makers' Disease.
 The process of necrosis can be related as fol-
 lows : In the first place, Inflammation, in the
 second  Death, in the  third Separation, in the
 fourth,  Reparation.
  (i)  Inflammation.—This inflammation  may
 be the result of a wound, bruise, or fracture ;
 or  it may  be  apparently  of  spontaneous
 origin.   The periosteum is removed, and in-
 flammation of the bone supervenes, and death
 of the  bone is probable, although  it does j
 occasionally recover ; but if the  internal  per-
 iosteum be  removed  or perish, the death of
 the bone is certain.   Exposed bone often re-
 tains its vitality, though apparently dead ; in
 these cases, it is  of a brownish color, is dull
 on  being struck, somewhat slippery  to the
 feel, and if pulled about with  instruments,
 bleeds.   If  all vitality be gone, it is white,
 dry, resonant  on being struck with a probe,
 and is perfectly bloodless.
  (2) Death.—Death  of bone  is often very
 rapid, sometimes occurring in a few hours  ;
while at others it takes a considerable time.
The appearance of the necrosed portion varies
in accordance with the period during which
 the bone is perishing.  If very rapid, it hardly
 appears different from healthy bone.
   (3) Separation.—The separation of the dead
 portion from the  living is slow, and its pro-
 cess is somewhat similar to the detachment of
 sloughs in the soft structures.  There is great
 activity  in  the structures immediately  sur-
 rounding this dead portion.   The vascularity
 is increased.  It is painful to the touch, and
 bleeds, the blood  being florid and arterial in
 color. A line of separation forms at the junc-
 tion of the dead with the living,  and the peri-
 osteum at this point is thickened. The living
 osseous substance along the line of junction,
 by becoming transformed  into a soft granula-
 tion material,  at  length becomes  a continu-
 ous trench ; this goes  on  deepening, and the
 above-mentioned  substance  is  firmly  con-
 nected with the living  bone.   The formation
 of this trench is accompanied by suppuration,
 and the  pus formed in the neighborhood of
 the dead parts  makes  its  way to the nearest
 surface, and in so doing interrupts the forma-
 tion of the  new bone which is being formed,
 and leaves  sinuses, or,  as they are  called,
 cloaca'; these cloacae correspond with sinuses
 in the soft parts, the pus passing out through
 them.  A probe passed  down any of these
 cloacae detects  the peculiar feeling of the dead
 portion or sequestrum  at the bottom of the
 openings. The separation of dead bone, and
 the formation of the new  bone, are  processes
 which advance together ; consequently  the
 sequestrum  is often  entirely surrounded by a
 shell of   newly-formed bone.  The  seques-
 trum is, after separation,  to be regarded as a
 foreign body, of no  use to the bone, and un-
 connected with it, and  must consequently be
 treated as such, and   its removal  assisted.
 The sequestrum is always smaller  than  the
 recess in which it lies, not from its absorp-
 tion,  but from the transformation of more or
 less  of the living bone  into  soft texture,
 whereby separation is  effected.
  (4)  Reparation.—The process  of reparation
 advances  both  superficially  and deep,   the
 former carried  on by the periosteum, a mem-
 brane invested with special ossific power, and
 the latter  consists of.osseous production from
 the living bone beneath the loosening seques-
 trum.  If the necrosis be internal, and a part
 of  the cancellous  structure only  has  be-
come dead, as soon as  the sequestrum is ex-
 truded, reparation rapidly follows.  The pus
 escapes through the laminated portion of  the
 bone by cloacae, which have been formed by
ulcerative action,  and  the process  is  a very
 tedious one, if  the sequestrum be small, and
 the original  inflammatory action limited,  the
 resulting  suppuration  being slow and slight.
 When the necrosis is general, the processes
of separation and  reparation advance in  the
same way.  There are instances where long
bones have been almost entirely reproduced.
Great care must be taken  throughout  the 
330           NECROSIS
NERVES
 whole period of treatment to keep the pcrioG-
 teum as entire as possible, and not to remove
 the  dead shaft too soon.   Short bones, if
 wholly necrosed, are never  reproduced, and
 reproduction is rare in the flat ones.
   Symptoms of Necrosis.—In the first place,
 there will be signs of some local injury, with
 suppuration  of the soft textures  round  the
 affected bone.   In old-standing cases there is
 great thickening of bone and superficial  tis-
 sues, with sinuses  leading to the dead bone.
 The dead bone, however, can only be felt by
 probing or by seeing it.   If  it can be seen,
 it is either white and dry or black, or yellow-
 ish and bare and hard to the touch.
   Treatment.—In  the early stages of necro-
 sis,  active measures  are   not  admissible.
 When abscesses point, they should be opened,
 all sequestra should be assisted to escape, and
 the health supported by nourishing diet  and
 stimulants.   If  the new shell of bone is  not
 able at first to support the weight of the limb
 or muscular tension,  splints must  be  em-
 ployed.   No attempt is to be made to detach
 the sequestrum, unless nature has done  her
 part of  the  work by entirely freeing it from
 the living tissue.   During  this  process  the
 surgeon's duty is to mitigate the symptoms,
 to prevent the  extension of  the evil, and to
 favor  the advancement  of repair.   From
 time to time the rate of progress of the sep-
 aration is to be gently tried by careful prob-
 ing, and the  sequestrum having been deter-
 mined to be loose, steps  for its removal must
 be taken.  An incision is to be made over it,
 and if the natural openings or cloacae, etc., be
 sufficient without  further  interference,   the
 mass may be withdrawn  by properly-devised
 forceps.   If, however, such openings are not
 large enough for its evulsion  the  new bone
 must be  cut away, with gouges, chisels, saws,
 trephines, etc., taking care that as  little new
 bone as possible is  removed, so that it may
 be brought to the surface.   All  unnecessary
 violence must be avoided, from the risk of
 doing damage  to surrounding parts.  When
 the sequestrum has  been removed, the wound
 must be moderately stuffed with lint, to arrest
 bleeding, and to insure granulation from  the
 bottom.   Antiphlogistic treatment must  be
 maintained to keep under any accession  of
 inflammation, and perfect rest insisted on, as
 it must be borne in mind that even in the most
 favorable cases, a  considerable time must
 elapse before the necessary consolidation has
 been  accomplished.  Amputation  is rarely
 demanded ;  but in young subjects, when vio-
 lent inflammation is followed by hectic, or in
 very chronic  cases,  when separation has be-
come far advanced,  but does  not complete it-
self,  and when the system has  been  long
battling with the exhaustion of irritation and
discharge, and  there is  evidently no chance
of a continuance of the struggle, the cause
 must be removed.    Again, amputation  is
necessary when in  the case of the extensive
death of a bone throughout  its whole thick-
ness, the expected reproduction fails.
  NEPHRALGIA is  a technical term for
pain in the kidney.   (See Kidneys.)
  NEPHRITISsignifiesinflammation of the
kidney ; the disease may be  either acute or
chronic ; but for the various kinds the reader
is referred  to  the  article on Bright's  Dis-
ease.
  NERVES play a most importantpart in the
phenomena of disease, but the exact nature of
the influence so exerted is far from being fully
understood.  The nervous system consists of
certain central  parts called ganglia or nerve
centres,  and certain cords  connected  with
these, which we commonly call nerves. These
centres are  distinguished by being made up
of small masses, more or  less irregular in
shape,  and called  cells.  These cells com-
monly send off one or more projecting  por-
tions of their  substance, like  tails.   These,
which are excessively minute,  serve  to con-
nect one cell with another, so as  to bring all
into accord, or, after being carried over by a
kind of sheath, go along with many others of
a like kind to form  one of the strings or cords
already alluded to,  and called nerves. Nerve
centres, then, are mainly composed of nerve
cells.  Nerves or nervous cords are made up
of bundles of finer cords directly communica-
ting with these central nerve masses.   The
functions  or duties of these two  are totally
different ; the nerve cords can only conduct
impressions, whether they originate without
the body or within it.   The centres, on the
other hand, take note of these impressions
and  convey a knowledge of  them  to  our
understanding.    Moreover,  should  these
impressions conveyed from without be of
such a nature as to demand active exertion
on the part of the body, the appropriate com-
mand, so to speak, comes from  the central
organ of the nervous system, and passes to
those  muscles  which have to execute  the
order.   Now, the set of nerve fibres which
fulfil the one function will not fulfil the other,
and so we have two  sets of nerve fibres, those
which convey impressions to the brain, called
sensory, and those which convey  impulses to
motion from it; these are called motor. Some-
times we find nerves entirely made up of one
kind of fibres, motor or sensory, as the case
may be, but most  frequently nervous cords
are made  up of both kinds.   If we take a
simple illustration of the two kinds of nerves
and their respective functions, we shall better
understand  them.    Suppose by  chance  wc
touch  a  piece  of   hot iron, the  flame  of a
candle, or anything of the kind, this conveys
to the part of the body touching  an  impres-
sion ;  this  impression is conveyed  by   the
nerves to the  brain, and is converted into a
sensation of pain, but promptly, as the result
of experiencing this sensation,  a  stimulus is 
NERVES
NEURALGIA          331
 conveyed  through the motor nerves  to  the
 part in  contact  with the  hot object, which
 causes it  to be  promptly withdrawn.   So
 speedily, however, all these various acts fol-
 low the one on the other that they seem to us
 simultaneous.  This is not the place to enter
 into proofs of this position, we  merely make
 the assertion, knowing that  it can be easily
 proved.
   There are several nervous cords, however,
 which have a function quite different from
 these.  They provide all  ihe various move-
 ments of life,  especially respiration, circula-
 tion, and digestion, and these have a most
 important bearing on the subject of disease,
 especially  those   presiding over circulation,
 which are  sometimes  grouped  under  one
 heading and called  the  vaso-motor nerves.
 One of  the most important bearings  nerves
 have on disease,  however, is that exercised
 through sensory nerves ; these, whenever over-
 stimulated,  it  matters  not by what means,
 give rise to a peculiar sensation  called pain,
 and this pain, which  is a purely  nervous ad-
 junct to most diseases, sometimes rises to the
 dignity of disease itself.   But the pain  thus
 experienced and  referred to  some particular
 part, is not really felt there ; it  is felt in the
 brain, but  the  origin  of  the impression is
 ordinarily, but not always,  referred to the dis-
 eased or injured  spot.   But this painful im-
 pression in  its turn  affects other parts ;  the
 nerves which rule the action of the heart are
 affected, and so that peculiar sickening feel-
 ing and  palpitation  or tremulous action of
 the heart is produced, which is commonly the
 result of great bodily pain.  The sickness is
 referred to the stomach, the palpitation to the
 heart, but it is the same nerve which produces
 them both,  and   the same  stimulus  which
 affects the nerve.  In recent times this mode
 of arguing has had  wider  application.  The
 set of nerves already alluded to as vaso-motor
 run along the  blood-vessels, and with them
 penetrate into every part.  The blood-vessels
 possess a  distinct muscular  coat which is
 ruled by these nerves, insomuch that when
 the  nerves  are  stimulated, these  muscular
 fibres contract and so diminish the calibre of
 the vessels,  and  consequently the supply of
 blood  sent  to  a  part.   On the other hand,
 when the power of these nervous cords is re-
 laxed, the muscular coat of the vessels  di-
 lates, and so their calibre is increased,thereby,
 of  course, increasing the quantity of blood
 sent to a part.  Some seek to account for the
 phenomena of inflammation in this way, but
 in the meantime our knowledge is too scanty
 to admit of  any wide generalization ;  never-
 theless, such facts show how much nervous
 influence is connected with disease, and  that
it is a fact never to be overlooked.
  No part or organ  of  the body can  be iso-
lated or considered apart from its neighbors ;
all are mutually dependent, so that when one
is ill the others are sure not to be well.  This
is especially  true  of the  nervous system.
Sound health  requires that it should be in a
carefully-balanced condition, and  any organ
out of order is apt to give rise to this imper-
fectly-balanced state of the nervous system.
Say, for instance, that an individual suffers
habitually from indigestion, so that  his body
is ill nourished, his brain of course will be so
also.  In him comparatively slight causes will
bring on nervous manifestations,owing to this
condition  of his system  ; he may  be impa-
tient  of slight sounds  or garish  colors, in
point of fact slight stimuli give rise to inade-
quate results.  This  is the condition  which
in ordinary parlance is called nervousness, or
the individual is said to  have  " the nerves."
Rest, quiet, and  good nourishment are  the
appropriate  remedies.
  NETTLE-RASH, or Urticaria,  is a
troublesome,  stinging,  skin eruption, which
gives rise to a sensation  resembling that  felt
after being stung by a nettle.   It appears on
the skin in red  and white wheals,  slightly
raised above the  surface, and producing  tin-
gling and  itching.   It may come on very sud-
denly and disappear in a few hours, and then
again temporarily appear ; eating muscles or
periwinkles,  or some kinds of oysters, will
sometimes  produce this disorder,  and  the
whole of the face and the body may in a very
short time become swollen and marked with
the eruption.  An emetic is the best remedy
in such cases, so  that the irritant matter in
the stomach may be at  once expelled ; bath-
ing the  skin with  warm  water will allay the
tingling.  Some people  are very susceptible
to this rash, and  in some it comes  out after
taking beer or any stimulant ; some,  again,
have  it after  eating  mutton,  or  pickles, or
any  acid  substance.   The eruption is dis-
agreeable  but harmless ; the treatment must
consist  in removing the  cause and in  avoid-
ing any article of diet which will  produce it ;
when it appears, bathing with warm water or
lead lotion will give relief, while  a purgative
should be  administered so as to remove anj
irritating cause in the intestinal canal.
  NEURALGIA  is  a term given  to  pains
sometimes following the  tracks  of nerves,
sometimes lying apart from them,  which can-
not be referred to any distinct morbid change
going on in the part.   Nevertheless, though
there  be nothing  in  the spot to  account for
the  pain, this may be  of  the severest possible
character, and we are fain, for want of a bet-
ter causation,  to refer it  to the nerves of  the
part.  Now, nerves, when cut, are not more
painful than other parts.   There is absolutely
no pain experienced in slicing the  brain ; in-
flammation  in tendons,  ligaments,  perios-
teum, and the like, where  there are  few or
no nerves, is intensely painful.  Sometimes,
however, pressure on  a  nerve  will give rise
to pain  in distant parts of a most intolerable 
332          NEURALGIA                               NEURALGIA
character.  Such is seen in aneurisms of in-
ternal vessels pressing upon nerves, and giv-
ing rise to frightful neuralgias.  But in ordi-
nary neuralgia  we have nothing of  the kind,
we have only most intolerable  pain and no
apparent cause for it.  In point of fact,  wher-
ever we see pain long continued and aggra-
vated, and at the same time we can make out
no definite cause for the pain, we term it neu-
ralgia.   Neuralgia,  strictly speaking,  how-
ever,  ought to  be restricted  to  pain in the
course  of nerves,  and  some  nerves  are
affected much  more frequently  than others.
Thus, neuralgia of the nerves which give the
face sensation is by no  means infrequent;  it
is most  commonly  called  tic-douloureux.
Sometimes the head on  one side may  be
affected, or yet again the sciatic nerve be its
subject,  giving rise to the condition  called
sciatica.  But internal organs maybe affected
in like manner, so that vve  may have neural-
gic pains of the heart, stomach, or intestines,
still more frequently of the womb, the blad-
der, and the rectum ;  pain not  due, that is,
to any  inflammatory or other local change,
but due merely, as far  as we  can say, to irri-
tation of the nervous filaments supplied to the
parts.   It is  hard,  however, to determine
whether such and  such a pain  is neuralgic,
where internal organs are concerned, so here
we shall limit ourselves to  an account  of the
simple and better-known varieties of  neu-
ralgia.
   Facial neuralgia, or  tic douloureux, is per-
haps the  most common of all, and  as the
nerve attacked  is made up of three branches,
any one of these may be affected.   One of
these branches  goes to the eye, and a part of
it passes out from the orbit and turns up over
the forehead.   This is often the  seat of pain,
and when so, the neuralgia generally affects
one side of the forehead, extending upward
toward  the hair.  The next branch of this
nerve comes below the eye and extends over
the cheek and on to the  side of  the  nose.
This, too, may be affected, and very often  is
so, especially  when the teeth on the  corre-
sponding side are decayed. The  third branch
of the nerve extends  along  the lower jaw,
and is not so often the seat of pure neuralgic
pain as  the others.  For instance, the branch
on the forehead may be affected  without any
definite  cause being ascertainable, that is to
say, purely neuralgic,  and very possibly de-
pendent on some change in the nerve centre,
rather than in the branch  itself.  But  in the
other branches we are much more likely to
find a cause in  some decayed  teeth or some
condition  of the jaw which gives rise to irri-
tation, and though we  include such  maladies
under the heading neuralgia, they are rather
instances of pain produced in one spot appre-
ciated by  the  sensory centres  in  another.
Neuralgic attacks commonly affect one side
only, and they are often attended by or end
in attacks  of  nausea and  violent vomiting.
The pain varies in severity  from a  slight
twinge now and again to unbearable agony.
Not unfrequently this pain  becomes periodic
in its onset, appearing at certain hours  of the
day and departing at others—thus simulating
the effects of malaria.  Whether such periodic
neuralgias are really produced by malaria is
not plain, undoubtedly cold and damp, do ex-
ercise a powerful influence  over them.   Cer-
tain forms  of  neuralgia appear to be associ-
ated with anaemia, and a goodly number with
imperfect digestion, so that  frequently bad
teeth and the  consequent imperfect mastica-
tion of the food  setting  up dyspepsia,  go
hand in  hand in producing face-ache.  Un-
doubtedly, bad  teeth are  one of the most
prominent causes of face-ache, neuralgic and
otherwise,  insomuch  that when  a patient
comes  complaining of pain in the face, espe-
cially the cheek.the first thing we do is  to ex-
amine  the teeth, and if any  be decayed we
send him or her to the dentist before  trying
any local remedy. . But even  with this pre-
caution we sometimes miss our mark, for the
source of the malady may  be the teeth, and
yet that  source  be not apparent, for one of
the common causes of this  form of face-ache
is an outgrowth  from the tooth itself, what is
technically called an exostosis.  This is often
difficult to detect, though pressure on  the
affected portion of the gum  gives rise to pain,
and even when  detected, the patient, having
had no toothache,and having nothing the mat-
ter with the tooth, may refuse to have it re-
moved.  To those not  conversant  with the
influence exercised by  the  teeth, particularly
the molars or grinders,  on the neighboring
parts when diseased, it would  be incredible
the amount of suffering  which may be pro-
duced by an apparently slight cause.  In some
instances so obstinate  is the pain  produced
by irritation of the jaw, that all the teeth may
have to  be removed  for  the  relief  of  the
malady, and even this may  not suffice, for we
have known violent face-ache produced by a
badly fitting set  of false teeth.   Exposure to
a draught of cold air falling on the side  of the
face is  not an uncommon cause of neuralgia.
This, perhaps,  most  frequently occurs  in
crowded  halls or assemblies, when a window
or door has been paitially opened for ventila-
tion, or driving home in  a  carriage, with the
windows open, or the like.  These causes are
all the more likely to  set the pain going  if
any such permanent irritation to the gum as
bad teeth exist, or  if the patient is liable to at-
tacks of neuralgia  of the face.  The pain fre-
quently prevents all attempts to sleep, 'but
once the patient has fallen asleep,  he may
rest soundly, for the pain no longer torments
him. Neuralgia  of the head presents nothing
special.  Fatigue or debility  is its most  fre-
quent cause.   (See Headache.)
  Sciatica is a form of neuralgia which in a 
NEURALGIA
NEURITIS           333
 good many respects differs from those already
 noticed.  (See Sciatica.)
   Treatment.—One thing is to be noticed
 with regard to all neuralgic attacks, they are
 most frequently brought on by fatigue, men-
 tal  or bodily,  or if  not produced by these
 causes, are most  readily produced  by  any
 other  cause in  subjects who have been ex-
 posed to these, or are  suffering from the
 weakness produced by them.   This is a most
 important indication in treatment ; indeed it
 may be said to  be its basis.   Rest and nour-
 ishment—nourishment and rest are the foun-
 dations of our means of dealing with neural-
 gia.   Nourishment may be taken with toler-
 able ease, but in certain cases where there is
 sickness and vomiting,  there may be some
 difficulty in improving  the general condition.
 This  form  of  neuralgia  is  often  associated
 with bad teeth, as  already pointed out, and
 these must promptly be removed. Frequently,
 after this is done, nothing except tonics are
 required. Stimulants, too, are as a rule neces-
 sary, but must be carefully selected  to  meet
 the  wants of each individual case. Rest is all-
 important, but  rest is not always  attainable
 without  something being done for  the pa-
 tient.  Where the pain  is very severe, the
 best thing that can be  done after having had
 the  bowels well cleaned out (this in all  cases
 is an  indispensable preliminary), is to  give
 the  patient the fifth of a grain of morphia
 acetate under the skin  of the  arm.  This will
 relieve the pain, and  procure  rest so much
 needed.   Many, indeed,  look upon  this as
 being  the  treatment in all instances, but its
 true value  we  have just pointed out—it pro-
 cures rest, and  so allows time for self-recu-
 peration.
   For opening the bowels in the first instance,
 saline purgatives are  perhaps best, but they
 may not act sufficiently  powerfully, and so
 calomel  or even croton oil is required, best
 of all  use  the  repeated doses of a laxative
 mineral water, such as Hunyadi Janos water.
 Aloes, especially as watery extract, is a good
 preparation,  particularly  in  sciatica,  where
 there is a suspicion that the cause of the mal-
 ady  is habitually over-distended bowels.   In
 most cases iron  and cod-liver oil are essential.
 Iron is best given in some mild form, as car-
 bonate, or  as reduced  iron, or as  peroxide.
 Cod-liver oil is best given  just after food, iron
 a.ong  with  food.   In   reality they are  both
 forms of food rather than of medicine.  If the
 malady is  periodic, as it often is, whether
 this  depend on malaria or not, quinine had
 better  be given,  at first in full doses (5 grains
or so),  after in smaller quantities, say 5 grains
of the citrate of iron and quinine three times
a day.   If there is indigestion, that too, must
be seen to,  rhubarb and soda or potass being
usually the best  remedies.
  In  rheumatic  cases,  especially in sciatica
dependent on this cause, iodide of potassium
 is the remedy.   Full  doses of 10 grains or
 more must be given.   Bicarbonate of potass
 is useless.  In neuralgic headaches,  sal am-
 moniac often does the greatest good.  That
 too, must be given in large doses, 30 grains
 or so, and it does not always succeed.  If the
 pain be  very intense,  chloroform  may  be
 given, but as we can  generally procure rest
 by the administration of opium  subcutane-
 ously, that  is to be preferred.  Chloral is a
 totally different thing—doubtless it will be of
 the greatest use, but its exact value  remains
 to be determined.  (See Narcotics.)
   In sciatica, local remedies have, as a rule,
 more  power than general ones.    This   is
 hardly true  of real neuralgia, but even in that
 one local remedy seems to surpass all others ;
 moreover it  seems to  be  best adapted  for
 those very cases which we cannot treat other-
 wise ; we allude to the continuous current of
 electricity.   This form  of electricity is to be
 carefully distinguished from those commonly
 in use, which is  termed  the interrupted cur-
 rent, and which not  only  is of no  use, but
 may positively do  harm.   The  continuous
 current is that which does most good in true
 frontal neuralgia.  Other local means have
 been tried—blisters, red-hot irons, ointments
 containing aconite, belladonna, veratria, and
 other powerful drugs—all have been tried,and
 too often tried in vain.  As a rule, if the neu-
 ralgia depend on a local cause, it will disap-
 pear with the removal of that cause,  and will
 not disappear until it is removed.  Thus, it is
 utterly useless to apply soothing remedies
 ointments, lotions, or what not, for a neural-
 gia  dependent  on a  bad tooth or diseased
 jaw ;  once these are seen to, the neuralgia will
 go.   (See Sciatica.)
   NEURITIS (optic) is a condition of  the
 eye not yet fully understood, and  only com-
 paratively recently discovered.  It affects the
 back part of the eye, and is only discoverable
 by means of  the instrument which allows of
 the  posterior part of the eye being examined
 during life.   If this instrument is so  held as
 to throw a beam of light into the eye while
 the observer's eye is  situated  at the  proper
 point of observation, there will generally  be
 seen a kind of reddish glare, indicating the re-
 flection of the retina,  or fine  nervous net at
 the back of the eye, with its blood vessels. At
 one  particular point, however, if the  instru-
 ment is in proper  focus, a white  patch be-
 comes clearly defined, and in its centre are to
 be observed blood vessels, to and from which
 branches of other vessels are  seen to ramify
 in every direction.  This is the optic  disk,  or
 papilla, the  point where  the  optic nerve
 enters, and inflammation of this spot is what
 is called optic neuritis.   The marks of this
form of disease are commonly  laid down  as
being an irregular, hazy, or woolly  appear-
ance of the  margin of  the disk  instead of its
clear, sharply-defined edge, as seen in health ; 
r><-> t
OO-i
NEUROSIS
NIPPLES
the surface, too, seems swollen and the whole
seems  to merge into the surrounding parts.
The most peculiar point connected with optic
neuritis  is,  that it  may exist  in the  most
marked degree without any interference with
vision, so much so, that  most frequently this
condition is  first discovered  by ophthalmo-
scopic examination.  The great value of optic
neuritis seems, indeed, to be as  a sign of  in-
tra cranial  disease—disease, that is  to say,
under  the  skull, which imght not otherwise
be detected.  Tumors of the brain are com-
monly  so indicated, but many points have to
be made clear with regard to it.   Indeed, its
mode of causation is by no means clear, some
supposing  that  the  influence is propagated
along the nerve of vision, that  is, the optic
nerve  and its covering ;  others rather by
means of the blood vessels which pass from the
interior of the skull to the interior of the eye.
  NEUROSIS is a word employed by mod-
ern physicians to  indicate  a  malady  which
depends on some perverted nervous influence
rather than on merely local change.   There
may be local change, but this would probably
depend on the perverted nerve  force rather
than the perverted nerve force should depend
on  the  local change.  A goodly number of
cases of palpitation  of the heart are of this
character ;  that is to say, dependent rather
on perverted nerve influence than on disease
of the heart itself.
  NICOTINE.  (See Tobacco.)
  NIGHTSHADE, Deadly.  (See Bella-
donna.)
  NIPPLES,  Affections of.—Excoriated
or  Sore  Nipples.—This  troublesome  and
painful  affection,  in almost  all  instances,
is met  with during suckling,  usually of  the
first child, and is due to irritation and ulcer-
ation of the delicate skin  of  the nipple.  The
mother first notices one or more  deep cracks,
which are extremely tender and bleed  when
touched.  The skin around these cracks, fret-
ted by  the  suction of the child's mouth and
constantly bathed by milk and discharge,  be-
comes inflamed and raw.   In debilitated and
unhealthy women the inflammatory mischief
extends deeply into the tissues of the affected
nipple   and also to the  skin covering  the
breast.   When the nipple has become so ten-
der that the  mother is compelled to suckle
the child almost entirely on the opposite and
healthy side,  the breast corresponding to  the
excoriated  nipple is engorged  with milk and
finally   attacked with acute  inflammation,
which results  in the development of  a large
mammary abscess.   The usual cause of sore
nipples is  the  disregard  of cleanliness and
neglect on the part of the mother to keep  the
surfaces of the nipples dry.  The tender cuti-
cle covering these  structures is readily exco-
riated by the contact of fluids, and by the fric-
tion of moist and dirty linen.  In most cases
the affection is produced by the suckling of
the first child, and  never occurs again ; but
some mothers, in spite of their careful prep-
aration of the nipples before lactation, and
constant attention  to those parts after the
birth  of the child, are troubled with painful
cracks and all  the  inconveniences to which
these give rise  during every period of  lacta-
tion.  Some mothers suffer from sore nipples
in consequence of their  allowing the child to
retain the nipple in its mouth for too long a
time.  It  is very  probable that a  diseased
condition of the child's mouth may also be a
cause of this irritation.   In order to  prevent
sore nipples, the delicate skin should be har-
dened by the frequent application of diluted
spirits of wine, weak lead lotion, or  a lotion
containing one drachm of alum to half a pint
of water.  A strong infusion  of green tea,
with  the  addition  of about  one-fourth of
brandy  or gin, will  also  be found  a good
astringent wash. The use of the lotion should
be commenced early  in  the seventh  month,
and the nipples should  be bathed night and
morning.   A bottle with the mouth and neck
just large enough to admit the  nipple should
be half  filled with  the astringent lotion and
then be applied over the  nipple and inverted,
so that the lotion may fall  down upon this
organ, and bathe it at every part of  its sur-
face.  During suckling, the nipples should be
kept as dry as possible, and when not used be
covered by cotton wool  dusted with  lycopo-
dium or starch. When ulcers and cracks heal,
and there  is  no inflammation of the sur-
rounding skin, these should be lightly  touched
with a pointed crystal of blue-stone, but when
the nipple is hot and tender, the application of
caustic must be deferred until the irritation
has  been allayed  by warm  fomentations.
When a considerable extent of skin  both of
the nipple and on the breast  is red,  raw and
moist, the best local application will  be a so-
lution of five grains of  lunar caustic in one
ounce of water. This should be brushed over
the affected parts  every morning.  After the
application of any active or caustic agent to
the nipple, the mother must take care to keep
the child from  the breast until all traces of the
local remedy have disappeared.
  Retraction of the nipple  when  associated
with a hard and painful swelling of the breast,
in a woman above the  age  of  thirty-five
years, is diagnostic of cancer.  This condi-
tion is occasionally met within young women
whose breasts  in all  other respects  are per-
fectly sound and healthy.  This, when the
patient becomes a mother, gives rise to much
trouble, as the flow of milk is obstructed, and
the secretion accumulating in  the  gland sets
up acute inflammation, which may terminate
in the formation of a large abscess.   Simple
and uncomplicated retraction of the nipple in
young females is caused in most instances by
tight lacing and compression  of the breast,
which flattens  the nipple and prevents its full 
NITRE                                      NODES
 development.  In cases of this  kind an at-
 tempt should be made at the commencement
 of the period of lactation to produce protru-
 sion  of  the nipple by  means of a breast-
 pump, or  by the  suction  of a strong infant
 of five or six months, if this can be made to
 take a strange breast.  The infant just  born
 should be handed over to a wet-nurse  until
 the  state of the mother's nipples has  been
 improved.
   NITRE, or NITRATE OF POTASS, is
 a remedy of considerable  value.   It is  pro-
 cured, by washing the soil or beds of vege-
 table matter specially prepared for the  pur-
 pose, and is mainly used for the manufacture
 of gunpowder.  In medicine it is chiefly used
 as a cooling remedy, for, dissolved in water,
 it has a cooling saline taste, which is some-
 times very grateful.  It is also given with a
 view to acting as a diuretic,  but its efficacy
 here  is  doubtful.   Szueet Spirits of Nitre is
 treated of under Nitrous  Ether.
   NITRIC ACID is one of the mineral acids
 used  in medicine,  but not, perhaps, so much
 as the others.  It does not, for  instance, seem
 so stringent as sulphuric acid,  nor does it aid
 digestion so well as hydrochloric acid.   It is
 procured from nitrate of potass by distillation
 with sulphuric acid, and should be quite col-
 orless.   Usually, however, it contains nitrous
 acid,  which gives it a green or  yellow  tint.
 The mixture  of  this acid with hydrochloric
 acid,  called aqua regia, or nitro-hydrochloric
 acid,  is  much  used.   Nitric acid is used ex-
 ternally as a caustic more than the other  min-
 eral acids.  It  is applied by means of a piece
 of stick to the  sore, which it completely de-
 stroys.   The sores so treated  are usually of
 an unhealthy description, and this destructive
 agent is applied for the purpose of procuring
 a fresh  and  healthy surface with  a prospect
 of healing.  A similar plan is adopted forget-
 ting rid of  piles.   In  these cases  the  sur-
 rounding skin must be protected ; if the acid
 touches it, the skin is stained yellow, which is
 characteristic of the acid.   It has been in-
 jected into the  bladder in a very dilute state,
 for the purpose of neutralizing the evil effects
 of  alkaline  urine.   Internally, the acid  is
 mainly given as a  refrigerant,  and to remedy
 phosphatic urine.   Sometimes  it seems to do
 much good in cases where mercury cannot be
 given, in syphilis,  and also in some liver dis-
 eases,  especially those  of  tropical climates.
 Dilute nitro-hydrochloric acid is perhaps pref-
 erable as an internal remedy.  It acts better
 as atonic, and as a remedy in dyspepsia aris-
 ing from chronic catarrh,   When the urine is
free of  phosphates, this  acid  may be given
with advantage,  certainly  with  more good
than can be obtained from  either acid singly.
 It  is largely used in liver mischief, especially
in chronic inflammation, as well as in the
cachexia of  syphilis.  The  ordinary dose of
either acid in its dilute state,  as sold by the
 chemists, is 10 or 15 drops in water, if freely
 diluted.
   NITROUS ETHER is only used in the
 form of spirit, commonly called Sweet Spirit of
 Nitre. It is made by a somewhat complicated
 process, and the product  is not  uniform in
 quality.  The basis of the product is alcohol ;
 this is treated and  decomposed by sulphuric
 acid, so that ether is formed.   At  the same
 time nitrous acid is set free by decomposing
 nitric acid by means of copper  ; the two unite
 together and form nitrous  ether.   This liquid
 is clear, transparent, sometimes with a slightly
 yellow tint, and a  fruity odor ; usually, too.
 it is acid.   The  therapeutic  properties  of
 nitrous ether are not very clear.   All kinds
 of things have been said of it, but as the prep-
 aration is of  most uncertain strength, and
 sometimes contains no nitrate of ethyl, its sup-
 posed active principle, it is somewhat hard to
 tell what these  really are.   It has been used
 mainly as a  stimulant  diaphoretic and a diu-
 retic.   It has been the  custom to order it in
 slight febrile cases, to open the skin, and  it
 has  been given in dropsies.  Its well-defined
 properties are limited to its refrigerant action.
 Hence, mixed with water, it is an exceedingly
 pleasant refrigerant to the lips of one parched
 with fever.  It is a good deal used for this pur-
 pose,and may very well be combined with nitre
 itself.  The dose should be about a drachm or
 two drachms, freely diluted with water.
   NITROUS  OXIDE—Protoxide of  Ni-
 trogen,  also  called  Laughing  Gas—is  a
 transparent, colorless gas with faint, sweet-
 ish smell and taste. It is easily made by sub-
 mitting crystals of nitrate of ammonia to heat,
 when  the  protoxide of nitrogen  will  pass
 over.  Sir Humphrey  Davy first discovered
 that this gas was respirable, and that it  pro-
 duced intoxicant effects upon the human sys-
 tem.   One of its peculiarities  is, when given
 in small quantities, to produce  uncontrollable
 laughter ;  hence the name laughing gas.   It
 was found subsequently that not  only would
 this  agent produce excitement, but anaesthe-
 sia, in the same way as ether and chloroform.
 After  the discovery of  the use  of the last
 agents, nitrous  oxide  was almost discarded,
 but it is again getting into use, as it has been
 found by experience that  it is less likely to
 produce fatal effects than either ether or chlo-
 roform.   It  is  now principally used  in  the
 operations of dentistry.  (See An/esthetics,
 Ether, Chloroform.)
  NODES are a term used to  denote certain
 tumors in connection with bone  and perios-
 teum.   It may be either scrofulous  or syphi-
 litic   In the  scrofulous node there is scrofu-
 lous matter confined between the carious bone
 and its periosteum, and is due to an affection
 of the bone.  The true node, however, is the
syphilitic, and  is caused by the effusion  of
lymph between the bone and periosteum, and
is due to inflammation of  its deeper layers. 
-job
NODES.
NOMENCLATURE
The  inflammation  in nodes is not  always
limited to the  periosteum,  and  the deeper
structures are thus implicated.  The subper-
iosteal effusion  either ossifies, or softens, giv-
ing rise to caries.  The most common  place
for these  tumors is  along the  shin-bone,  or
the radius and ulna,  and on  the clavicle and
cranium.   They frequently appear so hard  as
to seem osseous, but in reality it is the  semi-
solid effusion  beneath  the  dense thickened
periosteum which gives rise to the feeling.
Nodes sometimes soften, and pus forms, the
indications of which  are the  fact of the  skin
becoming shining, dense, and thinned.   The
formation of subperiosteal  abscess usually
ends in  exfoliation  of the bone.   (See  Ex-
foliation.)  The first  indication  of the ap-
pearance  of nodes in a person  affected  with
syphilis is tenderness of the affected  bone,
and severe pain and nightly exacerbations.
Soon roundish or oblong swellings are noticed
on the bones, usually commencing with the
skin ;  they are tender, and convey a sense  of
obscure  fluctuation.    If by treatment the
disease be arrested, syphilitic exostosis is the
result ; if not,  a quantity  of glairy serum is
effused between the periosteum and the bone,
forming a very  painful tumor.  Extensive ex-
foliation may ensue, causing  intense suffering
to the patient,   if  situated in the skull fre-
quently terminating fatally.
  Treatment.—The treatment consists in the
administration  of a  regular  course  of  mer-
cury  or  of the  iodide  of  potassium.   The
nightly pain is best relieved  by leeching  or
blisters, and the application  of strong iodine
paint. If  very tense,  fluctuating, and painful,
subcutaneous  incision,  made by  passing a
narrow knife under the skin, and  across the
tumor,  gives great relief.   But it generally
will be  found that such remedies as iodide of
potass,  sarsaparilla, and blisters will be suffi-
cient  to produce absorption and allay pain.
  NOLI  ME  TANGERE.  (See Lupus.)
  NOMENCLATURE treats of  the names
and classification  of  diseases.   Unto every
disease a name is given, and as our  knowl-
edge  increases year by year names are added
to  signify  either  new complaints or fresh
groups  of  symptoms.   It is  obvious  that
some diseases  are more closely  allied  than
others ; thus all those disorders which are ac-
companied by a high  temperature are called
fevers ; these, again, are divided  into those
which are catching and those which are  not..
Some diseases are caused by the presence of
parasites, others by accident or design.   To
arrange diseases according to any precise plan
is, however, extremely difficult.  If we knew
accurately the causes  of every disease, some
scientific  arrangement might be carried  out,
but our knowledge  on this point  is  as yet
very imperfect. Then, again, there are many
"causes of  death" registered  which are not
diseases at all, but  symptoms ; convulsions
and diarrhcea, debility and wasting, are exam-
ples of  this kind ; the true cause of the death
is really the cause of these  symptoms,  if in
all cases it  could be  ascertained.  The Eng-
lish Registrar-General has adopted a nomen-
clature  which has been long in  use, and is
V2ry well adapted for its purpose ; he divides
all diseases into five great classes,  and these
in their turn are  divided  into orders, while
under each order are placed the diseases  as
known  by their general name.
Classes.
I. Zymotic diseases.. -j
II. Constitutional
    diseases......
III. Local diseases___ -{
             Orders.

  i. Miasmatic diseases................Small-pox,  measles,  scarlet  fever,  diphtheria,
                                  quinsy,  croup, whooping-cough,  continued
                                  fever (comprising typhus, typhoid and simple
                                  continued fever), erysipelas, puerperal fever,
                                  carbuncle,  influenza,  dysentery,  diarrhcea,
                                  cholera, ague, remittent fever, rheumatism, and
                                  other zymotic diseases.
  2. Enthetic diseases................Syphilis,  stricture of  urethra,  hydrophobia,
                                  glanders.
I  3. Dietic diseases....................Privation, want of breast-milk, purpura, scurvy,
                                  alcoholism.
l_ 4. Parasitic diseases.................Thrush, worms, parasites, etc.

  1. Diathetic diseases.................Gout, dropsy, cancer,  cancrum  oris, mortifica-
                                  tion.
  2. Tubercular diseases...............Scrofula, consumption, hydrocephalus.

f 1. Diseases of nervous system.......Apoplexy,  paralysis, chorea, epilepsy,  convul-
                                  sions, brain diseases, etc.
I  2.    "     organs of circulation.... Pericarditis, aneurism, heart disease, etc.
  3.             "'    respiration.. .Bronchitis, pleurisy, pneumonia, asthma, etc.
|  4.    "        "    digestion.....Gastritis, peritonitis, ascites, hernia, intussuscep-
                                  tion of intestines,  etc., jaundice, diseases of
                                  slomach, liver,  and spleen.
  5.    "     urinary organs.........Nephritis,  Bright's  disease, cystitis,  kidney
                                  disease, etc.
  6.    "     organs of generation. ..Ovarian and uterine diseases, etc.
  7.    "        "    locomotion...Synovitis, arthritis, and diseases of the joints.
                                  etc.
I 8.    "     integumentary system..Phlegmon, ulcer, diseases of skin, etc. 
NOSE
NOSE
337
      Classes.                   Orders.

                   f i. Diseases of children.......
 IV. Developmental   \       „      d ,t .........
     dlseases......... |  3.    "     old people.....
                   [ 4.    "     nutrition.......

                   f 1. Accident or negligence___

  V. Violent deaths.... j  2 Homicide.................
                     3. Suicide....................
                   [ 4. Execution.................

   NOSE (Diseases  of.)  (i) Of the external
 nose.   Fracture of  the  nasal  bones.   (See
 Fractures.)
   Incisions.—Accurate adjustment of  the cut
 surfaces must be obtained at once, as owing to
 the extreme vascularity of the integuments of
 the nose, union takes place very  rapidly,  and
 unless  the adaptation be careful, deformity
 may be the result.   In cases where there has
 been removal of the  nose, either  partially or
 entirely, the  portion,  after washing and neatly
 stitching on, has completely united, leaving
 scarcely any scar.   The  same remark as to
 the  neat  approximation of the edges  of
 wounds is of equal importance in any part of
 the face.
   Hypertrophy  (Lipoma).—The   integument
 of the nose occasionally,  as the result of acne
 rosacea of long standing, becomes irregularly
 enlarged, and " fleshy excrescences" appear.
 They give rise to great disfigurement.  They
 are of a dusky purple color, cold and greasy
 to the touch, usually occurring in individuals
 over  middle  age,  and most frequently  in
 males.   They consist anatomically of hyper-
 trophied skin and connective tissue, with di-
 latation of the small veins and enlarged seba-
 ceous  follicles.  They are not dangerous or
 painful, only inconvenient and unsightly,  and
 of slow growth.  Removal is the only remedy.
 The mass must be entirely shaved oft, an oper-
 ation  requiring  some dexterity ; and  the
 growth does  not recur, except in rare  instan-
 ces.   The term lipoma, frequently given to
 this  skin disease, is  pathologically a wrong
 one, as it contains, as a rule, little or no fatty
 tissue.
   Lupus.—The  various forms of  lupus  are
 discussed in the article Lupus.
   Deficiency from disease or accident.—Cases
 where the whole or part of the external nose
 has been destroyed by disease, such as scrof-
 ulous ulceration, lupus, syphilis, etc., can be
 in great measure remedied by what are termed
 rhinoplastic operations, a  department of plas-
 tic surgery which consists in the transplanta-
 tion of integument from an adjoining part of
 the face.  Such operation requires consider-
 able ingenuity of plan and skilfulness of per-
 formance, but it must be borne in mind that
 if the entire bone or cartilaginous framework
of nose be wanting, it is almost useless to at-
tempt anything  of the sort, as the points of
.......Premature birth, cyanosis, malformation, spina
       bifida, etc.
.......Childbirth.
.......Old age.
.......Atrophy and debility,

.......Fractures, contusions, gun-shot wounds, cuts,
       stabs, burns and scalds, poison, drowning and
       suffocation, etc., by accident or negligence.
.......Murder and manslaughter (homicide).
.......Suicide by any method.
.......Hanging (execution).

support   are   gone.    The  most  common
method of supplying the deficiency is by what
is termed the Indian method.  A  piece of in-
tegument, the shape of the nose laid out flat,
is drawn upon  the forehead, and  the edges of
the mutilated nose pared, the flap is  dissected
off the forehead and  brought down and at-
tached to the pared edges just mentioned, by
sutures.   Flaps may be  dissected from the
cheeks, or from any convenient spot where
the integument is healthy.  Occasionally such
a flap has been  taken from the arm.
   Diseases of the Internal Nose.—In order that
the internal nose or nasal fossae may be com-
pletely inspected, with  a view to find out ac-
curately their condition, a proceeding termed
rhinoscopy is had recourse to.   Rhinoscopy
is anterior or posterior.  Anterior rhinoscopy
is an inspection through the nostrils.   The
nostrils must  be dilated, and  a good  strong
light brought to bear upon them.  A bivalve
nasal speculum, made on purpose, is used.
This consists of an  instrument  having  two
slightly curved blades, these blades are intro-
duced into the  nostril, and when separated by
handles they dilate the parts,and,  being highly
polished, they throw light into the cavity.
   Foreign  substances in  the nose.  (See For-
eign Bodies.)
   Posterior Rhinoscopy.—In rhinoscopy, or in-
spection of the nasal cavities from behind, a
somewhat more complicated mechanism  is
necessary.   The  instruments required  are
those similar to what are used in  examination
of the larynx (see  Laryngoscope),  and con-
sist of a mirror, perforated, and  worn  round
the head, hand-mirrors, somewhat longer and
a little more  bent than those used  in  laryn-
goscopy, and a blunt flat hook with which the
uvula and soft palate are supported and drawn
forward.   In  using the instruments the pa-
tient is seated with his back to the light, and
the head well thrown back, the mouth opened
to its fullest extent.  The operator, seated op-
posite to him, by means of the spatula, held
in the left hand, raises and draws forward the
uvula and soft  palate,  and directs  the light
reflected from  the perforated mirror, bound
round  his  head, down the pharynx.   When
the light is made to shine upon it, some por-
tion of the walls or contents of  the  naso-
pharyngeal or nasal cavities may be distinctly
imaged on the speculum.   If  a good view 
338
NOSE
NOSE
be obtained, the two superior meatuses can
be seen and their contents, and  the mucous
membrane of  the  three turbinated bones, a
considerable  portion of the septumnarium,
some portions of the posterior surface of the
velum pendulum-palati,  the lateral wall  of
the naso-pharyngeal cavity, and the orifices of
the Eustachian  tubes.  In  order to  see all
these  structures,  however,  at all  satisfac-
torily, great patience and  self-control on the
part of the patient are essential.
  Diseases of the nasal cavities. Nasal Calculi
or Rhinolilhes.—These concretions are gener-
ally found in the inferior meatus.   They con-
sist of phosphate and carbonate of lime and
magnesia, chloride of sodium, and mucus or
some  animal matter.  These bodies can  be
removed with forceps, a proceeding of  some
difficulty very  often, and the nasal cavities
must be  afterward  thoroughly  cleaned by
syringing or douching.
  Epistaxis or Nose-bleedhas been  discussed in
the separate  article on that subject.    (See
Epistaxis.)
   Coryza is an excessive discharge of mucus
depending upon catarrh, struma, syphilis, or
the presence of a polypus.   Best  treated with
mild astringent washes, or the insufflation of
powders, such as tannic acid, or some astrin
gent, warm, dry atmosphere, good living, and
cod-liver  oil  or  iron.   A  severe form  of
coryza, due to syphilis, is  occasionally met
with ; it commences as an ordinary cold in the
head, with increased secretion of  the mucus,
which, on exposure to cold or to alcoholic ex-
cess,  becomes  thicker,  more  profuse, and
greenish in color.   There is great uneasiness
and tenderness in  the nostrils, with continu-
ous desire to blow the nose.  It is frequently
attended with headache, alteration of the tone .
of voice, and impairment of smell.  With re-
gard to treatment, it is necessary to administer
mercury, both internally and by the exhalation
of its vapor, and mild astringent and detergent
lotions.
  Ozcena,  or  rhinorrhcea,  is a   purulent  or
sanious discharge, giving  rise to  most offen-
sive foetor, rendering the sufferer unbearable
both to himself and to those around him.  It
may be either (i) Catarrhal ; (2)  Strumous ;
(3) Syphilitic.  The catarrhal is  met  with in
patients of delicate constitution,  and after a
long and troublesome cold the discharge will
become very foetid, generally worst in the
morning.  The discharge is accompanied with
headache, relaxed  throat,  cough, and  great
depression of  spirits  and deafness.   The
treatment consists in sending the patients to a
dry, bracing  atmosphere,  the  inhalation of
steam, carrying with  it  vapor  of creosote.
Constitutionally,bark and mineral acid tonics.
  Scrofulous or strumous  ozcena,  generally
begins during childhood, and depends  upon
a strumous taint, causing ulceration of the
nasal mucous membrane.   The  discharge is
very offensive,  and if not treated may impli-
cate the bones and cartilages of the nose, set-
ting up destructive ulceration, whereby  the
most dreadful deformity  is occasioned.   The
treatment  consists in the  administration  of
bark, iodide of potass, cod-liver oil, phosphate
of iron, etc. ; of the washing out of the nasal
cavities with a large syringe containing a little
chloride of zinc in solution, or a little dilute
citrine ointment  to be applied  to the ulcers
with a camel's-hair brush.  With  regard to
the syringing out of the nasal cavities, it may
be borne  in mind that when one side of the
cavity  is  entirely filled  through one nostril
with fluid by hydrostatic pressure,  while  the
patient is breathing through the mouth,  the
soft palate completely closes the chorda;, and
does not  permit  any fluid to pass into  the
pharynx, while the fluid easily passes into the
other cavity,  mostly round and over the pos-
terior edge of the septum narium, and  escapes
from the  other  open nostril, after  having
touched every part of the first half of the cav-
ity of the  nose, and a great part,  certainly the
lower and median canals, of the second half.
The syringe should have a long  slender noz-
zle, with a bulbous extremity, perforated by a
rose of small  holes.   The best  apparatus,
however, for  the purpose is the nasal douche.
   Syphilitic ozcena has precisely the same gen-
eral character as  the preceding,  and must, of
course, be attacked on the general principles
indicated  for the treatment of constitutional
syphilis.
  Polypi.—The most  common are the simple
mucous or benign. The growth is soft, of a
rather tough consistence, and yellowish-gray
in color, bleeding slightly when touched, usu-
ally growing from the inferior spongy  bone,
never from the septum.  It may occur at any
period of  life, though most frequently in mid-
dle age.  It  obstructs  respiration, causes a
stifling sensation in the head, seriously affects
the senses of smell and taste, and often occa-
sions deafness.  The treatment consists in its
removal by lorceps.  The root of the growth
is to be seized with them, and, by a movement
of twisting and pulling, the mass is withdrawn
from the nostril.  The next variety of  polypus
is the medullary, bleeding or malignant, occur-
ring usually at  the middle or later periods of
life ;  the  growth causes great  pain,  and it
occasionally grows and  increases with great
rapidity.   Owing to  the malignancy of this
growth  it is impossible to remove  it thor-
oughly, although attempts may be made irom
time to  time to clear away the mass from the
nostril.  The third form to be mentioned is the
fibrous  variety, distinguishable  by its great
firmness.   It is distinctly fibrous in composi-
tion, and  occurs most  frequently  in young
male adults.  It seems  to adhere  to the
bone, but  not  to depend upon any diseased
condition of  it.  The operation of removing
a mass of this  nature is always a very serious 
NOSE-BLEED
NURSING            339
and  formidable proceeding.  These growths
occasionally grow backward down the pha-
rynx instead of forward, adding, of course,
greatly to the difficulty of any operative pro-
cedure.
  NOSE-BLEED.  (See Epistaxis.)
  NOSOLOGY, the systematic arrangement
of diseases.  (See Nomenclature.)
  NOSTALGIA means home-sickness. (See
Mal-de-Pays.)
  NUMBNESS, a peculiar sensation felt at
the  end  of a  nerve, and   caused  by som'e
altered condition of the nerve,  either at its
origin  or in its course.  It  may be caused by
an injury  or by pressure ;  it may  be  also a
sign of brain disease ; it is also caused when
a drug, like aconite, is rubbed into the skin.
  NURSING  of the right kind  is rapidly
coming to be  recognized as even  more im-
portant in the treatment of many diseases
than all the drugs that can  be administered.
Only doctors know how many valuable lives
are saved by good nursing, and  on the other
hand how many are  thrown  away by the
want of it ; but fortunately its importance is
beginning to be understood and appreciated
by the public at large.  In those cases which
are lingering, or  where bodily strength is re-
quired for proper attendance on the patient,
it is  better to employ a professional sick-nurse.
Such a nurse knows, or ought to know, how
to perform many, important duties  of  which
those  less  accustomed to sickness are igno-
rant ;  and  she will be quick to detect changes
in the patient's symptoms which others might
overlook, and which it may be important for
the  doctor to be informed  of.   In cases of
ordinary  sickness,  or where  professional
nurses are  not obtainable, the members of the
family usually do the nursing ;  and here many
mistakes are made for want of a little homely
and  practical knowledge, such as is contained
in an article entitled " A Few Hints  on Do-
mestic Nursing, by  the Mother of a Family,"
which  appeared lately in one of the English
magazines.   This article is written in very
familiar language, but  its  suggestions have
been indorsed  by competent authorities as
eminently valuable and practical.  The article
is as follows :
  "  There  are many little useful hints in nurs-
ing  the sick to be gained  only by personal
familiarity with illness ; and as my boys have
obstinately persisted in having almost every
form of infantile infectious disorder, I shall
jot down a few of the points which I found to
be most  useful to me during the long weary
time we were kept in  the nursery.
  "  When  my  little boys  Percy and Louis
were suffering from scarlet fever, I had every
article  of furniture save Percy's  little bed,
Louis's cot, two chairs, and a boxful of toys
—which were afterward burned—carefully re-
moved, all  curtains and carpets rigorously
excluded ;  while I  had  two  print  dresses,
which  I  wore alternately during the dreary
time.   I used to be so sorry for the little pa-
tients ; for of course all visitors were strictly
prohibited, and  children  naturally  like  a
change both of people and places.   It is al-
ways  advisable, if it  is possible  to have  a
choice of rooms for illness, to  choose a large
airy apartment with a south aspect ; for there
is nothing like  sunshine  for keeping one
cheerful, as well  as  acting most  beneficially
upon  the health of the patient ; besides it is
invaluable as a disinfectant, worth bushels of
chloride of lime.   In cases of  infectious dis-
ease,  people  cannot be too careful  in com-
municating with the outer world.   Many and
long-continued were the efforts I made to pre-
vent  the spread of scarlet fever  ; and truly
thankful I am that I never heard of any one
catching it from us.   I placed an old saucer
nearly full of cold water, in which I poured a
little  carbolic acid, in each room, on the hall
table, stair-head window, in  fact,  on every
available  spot in the house. At  first  the
strong gaseous  odor  was highly offensive,
but that soon  wore off, and in a very short
time its presence was almost unnoticed.
   " M-y boys used lo hate the sight of their
' bokkles,' as they called their medicine ; so  I
placed a little round table,  which I covered
with a clean napkin, outside the  room door ;
and thereon  I put the bottles, spoons, lini-
ments, etc. which were  needed, and found
it such an  improvement  on the  old plan of
keeping them promiscuously on the chimney-
piece that  I have adhered to it  ever since.
Every utensil as soon as used  should be care-
fully  removed and  well rinsed out—cups,
spoons, glasses, all should be at once cleansed,
and not suffered to lie about in disorder.   It
is rather more trouble ;  but surely the little
extra labor will  not be grudged when  the
comfort of the patient is increased.
   " In these enlightened days it is almost an
insult to write about the value of  fresh  air,
yet there are some people who carefully keep
their  rooms shut up ; and what a fatal mis-
take it is thus to exclude one of God's best
gifts  to man ;   If the patient be kept warm
and free from  draughts, plenty of fresh air
may be admitted  without the slightest danger.
In most  modern houses the  upper window-
sash lets down, and may be kept open a few
inches.  If there is the  slightest draught, it
may be prevented at a very trifling cost, by
having a light wooden frame from six to eight
inches in width made to fit the upper part  of
the window, and a single thickness of flannel
tacked on each side of it.
   " I find it a capital plan to fold a sheet  in
two,  lay it across the bed, above the under
sheet, with the upper edge just touching the
pillows, and the ends tightly tucked in under
the mattresses.  It does not wrinkle or crum-
ple up, as single sheets will do ; while crumbs
can be readily brushed off, and  it can much 
340            NURSING
NUTMEG
more easily be changed than a large one.  It
is best to fold the upper end of the quilt under
the blankets  before  turning down the  top
sheet, as it helps to keep them in place ; and
as there is nothing more fidgeting to a healthy
person  than   to  have  the  chin grazed by
blankets, the annoyance must be doubly great
to one lying on a bed of sickness.
  " The greatest care should be taken to keep
the beds  clean ; so  the linen ought to be
changed twice, and the blankets once a week ;
those that have been  removed hung in the
open  air for  a few  houis,  then thoroughly
dried in  a warm room, and  put away to re-
place those in use  which must be similarly
treated.  There  is nothing easier to  an ex-
perienced nurse, or more difficult to an inex-
perienced one, than  to change  the  bed-linen
when a patient is in bed.  I once noticed a cap-
ital plan in an American paper, which I  have
followed in scores of cases, and never found
to fail.  I shall copy  it here in extenso for the
benefit of those who may be placed where such
a scrap of advice may be useful : ' In the first
place, everything required must  be at hand
before beginning ; then move  t'~e patient as
far as possible to one side of the bed, and re-
move all but  one pillow.  Untuck the  lower
and cross sheets  and push them toward the
middle of the bed. Have a sheet ready folded
or rolled the long way, and lay it on the mat-
tress, finfolding it enough to tuck it in at the
side.  Have the cross sheet prepared the same
way ; lay it over the under one, and tuck it in,
keeping the unused portion of both still rolled.
Move the patient over  to the side thus pre-
pared.  The soiled sheets can then be drawn
away, the clean ones  completely unrolled, and
tucked in on  the other side.   The coverings
need not be removed while this is being done ;
they can  be  pulled out from the foot of the
bedstead, and kept  wrapped  round the pa-
tient.  To change the upper  sheet, take off
the counterpane, and lay the clean sheet over
the blankets, securing the upper edge to the
bed with a couple of pins.  Standing at the
foot, draw out the blankets and soiled linen ;
replace  the former,  and put on  the counter-
pane ; lastly, change the pillow-cases.'
   " I found  it most refreshing to my little
patients to sponge the entire  body with  vine-
gar  and warm water, and was very careful
not  to let them  catch  cold while  doing so,
just sponging over a small portion at a time ;
while the bed and the patients were equally
protected by a large blanket, which I carefully
pinned round their  shoulders.  It is a great
mistake to have large quantities of fruit, bis-
cuits, etc. lying  about a sick-room. A very
few  grapes, an  orange peeled and divided,
and two  or three milk or water biscuits are
quite enough to have displayed at  one time.
The same may be said of food.  I have  often
been pained, when  visiting  some of my sick
pensioners,  to  see  their  friends,  with  well-
meant but mistaken  kindness,  bring large
basinfuls of horrible compounds, which they
dignify  with the name  of  gruel  or sago
or tapioca, as the case may  be.  The mere
sight of the food seemed  to set them against
it. Whereas if a little care had been bestowed
upon  its preparation, and a small cupful pro-
vided instead of the large quantity I name,
they probably would have partaken of it with
pleasure.
  " Another  error,  committed with the best
of intentions, is to keep  asking  the patients
what they would like ;  if they could take this
thing  or the  other.  The sickened, wearied
expression I have often seen flit over the faces
of people who are recovering from  a linger-
ing illness, when their officious relatives come
teasing  them as to their requirements ! Dur-
ing the  lingering illness  of a dear relative, I
verily believe we made her often eat, just by
providing dainty morsels of food, displaying
them  temptingly arranged, and  taking them
to her bedside  quite unexpectedly ; when  if
she had been asked, could she eat anything, I
feel confident the  answer  would have have
inevitably  been, ' No ; thanks.  I don't feel
at all  inclined to eat.'
   " A very simple  and  expeditious  way  of
cooking a little  bit of chicken or fish is to
butter a paper thickly, place the food to be
cooked  within the paper, and place it on the
gridiron over a clear fire.  A very short time
suffices  to cook it  thoroughly ; and I have
often  found that to be eaten when all other
modes  of invalid cookery  have been tried in
vain.
   " I always find Percy  and Louis  take  ref-
uge in  milk when they are ailing, and truly
thankful am I  that such is the case.  Once
when Percy had a very severe attack of bron-
chitis, I felt in  despair, for all the  tempting
food I could contrive failed to make him eat ;
for several days—eleven  if I be not mistaken
—he lived  almost entirely on milk ; and when
I mentioned to our medical attendant my fear
that the child  would die  of  starvation,  he
quite laughed at the idea, and  said,  ' As long
as he can take the milk, the child will do very
well.'
   " In conclusion, I would earnestly impress
upon  my  readers the great  importance  of
having  every article in the shape of body or
bed linen thoroughly well aired.  The slight-
est trace of damp may undo the careful work
of days or weeks,  may  even cause  all our
nursing and attention to  prove in vain."
   NUTMEG  is the seed of the Myristica
Moschata, and is better known as a spice than
as a  medicine.  It contains  a  concrete  oil
solid  at ordinary temperatures, and a volatile
oil, to  which it mostly  owes its  property.
Nutmeg itself is mainly  used as a flavoring
ingredient in various important preparations.
The solid  oil is used  in some plasters, and
the volatile oil, dissolved in  spirits, acts as a 
NUTMEGGY LIVER                         NUX VOMICA
 gentle stimulant and  carminative.  It is also
 contained in aromatic spirit of ammonia and
 aloes pill.   It is  said in very large doses to
 produce drowsiness  or even  stupor.  The
 dose of the spirits is about a drachm given in
 Gugar.  (See Mace.)
   NUTMEGGY  LIVER is  produced in
 some cases of heart disease when that organ
 becomes  gradually congested  and  full  of
 blood ; slight jaundice may come on,  and
 there is generally a  dull pain over the  liver.
 It is also the result of drinking alcohol.  (See
 Liver.)
   NUX VOMICA is the seed  of the koochla-
 tree, growing in the East Indies.  It and the
 fruit of another  plant called the St. Ignatius
 bean,  owe their properties  to the strychnine
 which they contain.  The fruit of the tree is
 a round berry like an orange, filled with  these
 peculiar seeds in  its pulp.  The seeds of  the
 nux vomica are hollow on one side and raised
 on the other, as  if pinched by the  thumb.
 They are very tough and hard, so that they
 are hot easily crushed. They are covered with
 hairs of a velvety character.  Two alkaloids
 are contained in these,viz., brucia and strych-
 nia, combined with an  acid,  igasuric  acid  ;
 the properties of  the drug, however, depend
 almost  entirely on the strychnia.  The  prep-
 arations of  nux vomica are an extract and a
 tincture, and there is  an officinal solution of
 strychnine.   Of these the doses  are  as fol-
 lows :  of the extract, a  quarter of a grain to
 2 grains ;  of  the  tincture. 10 to 20 minims  ;
 of the solution of strychnine, 10 to 20 drops.
 The alkaloid itself may be given, but never in
 doses which exceed the  one  twenty-fourth of
 a grain  ; even these may give  rise to trouble-
 some symptoms.  Given internally strychnine
 produces spasms, mainly by  acting  on the
 spinal cord.   It  does not seem to influence
 the brain to  any  extent, for in cases of  fatal
 poisoning through its  means, the mind is
 usually clear to the last.  The  mode in which
 it acts  would seem to be the induction of  an
 over-sensitive condition of the  spinal marrow,
 so that impressions which under ordinary cir-
 cumstances would produce little or no effect,
 give rise to  violent convulsions.   The first
 symptoms of an overdose are twitching of the
 muscles, often of  the  lower  extremities, and
 a kind of choking sensation about the throat.
 These gradually spread and increase in inten-
 sity till the whole body seems  rigid from vio-
 lent muscular contraction.  These in many
ways resemble those of tetanus.  The body is
often so contracted by the powerful muscles of
 the back as to resemble an arch, and to rest
only on its head and its heels.   The muscles
of respiration are likewise convulsed, so that
no respiratory movement is possible, and the
face becomes first red, then livid, and almost
black.  Such attacks are not continuous, but
last for a minute or more ; during the interval
the patient is quite sensible, but the slightest
motion of those round about him,  sometimes
even a breath of air, will suffice to bring the
attack on  again worse than ever.  The great
thing,  therefore,  is to avoid disturbing the
patient if the attacks be slight, but if they be
severe, or  seem to  increase  in  severity,
prompt remedies must be employed  or death
will speedily ensue.   If in  point  of fact the
fatal issue can be postponed for three or four
hours after the beginning of the attack, there
may be good hopes of ultimate success.  The
cause of death may either be a too prolonged
interference with respiration  or  exhaustion
caused by repeated convulsive attacks.
  Used remedially nux vomica  or strychnine
acts as an incentive to digestive action, gives
rise, that is, to the sensation of hunger, and
probably aids digestion.  It is one of the best
of its class, especially in chronic catarrh of
the stomach, when the tongue is loaded and
the bowels irregular.   Two or three up to ten
drops of the tincture  of  nux vomica given in
a little water will often effect great relief in the
way of temporary  symptoms.    Flatulence
from the same or allied causes it also relieves
more than  any one  drug.   The dose  is as
before,  and should be taken just before meals.
Some varieties of headache it also remedies,
especially those  connected with gastric dis-
turbance and  foul tongue.   Extract of nux
vomica is  a favorite remedy in  constipation,
especially that which  is habitual.  It is, how-
ever, seldom  given  alone,  but is combined
with  other  substances,  like aloes,  rhubarb,
and steel.  All cases,  however, do not answer
to the stimulus.   The action of nux vomica
or its alkaloid is, however, still more marked
in diseases  connected with the nervous sys-
tem, especially those of  a functional charac-
ter.  What is  commonly called nervous ex-
haustion, from whatever cause arising,  is bet-
ter  treated by  this than any other drug what-
ever.  In business men  who have  been ex-
posed  to much  mental worry, and  partly
broken down,  its use is attended with  singu-
lar benefit.  In  females affected with low spirits
and hysteria this  is  often  a most  valuable
remedy, more  so than any other ;  but on the
whole it seems better  adapted for the coarser
maladies of the male sex.
  In poisoning by either nux vomica or strych-
nia, the remedies must be prompt removal of
the  poison  where  possible,  either by the
stomach-pump or vomiting, but when the par-
oxysms have set in, an attempt  to use  either
generally brings on convulsions.  Then it is
best to trust to choloroform  inhalation. 
342           OAK BARK                             OBSTRUCTIONS


                                         0.
  OAK BARS,  the  bark of  the stems  and
small branches of our  common oak tree  is
mostly used as an external remedy.  It should
be collected in spring. Its smell when moist-
ened is  somewhat peculiar, but its taste is al-
most purely astringent, owing to the tannic and
gallic acids which it contains.  The quantity
of these in different  species  of bark vary a
good  deal, especially  with age,  season,  and
the part of the tree from whence the bark  is
taken.  Its only officinal preparation is a de-
coction  which is  only  used   externally.   It
may,  however, be given whenever tannic acid
is indicated.   It is best suited for astringent
lotions and injections, and may be combined
with various other remedies, provided these
are not incomparible with tannin.
  OBESITY. (See Bantingism,and Weight
and Height.)
  OBSTRUCTIONS may occur in many of
the organs of  the body and set up a train of
symptoms  of  a very  serious nature, but in
each  case  it  will depend much  upon  the
nature and seat of the obstruction. The most
important obstructions are those  which  take
place  in the intestinal canal, in the liver, or
in the kidney, or  in the course of the circula-
tion.
  Intestinal Obstructions.—The  causes of
this mischief  are very various, and  most of
them are very difficult to make out, and also to
relieve ;  hence  the  treatment is uncertain,
and often  unsuccessful.   The causes of intes-
tinal obstruction  may  be divided  into  two
classes : i. Those which come on suddenly,
pursue an acute course,  and which will prove
fatal if  relief be not quickly afforded.   2.
Those which come on gradually and pursue
a chronic  course, and  produce  symptoms
which may subside more readily under the
aid of medical or surgical  measures.  Under
the first division may  be mentioned  :
  a. Congenital  stricture or  malformation.
  b. Foreign  bodies impacted  in the intes-
    tines.
  c. Loops formed as a result of inflamma-
    tion which  may entangle  portions  cf
    the bowels.
  d. Invagination or intussusception of  the
    intestines.
  Under the second division may be classed :
  a. Constipation, habitual or accidental.
  b.  Inflamed intestine, the result of injury.
  c. Chronic inflammation of the peritoneum.
  d.  Tumors pressing on the bowels.
  e. Simple stricture of the  bowel, the re-
    sult of ulceration  generally.
  f.  Cancer of the bowel.
  Congenital malformation of the  intestinal
canal is generally confined to the  rectum or
the  lowest  portion of the large  intestines ;
this deformity, as its name implies, occurs be-
fore birth, and  the only thing  that can be
done, if the bowel is closed up, is to make an
artificial opening for the passage of the ex-
creta.   (See Anus,  Artificial.)  Sometimes
the malformation is higher  up  in very rare
cases.   Few  symptoms come on within  the
first twenty-four hours, but after that constant
vomiting comes on and continues  until relief is
obtained, or  until death  ensues.   When  the
deformity is in the upper part of the intestines
nothing can be done.
  Foreign bodies may become impacted in the
intestines,  either by being accidentally swal-
lowed or introduced up the  rectum,  or as a
result of external injury, but this subject has
been dwelt upon in the article on  Foreign
Bodies.
  Twisting of the  intestines,  so as to form
loops, which prevent the passage  of the faeces,
is  not  a  very  common occurrence.   The
symptoms  are very urgent  from the  first  ;
great pain is suddenly experienced in a small
circumscribed spot  of the abdomen, and ob-
stinate constipation  begins from this time  ;
the part becomes much distended and painful
on  pressure ;  vomiting  is generally present,
and  often  constant; the pulse is small and
the countenance is expressive of pain and ex-
haustion.   Medical aid in such cases must be
at once sent for.
  Invagination,  or  intussusception  of  the
bowel, is often the result of worms or of some
other irritant  cause acting  on  the bowels.
(See Intussusception.)
  The second division of obstructions offers
a more hopeful chance for treatment.
  Habitual constipation  may  go on for so
long a time that  a hard mass of faecal matter
forms in the  intestines,  and cannot be dis-
lodged by the natural efforts ;  the mass gen-
erally forms  in the  large bowel,  and may be
sometimes felt as a tumor ; it may occur in
those who take large doses of  opium, or any
drug which has a constipating effect.  Injec-
tions of warm water must be given until the
mass is softened, or portions may be removed
by a scoop from the rectum.  (See Consti-
pation.)
  Inflammation  of the intestines, as a  result
of  injury, may cause portions of  the bowel to
adhere  together and set up  obstruction ; if
high up, little, if anything, can  be done ; if
low down, an artificial opening may be made
in  the loin so as to give relief; in all these
cases pain  in the abdomen, distension,  and
vomiting are  the most marked symptoms.
  Obstruction may  result from  adhesion of
two portions  of the intestines  in cases where
there is a tubercular deposit on the peritonc
um,  or where two ulcers have set up inflam- 
             OBSTRUCTIONS

 mation  around them  and caused adhesions ;
 sometimes an  abscess may then be formed ;
 in such  cases  there may be no constipation,
 but often diarrhcea, and especially at first;  it
 is very difficult to find out the nature of such
 cases during life.
   The most common cause of obstruction is
 stricture of the bowels ; it follows generally as
 a result  of ulceration ; rarely met with in the
 upper part of the intestines, its common seat
 is in the rectum, or within a foot of the end
 of the canal.   The lower  the stricture is the
 more distended becomes  the abdomen with
 flatulence ; there  is  great  pain,  vomiting,
 anxious countenance and constipation ; often
 a copious vomit relieves the pain for a time ;
 surgical aid must be sought early, and if the
 strictures  cannot be  overcome, an artificial
 opening may be made  in the loin so as to give
 great relief, and perhaps save life.  The oper-
 ation is called colotomy, and it is of course
 only useful in those cases where the mischief
 is below the seat of the operation.  The pa-
 tient will afterward pass the excreta through
 the new opening, and must wear an appara-
 tus for the purpose.
   Tumors pressing on the bowel may cause
 obstruction,  as  hydatids,  ovarian tumors,
 etc.,  but these cases will vary so with  each
 individual state  that no description of them
 would be  useful.  Cancer  may  affect the
 bowel and chiefly the  rectum, and cause ob-
 stinate  constipation  and  obstruction ; the
 emaciation, pain, loss of flesh, and gradual
 onset of the symptoms will help to reveal the
 nature of the case, although it may be  mis-
 taken for simple stricture ; usually the dis-
 ease may be made out on examining the rec-
 tum.  Colotomy will often give great relief,
 although it cannot save life.
   Hepatic Obstructions.—The only obstruc-
 tion in the liver that need be  mentioned here
 is due lo the presence  of a gall-stone  in the
 duct or tube which conveys the bile from the
 liver to the intestinal canal.   The symptoms
 of a  gall-stone  in the  duct would be great
 pain in  the right hypochondriac region and
 over the liver, vomiting, anxious expression,
 thirst, loss of appetite, and a  yellow tinge of
 the skin  ; when the stone has passed into the
 intestinal canal great relief is  at once experi-
 enced, and the  urgent  symptoms pass away.
 If the jaundice is  intermittent  and persists
 for some time,  it may be  due  to  several
 smaller  stones   passing  at different  times.
 The treatment of such obstructions during the
 attack must consist in  putting the patient in
 a hot hip-bath,  applying hot poultices  or hot
 fomentations to the seat of pain, and  in giv-
 ing some purgative medicine ;  should the pain
 be very severe, chloroform may be adminis-
tered  with caution, and opium may be given
so as to try and procure  sleep.   After the
severe symptoms have passed away the pa-
tient should lead a regular life, be  careful of
             OBSTRUCTIONS        343

 his diet, take plenty of exercise, avoid intoxi-
 cating  liquors,  and sec that the bowels are
 kept regularly open.  Tumors pressing on
 the bile duct, as in some cases of cancer, may
 produce obstruction, and so will any inflamed
 condition of the  bile duct itself ; in  the first
 instance,  nothing can be  done,  but  the last
 cause will generally be removed  by  treat-
 ment.  The administration of  purgatives, as
 rhubarb draughts, and an  occasional dose of
 calomel, the regulation of the diet and active
 exercise will generally bring  about a cure,
 although  such  cases  may  persist for a long
 time.   The main symptoms are a dull, aching
 pain over the liver, constipated bowels, pale
 feces, a jaundiced skin, dark-colored urine,
 loss of  appeite, a furred  tongue, and dyspep-
 sia ; under treatment these symptoms gradu-
 ally subside.  (See Liver.)
   Renal Obstructions.— A stone or calculus
 in the kidney is one of the most troublesome
 obstructions that can occur in that organ, for
 if situated in the pelvis  of that organ it pre-
 vents the flow  of urine  to a greater or less
 degree  into  the  bladder ;  great  pain in the
 back in one loin or other so severe as to double
 the patient up, and pain passing downward
 to the  groin, nausea, vomiting, and  often
 blood in the urine  are the main symptoms.
 They may occur at intervals, and generally
 come on after exertion,  as riding on horse-
 back  or in a jolting  vehicle.   Often small
 pieces of stone  become detached and pass
 away in the urine, but their passage is accom-
 panied  with very  severe  pain at  the time.
 A hot hip-bath, cr hot poultices and fomenta-
 tions must be used to ease the pain, and, if
 needful, opium may be given or chloroiorm
 may be cautiously inhaled.   If the stone pass
 down into the bladder, it may then be recog-
 nized and removed  by the operation of lithot-
 omy or lithotrity ;  very  often  it remains in
 the pelvis of the kidney, and then causes dila-
 tation  and  subsequent  destruction of that
 organ.  Tumors  growing in  the  abdomen
 and hydated  cysts may cause an obstruction
 to the flow of urine, so also will cystitis or
 inflammation of  the bladder, a stone or tumor
 in the bladder, and a stricture of the urethra.
 In all these cases the flow of urine is more or
less  impeded and the parts behind  the ob-
struction become distended, and finally cause
a serious disease in the parts behind.
  Obstructions  of  Circulation.—Obstruc-
tions  may take place  in the course of the cir-
culation ;  thus a vein may be plugged with fib-
rine,and if this occur in a large vessel the parts
below will  become  swollen and cedematous ;
in this way gangrene  of an extremity may
be caused ; in other cases  an artery may be
blocked up, as occurs in  some cases of hemi-
plegia or  paralysis, because  the supply of
blood is then cut off  from the part ; if the
block exist in the brain, it  may cause serious
consequences,  but  if  a  small  vessel  be 
344            OZDEMA
OLFACTORY  NERVES
blocked in other parts of the body very little
harm is done. A plug which is formed at the
spot of obstruction  is called  a thrombus ; a
plug which  is carried from a distant point to
ihe seat of obstruction is called an embolon.
(Sec  Embolism and Apoplexy.)  In  very
rare cases a plug forms in  the right side of
the heart, and may  cause death in a short
time ;  very  often, in the process  of  dying
slowly, clots form there, but give rise to no
symptoms to call for remark.  Any foreign
body met with in any part of the body may
be looked  upon as  an obstruction ;  thus  a
marble or coin in the air-passages, a piece of
meat or false teeth lodged in the oesophagus,
a bean or pea in the  nostrils, are all instances
of obstruction.  (See Foreign Bodies.)
   In addition to the  above obstructions there
are some  which are of  a much more minute
character,  by which very small vessels get
blocked up,  and as a consequence  of which
very serious mischief may  be set up  in the
organs thus affected.  It now and then hap-
pens that when the heart has become affected
after an attack of rheumatic fever, vegetations
or growths of fibrine which  are then found in
the valves of the heart become washed off by
the stream of blood,  and block up vessels in
different parts of the body ; in  such cases
there is generally pallor of the skin, a fluctu-
ating temperature, as shown by the thermom-
eter, and much prostration ; such cases gen-
erally  prove fatal.  In all cases of disease of
the heart and in many affections of the lungs,
as emphysema, etc.,  the general course of the
circulation is impeded, and often dropsy may
ensue  in consequence.  (See  Dropsy and
Heart.)  A  diseased condition of liver, as
in cirrhosis, will also cause an obstruction to
the circulation,  and  since the blood  cannot
flow freely  through the portal vein, ascites
or dropsy of the abdominal cavity will ensue.
Also see Gullet.
  CEDEMA is the swelling caused by effu-
sion of serous or inflammatory fluid into the
loose areolar tissue  lying under the skin or
mucous membrane.  A well-known example
of oedema is  the  diffused and soft swelling
which occurs over the feet and ankles, either
as a result of general debility or in connec-
tion with  dropsy due to disease of the heart
and kidneys.  Pressure upon the veins of a
limb,  and consequent obstruction to the flow
of blood toward the heart, constitute a fre-
quent cause of cedema.  In the last stage of
cancer of the breast, the arm  often becomes
enormously swollen  in  consequence of the
pressure of the enlarged and cancerous glands
in the armpit upon  the veins which return
the blood  from  the  upper extremity to the
heart.   A  similar result  is sometimes pro-
duced  at the  extremity of a  limb,  in conse-
quence of tight bandaging after fracture.   In
inflammation a modified serous fluid is gener-
ally poured out, which causes swelling and
cedema of the affected part.   True cedema,
caused by effusion of fluid, always forms an
inelastic swelling, which retains for some time
any  marks made on its surface by compress-
ing it  with the finger.  It may be thus distin-
guished  from the hard,  solid effusion pro-
duced by chronic inflammation.
  The following arc some of the chief forms
of cedema :
  Dropsical oedema, as maybe met with in the
swollen limbs  of patjents  suffering from
Bright's disease of the kidneys, from  disease
of the heart, and from exhaustion.  The legs
sometimes become much swollen, and  the dis-
tended  skin smooth, glistening,  and  some-
times red and inflamed.
  Inflammatory cedema  is caused by the effu-
sion  of a fluid  containing fibrine, which coag-
ulates spontaneously on exposure to the air ;
fluid of this kind is formed whenever the sur-
face of the body is inflamed by the application
of a  blister ; but here  the effusion is quite
superficial.  When a similar fluid is  poured
out into the loose areolar tissue  under the
skin  in  connection with irritative or  inflam-
matory processes, the  swelling is called in-
flammatory,  cedema.   The  extent  of  the
swelling depends upon the amount and the
character  of the  areolar  tissue found in the
region inflamed.  In the loose and abundant
subcutaneous tissues  of the eyelids a consider
able quantity of  fluid may be readily effused.
Hence  the rapid  and extreme  swelling  of
those structures in cases of erysipelas  and in-
flammation of the face.  The tissue under
the conjunctiva is also very loose, and swells
up rapidly, in  some severe cases of ophthal-
mia, constituting  the  condition  known by
surgeons as chemosis.  The most dangerous
form, probably, of local inflammatory cedema
is the  effusion of fluid into the loose tissue
at the upper  part of  the larynx,  which is
often produced  in children who  have inad-
vertently  swallowed some very hot fluid.
The  narrow orifice leading to the larynx and
windpipe  is speedily closed  by  the swollen
tissues, and the patient,  if not relieved by
surgical treatment, soon  dies from suffoca-
tion.
  (ESOPHAGUS is a muscular tube which
connects the pharynx above with the stomach
below, so as to  allow of the passage of food
from the mouth into the intestinal canal.  It
is lined by a smooth epithelial  membrane,
and is capable of expansion according to the
size of the food  swallowed.   It is commonly
known as the gullet.  It is sometimes the seat
of cancer and stricture, and it may become
seriously  injured in cases where children
swallow  boiling  water  by mistake.  (See
Gullet.)
  OILED SILK. (See Silk, Oiled.")
  OLFACTORY  NERVES  are  special
nerves emerging from the brain, one on each
side, which, spreading out over the interior 
OLIBANUM
OPHTHALMIA
340
of the nose, enable man to have the sensation
of smell.  The nerve filament may be stimu-
lated, as  in  cases of taking  smelling-salts,
and, if seriously  injured, the sense may be
lost.  (See Brain.)
  OLIBANUM  is a kind of gum resin ob-
tained from a plant called the Boswellia ser-
rata.  It is not now officinal. It occurs in small
masses called tears, of an oblong shape, and
having  a peculiar odor.  The resin in  it
enables it to burn with a peculiar odor, and
the gum to form an emulsion with water.  It
is a stimulant like myrrh, but is mainly'used
as  incense   in Roman  Catholic  places  of
worship.
  OLIVE OIL is perhaps better known  as
an  article of  food than of medicine,  yet it is
valuable as both.  This oil, which is obtained
from olives  grown in  Southern Europe, by
pressure,  and commonly called  salad-oil, is
of a pale straw color  with a tinge of green in
it.  It tends,  at a  low  temperature, to become
solid, apparently by the crystallization of  its
bases, oleine and palmitine.  When  brought
into contact  with an alkali these  bases are
decomposed, the acids, oleine, and palmitine
uniting with that to form a soap, the glycerine,
which is the normal base,being* set free.  (See
Soap and Glycerine.)   The oil itself is used
in making several liniments, plasters,and  oint-
ments, and is sometimes given internally.   In-
ternally, in large doses, whether given by the
mouth or  as an enema, it  tends  to open the
bowels, and  to act as  a  laxative.   For this
reason  the plentiful use of salad with oiive
oil  will not  infrequently  tend to  open the
bowels  regularly.   It is also  used externally
for lubricating  the surface.  When cod-iiver
oil  cannot be taken, olive oil often can,  and
if so, is sure  to  do some good.  It is  not so
easily digested as cod-liver oil ; nevertheless,
its pleasant flavor and taste  render it superior
to the former in a certain number of instances.
It  may  be  used  with advantage  by  in-
unction in some wasting diseases of children,
the smell produced being not nearly so un-
pleasant as  that  of  cod-liver oil  used  the
same way.
  OINTMENTS are forms of remedies in
which the active  substance  is wrought up
with  lard or some similar fatty substance,
which, being smeared on the skin or raw sur-
face, keeps the part moist and prevents evap-
oration.   Formerly a distinct kind of oint-
ments, called cerates,  was employed ; in these
a considerable quantity of wax was mixed up
with the other substances, so that their  sub-
stance was harder and firmer than those of
ordinary ointments.   The name is now done
away with, but  the substance  remains, for a
good many of the ordinary ointments  contain
wax, and are essentially cerates.  Ointments
have  been long in favor as  applications to
wounded  surfaces, and  doubtless  in many
cases they do good ; but in certain instances,
especially  when  the  discharges  tend   to
decompose, they do harm : the fats break up
and the fatty  acids are  set free, and so the
application becomes a curse rather than  a
blessing.  The same untoward results follow
the use of a single application of ointment too
leng.   (See Golden Ointment.)
  ONYCHIA. (See Nails, Diseases of.)
  OPHTHALMIA is a term applied to in-
flammation of  the conjunctiva or thin mucous
membrane, which covers  the front of the eye-
ball and lines  the inner surfaces  of the lids.
In some forms, however,  of ophthalmia, there
is inflammation also of the cornea, and of the
anterior part of the  strong fibrous coat of the
eye which  is  called the  sclerotic.  Ophthal-
mia  is  a very frequent affection,  presents
very many forms, and originates from one or
more of a great number  of  local and consti-
tutional  causes. , Its simplest form consists
in slight and temporary  redness  and itching
of the surface  of the eye, due to the presence
of a particle of dust or to the prolonged ex-
posure  of the eye to  strong  light.  At the
other extreme of a long list of ophthalmic
affections  is  placed the acute  purulent or
Egyptian ophthalmia,  in which  there is in-
tense inflammation of  the conjunctiva,  at-
tended with profuse suppuration  and consti-
tutional  irritation, and,  in  many cases, ter-
minating in rupture of  the eyeball and  total
loss  of vision.  The following are  some of
the principal  and  most common  causes of
ophthalmia : the  presence between the  lids
and  ihe surface  of the eyeball  of foreign
bodies, such as  particles of dust, sand,  and
other matters.  Particles cf steel and iron,
when impelled with much  force, adhere to
or are imbedded in the tissue of the cornea or
conjunctiva, and so long as they remain keep
up inflammation.'  An inverted eyelash, by
irritating the conjunctiva on the  front of the
eyeball, often  causes ophthalmia.   Exposure
of the eyes to  a strong  draught and the pro-
longed  action of a heated  atmosphere  are
common causes, and also much and long-con-
tinued exercise cf the eyes on minute objects,
especially if this be carried on under artificial
light and in close,  badly-ventilated rooms.
To these conditions may  be attributed the fre-
quent occurrence of ophthalmia among watch-
makers,   working  jewellers,  compositors,
needlewomen, reporters, and  clerks.   The
eyes are usually much irritated by very bright
artificial light,  whether director reflected, and
by the reflection of strong sunshine from very
extensive light-colored surfaces, as the sea,
a long stretch  of sand, or snow.   There are
certain  constitutional diseases which render
their subjects liable  to attacks of ophthalmia ;
of these, the principal are gout, rheumatism,
scrofula, and inherited syphilis.   Individuals
who, in consequence of high living and of in-
dulgence in alcoholic drinks, suffer from dys-
pepsia and congestion of the liver and other 
34G          OPHTHALMIA
OPHTHALMIA
digestive  organs,  are  much predisposed to
inflammation over one or both eyes.  Oph-
thalmia is very common among the very poor,
and  in bodies  of men who are crowded to-
gether in foul and close rooms, and who are
badly fed.  Under these circumstances the
ophthalmia is caused directly by the presence,
on the inner surfaces of the eyelids, of firm
and rounded swellings  called granulations.
  Simple  or Common  Ophthalmia  is  pro-
duced by slight injury or by exposure to a
draught.   The  symptoms are,  redness of the
conjunctiva, "  watering" of the eye, and a
feeling of smarting and stiffness.  These, in
most cases, soon pass away after the applica-
tion  of a cooling lotion, care having  been
taken to   protect:  the  eye both  from  light
and the action of cold.
  Catarrhal Ophthalmia is so named because
it is caused by exposure to those external and
climatic  influences which give rise  to  the
symptoms of the affection known as catarrh,
or common cold, but which here attack the
mucous membrane of the eye and lid's exclu-
sively, or to a greater extent than that of the
nose, fauces, and air passages.  This form of
ophthalmia  is  met with in patients attacked
by measles, and  occurs  in  some  cases of
scarlet fever and of  erysipelas.   The symp-
toms resemble those of  simple  ophthalmia
much aggravated.  The eyelids feel stiff,  and
the patient complains of a feeling as if " sand
or dust  had got into  the eye."   There is
a bright  scarlet redness  of the conjunctiva,
disposed   not regularly over the whole  sur-
face, but in irregularly formed patches. There
is a discharge from the eye, which at first is
clear and thin, but  afterward  of a  yellow
color, and thick and  viscid.   During sleep
this discharge collects at the edges of the lids
and  dries there,  gluing   together  the  eye-
lashes.  The lids become red and swollen.
The  general health gradually becomes disor-
dered, and  the patient  complains of head-
ache, fever,  dryness of the mouth and throat,
and loss of appetite.   In ordinary cases the
affection  generally lasts for about ten days or
two weeks,  but when  the inflammation has
been allowed to proceed  without treatment,
it often passes into an  obstinate and danger-
ous purulent ophthalmia.  In most cases both
eyes are affected.  In old people this form of
ophthalmia  often  becomes chronic, and is
then very rebellious to treatment.  In ordinary
cases of catarrhal ophthalmia,  where there is
not very  much  local  irritation, frequent bath-
ing of the eyes with  cold  water and  the ap-
plication   of alum lotion  (one  grain  to one
ounce of  water), or of  one or two drops  of a
solution  of  lunar caustic (one grain to two
ounces of distilled water), will generally be
found effectual.  The application of the lotion
or drops  should be made thrice daily.  When,
however, the patient complains of severe pain,
and  the eyelids are  red  and inflamed,  light
poppy fomentations should be applied, and
afterward, if these give no relief, a leech to
each temple.  The edges cf  the  lids should
be anointed every night at bedtime with gly-
cerine or olive-oil.  The patient should keep
to a light diet, and  the bowels be kept freely
relieved, if necessary, by the administration
of calomel and  black  draughts.   The eyes
should be protected by a dark green shade.
  Puruhnt  Ophthalmia sometimes  attacks
new-born infants, and under  these circum-
stances  is  regarded as a distinct affection,
which has been styled ophthalmia neonatorum.
The purulent ophthalmia  of  adults, or the
Egyptian ophthalmia, as it is called, in con-
sequence of its prevalence in the French army
after the campaign of iSos, sometimes attacks
individuals who have been collected together
in numbers under faulty hygienic conditions,
and breaks out occasionally in large schools
of young children.  The symptoms of puru-
lent ophthalmia at first resemble those of the
catarrhal form, but they rapidly  increase in
severity, and in the course of twenty-four or
thirty hours the eyelids  become  of a deep-
red color, and swollen to such an  extent that
they cannot be opened.   The patient is much
alarmed by these symptoms, and, as he can-
not obtain  a glimpse of any object, or even
tell whether it be day or night, believes that
he is blind.   Now,  between the swollen lids
there is  a constant discharge of thick purulent
fluid, which, if applied even in  minute quan-
tity to  a healthy  conjunctiva, soon sets up
purulent inflammation.  The  conjunctiva is
reddened and much swollen, so that it forms
large rolls which cover over a greater part of
the surface of the cornea.  The patient com-
plains of acute  pain, which shoots from the
eye to the  corresponding cheek,' forehead,
and temple.  There is considerable constitu-
tional disturbance and the patient  is gener-
ally very nervous and  fearful of permanent
blindness.   The  affection, if unchecked by
treatment, causes ulceration with perforation
of the cornea, and,  in some cases, sloughing
of  the whole of this transparent  membrane.
In  the latter case there will, of course, be
complete loss of vision, with slight ulceration
and even perforation ; the sight, though not
destroyed,  will  in  most cases be seriously
impaired.   Occasionally the purulent oph-
thalmia extends with great rapidity from the
conjunctiva to the  other coats, and even to
the interior of the eyeball.
  The purulent ophthalmia of infants, gener-
ally occurs on the  third or fourth  day after
birth.   In many  instances, and especially
among the poor, it  is not noticed  for the first
day or two, and until irreparable mischief has
been  produced.  In the first stage the lids
are slightly swollen, and are stuck together by
some dried mucus.   There is intolerance of
light, and the infant's brow is generally much
contracted.   At a  more advanced  stage the 
OPHTHALMIA
OPHTHALMIA         347
 lids become red and puffy, and are separated
 from each other by the protrusion of rolls of
 inflamed and swollen conjunctiva.  From the
 surface of this  membrane there is  a profuse
 and continuous discharge of thick yellowish
 fluid, which is  sometimes stained with blood.
 The effects of this affection, when severe and
 if it be allowed to take its course, are slough-
 ing of the cornea and ulceration of this trans-
 parent membrane, and subsequent opacity.
 Purulent  ophthalmia  is more  amenable  to
 treatment in new-born children than in adults,
 and in the former class of patients, unless the
 cornea has been already involved, speedily
 and completely subsides without any bad re-
 sults, after the application of suitable reme-
 dies.
   The adult subjects of purulent ophthalmia
 are usually pallid and  weak, and  should not
 be  treated on any  lowering  system ;  the
 strength  ought to  be kept  up by  good  but
 easily digestible food ; beer, wine, and in very
 bad cases  brandy may be given in moderate
 quantities.  The most useful medicinal agents
 are quinine and opium.  The local treatment
 consists in incising the masses of  swollen
 conjunctiva, and  in applying  some  strong
 astringent, as lunar caustic in strong solution,
 or in the  solid stick.   The eyes are then to
 be frequently  syringed with a solution  of
 alum.  There is probably no other local affec-
 tion in which early professional assistance is
 more  necessary than  purulent ophthalmia,
 whether in the  adult or young infant.  But in
 all cases of this kind,  much  responsibility is
 thrown upon the  nurse or attendant.  The
 eyes have frequently to be bathed, the  face
 must be kept clean, and above all, great care
 must be taken to wipe away at once the puru-
 lent discharge, as the  contact  of  this  with
 the conjunctiva of a healthy eye will almost
 certainly set up fresh inflammation and  sup-
 puration.  The affected eye should be cov-
 ered by a  layer of  cotton-wool fixed by a
 bandage.  This covering should  be frequently
 renewed, and when removed should at once
 be burned.
   In the purulent ophthalmia of infants the
 local treatment need not be  so severe.  The
 frequent application of a solution of alum (15
 grains to  one  ounce of water) will in most
 cases prove an  efficacious means of arresting
 the course of the disease.
   Granular Ophthalmia  generally  presents
 the following appearances :  the  edges of the
 eyelids are red and swollen, the upper lid
 droops  over the front of  the eye, and  the
 lower lid is slightly everted ;  the conjunctiva
 is  reddened and on  exposure to bright light
 there is a free discharge of tears, and the lids
 are closed  spasmodically ; the cornea  is pit-
 ted on  its surface and more or less hazy,  and
near its circumference  is invaded by a well-
marked zone of dilated blood-vessels.  On
everting  the upper lid  it will be found  that
the conjunctiva lining its inner surface is very
red and vascular, and studded with numerous
soft  and  ruddy projections  resembling the
granulations observed on all healthy ulcers.
In consequence of this resemblance the soft
growths which are enlarged follicles  and pa-
pillae of the  conjunctiva are called granula-
tions, and the inflammation to which they
give rise by friction  over  the surface of the
eyeball is called granular ophthalmia.   These
granulations are  different in form, size, and
consistence  in different cases.  In some cases
the  inner surface of  the lid is studded by
minute and  pale gray granules, which have
been likened  to  soaked sago  grains.   The
precise nature and origin of this affection has
not  yet been made  out.  It is of frequent
occurrence  among sailors  and soldiers, and
in large parochial schools.  It  is  very  com-
mon among the peasantry in some parts of
Ireland.   The subjects of prolonged granular
ophthalmia  are usually pale, weak,  and out
of health.   It is a very chronic and obstinate
disease,  and often causes dense  opacity of
the cornea and incurable blindness.
  The treatment of this affection consists in
supporting the strength of the patient, and in
attempting  to  rub  down  and  destroy the
granulations by  astringents  and caustics.
The applications most  frequently used for
this  latter purpose are blue-stone, lunar caus-
tic, acetate  of  lead, liquor potassae,  tannin,
and  quinine.  These are all very powerful
agents and necessitate great care in their ap-
plication.
  Scrofulous or Strumous Ophthalmia differs
from the  preceding forms  of ophthalmia in
being an inflammatory affection of the cornea
and  not  of  the conjunctiva.   It is met with
generally in ill-nourished and unhealthy chil-
dren and young women.  It is often associ-
ated with pustular affections of the scalp, and
with eczematous scabs and excoriations about
the nose and ears.  Although called scrofu-
lous ophthalmia, this affection is not met with
exclusively in individuals in  whom  there is
any  morbid disposition  of a scrofulous or
tuberculous   character.  The  most  morbid
symptom of this kind of ophthalmia is  great
intolerance   of   light (photophobia).    The
patient generally lies with the face  downward
and  the eyes covered  by  the  hands or arms,
and  when he is raised and  brought to the
light, the eyelids  are closed spasmodically,
and  the whole face is  much contorted. There
is a profuse  flow of tears, which irritate and
redden the lower lid  and the cheek.   When
with much  difficulty  the eyelids  have  been
separated, the observer will find  at first sight
but very little to  account for the  acute pain
and  intolerance of light,  The conjunctiva is
generally clear and free from swelling and red-
ness. On examining the cornea closely, it will
be found somewhat clouded and studded by
a few small superficial pits or small ulcers, 
348      OPHTHALMOSCOPE
OPIUM
and at the margin may generally be seen one
or more whitish specks  surrounded by  dis-
tended  blood-vessels.    In  advanced cases
there is deeper and more extensive ulceration,
with dense clouding of the cornea.
  The essential point in  the treatment of this
affection is the improvement of the general
condition.  If possible, the patient should be
sent to  the sea-side and  be allowed  to take
exercise in the open air.   The diet should be
nutritious and easily digestible, and a small
quantity of wine may be allowed.  Prepara-
tions of steel and cod-liver oil are especially
beneficial in cases  of this kind.   The  intoler-
ance of light and  the  pain in the eyes may
be much relieved  by applying small  blisters
one  after the  other  to the temple and fore-
head.
  OPHTHALMOSCOPE is art apparatus
used for exploring the interior of the eyeball
and the  posterior  portions of the retina and
choroid. It was invented by Professor Helm-
holtz in 1S51, and  has since proved itself an
invaluable agent in the diagnosis of affections
of the organ of sight arising from local mor-
bid  changes,  and also  from constitutional
disorders.  Surgeons skilled in  its use are
now able to detect inflammatory and hacmor-
rhagic changes in the membranes and  humors
of the  eye, and  occasionally discover intra-
ocular indications  of disease of the brain and
of Bright's disease of the kidneys, of the ex-
istence  of which serious disorders there had
previously been no  suspicions on the  part
either of patient or medical attendant.   The
simplest form of ophthalmoscope is a round
concave mirror perforated at its centre by a
small orifice, through which the surgeon can
look directly upon the fundus of the eyeball
illuminated by the  rays of  a  bright light
thrown upon the  mirror and reflected to the
patient's  retina.  These rays are reflected
back from the bottom of the patient's  eye,
and converge at the surface of the  reflecting
mirror, to the back part  of which the eye of
the observer is  applied.  In addition to the
mirror a small  convex lens of short focus  is
often placed before the eye of the patient, in
order that the observer may obtain a clearer
and magnified view  of the  retina.  The ex-
amination is made in a darkened room, and
a gas-burner or oil-lamp  is so placed that it
is on one side  of, slightly behind, and  on a
level with the head of the patient, who sits
facing the surgeon.  Before the examination,
atropine is usually applied to the surface of
the eye, in order to dilate the pupil.   The
use of the ophthalmoscope seldom causes any
pain or uneasiness.   The temporary disturb-
ance of vision, which sometimes  follows the
examination, is usually  due to the action of
atropine.
  OPISTHOTONOS  is  a technical term used
to designate  those convulsions  in cases of
tetanus or hysteria, etc.,  in which the patient
is  arched backward, so that the head nearly
touches the heels.   (See Tetanus.)
  OPIUM  is perhaps the most important
drug in our  pharmacopoeia.  Various kinds
are in use, but all are obtained in the same
way.   The white opium poppy is allowed to
mature its capsules  only  for  a very short
period, only indeed for a  few  days after the
flower  leaves have fallen.  Then incisions are
made  in its  texture, so deep as to reach the
sap, but not so deep as to reach  the interior
of the  capsule.  The sap  exudes as a milky
juice which  speedily hardens  and becomes
brown, forming  little  masses.  These  are
carefully gathered or scraped off and wrought
up  into balls or  cakes, and usually covered
over with some leaf.  The preparations are
many and various, comprehending a confec-
tion, a plaster, an enema, an extract, a liquid
extract, a liniment, a pill (commonly called
compound soap pill), a lead and opium pill ;
aromatic chalk powdered with opium, com-
pound ipecacuanha powder, compound kino
powder, compound  powder of opium, tinc-
ture of opium or laudanum, compound tinc-
ture of  camphor, also known as  paregoric
elixir;  an ammoniated tincture of  opium,
opium lozenges, ointment of galls and opium,
and wine of opium.   Of course the doses cf
these vary according to the effect it is desired
to  produce, but supposing  it  is  intended to
give rise to an effect comparable to that pro-
duced  by a grain of opium, that is, an ordi-
nary full dose, they would be as follows : of
confection of opium 5  to 15 grains, of the ex-
tract about  a grain, of the liquid  extract 25
drops, of laudanum 25 or 30 drops ; of com-
pound tincture of camphor about  the same,
and of ammoniated tincture of opium rather
less, of opium  wine  rather  more than  30
drops  may  be given ; of chalk and  opium
powder 30 to 40 grains, of compound ipecac-
uanha powder 10 grains, of compound kino
powder 15 grains, of compound soap pill 4 or
5 grains, of compound powder  of opium 3
grains, of lead and opium pill 4 grains, of
opium lozenges 1 to 4.   Opium contains a
great variety of  substances of a crystalline
character, and possessed of distinct properties.
Its chief acid is one called meconic acid, its
chief base is  morphia.  But besides morphia
it  contains  codeia, papaverina,  thebaia,  or
paramorphia, narcotine,  narceia, meconine,
or  opianyl.opianine, and  porphyroxine, with
perhaps a variety of others.  On the whole,
not much is known  with certainty  of the
action of any of these bases except morphia.
Two salts of morphia are used, the  hydro-
chlorate and the acetate.   Of  the former we
have a solution, suppositories,  lozenges, and
another form of  lozenge combined with ipe-
cacuanha.   Of the acetate merely the liquor
or solution is officinal.
  In opium, to exercise its free influence, it is
necessary that it should be absorbed into the 
OPIUM
OPIUM
340
 blood, but it does not greatly matter by what
 way it is introduced, whether by the stomach,
 the bowel, by a raw surface, or, as is now ex-
 tensively practised,  by subcutaneous injec-
 tion.  If in any  of  these  ways an ordinary
 dose of opium,  or  its alkaloid, morphia, is
 introduced, there is  first of all a stage which
 might, though incorrectly, be called  one cf ex-
 citement.  The mind becomes quiet under its
 soothing influence,  the pulse quickens,  the
 mouth becomes somewhat dry, but  the moist-
 ure  of  the  skin  increases.  By and by  the
 pulse slackens, the breathing is long and full,
 and the  patient  sleeps.   When he  awakes
 there is generally thirst,  some nausea, and
 very often headache ; the tongue is furred and
 the  bowels confined.   Should a large dose
 have been given  the effects are more marked,
 the preliminary stage is hardly noticed, sleep
 of a heavy kind speedily  comes on, and the
 breathing is often stertorous, while the pulse
 is slow.   This condition  may be induced by
 very different  quantities of the poison in dif-
 ferent individuals.   Children  are  unusually
 susceptible to its action, in f omuch that there
 is danger in giving  them  the very weakest
 preparation of opium in  the smallest quan-
 tity.  On the other  hand, certain individuals
 can  hardly be affected by its use  except in
 large quantity.  Such a condition of system is
 especially brought about by prolonged use of
 the drug.
  After a poisonous dose of opium, the stage
 of excitement  is hardly noticeable, and  nar-
 cotism comes on almost at once.  There is a
 craving  for sleep which can hardly be over-
 come, and sleep if permitted soon passes into
 complete insensibility ; the surface  at  first
 pale and covered with sweat, becomes  cold
 and  livid,  the  breathing, exceedingly slow
 and  stertorous, gradually becomes  more and
 more shallow till it ceases.  The pulse from
 being  full  and  firm  becomes  smaller  and
 smaller,  slower and  slower until it  ceases to
 be felt.   The  muscles of  the whole body are
 relaxed,  there is complete  loss of sensibility,
 the patient  can  no  longer be roused.   The
 rattle begins in his throat, and gradually death
 ensues. One of the most marked peculiarities
 of the action of  opium is its influence on the
 pupil, which it contracts powerfully, so  that
 when the patient is  fully under its influence
 the pupil may seem  no larger  than  a  pin's
 point.   This is an important diagnostic as to
 the cause of   insensibility in poisoning by
 opium, and the insensibility produced in other
 ways.  As  to  the remedies  to be  employed
 in poisoning  by opium,  these are chiefly
 meant to prevent sleep, as the  system, after
 having once fallen under  its influence to the
full extent, is  not easily roused.   Shaking,
 flicking  the  soles of  the feet, etc., are com-
monly resorted to.   But these are only to be
had recourse to after the  stomach  has  been
emptied  of  the  poison.   Perhaps  the best
thing here is the stomach-pump, as it admits
of the stomach being washed out, but if that
is not at hand a stimulant emetic—mustard
is the best—should be given, after  which
black coffee should be  freely administered
from time to time till the patient gets well.
  There  are few diseases in which complica-
tions demanding  the use of opium  may not
arise.  In fact its uses  are legion.   Thus in
fevers, though we cannot hope  lo cut short the
malady,  we may obviate certain of  its most
distressing symptoms by means of opium :
want of sleep especially in  typhus often gives
rise  to delirium of a low muttering son, with
picking  of the bed-clothes and wandering.
Here opium  judiciously given  may  save the
patient, who in  such cases is in  very great
danger.  Graves used  lo  give opium  com
bined with tartar emetic in these  cases, ap-
parently with the  best results.   He  gave
three or  four drops  of laudanum, with a little
tartar emetic every  two  hours till the patient
was  quieted.   In any  malady accompanied
by this form of deiirium, where the  strength
is at  the lowest ebb, the tongue brown and
dry,   the  pulse  hardly  perceptible  and too
quick to  be counted, opium given in this way
along with  a certain quantity of brandy, to
be administered  as carefully  as the opium,
safety may be obtained almost when  past
hope.  But the opium must be given in  small
doses, frequently repeated, and the brandy in
teaspoonfuls.  In acute mania opium, with
or without tartar emetic, is of great service,
Sometimes it is best given  under the skin.
  But the great  use of opium is  to relieve
pain. For this purpose  it is now mostly given
hypodermically, that is, under the skin.   For
thereby  the digestion is less  disturbed, and
the patient is free to take food ; moreover, a
smaller quantity suffices. However, this must
be borne in mind, that  the quantity  required
to procure  case rapidly increases, so that
what would  suffice at  one time will net at
another,  some time thereafter  ; and the same
holds good of its  internal administration.  It
is best, therefore, to alternate its use with that
of other  sedatives,  especially chloral, so that
the system has time to  recover from the use
of the one before it is necessary to return to
it.   In this way opium  is of the greatest ser-
vice  in  gall-stones,  the passage of urinary
calculi, cancers, painful ulcers, etc.   A single
injection may suffice to cure sciatica and other
forms of neuralgia,  if applied on the spot, but
as the same result used  to  follow acu-punc-
ture  in certain instances, we cannot be quite
certain of the efficacy of the morphia.   The
same means may be employed  to cure  pleu-
rodynia,  that is,  pain in the side, if  the pain
be deep seated. The same form of the remedy
may  be of use in the vomiting of pregnancy,
or to assist persistent hiccup.  When the pain
is in  the stomach itself and the vomiting arises
from disease of that organ, of course it  is 
350
OPIUM
ORTHOPNCEA
better to give the opium by the mouth, pro-
vided it be not  rejected,  as it too often is.
If so, either a very small piece of morphia
and sugar may be given, or it may be admin-
istered  subcutaneously.  In certain  forms of
heartburn,  too. it may be employed with ad-
vantage, and may be combined with tonics.
On the bowels it acts much as it does on the
stomach, arresting their secretion and motion.
Hence constipation is one of the most certain
consequences of giving opium,  even in  small
doses.   This property becomes of great  value
in disease,  when it is desirable to restrain in-
ordinate action of the bowels.  To effect this
no substance is so useful as opium, especially
when it is desirable to  allay irritation as well
as to arrest action.   In diarrhoea, therefore,
both acute  and chronic, opium is  of  great
value, especially after  the irritant substance
which  has  given rise  to the  diarrhcea has
been removed ; previous to that its use  is in-
advisable.   Hence, too,  a prescription of use
in many forms of diarrhcea with griping—ro
drops of laudanum in half an ounce of castor-
oil.  This  combination insures the  ejection
of the  irritant matter,  and the  immediate
action  of  the opium to follow it.   In  some
forms of colic allied to the diarrhoeas we have
already spoken of,  the  castor-oil  and lau-
danum is the best remedy.   In peritonitis,
where the motion of the intestines is provo-
cative  of harm, opium is  the  best  remedy ;
so, too, in  injury to the  intestines, especially
rupture, from  whatever cause.   When the
bowel is affected, especially in  its lower por-
tion, it is  often  the  practice  to  administer
opium,  i.e., laudanum, by injections.  When
so administered the injection ought to  be of
the smallest possible bulk, not  exceeding an
ounce, and ought to be of the temperature of
the body, i.e.,  about 100° F.   This is very
effectual in  some forms of diarrhcea,  especial-
ly in those   dangerous  forms which  carry off
children rapidly.   In diarrhcea from tubercle
or typhoid  a  similar  law prevails.   Opium
may be exhibited in this manner  with  great
success when  it is  desired to relieve pain in
the neighborhood of the  rectum, especially in
the bladder and womb.   Commonly supposi-
tories are used in such cases instead of  injec-
tions.   Mixed with gall ointment it  is one of
the best remedies we possess  for ulceration
of the rectum and piles.  Fissure of the  anus,
one of the most excruciating of maladies, too,
may be relieved,  if  not  cured,  by a similar
application. Given internally, or by  the skin,
opium or morphia  are of  the  very greatest
service  to  patients the  subjects of  delirium
tremens. .  Frequently  it is advisable to add
tartar emetic or aconite to it :  but if, on the
other hand, the patient has long been without
food it is necessary to feed him carefully, and
even  to administer stimulants.    In  these
cases ammonia is invaluable.  In whooping-
cough  opium is  often  of signal service, if
swallowed slowly, as by sucking a lozenge,
it relieves the irritability of parts,  and  when
introduced into the system seems  to relieve
the irritability which gives rise to the whoop.
As, however, whooping-cough ordinarily oc-
curs in young people, and these bear opium
badly, care must be taken  in  its  administra-
tion.  A small dose of opium, especially in
the form of  Dover's powder,  will frequently
check a cold if  it is  as yet in the  shivering
stage.   It should be taken at bed-time, 5  or
10 grains for a dose, and care  taken to secure
a good  perspiration afterward.  When mor-
phia is  given hypodermically, the  acetate is
commonly used,  as  nearly as possible in  a
neutral  state, and some prefer giving a little
atropine with it.  The solution should  be  so
regulated that one or  two drops  suffice ; not
more than five should  ever be given, and the
quantity ought not to exceed the fifth part of
a grain.
   OPODELDOC  is the name  commonly
given to the soap liniment of the  pharmaco-
poeia.   It consists of hard soap, camphor, oil
of rosemary, spirit, and water.  Its chief use
lies in enabling us to rub a part with ease, ob-
viating  unpleasant friction, and at the same
time acting  as a slight stimulant to the  parts.
Its chief value is in sprains  after  they have
ceased to be acute, and when rubbing is of
value, tending to remove stiffness and  swell-
ing, and so  rendering ihe joint supple again
It is also a  most useful  basis  for other lini-
ments which it is desirable to  rub into a part,
when these contain no oil or soap,  such as is
necessary when much, rubbing is intended.
  OPOPONAX is not now contained  in the
pharmacopoeia ; but was so in that of London
up  to 1836.   Its  properties  are  similar  to
other foetid gum resins, perhaps most closely
approaching galbanum.
  OPTIC NERVES are two in number, and
one is supplied to each eye, enabling man to
have the sensation of sight.   (See Eye and
Vision.)
  ORANGES are the fruit of several species
of Citrus belonging to the family A urantiacea.
To the  same  order belong  the lemon, the
lime, and the shaddock.   These fruits are all
distinguished by containing citric acid.   The
orange  juice  contains  in addition  sugar.
Hence their use  as fruit for eating.   In ali
cases where  citric acid is indicated, oranges
may be  used.   As a refreshing article of food
in the  sick-room, there is no fruit superior.
The peel of  the fruits of the Aurantiacecc con-
tains in little receptacles a volatile oil, which
is a pleasant stimulant and flavorer. This oil
is  often  separated and sold  under the name
of neroli oil, oil of lemons, etc.  (See Citric
Acm, Lemons.)
  ORTHOPNCEA  means that condition of
respiration which compels the individual  to
sit  upright.   It is  one of great discomfort
and often is of dire  significance.    Like most 
ORTHOPNCEA
OVARIES            351
other symptoms, it  may depend on a variety
of causes, some of them  having apparently
nothing to do with respiration.   In  many
cases of disease of the heart, the patient, for
a very  long  period  before death, is quite un-
able to lie down.  The only sleep that can be
procured is  got while the patient is propped
up by  pillows.   In drospy, too,  though not
dependent on heart mischief, the patient is
often compelled to sit  up  continually, any
other position interfering so sadly with breath-
ing as  to necessitate instant change, and alto-
gether precluding sleep, except in  that pos-
ture.   In point  of  fact,  whenever  there is
difficulty in  obtaining breath, the patient in-
stinctively starts up, for  in the upright posi-
tion he is able to call into play many power-
ful  muscles, not ordinarily  employed in res-
piration.  Moreover, the weight or  pressure
of the contents of  the  abdomen against the
lower boundary of the chest is removed, and
the powerful muscle of  respiration called the
diaphragm,  or  midriff, may  be  called into
play with more advantage.
  In various maladies  affecting  the respira-
tory organs  this condition is noticeable.  Thus
it may be seen when, from whatever  cause,
the air is prevented from entering the chest
freely, as when in  any malady affecting the
air passages.  Perhaps  spasmodic asthma
furnishes as good  as example  of  extreme
orthopnoea as does  any  disease, for in  it the
patient may be  compelled to lay hold of
something over his head,  so as to fix his
arms, besides assuming the upright position.
Y/hen, too,  the pleuras are filled with fluid so
as to interfere  with  the  movements of the
chest, if the condition be symmetrical, that is
to say, affecting both sides of the  chest,  we
may have orthopncea very markedly.
  It is, however^ in heart disease that we com-
monly see the condition called orthopncea in
its extreme form, to an extent most  distress-
ing to the patient, and even to onlookers.  In
these unfortunates, owing to causes we can-
not here explain, the  circulation of the blood
is sadly interfered with.   The blood current,
especially in the veins, is  dammed back and
obstructed, so that these vessels become over-
loaded and over-distended. As a consequence,
the fluid portion of  the blood passes through
their coats into the  tissues beyond, and accu-
mulates  there.   This is dropsy.   Most fre-
quently these transudations begin in the feet,
and  gradually creep upward ; the ankles are
affected, then the legs  and thighs, and then
the abdomen, too,  is filled.  By this  time,
too,  the circulation of the blood through the
lungs is sadly interfered with from  the  same
cause.   The lungs  are  congested,  and the
blood cannot pass freely  from the right side
of the heart  to the left.   Now to give a sen-
sation  of comfortable easy breathing,  when
the process  is a pleasure  rather than  other-
wise, it is quite as necessary that there should
be a due flow of purified blood from the lung
as of pure air into it.   Now in  the condition
of which we speak the flow of blood from the
lung is sadly interfered with.   Moreover, the
accumulation of fluid  in  the abdomen pre-
vents the use of the diaphragm as a muscle of
respiration,  and so the  movements  of the
chest-wall must accomplish all.   But as mat-
ters  advance apace, the  fluid from the dis-
tended vessels  begins  to accumulate in the
pleura;, which in its turn sadly interferes with
the indrawing  of  air into  the  lungs.  Thus
there is the condition  of  the  circulation al-
ready alluded to as a cause of difficult breath-
ing, and a condition of the respiration arising
from the  former,  and intensifying its evil
effects added en to it, the consequence being
orthopncea of the worst kind, and in too many
instances  only to be terminated with the end
of the patient's life.
   It will  be seen  that the explanation here
given is mainly a mechanical one. The rem-
edies, too, are mainly  mechanical.  In  most
cases the orthopnoea depends on interference
with the circulation as  indicated by mechani-
cal congestion. In the olden time, men used
to remedy that by the lancet ; now vve seldom
use that instrument.   Hot-air baths and hy-
drogogue  purgatives take its  place.
   OSSIFICATION is a term applied to any
of the parts of the body in which calcareous
or other matter is  deposited in the  tissue, so
as to produce hardness or a bony-like aspect
and character.  (See Degeneration.)
   OTORRHCEA  signifies a discharge from
the  ear ; it  is often seen in children,  and
chiefly in  those who are scrofulous.   The ear
should be syringed with  warm water four or
five  times a day, and then filled with  cotton-
wool and  sweet-oil.  (See Ear.)
   OTITIS is a technical name for inflamma-
tion of the ear.  (See Ear.)
   OVARIAN DROPSY is the name  given
to that disease in which a large cyst or cavity,
filled with fluid, grows from the cvary and
fills the abdomen  ; these cysts may grow as
large as an adult  head, or even  larger ; the
walls are tough and fibrous, and contain gen-
erally fluid of a dark color.   (See Ovaries.)
   OVARIAN IRRITATION is sometimes
produced  when the ovaries are congested at
the time of menstruation ; pain, nausea, and
faintness are often the chief symptoms.   A hot
hip-bath, or the application of two or  three
leeches over the seat of pain, and then rest in
the  horizontal  position will  generally give
relief.
   OVARIES are two in number and are sit-
uated one on each side of the uterus or womb,
with which they  are  at certain times con-
nected by means of the Fallopian tubes.  Each
ovary is  about the size and shape of an al-
mond, and contains within  itself numerous
round cellular bodies, called ova, which are
of much importance for the development of 
3o2
OVARIOTOMY
PACKING
the ovary.   This substance is  liable  to con-
gestion as  each  menstrual  period  comes
round, and  it is often the seat of much pain
and suffering in  cases  of  dysmenorrhcea.
The ovary is liable to inflammation, and then
adhesions may  be  set up  with surrounding
structures, and sterility ; great  pain over one
or other side of  the lower  part of the abdo-
men, a feeling of languor and nausea,and pain
in the back,  are  among the chief symptoms.
The ovaries are liable to cystic disease, and
in some cases enormous tumors are formed in
the abdomen, and the case is commonly called
one of ovarian dropsy.   The tumor is gener-
ally of slow growth, commences  on one side
of the abdomen, gradually filling it  up and
making it tense and convex.   The  cyst may
be tapped, so as to allow the fluid to  escape,
or in some cases it may be removed altogether
by the operation known as ovariotomy.
  OVARIOTOMY is the operation by which
a surgeon removes an ovarian cyst  or tumor
from the abdominal cavity ; formerly it was
thought a.very formidable operation, but of
late years it  has been frequently performed
with success.
  OVUM is the small cellular body which
exists  in the ovary in great numbers,  and
which when they have passed  into the womb
and become impregnated, are developed into
the future embryo.
  OXALIC ACID is an organic acid found
present in many plants.  It gives the  acidity
to sorrel and rhubarb, hence these plants are
used as articles of diet.  Oxalic acid,  how-
ever, is a poison, and is often mistaken for
Epsom  salts, or used by  the  suicide.   The
best remedy for  poisoning  by oxalic  acid is
carbonate of lime—common chalk.  The lime
forms an insoluble compound with the oxalic
acid, and renders it innocuous.  (See Poison-
ing.
  OX-GALL, or BILE,  is  not very often
used in medicine.   It is purified after being
taken from the gall-bladder of the ox by add-
ing to it spirit ; this throws down the  mucus,
which is afterward separated  by decantation.
In color it is yellowish-green, with a peculiar
odor.  Its  taste is at first sweet, afterward
intensely bitter.   It is soluble  in water and
spirit.   Bile  contains many  things,  but the
bile acids seem to be the most important sub-
  PACKING, as it is technically termed, is
of two kinds, wet and dry, but the latter is so
uncomfortable that it is seldom had recourse
to.   Wet packing has become almost entirely
an instrument in the hands of hydropathic
practit:oners, but most certainly it  is worthy
of a  wider  appreciation.   One  reason for its
want of popularity is really a want  of knowl-
edge of how and  when to apply it.  A great
stances.  These are reabsorbed under  ordi-
nary  circumstances,  and  undergo  further
changes.  Bile prepared thus is supposed to
act as a laxative, and also to aid in preserving
the contents  of the  alimentary canal  from
putrefactive change.  Thus it is of use where
the entrance of the  bile of the  liver into the
ahmentary canal is  prevented from  whatever
cause, and in constipation supposed to depend
on insufficient bile flow.  Meanwhile its value
is mainly speculative.   (See Liver.)
   OXYGEN  is one of the elements, is a gas
and a supporter of  combustion.  It exists in
the atmosphere in the proportion of twenty-
one parts to seventy-nine of nitrogen. In the
atmosphere it  becomes the means of all kinds
of combustion,  and  the principal  agent in
putrefaction.  It is  the sole means of supply-
ing the  oxygen that is required for the oxi-
dation  of  the tissues of animals,  and the
maintaining of animal heat.   (See Air, Heat
(Animal), Ozone,  Respiration.)
   OXYMEL  consists of a mixture of honey
and acetic acid.  This preparation  is but lit-
tle used, even  as a vehicle, though it is rather
an agreeable one.   The  only oxymel of im-
portance is  that of squills,  which is largely
used,  especially among children, for the pur-
pose of. procuring  the effects of squill.  (See
Squill.)
   OXYURIDES is a word used for thread-
worms or ascarides.  (See Ascarides.)
   OZONE is  a peculiar substance discovered
by Schdnbein  in 1858.   It may be prepared
by passing a  succession of electric sparks
through atmospheric air or dry oxygen, when
a peculiar odor will be perceived.   Ozone is
much denser than oxygen itself ; it may be
destroyed by a heat of 5500 Fahr. ; it is in-
soluble in water and in  solutions of acids or
alkalies ; when present in the air it acts as an
irritant  to  the air-passages.  This substance
possesses considerable bleaching properties,
acts as a powerful  oxidizing  agent, and cor-
rodes organic  matters.  Its presence may be
detected by moistening  a slip of paper with
starch and  iodide of  potassium ; the ozone,
if present, will liberate the  iodine  from the
iodide of potassium, and the  free iodine will
color the starch blue.  Its influence on man
is  not vet understood.   (See Air.)
   OZCENA.  (See  Nose, Diseases of.)
number of slighter  maladies, such as incipi-
ent colds, etc., may be  cured  by it ; it  mar-
vellously removes fatigue, and withal may as
easily be given in a private house as in the
best appointed  hydropathic  establishment,
Perhaps the simplest form of wet pack is the
local  one for sore  throat, which  our great-
grandmothers were wont  to employ.   A
stocking  fresh  removed from  the  foot, and
P. 
PAIN
PAIN               353
 So somewhat  damp from perspiration, was
 applied to the throat, the damp part or sole
 next the skin, and the whole then wrapped
 round the throat and  kept on  all night.   In
 the morning  this was  removed, the parts
 washed with cold water, and very probably
 the pain was gone.  This was modified some-
 what by employing a towel or piece of linen
 wrung out of cold water, wrapped round the
 throat and Covered over with flannel.   This,
 too, is very successful, and well worthy of a
 trial.   The wet pack is the same in principle,
 but applied to  the whole body  instead  of to a
 part of it only. As a preliminary the  patient
 should take a smart walk or some similar ex-
 ertion,  not  enough  to tire, but sufficient  to
 put the surface in a nice warm glow.  When
 he returns his  bed should be found prepared,
 by removal  or folding down of all  the  bed-
 clothes, including the feather-bed, if  any.
 On the  mattress should be spread a piece of
 waterproof sheeting, if desired, but this is not
 absolutely necessary.  Over   this or   in  its
 place  may be spread a  thick blanket, and
 when the patient is ready,  this, in its turn, is
 covered with a sheet loosely  wrung  out  of
 cold  or nearly cold water, according  to the
 season of the year.  On this  the patient is
 stretched  quite naked, and then the sheet is
 tucked up tight all round about him,  so-that
 he lies swathed in the sheet like an  Egyptian
 mummy ;  over this blankets are tucked in,
 and the whole  may  be covered up  by the
 feather-bed,  if  there is one, if not, a due sup-
 ply of blankets must be used.   The head is
 carefully wetted, a wet towel placed over the
 forehead if desired, and  the patient  left  to
 himself for half an hour.  Though cold  at first
 the bodily heat soon begins  to  exert itself,
 and the whole  mass becomes  heated, so that
 the wet sheet acts like a kind of gigantic
 poultice applied to the whole  surface  of the
 body.   Should, however,  the reaction  not
 take place of its own accord,  it will be  neces-
 sary to  insure its appearance  by the  use of
 hot-water  bottles.  The result is a copious
 but imperceptible transpiration from the skin,
 which tends  to open  it more than anything
 else.   At the end of half an hour the patient
 is to be stripped and well bathed with cold  or
 nearly cold water, and the process is at an
 end.  During  the period he  is left he most
 frequently sleeps or dozes,  so  much tranquil-
 lity does it give. Dry packing is simply  sweat-
 ing induced by a heap of bed-clothes.
  PAIN is one of the most  common  symp-
 toms in disease, but it may arise from a great
 many conditions, and may therefore require
 a different mode of treatment.  No greater
 relief  can  be afforded than  to adopt some
 means by which a patient can be made easier
 and free from  this  disagreeable  symptom,
and whereas in many cases it may be impos-
sible to  cure the  disease or avert  the fatal
end, yet  it is often in our  power to modify
 the severe symptoms and give a vast amount
 of relief.  All pain is felt in the nerves, what-
 ever may be the cause which gives rise to the
 sensation. The causes of pain may be divided
 into two  great classes : 1. Those depending
 upon too much blood in the part, and where
 there is an increased tension in the vessels.  2.
 Those depending upon an impoverished state
 of the blood and  an altered condition  in  the
 nutrition  of the nervous centres ; such pains
 are  more commonly  known  as  neuralgic
 pains, although,  strictly  speaking,  all pain
 must be neuralgic.  Under the first head may
 be included the pain caused by inflammation
 of any part, and more especially of the serous
 membranes,  as In  pleurisy,  peritonitis,  and
 pericarditis, also in the joints, as in gout and
 rheumatic fever ; these cases are  attended
 with more or less fever, and the pain is caused
 by the over-distended vessels in the inflamed
 part interfering with the nerves distributed
 there ;  of this kind also is the pain  met with
 in an abscess, and it is well known how much
 more painful is an  abscess under the tendon
 of the finger or in the gum than in some more
 lax tissue, and this is clue to the tension of
 such  a  part,  for where the skin  is  loose the
 swelling  does not  hurt much, but where the
 abscess is bound in by firm  walls the pain is
 much greater. This accounts, too, for  the
 relief sometimes  experienced after  the  face
 has become swollen after a toothache, for the
 fluid has escaped  then from  the vessels, and
 the tension is diminished.   Pain, when due
 to this cause, can  be relieved in several ways,
 but all the methods adopted have in  common
 the object of relieving the distended vessels ;
 a few leeches over the affected part  will give
 relief by withdrawing some of the blood ; hot
 fomentations, made by wringing  out flannels
 in hot water, turpentine stripes, hot linseed-
 meal poultices, and cotton-wool,  are all most
 useful means of  locally allaying the  pain ;
 sometimes continuous cold,  applied by plac-
 ing pounded ice in a bladder, will relieve, at
 other times a hot bath will do  good.  Other
 measures may be adopted, as the hypodermic
 injection of morphia, the local  application of
 belladonna, or aconite, and the internal  ad-
 ministration of opium.  The  second class in-
 cludes tic-douloureux,sciatica,hysterical pains,
 and what are commonly known as  neuralgic
•pains.   They are  generally associated with
 pallor and debility.  Nothing is more  common
 than to  meet with such cases as the follow-
 ing : A woman who has  borne several chil-
dren and suckled them for some time finds
herself losing strength and flesh ; her appetite
is bad, and she generally has been unable to
get sufficient nourishment, perhaps only hav-
ing meat once a week, while all the time her
strength should have been  well supported
while nursing her  baby.  In  time, besides
feeling  weaker,  she  is  nervous and low-
spirited,  has  pain  across the  forehead  and 
354            PAINTS
PALATE
over the top of the head, dimness of vision,
occasionally giddiness, pain in the left breast
and left side, pain in the back and either across
the  loins  or between the shoulders.   Now
and then there isp*in in the limbs ; she is pale,
and may suffer from leucorrhoea, is unfit for
much exertion,  and although still feeling ill, is
obliged td  attend to her children and house-
hold work.  For such cases relief can only be
obtained by supplying them with nourishing
and wholesome food,  by rest in a horizontal
posture, by a short walk daily on a fine day,
so as not to tire themselves, and by moderat-
ing the quantity  of stimulants taken daily.
It is also most  needful to give tonics, as iron
and quinine, so as to improve  the general
health.   Iron is not often borne well at first,
and then the mineral  acids with some bitter
infusion may be given.   Change of air and
scene is very valuable, but in such  cases few
can afford it.
   Pain  of  this kind is very common in  preg-
nancy, and then one side of the face is gener-
ally affected ;  there is no swelling nor red-
ness, and leeching the gum  or extracting a
tooth is a perfectly useless proceeding in such
cases ; quinine and some chloric ether is  the
best remedy.   The  pain in   brow   ague or
migraine (see Intermittent  Fever) is of a
similar  nature,  and may be also caused by
malarious  influences.  Removal  from   the
damp locality, and the internal administration
of large doses of quinine are  the most likely
measures to give relief.  In these  people, as
in the previous cases, there is always pallor
and anaemia, and  the mischief is not  in  the
nerves but in the nerve-centres—as the brain
and spinal cord—which are not properly nour-
ished.   In many fevers and in cases of syph-
ilis, where the blood becomes  gravely altered
in quality,  neuralgic pains are  very common ;
in the former, the fever must be treated ; in
:the latter,  iodide of potassium will do much
good.   Lastly,   there  are  certain  muscular
pains which come on  because the  muscle is
tired.; of such  a nature are the pains felt by
one.after a long day's ride without being used
to it, the pains^caused by a troublesome cough
in the intercostal muscles on each side from
the violent exertion, the aching pains caused
by laughing immoderately,  and  the pains
brought on by any unusual exertion, and gen-
erally  known  as  stiffness.  The  treatment
must be rest for the affected part ;  when  the
cough is distressing, means must be taken to
relieve  this, and a warm  and wide flannel
bandage should be fastened round the waist.
Pain in the side is a frequent symptom  and is
treated  of in the article on Pleurodynia,
  PAINTS produce  diseases arising  from
working with lead which are described in  the
article on  Lead-Poisoning.   It may suffice
to state here the danger arising from children
using toys painted green,  or  from  the habit
children have  of sucking paint-brushes and
 the  cakes of  ordinary color-boxes.   Most
 green  colors contain arsenic, and the poison
 may cause a sore throat, running at the eyes,
 purging, sickness, and pains in the abdomen.
 Similar results are brought about by having a
 green  paper in a  room, and serious results
 may ensue.  (See  Poisoning.)
   PAINTER'S COLIC  is commonly met
 with in those who work with lead arid its prep-
 arations, and more especially with those who
 deal in white lead.   (See Lead  Poisoning.)
   PALATE (The) may be considered under
 the separate portions of the hard and the soft
 palate.  The hard palate is that portion of the
 roof of the mouth immediately  posterior to
 the gums  and teeth ; it is supported by  the
 bony arch  of the palate and upper jawbones,
 and is covered with  a  tough, dense mucous
 membrane, inseparably united to  the  pe-
 riosteum of  the  above-mentioned .bones.
 There is a median  ridge, which marks the
 position of the congenital division of   the
 parts,  and there  are numerous transverse
 ridges on either side of it.    The soft palate is
 a soft movable substance, attached above and
 in front to the hard palate, while behind and
 below  it terminates in a thin, free crescentic
 edge,  from the centre of  which  the uvula
 hangs, thus dividing the edge into two semi-
 lunes.   This velum is situated somewhat ob-
 liquely, its fixed edge being superior and an-
 terior to the bone, the surface looking down-
 ward  and  forward toward the  mouth  and
 tongue,  the opposite surface looking upward
 and backward.  The  mucous membrane con-
 tains a good many glands.and is covered with
 ciliated epithelium on its upper  surface, and
i squamous in its inferior.   In the act of deg-
 lutition the velum  and uvula are raised so as
 to touch the back part of the pharynx, and
 thus prevent the food from ascending into  the
 upper and nasal part of the cavity, from which
 it might regurgitate into the nares.  The soft
 palate  is each side attached to the tongue and
 pharynx by  muscles named palato-glossus
 and palato-pharyngeus, forming the anterior
 and posterior pillars of ihe fauces, and be-
 tween  these  pillars  lie the tonsils, vascular
 glands  which  secrete a viscid  mucus,  ex-
 pressed at the moment of deglutition,  and
 which  lubricates  the food on its  downward
 passage to the oesophagus.
   Affections of the Palate.—By far the most
 frequent affection of the palate,  which is met
 with either in the  hard or  soft,  or both com-
 bined, is cleft palate.  This  is a congenital fiss-
 ure, arising from  an arrest  of  development
 of the natural vault of the palate,  the nature
 of which is alluded to in the article on Hare-
 lip.  (See  Hare-lip.)  If  the hard palate be
 extensively deficient congenitally, it is very
 difficult  to remedy it  surgically, at least by
 operative proceedings.  The  dentist, by  ap-
 plying a metal  or vulcanite plate (termed ar,
 obturator), to take the place of a natural pal 
PALATE
PALMA CHRISTI        355
 ate, may do great good ; such a deformity,
 however, usually is coexistent with fissure of
 the lip,  and in such cases the lip affection
 should  be  first  attended to.  When  the
 chasm is very  wide, probably  an operation
 will not do much, but first-rate advice should
 be taken at the earliest stage of the child's
 existence.  A  mere  fissure or  crack often
 closes spontaneously, uniting during adoles-
 cence.   It  is in cases of fissure of  the soft
 palate that the surgeon has it in his power to
 render such valuable service.  It has been al-
 ready mentioned that the normal soft palate
 is arched and vaulted, and subject to varying
 degrees of tension during deglutition,  etc.
 The  muscles which raise the soft  palate are
 the levatores palati ;  those tending to stretch
 it and make it tense, the tensores or circum-
 flexi  palati ; while others, the palato-glossi
 and palato-pharyngei, likewise put great ten-
 sion upon it downward and laterally.  Now
 it is evident that the actions of these  muscles
 must tend to keep apart  the pre-existing fis-
 sure, and this fact having been determined, the
 surgeon has a plan of action before him.  The
 operation  for the  relief of this affection is
 termed staphylorhaphy generally, and it con-
 sists of three stages :  the first  is the setting
 free of muscular tension ;  the second the prep-
 aration of the  edges of the existing  fissure
 thus set Iree ; and, thirdly, the putting in of
 such sutures or  stitches as are necessary for
 the purpose of securing contact between such
 prepared edges.   The first stage requires a
 long time generally for its preparation, such,
 for instance, as the accustoming of the patient
 to keep the mouth  open for a long time at a
 stretch, the rendering the palate less sensible
 to the tickling, niggling proceeding to be here-
 after practised, the determination not to swal-
 low saliva, if the patient be of a sensible age
 (young children should  have chloroform).
 Then  the muscles, levator and circumflexus
 palati, and sometimes  the  palato-glossus and
 palato-pharyngeus, are divided by a peculiarly
 formed  knife  or  scissors ;  afterward  the
 edges  to be approximated are  pared of their
 mucous  membrane, so as to admit of their
 union  by adhesion ; and,  lastly, the  sutures
 to fix them are  introduced, and this is by far
 the most difficult  part of the procedure, re-
 quiring as much steadiness on the part of the
 patient as skill  on the part of  the surgeon.
 The patient should be thoroughly acquainted
 with the nature of the operation, as far as he
 can be, and must be convinced of its utility
 and chance of success.  The operation, how-
 ever, should be proposed, and, if  possible,  un-
 dertaken at infancy, with mechanical assist-
ance and chloroform,  in order to obviate any
defective articulation, which will have been
acquired if the operation be put off till puber-
ty or after.
  Dropping of the Palate.   (Sec Gargles and
Uvula.)
   Ulceration and Exfoliation.—The  mucous
 membrane is liable to ulceration, usually as
 a result of syphilis.  This form of ulceration,
 however, invariably affects the  bony palate
 as well, causing perforation,  exfoliation of
 bone, and adhesion of the soft palate by cic-
 atrix, occluding the buccal and nasal portions
 of the pharynx.  Such a state of things is as-
 sociated, ol course, with tertiary syphilis  and
 constitutionally requires iodide of potass, ton-
 ics, etc., and locally  nitrate of silver, nitric
 acid,  and chlorinated lotions.   If the hard
 palate exfoliates  (see Exfoliation),  the sep-
 aration  must be patiently waited for,  and not
 hurried  by rough  attempts at  pulling  the
 piece of  dead  bone away.  As the whole
 thickness of the palate perishes an aperture
 will exist between the nasal and buccal cavi-
 ties, and  if this cannot  be closed by sponta-
 neous cicatrization  an  obturator  must  be
 adapted ; a mere fissure or sinus can be closed
 generally by the repeated application of  a
 heated wire or  cautery.
   Tumors of the soft palate.—These may  be :
 (i) fibro-cellular  ; (2) cysts ; (3) warts.  (1)
 The fibro-cellular are usually  pendulous in
 character, painless,  usually attached to  the
 free border or  upper surface of the soft  pal-
 ate.   They are painless, and being inconven-
 ient  they must be  removed by scissors  and
 forceps.   (2) The  cysts  are generally  ob-
 structed muciparous  ducts ;  they  are to be
 treated  by free incision,  and the subsequent
 application of  nitrate of silver or nitric acid.
 Sebaceous cysts occasionally occur, appearing
 of a yellowish-white color through the mucous
 membrane ; free incision  and a drop  of nitric
acid on  a probe destroys them.   Abscess oc-
curs sometimes, and  should be immediately
opened.
  PALMA CHRISTI is the name by which
the castor-oil plant is known in this country.
 It is sometimes cultivated in  gardens on ac-
count of its beautiful leaves.   Its botanical
name is Ricinus  communis.  It is a native of
 India, but is widely distributed over the warm-
er regions of  the globe,  and throughout the
 Mediterranean   region.   In  our climate the
stems of the Palma Chritti do  not  attain a
height of  more than from three to five feet ;
in India  they grow from eight to ten feet,
while in Spain,  Crete, and  Sicily the plant  is
said  to  become a small  tree.   The  stem  is
pointed, of a purplish red color,  and  covered
with a glaucous bloom  like that of a  plum.
The leaves are  large stalked palmate ; deeply
divided  into  seven  lance-shaped segments,
and at the junction of the  blade with the stalk
of the leaf is a small saucer-like gland.  The
flowers are in spikes. There are several vari-
eties of  this plant, differing chiefly in  the  size
of their seeds.  It is  stated  that the best oil
for medicinal  purposes is derived from  the
small seeds ; that procured from  the large
seeds is coarser, and in India is only used for 
35G         PALPITATION
PANCREAS
lamps and veterinary purposes.  The oil is
extracted by boiling the seeds, and by press-
ure under a hydraulic  press ;  the latter pro-
cess without boiling the seeds yields the most
esteemed oil.  After expression the oil is pu-
rified by being allowed to stand, by decanta-
tion, and by filtration.  In India the oil, after
having been  obtained by pressure, is mixed
with a certain proportion of water and boiled
till the water has evaporated.   In France the
oil  is obtained  by macerating the  bruised
seeds in alcohol, but the process is expensive
and the product  inferior.  (See Castor Oil.)
  PALPITATION is the name given to the
beating of the heart, when that ceases to be
insensible and becomes obvious to the feeling
of the individual. The two things which seem
to have most influence in producing  this al-
teration are increased violence of the heart's
action, and perhaps even mere irregularity of
action.   Under  ordinary  circumstances the
motion of the heart is so even and regular that
one  can only detect its beatjng by  placing
the  hand over the spot where its apex strikes
against the ribs,  but in certain  cases of heart
disease  the beating may be so violent as to
shake the bed in which the patient lies.  Pal-
pitation,  though very  often a sign of heart
disease, is by no means invariably so ; per-
haps, out of all  the cases of palpitation one
sees, the majority are  in individuals  not the
subjects  of  heart  disease,  for as  already
pointed out.anything which interferes with the
regularity of  the heart's action  produces the
painful or unpleasant  feeling of palpitation,
and that  may readily be done in many ways
without  the  substance of  the  heart being
affected.
  Disorder of the motion of the heart, which
may be taken as synonymous with palpita
tion, is commonly  due to some  alteration  in
the  functions of  the heart necessitating more
violent effort on  its  part, or to some other
cause interfering  with its  movements, such
as disordered nerve influence.   Like other
muscular structures, the heart is directly under
the  control of the nervous system,  but its
nerve-supply is more than ordinarily  compli-
cated.  The nerve-supply is drawn from  the
brain, as is the case with other organs, but it
reaches the heart in two ways :  one by a nerve
called  the  vagus  or  pneumogastric, which
passes downward   from the  brain  through
the  neck to the chest to end finally in the ab-
domen ;  the other  by way of the spinal cord,
which at different   places gives off branches
which ultimately reach the  heart and control
its motions.   The  former of  these,  i.e.,  the
vagus, is mainly  engaged in  controlling or
regulating the heart's action ; the latter nerves
are  rather devoted  to stimulating its substance
to act.  Any  increase or diminution of the
action of the vagus is likely  to give rise to
alteration in the motion of the heart itself, to
produce quicker  or slower motion or irregu-
lar motion, in short, the phenomena we call
palpitation.   Now this nerve has a very wide
series of connections, supplying many organs
besides the heart itself, and any affection im-
plicating these is likely to derange the  nerve
influence  not only as  affecting the  diseased
organ,  but   also  as   influencing the heart.
Hence  it is  that  palpitation  is very fre-
quently brought about by  affections of the
stomach, the vagus supplying both.  Palpi-
tation or some other  form of irregularity  in
the heart's  action, say irregularity or even
intermittence of the  pulse, may be brought
about by  nerve action in  a totally different
way.   Thus, as is well known, anxiety, fear,
and various other mental emotions produce
beating of the  heart, i.e., palpitation, where
the stimulus  arises in the brain, and is con-
ducted to the organ  where it  is manifested,
i.e., the  heart,  by means  of nervous  influ-
ence.  In a goodly number of cases, however,
the palpitation is due to change in the  heart
itself.   This  change very likely is in the firbt
instance valvular,  that is to say, connected
with the floodgates of the heart.  The altera-
tion in the valve interferes with the heart's
action, chiefly in that the heart never is able
to empty itself  properly, or if  it does the
cavities are promptly filled again, so  that the
chambers become  habitually over-distended.
At the same time in many cases the substance
of the heart increases in  thickness, and  its
beat in  force, so that  the ordinary  work  of
the heart  is,  so  to  speak, accomplished with
greater violence than  usual,  this  violence
being manifested as palpitation.
  Treatment.—It  is  quite  plain that as the
cause of palpitation varies, so  must its  treat-
ment.   If it  depends on disease of the sub-
stance of the heart, then  treatment must be
directed to remedy that, and digitalis is most
commonly the  best remedy.   If from other
mischief, as indigestion or the  like, that must
be seen to, but  in the majority of cases the
palpitation yields to a stimulant, as  aromatic
spirit of ammonia.
  PALSY is the common name for paralysis.
(See Paralysis.)
  PANCREAS is a gland lying in the ab-
dominal cavity in front of  the  spine and be-
hind and below the stomach.   It consists of
a main tube from which branch off multitudes
of small tubes, each of which has a blind ex-
tremity or  dilatation ; these tubes  are lined
with epithelium, and around the tubes  are to
be found vessels and nerves which supply the
gland  with  nourishment  and regulate the
amount of its secretion.  The secretion from
the pancreas is called the pancreatic juice ; in
conjunction  generally  with  the bile-duct  it
opens into the duodenum or first portion cf
the small intestines.   Except  at the time of
digestion the functions of this gland are not
called into  action, but when  the  food has
passed from the stomach and become chyme, 
PANDEMIC                                PARALYSIS           357
 the secretion from the pancreas mixes with it
 and converts it into what is called chyle. The
 pancreatic juice seems to have the property of
 subdividing the fatty particles of the food into
 very minute particles, so as to make an emul-
 sion and cause an  easier absorption of the
 fatty matter .by the vessels which  lie in the
 walls of the intestines.   (See Digestion.)
   PANDEMIC is a  term  applied when  a
 disease has spread all over a large  continent
 at the same time ;  thus  an attack of cholera
 or  influenza  may  affect all  Europe  in any
 given year, and then the disease is said to be
 pandemic.
   PAPULES, or pimples, occur on the skin
 in  some diseases  of that tissue ;  small-pox
 generally begins with a papule, and  then goes
 on  to become pustular.  Lichen   is  also a
 papular disease, and so is the  small pimple
 caused by a flea-bite ; strophulus or red-gum
 and prurigo are also papular diseases.
   PARACENTESIS  means an   operation
 for  removing fluid effusion from the interior
 of the body.   The common and expressive
 word  for  this  operation  is tapping.  The
 region in  which it is  most  frequently per-
 formed is the abdomen.   Dropsical fluid,  or
 the  fluid effused in  connection  with ovarian
 disease, often accumulates to such  an extent
 as to  interfere seriously with the respiratory
 movements, and to threaten death by conges-
 tion of the lungs and suffocation.   Paracen-
 tesis by withdrawing the fluid gives great re-
 lief, and in  some cases strength, but in com-
 paratively few  assists  a radical cure of the
 dropsy.  The spot at which the surgeon gen-
 erally taps is in  the middle line of the anterior
 wall of the  abdomen, and about three inches
 below the  navel.  The instrument used  is
 a thick,  sharp-pointed  trocar,  which  slips
 through a tube called a  cannula.  After the
 abdominal wall has been punctured the trocar
 is withdrawn, and the dropsical  fluid  is dis-
 charged in  a full  stream through  the  can-
 nula.  The  chest is frequently tapped for the
 relief of the lung-mischief caused by accumu-
 lation of dropsical or  inflammatory  serous
 effusions and  of pus.  The operation  is usu-
 ally  performed with a small trocar  and  can-
 nula, and the  surgeon selects either the space
 between the fifth and sixth ribs at the side of
 the  chest, or  the space  between the  eighth
 and  ninth ribs in a line with the lower angle
 of the blade-bone.   In cases  where pus has
 made its way  outward from the  chest, an in-
 cision  is usually made at  the place where it
points.  Tapping has in some few cases been
 performed for the relief of dropsy of the peri-
 cardium, which is  the  loose  fibrous bag in-
 closing the heart and the roots  of  the large
 blood-vessels.    This operation  is  an ex-
 tremely dangerous  one,  and is not  resorted
 to save in  the  presence of  critical cardiac
symptoms.   The head is occasionally tapped
for the relief or radical cure of hydrocephalus.
 The  surgeon uses  a very fine trocaf, and
 punctures the head either at the anterior fon-
 tanels or at some other open  place  away
 from the middle line  of the  body.   But  a
 small quantity of fluid  is withdrawn  at each
 puncture, and the child's skull is then com-
 pressed by an elastic bandage.   This opera-
 tion  ought  only to be performed  in almost
 hopeless cases of the disease, as  it is by no
 means  a safe proceeding, and  is often fol-
 lowed by convulsions and other serious- symp-
 toms of nervous irritation.
   PARADISE,  Grains of.—A name  given
 to the larger cardamom seeds—a beautiful
 aromatic carminative ; but the lesser  seeds
 and of a smaller variety are supposed to con-
 tain more aromatic qualities  than the grains
 of paradise,  hence  they are generally pre-
 ferred.
   PARALYSIS, with which the word  Palsy
 is often used synonymously, signifies a loss of
 motion in any part of the body ; but as the
 nerves supplying most parts of the body are
 of a mixed character—that is, motor and sen-
 sory—the idea generally conveyed implies also
 a loss of sensation.  Paralysis may. however,
 be motor  or  sensory, or both.  Moreover,  it
 may be complete,  when there is a total loss  of
 power and sensation, or partial, when these
 are partly, not wholly,  lost.  Sometimes the
 word partial is used to imply  that only cer-
 tain parts of  the body are affected,  but for
 this purpose  the term local is perhaps prefer-
 able.    General   paralysis implies that the
 whole body is affected, but the term general
 paralysis of the insane expresses one  particu-
 lar form of malady,  which is accompanied by
 insane  delusions.   Occasionally  the  term
 Acinesia is used  to  signify paralysis  of mo-
 tion, Anasthesia being employed to  indicate
 loss of  sensation ;  but  most  frequently the
 idea of paralysis is limited to loss of  motion,
 anaesthesia being  the  corresponding  term
 made use of with regard to loss of sensation.
   The two most common forms  of paralysis
 are Hemiplegia and Paraplegia.   Hemiplegia
 is that form  of paralysis which  affects one
 lateral half of the body without the other side
 being affected. Hence hemiplegia is right or
 left.  Paraplegia, on the other hand, means
 paralysis  of  the lower half of the body, but
 there is no right  or left paraplegia—it must
 affect both sides, if  not quite  equally, at all
 events to some extent.
   There are certain other peculiar titles given
 to varieties of paralysis, such as Amaurosis,
 which used to be bestowed on any  form  of
 blindness supposed to depend on disease and
 paralysis of the optic nerve.   Loss of  hear-
 ing was  called Cophosis,  and loss of  smell
Anosmia.   Moreover, certain forms of paral-
ysis have the distinguishing character of pro-
ceeding from  bad to worse.   These  forms
are described as progressive, but this is a title
of little value. There are besides these many 
358           PARALYSIS
PARALYSIS
other forms of paralysis, the chief of which
we shall briefly record.
   General paralysis, as seen in ordinary prac-
tice; means  practically double hemiplegia.
Both sides  are  affected,  especially  the ex-
tremities ; but, of course,  respiration  and cir-
culation go on, otherwise  death would ensue.
In general paralysis the patient is motionless,
and  very  often unconscious ;  but the heart
and  the lungs having  a  nerve supply  not
affected by what may render the limbs motion-
less, go on,  the diaphragm becoming the  sole
organ of respiration.  This cannot continue
long—either the patient recovers or dies.   If
he  recovers  gradually,  it is  seen that  one
side has been affected more than  the other,
so that the  one  usually gets well  before the
other, and the case resolves itself into one  cf
hemiplegia.   For general  paralysis of the in-
sane, see Insanity.
   Hemiplegia is the most common form  of
paralysis.   It is fully treated in the article on
Hemiplegia.   For full particulars relating
to it, see Hemiplegia.
  Paraplegia, or paralysis of  the  lower  half
of the body, is generally due to disease or in-
jury to the spinal cord.  (See Paraplegia.)
  From what has  been hinted rather than
said above, paralysis may depend  on disease
of the  nervous substance itself, or pressure
on it interfering with the due fulfilment of its
functions.   But in a great number of cases,
perhaps the  majority, the paralysis depends
rather on the latter than the  former cause.
Say a man  is  advanced in years,  with weak
arteries, and from  some  cause or  other too
much pressure is applied to them.  They give
way, blood is  poured out, a clot  is formed,
and  stops the  bleeding.  As a consequence
of this  accident, he has what is  sometimes
called a " paralytic stroke ;" but this loss  of
power of sensation and consciousness is  due
merely to the pressure of the clot,  not to  any
disease  of  the nerve  substance.   Subse-
quently the clot may soften, and surrounding
portions of  the  brain substance soften with
it ; but  the  original  cause  of the paralysis
was  pressure only.   There  are,  however.
other causes of paralysis—the nerve substance
itself may  decay or soften, as  it  is  called ;
and if it does so, there is little hope of its re.
covery.  Or yet again the nervous  tissue may
gradually waste away.  Both of these forms
of diseases are such as give rise to progress-
ive symptoms ; but this is the grand rule  in
studying nervous maladies—that the  kind  of
lesion, except as giving  the symptoms a  pro-
gressive or retrogressive character, is of but
little  importance  in  producing symptoms.
That depends almost entirely on  the site  of
the mischief.  Thus injuries to or disease  of
certain parts of the brain give rise to symp-
toms of one  kind, and those of  others  to
symptoms of  a totally  different kind.   We
have  described  certain forms of paralysis,
which most commonly originate from injury
to or pressure  on nerve substance ; we may
now briefly allude  to  certain of a  different
kind, such as locomotor ataxy and wasting
palsy.
  Locomotor ataxy, or, as the malady used to
be called, tabes  dorsalis, is a form  of disease
apparently depending on wasting of the pos-
terior portions  of the  spinal cord  or of  the
nerve-roots arising thence.   (See Progress-
ive Locomotor Ataxy.)
   Wasting Palsy, also known as Progressive
Muscular Atrophy, is a malady  in some  re-
spects similar to the former, in some  totally
different.   It is fully treated of in  the article
on Progressive  Muscular Atrophy.
  In Hysterical Paralysis there is ol course no
disease  to be detected, and on probing  the
story told by  the patient it will  usually be
found that there are'discrepancies  in it alto-
gether irreconcilable with  the malady being
of an ordinary kind.  On inquiry, too, it will
be found that the patient has at some former
time suffered from hysteria.  Sometimes  the
supposed paralysis has been brought on by
some definite cause, as  fright or over-excite-
ment—causes quite  inadequate to  the pro-
duction  of paralysis, but quite sufficient to
evoke some  characteristic  symptoms  from
an hysterical woman. The forms of paralysis
assumed are of  all kinds,  but perhaps  para-
plegia is the fav®rite.   There is no difficulty
about it ; the patient  has only to refuse to
move the legs, and there it is.  Hemiplegia
is different: there are little  points  about  the
eyes and mouth which  are not easily mas-
tered, the tongue too  is a  difficulty which
these patients cannot get over ;  nevertheless
we have seen instances of patients the subjects
of hysterical  paralysis who had managed to
impose  not only  on friends—though that is
not saying much—but also on medical attend-
ants.  These are the class of  patients who
make the fortunes  of  quackish  impostors if
they fall into their hands, and so  wise men
will beware of allowing them to do so.  Fre-
quently the relations are fully  confirmed in
their belief as  to the  reality of the malady,
and any brusquerie on the part of an attend-
ant is likely to secure his dismissal—not, how-
ever, if  they are wise.  Far better is it, having
made out the malady to be what it is,  quietly
to take the patients in hand and subject them
to the remedies  most  likely to benefit their
hysterical  condition.  These of course  are
good nourishment, steel,  cod-liver oil, gal-
vanism  especially, quinine and nux vomica.
The bowels have to be seen to carefully, cold
or tepid baths given regularly, applying fric-
tion to the limbs  or parts affected.  But moral
control  is the  great thing :  let  the  patients
fairly know  that you are aware  of any at-
tempted imposture, let them feel  you know
it, and afford them every opportunity of giv-
ing  it  up without  creating anything  like 
PARALYSIS
PARALYSIS           359
 scandal,  and  success is  tolerably  certain.
 Nevertheless there are some of these patients
 who do not get better, who take to their bed
 and keep there, making a little  court round
 about them : any encouragement to this kind
 of thing is most pernicious, and ought to be
 instantly put a stop to.  Make such  patients
 invalids by all means, but furnish them with
 no enticements to continue such.  These pa-
 tients are rarely if ever wholly well—that is
 not  to   be  forgotten ; they  are really  ill,
 and must be treated kindly not harshly.   On
 inquiry  it will  generally be found  that the
 womb is  wrong or the menstrual function is
 disordered.  Usually, too, there are  pains in
 the back and loins.  There is indigestion, and
 in all probability constipation.   All these
 must be remedied before the patient is  well,
 only it is mainly—but not entirely—to these
 and not to the paralyzed parts that attention
 is to be directed.
   Rheumatic Paralysis is a  form of the dis-
 ease not  very well understood.   It affects the
 muscles of the extremities for the most  part,
 especially those  of  the  lower  extremities or
 the muscles which raise the arm.   It  is by
 no means clear, however, that this  paralysis
 is due to nerve change, many facts  pointing
 rather to the conclusion that the change lies
 in the muscle  itself  or the nerve  sheath.
 There is usually pain along with the  inability
 to move the parts, and this pain is increased
 on pressure.  It may come on suddenly  after
 exposure to cold, or it  may creep on more
 gradually.  These cases are best treated by
 hot mineral waters,  but if dealt with at home
 the hot douche and  friction with stimulating
 liniments do  most  good.   Iodide of potas-
 sium in 5-grain doses and cod-liver oil should
 be given  internally.
   A third form of paralysis of uncertain nature
 is that which  is called Diphtheritic Paralysis,
 from its  following  the disease  diphtheria.
 This paralysis, which mainly affects the throat
 or the muscles of swallowing, may  come  on
 during the  disease,  perhaps just after the
 throat is  cleared and  convalescence sets in,
 or it may appear later when the patient is
 getting about. If, however, it comes on so late
 as this, it merely affects the extremities, so
 that for a time the patient can  hardly walk;
 The main point is, that if the symptoms can
 for the time be  overcome, the patient is al-
 most sure ultimately to get  well, though for
 a  time the  health may be delicate.   When,
 however,  paralysis comes on in the last stage
 of the malady, it is a somewhat serious  mat-
 ter, because it is just then that nourishment
 is most valuable, and the paralysis  sadly in-
terferes with the power of  taking it.   The
soft palate is paralyzed, and so are the mus-
cles of the upper part of the gullet, but the
tongue and cheeks  are not.   Hence, as the
mouthful  of food and still more of  liquid is
passed backward, the soft palate  does  not
close the posterior orifice of the nostrils, while
the muscles of the gullet refuse to pass it on ;
it is therefore compelled to regurgitate through
the nostrils.  This of course is excessively
unpleasant  and not a  little alarming.   The
only remedy is to pass the food so far down-
ward  as to be beyond the influence  of the
paralyzed muscles.   This may be  done by
meansof a tube, but it is not pleasant to have
to pass  a tube down a passage of raw flesh,
as is the condition of  the throat just after the
diphtheritic sloughs  have  peeled  off.  Ac-
cordingly should the  paralysis come  on so
early, it may be desirable for  a  time to give
nutrient injections.   Care must be  taken in
feeding those the subjects of this form  of pa-
ralysis,  as the sensibility as well as the motor
powers  of the parts may be  lost, so that there
is risk of cramming food into the gullet so as
to press on the windpipe fatally, rather  than
into the stomach.   As for remedies, the chief
are time  and good nourishment-!-food and
port wine—with strychnine and the  use of
galvanLm.
   Infantile Paralysis, also called the essential
paralysis of children, no immediate cause of
it being ascertainable as far as the brain and
spinal cord is concerned, is a disease peculiar
to childhood, and though not fatal  to life, is
often of a most inveterate description.   This
paralysis often seizes upon one limb, less fre-
quently one arm, or  a single group of mus-
cles.  Sometimes it gives rise to hemiplegia,
sometimes, and more frequently, to paraple-
gia.   This  form of  paralysis is  not infre-
quently the source'of very great deformity,
for it begins early in life, and the  parts not
only  cease  to  grow  in due  proportion, but
also waste.   If  this condition becomes per-
manent, the limb is utterly dwarfed compared
with the other ; or  if  a group of muscles are
affected, their antagonists are so much more
powerful  as to drag the limb  over to  one
side.  This form of  paralysis may  come on
suddenly  ; the child  will be  noticed to drag
the limb ; if it is lifted, it will fall as if dead,
and though sensation remains, yet  it seems
useless.   Very often this condition comes on
after  one of the eruptive fevers, when the
dregs of the fever are described as lodging in
that l:mb, or, yet again, it may appear  during
teething, when the  nervous  system generally
is in an irritable state.   Such paralyses  have
been mistaken for  hip-joint  disease, but the
absence of  pain is  a sufficient guide to dis-
crimination.   Sometimes  the  unfortunate
child  is supposed  to be  playing at  make-
believe, and punished.  Fortunately,  this is
not very  often  the case, at all  events  with
parents  interested in the welfare  of  their off-
spring.   When paralysis occurs at the period
of the first dentition,  and the  child  recovers,
there  is  a risk  that it may occur again  with
the second.  If so,  the second attack is more
likely to  be permanent.  Infantile  paralysis 
3G0           PARALYSIS
PARALYSIS
 passes away in  the  majority of cases, but in
 a good many it  does not, and as there is no
 very good test  for those  cases  which  are
 likely to get well ;  anything  like  a forecast
 must be received, not exactly  with doubt, but
 with a knowledge that it may  prove wrong.
   As to treatment, one remedy here is of un-
 doubted efficacy,  and has  done more good
 than, perhaps,  all  the others put  together ;
 that is electricity,  in the form of continuous
 currents.  If this be not available, the health
 must be attended to, the  parts daily bathed,
 and kept as  near  their normal state by fric-
 tion as possible. The limb should be wrapped
 in flannel,  to keep it warm.  The food must
 be good ; tepid salt  bathing is most useful ;
 finally,  strychnine or nux  vomica in  small
 doses is likely to  give rise  to good results.
 Cod-liver oil and steel must  not be neglected ;
 but with all,  recovery may fail to take place,
 and permanent deformity result.
  Facial Paralysis in some respects  resembles
 infantile paralysis, inasmuch as what is called
 facial palsy, in contradistinction lo that  pa-
 ralysis of the face which depends on disease
 or injury to the brain, seems to depend rather
 on local than central  change.  The nerve
 affected is  the motor nerve of the whole face,
 and its  power over the  muscles being  de-
 stroyed, that side of the face is a blank, while
 the muscles on the opposite side being unop-
 posed, that side  is more or less contorted  by
 dragging.  The  angle of the mouth  is accord-
 ingly dragged over to the  sound side, and on
 the side which is paralyzed the patient is un-
 able to  purse up the eyelids as in  grinning.
 In the same action, too, the mouth is drawn
 up on one  side, and  not on  the  other, giving
 the individual a very peculiar appearance.
 The mouth droops at the paralyzed side, and
 the  patient has  difficulty  in  pronouncing
 lateral consonants.   Double-facial  palsy  is
 rare, and most commonly  the  palsy on one
 side is due  to exposure to cold air, especially
 draughts.  Sometimes, like  neuralgia, it may
 be due to stumps or  bad teeth,  so the mouth
 should be  carefully  examined.  Inflamma-
 tion of the  cavity of  the ear, or  of the bones
 behind the  ear, may  lead to a less tractable
 form of the malady.   This simple variety  of
 facial palsy does not last long, and a little
 attention to the diet  and bowels, a few doses
 of strychnine, with the application of the gal-
 vanic current, will  most  probably soon  re-
 store the functions of the part,
  Labio-glosso-laryngeal Paralysis is a very
 peculiar form of paralysis,  well illustrating
 certain facts already alluded to, illustrative of
 the phenomena  of paralysis generally.   As
 its name implies, this form of paralysis affects
specially the lips, tongue, larynx, and gullet,
but often it may affect many other  organs in
the chest, the heart especially.  In, it the voice
is lost, the  power  of swallowing is  lost,  the
lips  can no longer retain the  saliva,  which
constantly dribbles from the mouth. In other
respects the patient may be said to be well.
Ultimately, however,' in most cases  the mal-
ady carries him  off,   sometimes  from one
cause, sometimes from another.   It is hard
to say what is the most prominent symptom
in the disease.   To the patient  himself it is
loss of the power to swallow,  for not even the
saliva, which is abundantly secreted, can be
got over ; it  dribbles from his mouth ; any
attempt to give him food occasions great dis-
comfort, and  even risk  of  choking.  If it
comes on suddenly, then all  these things ap-
pear at once and there may be risk of starva-
tion ; in that case the patient must be fed by
the  stomach-pump passed   downward  far
enough to reach  the oesophagus, but not the
stomach.   It is useless lo speak here of the
remedies  for such a malady ; this must de-
pend on the causes.
  Scrivener's Palsy is an exceedingly curious
form of nerve affection, which,  fortunately,
is not very common. It is also called writer's
cramp, apparently from the fact  that it most
commonly attacks those who have  long used
the pen ;  but it is  by no means confined to
these, and may attack any handicraft worker
almost.  The mischief seems to lie in a want
of co-ordinating power in the muscles, which
have long been accustomed to fulfil one defi-
nite function.   Each one seems  to act  inde-
pendently, and so it becomes  quite impossible
to call them into simultaneous or concerted
play.  At first  there  is merely unsteadiness
or stiffness  after a long day's work, which
speedily passes away,  but by  and  by this
makes mischief, for the writer scrawls at some
point perhaps where  he wishes  to be most
particular, the pen darting away out of his
hand.  As the disorder  advances the patient
gets worse ; as soon as the pen is touched,
off starts the arm,  so that it is quite impossi-
ble  for  him to  write even legibly.  At the
same time, curiously enough, he may be per-
fectly able to use  his  hand for other pur-
poses ; but the  moment  he  takes a pen in
hand it  becomes  altogether unmanageable.
Now as to the remedy.  There is only one—
that is, giving over the  kind of work which
has  brought on  the malady.   The  patient
may do anything else he likes, but it is use-
less  to  attempt to carry that one  on, and
though  it appears  late   in life,  the patient
must seek  another vocation.   The sooner
this is fairly faced the better.   If it comes on
in one who can afford  complete relaxation,
who can go off and travel for a time, he may
come back perfectly well and able to take pen
in hand again for a moderate time only. Not
so one who can only take partial rest  ; that
is simply useless.  Many poor clerks, com-
pelled to give  over  work,  put themselves
under treatment, and just when they begin to
get well they get sold out of all they possess.
Better for them had  they at once taken to 
PARAPLEGIA
PARAPLEGIA          301
 something which would have permitted them
 to use the other hand  until- the affected one
 got well.  The great remedy is the continu-
 ous galvanic current and rest.   Cod-liver oil,
 good  food, and  strychnine, with change  of
 air, should be had if possible.
   Paralysis  agitans,  in common language
 called Shaking Palsy,  is a malady in certain
 respects resembling that just discussed.   The
 disease consists in a want of  power in co-
 ordinating the  muscles, and also, it may  be
 said, of keeping them at rest.  The shaking
 commonly begins by affecting the hands and
 arms, but later it may affect any part of the
 trunk or limbs.  Very often the head is early
 affected ; later, even the jaws may be affected.
 This agitation  is  increased by any mental
 effort, especially to call into play the muscles
 affected.   The  disease  is  progressive, and
 by and by the whole body becomes affected,
 so that the  patient can hardly walk,  being
 always  induced  to  run.  All  this time the
 senses are unimpaired, and the patient  is
 acutely  sensible of his misfortune,  which
 often  sadly  interferes  with his occupation.
 His bodily powers by and  by  become im-
 paired, for he  is often unable  to sleep  at
 night, and even  unable  to  take his food  in
 comfort from the unceasing agitation.  These
 cases  commonly occur  in  men  advanced  in
 life, and in them little benefit is to be hoped
 for ; but it may occur earlier, and then we
 may hope to alleviate if not to cure the con-
 dition by the use of strychnine,  iron and gal-
 vanism, especially of the continuous current.
 Even  in  the most favorable cases the prog-
 nosis is bad  ; but with  care a  long life may
 be possible, and as the intellect is quite clear,
 much good work may be done in it.
   There are  still certain forms of paralysis
 to be attended to.  These are due to mineral
 poisons slowly imbibed until the system be-
 come  impregnated.  The  mineral  poisons
 thus  giving  rise to nervous symptoms are
 lead and mercury.   Lead gives rise to paraly-
 sis through wasting of the muscles, affecting
 first of all the muscles which raise the  fore-
 arm and arm, afterward  those of  other por-
 tions of the  body.  The malady is  always
 symmetrical.  Mercury gives rise to tremors
 rather than  paralysis.   Its  effects are best
 seen in miners, or in those who gild looking-
 glasses by the old process.   (See Lead and
 Mercury.)
  PARAPLEGIA denotes paralysis, or loss
 of  power, over  the lower  extremities  and
 lower half of the body, and it is  always de-
 pendent upon some change in  the nervous
 system,and generally upon some disease in the
 spinal cord.  The spinal cord may be looked
upon as a long  prolongation of the  brain ;
like  the  latter,  it is made up of nerve fibres
and nerve cells, and it also sends forth a vast
 number of nerves of motion and sensation to
the trunk and extremities.   When, however,
 these  nerves  or their nerve centres are de-
 stroyed, the power of motion  or sensation,
 or of both, is lost, and paralysis ensues.
   Causes.—Inflammation of the spinal cord
 or its membranes, cancer of the cord, or any
.other tumor pressing upon it, or growing into
 its substance ; fracture or dislocation of the
 vertebrae or bones forming the spinal column ;
 a stab or gun-shot  wound of  the  spine ;
 hemorrhage into or  softening of the spinal
 cord, are among the chief causes of paralysis.
 It may come on in cases of hysteria without
 there  being any true paralysis at all ; and,
 finally, a person,  for various  reasons, may
 simulate paraplegia.
   Symptoms.—In most cases  there is  ting-
 ling and numbness of the legs and feet, occa-
 sional  twitchings,  followed by loss  of the
 power  of moving them ; sensation is gener-
 ally interfered with, but not absolutely gone.
 If the cause be due to an accident, the paral-
 ysis may appear at once ; if to cancer or any
 tumor, the symptoms may come on gradually;
 if to inflammation,  as after exposure to cold
 and wet or from syphilis, the paralysis may
 come in a very few days, and often terminate
 fatally from its extension upward and involv-
 ing  most important  parts.   In most cases
 the bladder  is also paralyzed, so that there is
 retention of urine ; and as the patient has no
 control over that organ, it becomes full and
 distended ; the urine remains there and de-
 composes, becoming  thick  and purulent, and
 having a strong ammoniacal odor.  It often
 happens that the patient's urine is constantly
 dribbling away, but this is due to the bladder
 being too full, and  the overflow, as one may
 term it, comes away.   The patient generally
 loses power over his bowels, and the stools
 may pass away unconsciously.   If the affec-
 tion spread upward,, the abdominal and in-
 tercostal muscles become involved, and there
 is great distress in breathing ; presently the
 arms are paralyzed,  and the patient dies of
 suffocation,  as  he cannot expand his chest.
 This  happens  chiefly in the  inflammatory
 cases, while, if the  paralysis  be due to other
 causes, the parts affected  will be below the
 seat of  injury, and the sufferer may go on
 for many months and even years ; but then,
 in most cases, he is an invalid, and can hardly
 help himself about at  all.  Those cases which
 depend upon a syphilitic state of the consti-
 tution  may  generally be much benefited,  if
 not cured, by iodide of potassium.  In many
 cases a certain amount of power is regained ;
 but,  as a rule,  even in cases of so-called re-
 covery, there is an impaired gait, and  the use
 of the legs is never fully regained.  The dan-
 ger depends much upon the cause. Any frac-
 ture or dislocation of the spine is always seri-
 ous, but even then life may be  prolonged for
 many weeks ;  as a rule,the higher the injury
 the greater the danger.  A tumor of the cord
 will gradually  make its progress onward and 
o02         PARAPLEGIA
PARASITES
finally kill.  Inflammation of the cord is gen-
erally fatal within a week or a fortnight; other-
wise a slow recovery may be looked for.  When
the cause depends on syphilis or rheumatic
fever, great improvement may sometimes pro-
ceed from treatment.
  Treatment.—In all cases of paraplegia  the
patient should  lie on a water-bed, if possible,
so as  to prevent the  formation  of  bed-sores,
which are very liable to form in this  disease.
Great cleanliness must be  observed,  and any
excreta removed when passed.  A draw-sheet
must be placed beneath the  patient, and re-
moved whe.n required.  The urine must  be
drawn off bv a catheter at least twice a day,
if the  patient cannot pass it, or if  it dribbles
away  ; often, too, it is a good  thing  to wash
the bladder out night and morning with warm
water.  The feet should be kept warm in hot
flannels,  but the heat  must not be  too  great,
for the feet  are very liable to blister in this
affection.  The diet must be light  and  nour-
ishing, and modified to suit the  patient's pal-
ate in long-standing cases.  No bleeding must
be used ; no mercury is to be  given, except
in cases of a syphilitic origin, and not always
then ; no blisters need be applied,  as they do
no good.  For acute  cases,  an ice-bag may
be laid along the spine, and this  gives relief
sometimes.  In chronic cases, when the pa-
ralysis is made out cleariy to be incurable, the
only thing one can do is to make the rest of
life as easy  as possible for the patient.   In
hysterical cases treatment is of much  avail.
It is too common for people  to look upon a
case of hysteria as synonymous with a case of
shamming ;  but this is a totally wrong view
to take of the  subject.  It is  very common
among both sexes, and  especially among
young women,  to  find cases  in  which  the
emotional faculties seem  developed  out of
proportion to the intellectual ones ; such peo-
ple are what are ordinarily  called of a nerv-
ous and excitable temperament ; they often in-
dulge in  emotional excitement,  and this gen-
erally assumes  a religious aspect,  varying in
its  development according to the  people as-
sociated  with  the patient in  ordinary life.
Intense mental worry,  great  grief, loss of a
relation,  and numerous other causes tend to
produce an excitement of  the emotional  fac-
ulties, while at  the same  time they are not
duly balanced  by a well-taught intellect ;  this
is what is meant by " giving way to  the feel-
ings."  In some cases this  goes  on to such
a degree that the will is not exerted by the pa-
tient,  and  cannot  be exerted unless  some
strong stimulant, as electricity, etc.,  is given
to  the  nervous system.   At  one time  the
voice  is lost or an arm is palsied ;  in another
case the leg is  paralyzed,  and it is put down
often  as  hip-joint disease.  And these cases
do not occur because the patient  won't use
the limb ; it is because  she  cannot  unless
you apply a shock.   Such cases  are  nearly
always  worse  in young people,  and  their
state, which, when once recognized, is easily
cured, is often pronounced incurable, and the
poor creature falls into the hands  of  quacks
and wise women ; while, if her tone of thought
has taken  a religious turn, she is looked upon
by the sect as one specially afflicted by Divine
Providence.  And it often happens that hys-
terical paraplegia may  be cured  suddenly ;
and  then,  to the  surprise  of surrounding
friends,  she,  who had been confined  to  bed
for months, is suddenly able to  walk.  Of this
nature are the reputed cures  and miracles
which now and  then are heard of ; and un-
doubtedly  recovery  does occur,  because  a
mental shock is really given in those cases.
Intense  faith, a sudden fire, and a shock of
electricity, all act in a similar way, and most
cases of recovery are brought about by one or
other of these means.  Telling  a patient she
will recover on a certain day has sometimes
a similar effect, and  the more especially if it
is said by  some one who harmonizes with her
train of thought.  The best treatment for such
cases is not to oppose their views, nor, on
the  other  hand,  sympathize with them too
much.   Daily reading some sensible book,
removing  all trashy novels, trying  to  engage
the mind on some amusing topic, avoiding all
excitement, and  some light occupation, as
sewing,  knitting,  or wool-work, will be most
likely to do good.  Cold  bathing, electricity
for a short time every morning, and firm but
kind discipline  will promote a cure.
  PARASITES are animals  or  vegetables
which live upon other organisms.  The mis-
tletoe which  grows  upon the  oak tree  is a
familiar example.  Those found in man are
of two kinds—I, animal ;  2, vegetable.  The
animal parasites may affect  the skin, hair, in-
testinal  canal, or almost any internal organ.
Those which attack the skin are the  Acarus
scabiei, or itch insect, the pediculus, or ordi-
nary louse, the flea, and the bug.  The tape-
worms (Tania  solium and Taenia mediocanel-
lata,  and  Bothriocephalus latus), the  round-
worms  (Ascaris lumbricoides), and  the thread-
worms  (Oxyuris  vermicularis)  are met with
in the intestinal canal.   The  hydatids are
animals like bags or bladders of water which
occur in the internal organs of the body, and
more especially in the liver ; they are  pro-
duced by ova, which, escaping from the  tape-
worm of  the dog (Taenia Echinococcus), are
swallowed in drinking water,  and, passing
into the system through the alimentary canal,
become developed into cysts or bags contain-
ing  fluid.   Another worm,  the  Trichina
spiralis, is sometimes, but  in this country
very rarely, met  with in the muscles of the
body.   It  is caused by eating  diseased pork
or sausages,  and much excitement was  pro-
duced in Germany some years ago by a num-
ber  of  persons eating  half-cooked sausages
and becoming the victims of this disease. 
PARASITES
PAREIRA            363
  Since all these parasites are produced from
pre-existing living organisms, and enter the
human body from without, it is most  impor-
tant to note in what way they enter,  and to
take proper precautions.   Drinking contami-
nated water or eating food which is affected
with  the  parasite are two most common
causes  of  this    disease.   Hydatids,  for
instance, are descendants of the tape-worm of
the dog, wolf, or other  animal ;  this tape-
worm  infests  the alimentary canal of those
animals, and the ova or eggs which are  met
with in the  last  segments of the worm pass
at different times-out of the intestines with
the excreta, then they are probably washed
by  the rain into a dike or running stream,
and a person drinking the water may become
affected ;  or else he may  eat some  water-
cresses or some plant which has been grow-
ing in  the water  and on which the ova have
settled, and so they enter the system.
  It is remarkable that these ova do not pro-
duce in man a tape-worm, but are  developed
into bags or cysts in some internal  organ,
and these, when  swallowed by a dog,  will
reproduce the  entire worm.  It is necessary,
therefore, for uncooked vegetables to be most
carefully washed in clean  water before being
eaten, and  whenever a dog is seen to pass a
worm the parasite should at once  be burned
or thoroughly destroyed so as to remove all
source of danger.
   Tape-worms may be produced by eating the
raw meat of the pig, ox, or cow ; all such meat
should be well cooked, but neither that  nor
salting are quite preventative, though the dan-
ger is  much lessened.  Smoking appears to
kill the worm, and also a temperature equal
to that of boiling water.   But it is not  proper
to eat of such meat at all except dire necessity
compels.  The presence  of tape-worms may
be known by persons passing small pieces con-
sisting of one or more segments, of a white
color, longer than they are broad, and not un-
like pieces of tape. There is generally more or
less hunger, unsatisfied appetite, and a feeling
of discomfort  in  the stomach.  The  worm
affects  the  adult  more commonly  than chil-
dren ;  various remedies have  been recom-
mended, but it may generally be easily  got
rid of by a dose of a preparation of male fern
taken early in the morning, while the individ-
ual has been fasting a few hours previously.
(See Fern.) It should be remembered  that
the worm  diminishes in  breadth near  the
head, and  the neck is, therefore, long  and
slender, and so when the parasite escapes,
this part should  be  carefully sought  for, as
then the patient  may be sure that the white
worm has been expelled and will trouble  him
no more.  Pieces several feet in length may
come away, while the head still remains to
form a  fresh worm afterward.  The parasite
should  be burned  when it is expelled.
 The Round-worm, in shape, size and general
appearance, is very much like  the  common
earth-worm, but the latter is redder and not
so pointed at its two extremities ; the earth-
worm also has little projections on  its under
surface, which probably aid it in locomotion,
while they  are  absent in the  parasite.   It is
found in the small intestines, or that portion
of the alimentary canal  which  is next to the
stomach ;  they may  occur singly or several
together, and are either vomited up or passed
by the bowel ; it is more common in children
than in adults.   A  purgalive or a dose  of
rhubarb or aloes will generally suffice to get
rid of the worm.   When the worm is present
the patient generally has colicky pains in the
stomach, foetid breadth with nausea, or vom-
iting, and bad appetite.  Santonin is perhaps
the medicine most certain to expel this worm ;
it  may  be combined with a purgative ;  it
forms  the chief ingredient in the  so-called
" worm powders."
  The origin  of  parasites which  affect the
skin  is of course well known.   In the case of
itch,  there are two kinds of insect, male and
female ; these  burrow a short  way into the
skin,  and  there  the female  lays  her eggs,
which in a short time become developed into
their mature form  ; they are chiefly met with
between the  fingers and on the arms and
trunk ;  they are not common on the head  or
face  ; they produce  an intolerable itching,
and  the patient  vigorously  scratches  the
affected parts.   They  are produced by dirt
and direct contact with clothes or people sim-
ilarly affected.   (See Itch.)
  There are several varieties of the  pediculus
or louse ;  they affect the hair of the head  or
genitals, or they may  attack the whole sur-
face  of the body or only the armpits.  (See
Ectozoa.)
  PAREGORIC ELIXIR is the name com-
monly given to compound tincture of cam-
phor, a preparation which owes its activity to
opium.  This elixir is sometimes ordered for
children, under the belief or  pretence that it
contains no opium, but the modern  paregoric
elixir contains one grain of opium in half  an
ounce of the elixir, so  that a teaspoonful or
two of it is a tolerably  full dose.   Formerly
it was stronger than it now is, and often gave
rise to mishaps.
  PAREIRA is the wood of the root of the
Cissampelos Pareira,  a  climbing plant  grow-
ing in Brazil.  It occurs in cylindrical pieces,
sometimes split, and  covered  wi.h a most
peculiar bark, if such  it  can  be called ;  its
substance is  vascular and porous.   It Las a
sweetish odor and taste, arid contains a prin-
ciple which has been called cissampeline and
pelosine.   The preparations,   as   contained
in the pharmacopoeia, are a decoction, an ex-
tract, and  a liquid extract,  or concentrated
decoction ; of these the first and the last are
mainly used.  Pareira contains a bitter sub-
stance,  and may  act like columba, but  is 
364         PARONYCHIA
PELVIC  CELLULITIS
chiefly used in maladies affecting the bladder,
especially  chronic  catarrh of  that  organ.
Sometimes it is combined with an acid, espe-
cially nitric acid ;  sometimes with an alkali,
especially  liquor  potassae,  seldom  alone.
Opinions consequently differ  vastly as to its
efficacy in such complaints as those of which
we have spoken (which,  be it said, are com-
monly very intractable), some thinking it of
vast and others maintaining that it is of little
or no  value.  Altogether, in the mean time,
we can hardly be  said  to know if it has  any
influence at all beyond serving as  a vehicle to
the  potent remedies mentioned.   The dose
of the decoction is about  two fluid ounces, of
the  liquid extract  two fluid drachms.
  PARONYCHIA.  (See Whitlow.)
  PAROTID GLANDS are two in number,
one on each side,  just below  and in front of
the  ear.  They secrete  a great portion of the
saliva, and are most active when  mastication
is going  on.  When inflamed they become
painful,  and  form  the  disease  known  as
" mumps ;" the  patient  is" then unable to
open the mouth for a few days,  but  the  dis-
order will soon pass away.  (See Mumps.)
  PAROTITIS.   (See Mumps.)
  PARSLEY is  Petroselinum sativum,  and
belongs to  the order  Umbellifero;.  It  is  a
well-known seasoning  herb, and  was at  one
time included in the Materia Medica.  It pos-
sesses certain  medicinal  properties which
might  be turned  to account when other rem-
edies are not at  hand.    Parsley acts on  the
system as a diuretic, emmenagogue, and as a
carminative.  In  all affections of  the bladder
and  kidneys, gravel, or stone, this plant was
formerly very largely used, while the seeds,
taken two or three times a day, are said to ex-
ert a powerful effect on the uterine secretions.
At  one time a poultice made of the bruised
leaves and  stems, with  vinegar  and water,
was  considered a specific for  the  bites of all
venomous reptiles.  Parsley chewed has  the
property of destroying   any foetor  in  the
breath, or the smell imparted to it from spir-
its,  onions, or other articles.   If dried  and
preserved in bottles excluded from the air,  it
retains its flavor for a long time,  and is very
useful  in flavoring omelets and  similar dishes.
  PARSNIP is  the cultivated variety of  the
wild parsnip—Pastinaca  sativa.   On account
of the woody fibre it contains it is less diges-
tible than  potatoes.   It contains also  less
sugar,  starch,  and  flesh-forming  matters.
Hence on the introduction of the potato into
the  Old World it  became very much less con-
sumed.  It  has a peculiar flavor,  which is
much liked by some people, and it still con-
tinues  to be used  as an  article of diet, espe-
cially with boiled  salt fish and beef.   In Hol-
land parsnips are much used in soups, while
in Ireland  cottagers make a sort of beer by
mashing  the roots and   boiling them with
water  and  hops,  and  afterward  fermenting
the liquor.  A kind of marmalade preserve
has also been made from  parsnips, and even
wine.which in quality has been considered to
approach the far-famed Malmsey of Madeira.
  PARTURITION is the process of giving
birth to a  child, and is synonymous with the
term labor or confinement.  (See Labor.)
  PATELLA is the anatomical name for the
knee-cap.   (See Knee-Joint.)
  PEAS are the product, of various species of
the genus Pisum, belonging  to the legumi-
nous order of plants. Both in a fresh state and
when dried they are a valuable article  of diet,
and contain a  large  quantity of caseine in a
digestible   form.    The  green pea contains
more sugar and less caseine than when dried.
Dried peas  are a wholesome  and  nutritious
addition to other kinds of food.  When add-
ed to  soup they are agreeable and econom-
ical, and in the form of  flour when  ground
they may be advantageously made into pud-
dings or bread with wheaten flour.
  PECTORILOQUY.   (See Stethoscope.)
  PELLITORY, or PYRETHRUM, also
known as  Pellitory of Spain, is the root of a
plant, Anthemis  Pyretrum, growing  along
the coast of the Mediterranean, and imported
from its eastern shores.   The root is spindle-
shaped, and is  ordinarily cut into pieces two
or three inches long.  It has a  thick brown
bark and breaks with a resinous fracture, dark
brown in color with  black shining parts. Its
tincture is  the pieparation  used,  but  even
that  is seldom  employed, and then only as a
gargle.  Chewed, it gives rise to a feeling of
pricking in the mouth and a flow of saliva.
Hence it is  called a masticatory.   It is only
used as  a local stimulant.
  PELVIC CELLULITIS is an  inflamma-
tory symptom of the  cellular tissue which sur-
rounds the bladder and womb.  It  may come
on after a difficult labor, or after  an abortion,
or after an attempt  to  procure premature
labor.
  Symptoms.—It is  characterized by  great
pain in the lower part of  the abdomen, with
loss of appetite and strength. There is always
a good  deal of fever attending it, and the pa-
tient is  generally worse at night.  Shivering
and rigors cause much distress ; the  patient
feels weak and prostrate and loses color, so
that the face has a sallow, earthy look.  This
disease  is very apt to go on for several weeks,
during which time the patient  becomes  ema-
ciated, and of course is  obliged to keep her
bed.   Very  often the inflammation goes on
to form an abscess, and in  time this points
and discharges a great deal of matter.  It may
burst inwardly, or sometimes in the skin over
the groin,  and the escape  of pus is generally
attended with relief.  The convalescence is,
however,  very prolonged,  and it may  be
weeks or months before the woman finally
recovers her former strength.
  Treatment.—The  patient must  be placed 
PELVIS
PELS IN
365
in bed in  a cheerful and   well-ventilated
room.   Her diet must consist of milk, beef-
tea, broth, eggs, jellies, etc.. and while it  is
light and  nourishing it should  be  given in
abundance so as to keep up her vital powers ;
a small chop can be taken if desired by the
patient, but on no account must the woman
be kept too low.   Three  or  four glasses of
purt wine a day will do much good, or  some
bottled stout may be given if  preferred.  To
relieve the pain hot fomentations or hot lin-
seed-meal poultices must be applied, but they
should be made as light as possible, as their
pressure may cause pain.  It is useful also
to remove the weight of the bed-clothes from
the  abdomen by placing an ordinary fire-
screen or  some similar contrivance over the
body.  Great care should be taken lo prevent
the formation of a bed-sore ;  for this purpose
great cleanliness  must be  observed, and the
patient should  lie  on a water-bed or water-
cushion.  (See  Bed-sores.)   At first  saline
medicines  and  anodynes  may  have to  be
given,  afterward quinine, or some other tonic.
Convalescence will be much aided by change
of air,  and especially by residence at the sea-
side if not  too cold.  If  an  abscess form it
will  either burst or have to  be  opened, and
be treated in the usual manner.
  PELVIS is a space formed by the haunch
bones  and lower  part of  the  spinal column
which  communicates  freely with the abdom-
inal cavity above, but is elsewhere closed.  It
contains the bladder in front, and the rectum
behind, besides several important vessels and
nerves ; in the female it contains, in addition,
the uterus or womb,which is situated between
the bladder and rectum.  The pelvis is wider
and shallower in the female than in the male,
and in this way the  process of parturition  is
facilitated ;  from  this cause,  also,  the hips
are wider apart than in man,  and this makes
the difference in  the gait between the two
sexes when walking.
  PEMPHIGUS, or Pompholyx, is a skin
disease characterized by the presence of large
blisters called bullae on the  surface  of the
skin ;  often the arms and  hands or  the lower
extremities are more affected than the trunk ;
the disease may be  either acute or chronic,
and  sometimes   very troublesome to  heal.
The bullae or blisters are surrounded  by a
narrow red raised aureole, or ring ;  when the
blisters burst a scab may form, and that spot
may heal while a fresh one  will form else-
where.  Zinc ointment must be applied ex-
ternally, and small doses of  arsenic may be
^iven internally ;  the general health must be
improved  by a  light and nourishing diet.
The bullae should be pricked with a needle  to
let the  fluid escape.
  PENNYROYAL, the Mentha Pulegium,
is only employed  in medicine in the form  of
oil ;  even that is not now officinal.  The oil,
which is yellowish and of  a peculiar odor,  is
obtained by distillation from the plant, which
grows in marshy places.   The  oil is used in
the same cases as peppermint and spearmint.
The herb itself has obtained a false reputation
as an abortive.
  PEPPER is the fruit of the Piper nigrum,
a shrub belonging to the family Piperacea:. It
grows  both  in  the  East and  West  Indies.
There  are two  sorts sold in the markets—
" white" and " black."   The  white  is pro-
duced  by the same plant as the black, and
consists of the berry from which  the  skin or
bark has been removed.   The pepper berries
contain an  active principle  called piperine,
and an acrid resin as well as a volatile oil.
  PEPPERMINT—the Mentha piperita —is
only used nowadays as  oil obtained by dis-
tillation  from the well-known  plant.   This
oil is colorless,  turns pale yellow by keeping,
has a warm aromatic taste, and  the odor of
peppermint.  Peppermint water is now made
by distilling together a  large  quantity -of
water and a  small quantity of  the oil.  The
essence of peppermint consists  of the oil dis-
solved in a small quantity of rectified  spirit.
Peppermint water is largely used as a vehicle,
but to  some  people  the  odor and flavor are
both very disagreeable and should be avoid-
ed.  The essence may be given  dropped on
sugar  to infants for spasms or  gripes, and
many adults find the same prescription grate-
ful.  The oil is used as an adjunct to  purga-
tives tp prevent them griping.
  PEPSIN  is  a modern remedy, if,  indeed,
it can be called  a  remedy at all,  seeing that
it consists as far as  possible of the digestive
principle secreted  by the stomach, made use
of to aid digestion.  The best pepsin is made
from pigs' stomachs ; it is known as Pepsina
porci; it is  free from acid and  starch, and
has an odor by no means disagreeable.  The
pepsin most  frequently used is of French or-
igin—the Pepsine Boudault—and is obtained
from the stomach of the calf.  It is also large-
ly mixed with starch, so that it is, compara-
tively speaking, inert.   It is grayish-white in
color,  always acid, and  very often its smell
is quite disagreeable.  Pepsin  has this pecu-
liarity, that when acidulated with hydrochloric
acid greatly diluted and kept  at a tempera-
ture of ioo° F.,  it  speedily dissolves all albu-
minous  substances,  reducing all to  a com-
pound of  nearly uniform character  called
peptone.   This differs altogether in its char-
acter from any  other albuminous substance,
in that  it is easily miscible with water and
readily diffusible, resembling in  this  a saline
substance.  Other acids, especially lactic, have
the same power as hydrochloric,  but in a
much less degree.
  The value of pepsin in a certain number of
cases is  undoubted ; but  the exact cases for
its employment are  not  yet quite manifest.
It has  been mainly used in cases of dyspepsia
where there was  reason to  believe  that the 
366         PERICARDITIS
PERICARDITIS
secretion of gastric juice was imperfect.   It
should in these cases be given during or after
a meal.  Sometimes it is made up in the form
of a lozenge, to be swallowed just after food ;
but this is not, perhaps, the best way.   Pep-
sin has this peculiarity, that when it acts' on
albuminous  substances  it does not itself be-
come destroyed, but is quite capable of  acting
on quantity after quantity of the albuminous or
fibrinous material, provided  only a sufficiency
of dilute acid be supplied.  Apparently,  there-
fore, the best plan would be to give this sub-
stance in a dose of three or  four grains along
with food, and from time to time thereafter to
swallow small  quantities  of diluted  hydro-
chloric acid, a few drops at a time, until diges-
tion is complete.  In cases  of great debility
of stomach, especially in old  people, the ha-
bitual use of pepsin may render life easy and
pleasant where formerly it  was unendurable.
It will be of great value where there  is  regur-
gitation of half-digested  or half-putrid food,
especially in  cases of obstruction at the py-
lorus  ; for it has been tolerably clearly proved
that substances  which are digested  in  the
stomach are absorbed there, so that if albumen
be converted into peptone,  and there absorb-
ed, there will be no necessity for it to pass
the pylorus, nor will there  be time for it to
undergo decomposition.  After a  time a few
drops of weak carbolic acid might be given to
prevent putrefaction of what remains.
  PERICARDITIS is an inflammation  of
the pericardium or membrane which  envel-
opes  the heart.  Involving so important an
organ as the heart, and interfering so gravely
with its action, it is therefore a  disease  of
serious significance.   Pericarditis very rarely
comes on  as a primary disease ; it generally
comes on  as  a secondary complication in the
course of rheumatic  fever  or Bright's dis-
ease.   More rarely it occurs by the spread of
inflammation from adjacent parts, as in cases
of pleurisy and pneumonia ; sometimes from
the presence of an aneurism or  other  tumor
in the chest, and still more rarely from exter-
nal injuries, as gun-shot wounds, stabs, etc.,
for these  generally prove  fatal  before there
is time for the inflammation to appear.
  Symptoms—It will be most convenient to
give the signs of pericarditis as they occur in
a case of rheumatic fever.   In such cases the
patient will have had pain and swelling of the
joints  some  days previously ; the skin  will
be hot and perspiring freely, while the tem-
perature may have risen to 102°  or 103°, or
even higher.   There will be loss of  appetite,
thirst, headache, and a white, furred tongue.
If now pericarditis should come on,  the tem-
perature will rise higher by a degree or two ;
the pulse will be quick and excited ; there will
be pain across the chest,which is worse when
the patient takes a deep breath ; the face will
be pale, the breathing shallow and hurried,
as  the pain  is  worse on  inspiring deeply ;
the patient will lie flat on his back, and feel
faint if any attempt is made to raise him.   If
now one listen  over the region of  the heart,
a rough sound will be heard, because the op-
posed  surfaces of  the pericardium  are  no
longer smooth but rough.  In a day or two
there will also  be signs that the cavity of the
pericardium  is  full  of fluid,  and as this,
pressing upward and laterally, displaces the
lungs,  the breathing is still  more  interfered
with.   There may  also  be  heard numerous
new sounds,  called  rales, over  the  chest, for
the air-passages contain more mucus, and the
air, in  passing over  them, causes  these rat-
tling noises.  These symptoms are  generally
attended with an abatement or even cessation
of all pain in the joints.  So  the patient goes
on for  a few days,  when, if recovery  takes
place,  the temperature begins to decline, the
breathing is easier,  the  pulse, lessens in fre-
quency, and  a  general  improvement may be
noticed.  If, however, the case goes on from
bad to worse, there  is generally low, mutter-
ing delirium  ; weak  and muffled sounds are
heard  over the  heart ;  there is  greater pros-
tration, and the patient dies from exhaustion
or syncope.  In all cases of recovery the ab-
sorption of the fluid is a slow  process, and
convalescence is retarded.   In  many cases,
as the  pericarditis abates, there  may be signs
that the endocardium, or lining  membrane of
the heart, is  also affected, and so, while they
recover for a time, there is left behind  much
serious mischief, which will sooner or later
shorten  the  life of  the  patient.  It is a re-
markable fact that in some years it  is much
more common for inflammation of the heart
to accompany rheumatic  fever  than at other
times,  nor is there  at present  any  satisfac-
tory explanation to be given.  In some cases
the muscular wall of the heart is inflamed as
well as the outer covering, and  this seems to
be the case in most  of those  which are fatal,
so that it adds  to the danger of a case.   In
Bright's disease,when pericarditis comes on.it
is generally found that the patient has suffered
from the chronic form of this  disease for a
long time, and it generally supervenes in those
who are the subjects of the gouty and con-
tracted kidney.  There is great  pain over the
front of the chest,  and the rubbing sounds
may be heard on placing the  ear to  the chest ;
in other respects the symptoms  are very sim-
ilar to those  mentioned above.  Nor in those
for whom there is some other cause for the in-
flammation are there any other marked  symp-
toms than those described ; but in  addition
there  will be the evidence  of  an aneurism,
pleurisy, pneumonia, stab,  wound,  etc., ac-
cording to the nature of the cause.
   Treatment.—In all cases perfect rest must
be enjoined  in bed, and the horizontal posi-
tion kept ; in  some  cases,  however, of old
standing heart disease the  patients cannot lie
down,  and  then they  must be propped  up 
PERICARDIUM
PERITONEUM          367
 with pillows.  No exertion  should be made
 by the sufferer, nor should he attempt to rise
 lor any  natural purpose ;  nor should he be
 moved from bed  to bed in the early days of
 the illness, for whenever movement  is made
 the heart is called upon to do more work, and
 in its  weak, inflamed state  it may  cause a
 fatal faint, or syncope.  The  diet must con-
 sist of milk,  an egg  beaten up  in the milk,
 beef-tea, broth, etc., but no solid food should
 be given,  nor anything which distends  the
 stomach.  Stimulants must be given accord-
 ing to the  requirement of  each case, and ac-
 cording  to the age of the patient ; but no
 rules can be laid down here as to the quan-
 liiy to be given daily.  The nurse and medi-
 cal man should look out carefully  for any
 signs of bed-sores, and try and prevent their
 forming by perfect cleanliness and a smooth
 bed ; they are very apt to form in these cases.
 (See  Bed-Sores.)  When  the pain is great
 across  the chest,  and the  breathing very
 quick, four or  six leeches will give a great
 deal of relief by abstracting the blood ; then
 a hot  linseed-meal poultice, not  too  heavy,
 should be laid across the chest and changed
 every  three hours ; but care should be taken
 that the  leech-bites have stopped bleeding, or
 otherwise the moist heat will make them bleed
 more, and exhaust the patient  too much.
 Cotton-wool may be applied  to the chest  in
 some  cases instead of a poultice.   As such
 patients  sweat profusely, the chest should be
 wiped dry and gently just  after the poultice
 is removed, or the moisture  soon  cools and
 makes an uncomfortable feeling. Opium may
 be given at bed-time to procure  r.leep, but
 with great care in such as have affection of
 the lungs at the same time.   Now and  then,
 in the  course of rheumatic fever, the pulse and
 temperature  suddenly rise, and there is  in-
 tense headache and delirium.   In these cases
 of  hyperpyrexia, or excessive fever, the ther-
 mometer may  rise  to 1070,  109°,  or even
 higher.  Most of these prove fatal, but some
 cases have lately  been cured  by  the use of
 the cold-bath, or by packing in sheets dipped
 in cold water and often renewed.  The great
 principles of treatment in pericarditis are—1.
 To give the  patient light  but  very nutrient
 diet.   2. To avoid  all exertion.  3.  To try
 and abate any pain, cough, or  other trouble-
 some symptoms.  4. To sustain the patient's
 strength  until such time as  the  acute  inflam-
 matory symptoms have abated.  The period
 of  convalescence follows,  and those tonics
 may be given, and the rules may be adopted
 which are laid down in the article on Fevers.
  PERICARDIUM  is the  name given to
 the membrane which surrounds the heart and
 incloses it in a bag.  Thus  there are two op-
 posed  surfaces,  each  of which, in health, is
perfectly smooth,  and enables the heart to
move freely with the least amount of friction.
The sac  or  bag secretes a small quantity of
fluid so as to lubricate the parts, and  this is
much increased in quantity in cases of hydro-
pericardium, when there  is  a dropsical  ac-
cumulation of the fluid ; this condition arises
in cases of disease of the heart, kidneys, and
lungs, and it  is generally associated with a
dropsical  condition of other organs.
  PERCUSSION is the  art of ascertaining
the state of internal organs by means  of  the
sound produced by striking the part over them
with the fingers, or by means of striking on a
little ivory plate placed  over the part.   It re-
quires a delicate ear and much practice to be
able to use percussion skilfully.  (See Steth-
oscope.)
  PERICRANIUM is the tissue which over-
lies the skull,  and aids in nourishing the bone
which lies beneath it.
  PERINjEUM is the name  applied  by
anatomists to the region at the lower part of
the body  which is perforated  at its centre by
the anus.   It  is bounded in front by the geni-
tals, behind by the buttorks, and at the sides
by the inner surfaces of the thighs.  It corre-
sponds to the outlet  of the pelvis, or bony
gristle at  the lower part of the trunk, this out-
let being bounded in front by the pubic bones,
behind by the coccyx or terminal bone of  the
spinal column, and at the sides  by portions
of the  pubic  and ischial  bones,  and by a
fibrous structure called the great sacro-sciatic
ligament.   In the deep parts  of  this  region
are contained the lower portions of the rectum
and the generative and urinary organs, with
their appendages.- At the surface it measures
four inches from before backward, and from
two to three and a half inches in breadth at its
widest part. The skin is loose, dark in color,
and covered by short hairs ; around the anus
it  is  puckered by radiated folds,  and it is
traversed  from  before  backward,  exactly in
the median line  of the body, by a prominent
line called the raphe".  This region is one of
great importance and interest to the surgeon,
as it is here  that  the incisions  are made
through which a stone can be  removed from
the bladder.   It  is occasionally  the seat of
abscess, connected  in most  instances with
perforation of the walls  of  the  rectum or
urethra, and terminating in the  one case in
fistula, and in  the other in  urethral or perineal
fistula.  Injuries,  especially heavy falls upon
some hard body, are especially dangerous in
this region, as they often cause laceration of
the urethra and retention of urine.
  PERIOSTEUM is a delicate covering to
the bones  ; it  is richly supplied with blood,
and takes an  important part in the proper
nourishment of bone.
  PERITONEUM is a serous and smooth
membrane which forms the outer coat of  the
stomach,  liver,  intestines, and  some  other
organs  of the abdomen and  pelvis ;  it also
lines the wall of the abdominal cavity ;  in this
way a cavity is formed between its two sur- 
3G3          PERITONITIS

faces, and this only contains a little fluid, just
enough to moisten the opposed surfaces and
to enable the intestines, etc., to glide  over
each other with the least possible amount of
friction.   When this  membrane is  inflamed
it gives rise to great  pain and  sets up perito-
nitis.  (See Peritonitis.)  When fluid accu-
mulates in the cavity formed by the perito-
neum, as in cases  of  dropsy, ascites is  then
produced. Cancerous growths may  be found
in this membrane, causing a form of periton-
itis, and also deposits of tubercle may be met
with.  Any injury to the membrane, as stabs
or wounds from without, may set up a  seri-
ous inflammation.
  PERITONITIS is an inflammation of the
peritoneum.    Its danger will  vary with the
cause ; it  may be produced by  external in-
juries, as  a  stab or gun-shot wound in the
abdomen.   These cases  are  often fatal.
Cancer and tubercle may bring it on, but this
is generally only a part of the malady, and the
chief seat of disease is elsewhere.  Any tumor
of any organ in the  pelvis or abdomen may
cause  it,  as hydatid  cysts,  ovarian tumors,
etc.  Stricture, hernias, and ulceration of the
intestinal  canal will bring it on, and it is often
associated wth typhoid fever.
  Symptoms.—Pain  over the   abdomen,
vomiting, and a raised  temperature are the
chief symptoms ;  the pulse is quick and small,
the countenance  anxious  and sunken, the
legs drawn up, so as to relieve the pain.  The
pain is worse on any movement, and is very
wearing  to  the patient.   In some cases  of
blood-poisoning,  as in pyaemia and puerperal
fever,  etc., there  may be peritonitis and yet
no pain.   Colic, which often comes on in lead
poisoning, must not be mistaken for this dis-
ease.  There  will be no  fever then, while
there will be the occupation of the patient to
guide one, and the individual will have a blue
line on the  gums.  Some  cases  of hysteria
may  simulate  peritonitis ;  here, again, the
temperature is  normal, and  there are the
usual signs of hysteria.
   Treatment.—Perfect rest in bed  must  be
enjoined ; hot fomentations, made as light as
possible, must be applied over the abdomen ;
the weight of  the bed-clothes should be taken
off from the patient as far as possible.  Opium
must be given to  relieve the pain.   Cooling,
saline drinks and iced  water may allay the
thirst  and sickness, while  milk  and beef-tea
must be given every  three hours or oftener,
so  as to keep up the patient's strength.   But
each case will vary so with the cause as that
any given case might require a somewhat dif-
ferent line of treatment.  The only  thing that
a good nurse can do is to see that  the  room
is cool and well-ventilated, to secure perfect
cleanliness,  to give light and nourishing diet,
and to enjoin perfect rest.  Peritonitis often
forms a serious complication in cases of ty-
phoid fever.   (See Typhoid Fever.)
               PESSARIES

  PERITYPHLITIS signifies inflammation
around  the  caecum.   It may  come  on after
taking  an indigestible meal,  as partaking
freely of nuts, etc., or a foreign boay, as a
pin,  cherry-stone, etc.,  may lodge  in  the
vermiform appendix, and  set up inflamma-
tion around.   The symptoms  are great pain
on the right side of the abdomen and fulness
there ; great tenderness on  pressure ; sick-
ness,  faintness, furred tongue,  and  fever.
The  treatment will be the same as that rec-
ommended  in  cases  of  peritonitis.  (See
Peritonitis.)
  PERRY.  (See Cider.)
  PERSPIRATION, or  SWEAT,  is the
secretion  which is always taking place from
the skin.  Under ordinary circumstances, no
liquid water  appears on  the  surface  of the
skin  unless  very active exertion be  made.
The  quantity secreted varies very much ac-
cording to the temperature and moisture of
the air,  and the state of the blood and nerv-
ous system.  A small quantity  of carbonic
acid  and  urea are excreted, but the  greater
part by  far is water ; the  secretion  is acid,
and contains fatty matters derived from  the
sebaceous glands of the skin.  (See Skin.)
  PERTUSSIS.   (See Whooping Cough.)
  PERU, BALSAM OF.  (See Balsam of
Peru.)
  PERUVIAN BARK.  (See  Cinchona.)
  PESSARIES  are  instruments  intended
for introduction into the vagina for maintain-
ing the  womb in its proper place and attitude.
These are of various  shapes  and characters,
but it is bootless to describe them here, since
almost every practitioner has got some notion
of his own on the subject of which  are best
for each  particular case, and  such  mechani-
cal appliances must  always be  selected  and
adjusted by a practitioner.  The pessaries we
here refer to are what are called medicated
pessaries, and consist of some drug made up
into a conical mass,  and introduced  into the
vagina  in cases of  disease of  the   womb.
These are sometimes capable of giving great
relief, and are never to  be neglected, espe-
cially where it is found necessary to  employ
sedatives locally.    The  best  material  for
making these pessaries  is the  hard oil  ob-
tained from the fruit of the cacao-tree, which
is separated in preparing some of the varieties
of cocoa in ordinary use.   This oil is hard as
frozen  butter,  but is easily  melted ; mixed
with a  little  olive oil or  other  similar  sub-
stance  it easily takes up  the remedy when
stirred  with it, and  when  introduced melts
slowly  so as to allow of  the  remedy being
gradually absorbed.   Perhaps the best seda-
tives to be mixed with cacao  butter are ex-
tract of belladonna  and extract of  cpium.
Acetate of lead and sulphate of  zinc may also
be added if it is necessary to arrest discharges.
Tannic acid, too, is  very  usefully  combined
with  it  ; as is alum or similar substances.  In 
PESTILENCE
PHLEBOLITHES
3G0
most cases injections do better  than  pessa-
ries,but when sedative applications are desired
the pessary allows of their reaching the parts
more gradually and in more divided doses.
  PESTILENCE.   (See Fever;  Plague.)
  FETECHI2E are the spots  which  make
their appearance  in certain diseases wherein
is much disorder of the blood.   Chief among
these are typhus  fever, purpura, and scurvy.
In typhus the spots begin as irregular patches
of a dusky hue, which may be elevated above
the skin so as to be perceptible to  the finger.
If there  is  much blood  derangement, these
spots are very dark in color, and  it is these
dark-colored spots indicative of blood effusion
and alteration, which are  called  petechial.
In scurvy and purpura the patches are very
much larger than in typhus, but in patients
who have  been exposed  to the  conditions
which  gives  rise to scurvy  or  purpura, any
acute disease may produce petechial spots in
the skin and mucus membranes.   Petechiae
on the surface  of  the pleurae are  indicative
after death of violent suffocation.
  PHAGEDENA, derived from the  Greek
word  Quyu, to gnaw, is  used  to  express a
variety of ulceration which destroys the tis-
sues more rapidly and to a greater extent than
ordinary forms of ulcer.   The subjects of this
local affection  are usually  individuals who
have been debilitated 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  are irritation of
the open surface  and gross  neglect of  clean-
liness.   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 phage-
daenic and  produce  much destruction  of  the
soft parts.   It has been  most frequently met
with in connection with venereal ulcers, espe-
cially in those cases in  which  the patients
have been submitted to a prolonged and ex-
cessive use of mercury.   Phagedaenia  varies
in intensity in different cases ; it is sometimes
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 known as hospital
gangrene.   This latter form  of phagedaena is
met with in noma, cancrum oris,  and  the
sloughing throat of scarlatina.   It  is believed
by  many  surgeons  that phagedaenic ulcera-
tion is  caused by poisoning  of  the blood, in
consequence of the absorption of putrid mat-
ter.
  In phagedaena there is a large and rapidly
spreading  ulcer,  the  edges of  which  are
formed of sharply-cut, indented and under-
mined skin.   The surface of this ulcer is un
even and of grayish color, and is covered by
a dark colored, thin and very foetid discharge,
which is often marked by streaks  of blood.
The  integument  surrounding the  ulcer is
swollen, and of a dusky-red color.   The ul-
cerative process is attended with severe gnaw-
ing pain.
  Treatment.—In the treatment of this affec-
tion  it is  necessary that the patient be sup-
plied with good nourishment, and  that alco-
holic stimulants be given freely, but at regu-
lar intervals.  Opium  is generally  adminis-
tered for the  purpose of  relieving the severe
pain and of allaying nervous  irritation. The
diet  should consist chiefly of fluid food, such
as milk,  beef-tea, and strong broths.  The
patient should be kept in bed in a  large  and
well-ventilated room.  The bowels should be
kept open by mild purgatives, but great care
must be taken to avoid diarrhoea, as the sub-
jects of phagedaena  may rapidly sink under
any  excessive drain upon the system.  The
local treatment consists in cleansing the sur-
face  of the  ulcer  by frequently syringing  it
with some disinfectant lotion, as  a solution
of carbolic acid, of  permanganate of  potash,
or chloralum, and in relieving the pain by the
application of poultices  or  poppy  fomenta-
tions.  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  applications,  fuming
nitric acid seems to be the one most in favor.
  PHALANX is a technical term for the
small bone  of a finger  or toe ; each finger
and  toe, therefore, has three phalanges.
  PHARYNX is the upper part of the gullet,
and  may be seen at the back part of the mouth
behind the tonsils.  It communicates in front
with the mouth so as to allow the  food to
pass down into the stomach ; above, with
the nose,  as is shown in cases of  vomiting ;
and  below and in front of it lies the larynx
or windpipe,  from which food is prevented
from entering by means of  the  epiglottis.
The  Eustachian  tubes, one  on  each  side,
also  enter  the  pharynx,  and connect  it
with the  ear ; it is along these  tubes  that
inflammation  may  extend when  the  throat
is affected, as in cases  of  common cold or
scarlet fever, and so give rise to deafness.
  PHENIC ACID.  (See Carbolic Acid.)
  PHLEBITIS means strictly an inflamma-
tion  of a vein ; in cases of pyaemia, a clot may
form in a  vein and give  rise to some of the
symptoms ;  but it is doubtful if actual inflam-,
mation of the walls of a vein ever  occurs.
(See Pyaemia.)
  PHLEBOLITHES are small concretions
or particles, made  up chiefly of calcareous
matter, which now and then form in the small
veins.   They are seldom recognized during 
370         PHLEBOTOMY
PHOSPHORUS
life, ana rarely give  rise to  any symptoms.
No treatment is required, and the only result
of their presence  is that  the  circulation
through that vessel is  obstructed, and the
blood has tD go round another way.
  PHLEBOTOMY  means  cutting a  vein,
as in  the  ordinary  operation of  bleeding cr
venesection.  (See Bleeding.)
  PHLEGM is a common name for the fluid
coughed up from the air-passages.  (See Ex-
pectoration.)
  PHLEGMASIA DOLENS, also known
as white leg or milk leg, is a malady affecting
women, in childbed especially.   It is  most
likely  to  occur  in  women  who have been
weakened by  flooding or  other  causes.   It
sometimes occurs toward the latter stages of
cancer of the womb.  One or both extremi-
ties may become  affected, and  it is said that
the left is more frequently its subject than the
right.  The limbs become brawny, but do not
pit on pressure, and from altered conditions of
the circulation the parts become  quite white.
It has been  assumed,  rather  than proved,
that  it depends on coagulation of the blood
in the veins, and it  has been called  obstruc-
tive phlebitis,  Others, again, have said, that
the obstruction in the veins is quite a secon-
dary matter.   Be that as it may, the disease
commonly occurs in a first pregnancy, mostly
within a month  after labor.   The  symptoms
of phlegmasia  may  be  thus  enumerated.
They begin with  fever,  headache and  pain,
not infrequently  preceded by  a rigor.   In
about four-and-twenty hours  the  limb begins
to swell ; the two limbs  are  seldom affected
together.  This  swelling  commences in the
foot or ankle, and  gradually creeps upward.
Sometimes, however, it begins  in the thigh,
and  passes downward,  or all  parts  may be
nearly simultaneously affected.   The limb is .
hot and tender, swollen to nearly  twice its
size, pale white in color, tense, shining, and
elastic, but not bagging  on  pressure.  This
acute stage  may  remain  three weeks or
longer, but the limb  remains useless a very
much longer time, only  gradually recovering
its normal size, power, and pliability.
  Treatment.—The treatment may be said to
be in  the main prophylactic ; that is to say,
it should be the aim to prevent such an acci-
dent,  if there be any likelihood of iis  occur-
ring ; and if it threatens, the aim should be  to
arrest the  malady  as speedily as possible.
The great thing is absolute rest ; the patient
must  not be moved.  Bran poultices should
be applied the whole length of the limb, or
hot-water fomentations freely employed ; but
the former are best, as necessitating  less in-
convenience to the patient.   Opium should
be given internally to soothe pain, or chloral
may be used  for  a  like  purpose.  At a later
period, good  food,  wine, bark, and iron are
to be  given, and  bandages and hot fomenta-
tions,  with  gentle  rubbings applied  to the
stiffened limb.   The  malady rarely  if ever
proves fatal.
  PHOSPHORIC ACID, in its diluted form,
is used in medicine, but not very extensively.
It may be prepared directly from phosphorus
by oxidation, by means of nitric acid.  The
liquid thus obtained, when diluted, is colorless,
and has an agreeable taste.  Its reaction, of
course,  is acid, and generally it may be said
to act much in the same way as sulphuric acid,
but is not nearly so  astringent.  It may be
given in good large doses, and it  has been
suggested  that this would render it of value
when combating the tendency of urine to be-
come alkaline in the urinary passages.  It is
a good  medicine when given  freely  diluted
with water, the pleasant acid taste  rendering
it agreeable to many parched  invalids.   To
many it may be given freely as a drink, suf-
ficient only being added to the  water to ren-
der it pleasantly acid.  The ordinary dose is
about half a drachm diluted. The chief com-
pounds of phosphoric acid employed in med-
icine are phosphate of ammonia, chiefly used
for aiding the solution  of uric acid  in the
urine, where there is a tendency to the forma-
tion of uric acid calculi.   Phosphate of soda
or tasteless purging salts  is a capital laxative
for children, and may be  given in  their food
with ease.   Phosphate of  iron is a remedy of
undoubted value  as  a  ferruginous  tonic,
while it wants the   binding  and irritating
qualities of some other iron salts.   Hosford's
Acid Phosphate is an excellent form in which
to administer phosphoric acid.
  PHOSPHORUS is a  waxy-looking sub-
stance of very peculiar properties, obtained
from bones.  The bones are first of all acted
on by oil of vitriol, and the solution which is
thus formed   is subsequently  distilled with
charcoal.  The phosphorus, which is volatile,
passes  over, is collected  in a  cool receiver,
and subsequently moulded into  sticks.  These
it is necessary to keep under water, otherwise
they would  take fire.  When freshly pre-
pared, phosphorus is colorless, and semi-
transparent, but after a time a film forms on
its surface.  When set on fire,  it burns with
a bright flame, giving rise to fumes of phos-
phoric acid. It may be converted into a pecu-
liar  form, known as  red  or allotropic phos-
phorus, which possesses properties quite dis-
tinct  from those  of  the ordinary variety.
Ordinary phosphorus readily takes fire ;  the
other  iorm   does  not  till   it  has  been
heated to a high temperature,  and it  is said
not to  be poisonous, whereas the ordinary
variety is intensely  so.  Phosphorus is  not
often given  internally ;  if given in  large
doses, it acts energetically  as  a poison, and
seems almost invariably to give rise to a form
of degeneration  of  the liver.    In  smaller
doses it has been given in nervous diseases,
and as a stimulant in  low  nervous  fevers.   It
has also been given in other diseases, with no 
PHOSPHORUS  DISEASE
PICROTOXINE         371
 very marked benefit.   Indeed, it may be said
 that up to the  present time  no malady  has
 been  treated with  any  peculiar benefit  by
 phosphorus.  Moreover, it is dangerous and
 unpleasant, and except  some other use  be
 found for it, perhaps it had better be left out
 of the list of available remedies.  The dose
 is about  one fifteenth of  a grain, and should
 be given dissolved in olive oil.
   PHOSPHORUS DISEASE.  (See Luci-
 fer-Match-Maker's Disease.)
   PHOTOPHOBIA, or  dread of light, is a
 symptom common to a good many diseases
 of the eye.  The patient its subject,  shuns
 light in every way, and if introduced into a
 room with a bright light, obstinately shuts
 the eyes, and cannot be  persuaded  to open
 them.  It is characteristic of no one disease.
 (See Ophthalmia.)
   PHRENOLOGY is a system of mental
 philosophy designed and  taught by Drs. Gall
 and Spurzheim  on the continent, and by Mr.
 George Combe in England.   The believers
 in this system maintain that it is an infallible
 index to the mind, and that the  elevations or
 depressions in the head exhibit to the student
 of phrenology the whole nature of the mind,
 as on a map  or chart.  The  brain in  phre-
 nology is divided  into three parts—the an-
 terior,  middle, and posterior.   The anterior,
 or front portion, is supposed to contain all
 the   intellectual and   perceptive  faculties.
 The moral sentiments or emotions are situ-
 ated in the middle region, and the animal
 propensities are confined  to the back of the
 head.   Each  of these portions  of the  brain
 is divided again into individual organs, hav-
 ing  special  functions  assigned  to  each.
 Phrenologists enumerate about forty differ-
 ent organs  or bumps, as  they are familiarly
 called, each independent  of  the other, and
 capable of development or repression as the
 character is governed and controlled by the
 educated will.  These  dispositions are said
 to be affected by constitutional temperament,
 of which three varieties are recognized.   The
 vital  or  vigorous  and  powerfully  physical
 temperament ; the motive or bilious,  charac-
 terized by dark  hair and eyes, bony structure,
 and muscular development ; and the mental
 or nervous temperament, distinguished  by
 delicacy of  body, great susceptibility, and a
 light elastic frame, with  fair  hair and  eyes.
 Phrenologists divide the  mental organs into
 five groups, and  there are many drawings and
 casts of the  head  illustrating this division
 and the situation of each  faculty.   Phrenol-
 ogy was at one time more studied than it is  at
 present, but associated with mesmerism and
 electro-biology, as it is called, it has yet many
 votaries.
  PHTHISIS is the technical name for pul-
monary consumption.  (See Consumption.)
  PHYSIOLOGY is the science which treats
of the history and  functions of the  human
 body and its several  parts.  It  teaches  the
 function and nature of every texture and por-
 tion of the body, and enlightens  us as to  the
 economy and use of the organs of the human
 system.   Physiology is divided  into animal
 and vegetable, and again into  human and
 comparative physiology.   All the principal
 portions  of  human physiology  are  treated
 under their several heads in the present work.
   PHYSOSTYGMA, better known as  the
 Ordeal bean of Calabar, in West Africa, is a
 substance recently introduced into practice,
 and though it has had the advantage of  an
 unusually careful and  accurate physiological
 investigation, has not yet come fairly into
 general use.  The beans  are the fruit  of a
 tree belonging to the leguminous order, and
 each contains  two lobes   easily  reduced  to
 powder, and having a taste somewhat similar
 to that of other seeds of the order,  which are
 wholesome enough,  The active principle has
 been called physostygmine.   It  is  mostly
 contained in the kernel, and may be extracted
 by alochol.  This extract  is officinal, and is
 the  only preparation  which is  so.  When
 taken internally these beans, or even a por-
 tion of one ot them, give rise to serious symp-
 toms.  The  bean was used in Old Calabar
 and  neighboring countries  as  a test  for
 witches, hence the title Ordeal beans.  If any
 one accused of this, to the savages there,
 horrid crime, could devour a bean and still
 live,  the  charge was  repelled and without
 hurt ; but if, as most  frequently happened,
 the trial was attended with fatal results, then
 general suspicion was supposed to be con-
 firmed.  In point of fact, if an excessive dose
 was taken, the patient sometimes recovered
 by vomiting , but if only  a moderate  dose
 was swallowed, then death most surely fol-
 lowed.  It seems to act  especially on the
 heart and spinal cord, paralyzing the former,
 and arresting the  functions of the  latter.  The
 spinal cord, under its influence, seems to lose
 the power of fulfilling its functions,  the  affer-
 ent nerves ceasing to act before the efferent.
 The most apparent action of the  Calabar
 bean is  however, to cause  contraction of the
 pupil of  the eye.  It  has  accordingly  been
 used in certain forms of long sight to remedy
 that by applying it locally to the eye.  It has
 also been  given with some  apparent success,
 real or fancied, in tetanus, even in the  trau-
 matic variety ; but so many remedies  have
 been  vaunted for this—none  having  been
 found really efficacious—that men are scepti-
 cal.  The dose of  the extract  is from  one-
 sixteenth to one-fourth grain internally given
as pill.
  PIA MATER is one of the coverings of
 the brain  and spinal cord.  (See Brain and
 Spinal Cord.)
  PICROTOXINE is an  active  principle
contained in Cocculus Indicus,  which, as  al-
ready pointed out, is mainly used for nefari- 
372        PIGEON-BREAST
PLAGUE
 ous purposes.   Picrotoxine is  not used  in
 medicine.   Even  cocculus  has  been used
 mainly for destroying vermin.
   PIGEON-BREAST is a condition of the
 chest due to malformation, generally indica-
 tive of deficient respiratory space.  In pigeon-
 breast, the  chest, instead of being  more  or
 less rounded or  flattened from  before back-
 ward, is flattened from side to side,  and pro-
 jects  in front.  This renders the chest ex-
 ceedingly narrow  from  side  to side,  and
 causes the  breastbone to  project as it does
 in birds, so  as to form a ridge in front.  This
 arrangement sadly cramps the space available
 for the lungs, for  the size of the heart does
 not greatly vary.  Moreover,   the  shape  is
 unfavorable to chest  movements, and is ac-
 companied  by other imperfections of build,
 which  indicate weakness   of   constitution.
 The shape of the chest is mainly of impor-
 tance as indicating a tendency  to consump-
 tion, which is very'unfavorable to the subject
 of lung disease.
  PIGMENT is the coloring matter which
 is found in  the  blood, bile, urine, and  in
 nearly all the fluids of the body  ; it gives the
 color to the skin,  and is, of course, most
 abundant in the  negro, being  deposited   in
 the rcte mucosum  of the skin ; it  is due to the
 action of sunlight upon pigment that people
 are liable to become tanned.  It is present  in
 excess  in cases  of Addison's  disease, and
 sometimes in pregnant women.   It is  in ex-
 cess, also, in cases of melanotic degeneration.
 (See Degeneration.) It is  more abundant
 in old age than in youth or childhood, and it
 gives the iron-gray color to the lungs in ad-
 vanced age.
  FILES.  (See  Hemorrhoids.)
  PIMENTO is the unripe  fruit of  the
 Eugenia Pimento or Allspice tree.which grows
 in the West  Indies.   An  oil is distilled from
 the fruit in  England.   The pimento is  a
 small, round berry, brown  and rough on the
 surface, having the  remains of the calyx man-
 ifest on  it.   The oil  is  yellow,  and heavier
 than water.  Like the  oil of cloves, it appears
 to consist of two ingredients, similar in com-
 position.   The  odor is aromatic,  and  the
 taste is hot and pleasant.   It is  mainly used
 as a flavoring ingredient in cooking, but the
 oil may be  added to  purgatives to  prevent
griping.   The  only officinal preparation  is
pimento water, mainly used as a vehicle.
  PINS AND NEEDLES is  a  popular
phrase applied to that peculiar numbness and
pricking of the arm, hand, foot, or leg, which
is so commonly felt after pressure or a long-
continued constrained attitude.   It is caused
by some interruption  to the circulation, and
is generally  removed by rubbing or exercise.
 If it  should  continue, it  may  be  the pre-
cursor of some serious  attack,   and  medical
advice should be  sought.
  PITCH, or as the officinal variety is more
strictly termed, Burgundy  Pitch, is  the resi-
nous exudation from the spruce fir,  imported
from Switzerland.  It is hard and brittle, yet
gradually takes the form  of  the  containing
vessel.  Generally it  is of a  dull, reddish-
brown, of a peculiar odor and taste. It is not
bitter.   It consists almost entirely of a resin,
but a little volatile oil is also contained in  it.
This gives it its perfume. The resin  is similar
to that obtained from other plants of the tur-
pentine group.  The only preparation  is  the
well-known pitch plaster,  which is  intended
as a slight stimulant to the .skin.  The pitch
plasters ordinarily sold often contain no pitch
whatever.
  PITYRIASIS is a trifling redness of limit-
ed portions of the skin, with a scaly or brawny
condition of the cuticle covering the part.   It
is most common  on the head, and  is known
to nurses as  scurf and dandruff.  The head
itches,  and directly it is rubbed quantities  cf
little scales,  formed  of epithelium, are de-
tached. A similar affection is sometimes found
at the  bends of the joints and on  the  trunk.
When  it occurs in a severe form the hair grows
thin and  comes  out  in considerable  quan-
tity, but not sufficiently to cause baldness.  A
solution of borax and mild astringent oint-
ments  are often  found enough  to  cure  this
condition ; hard friction to the  skin must be
avoided.  It  must not be confounded with
pityriasis versicolor or chiasm a, which is a par-
asitic disease.  (See Epiphyta.)
  PLACENTA is a flat, rounded body which
is formed in the womb during pregnancy  and
which  serves to connect the circulation of the
mother and child, and so enable the latter to
carry on the  function of nutrition and  respi-
ration  until birth.  This structure comes away
a few  minutes after delivery, and it is com-
monly  known  as the  after-birth.   The  pla-
centa  is  often  diseased  in cases of  abortion
and  premature birth.
  PLAGUE is  a  form of low fever associ-
ated with swellings of the glands, carbuncles,
and  petechia:,  or  hemorrhage  in  the sub-
stance  of the skin.  It  has been known  for
many  years  under dfferent  names, as the
black death, Levant plague, pestilential fever,
and glandular pestilence.
  History.—Before the end of the seventeenth
century this disorder seems to have prevailed
in many countries of Europe, and to have
been endemic, occasionally bursting out over
a  wider area.   In London,  for the  first
seventy years  of the  century, not a year
passed by  without a few  deaths being  re-
corded as due to this disease, while it appeared
in an epidemic form in  1603, 1625,  1636, and
1665.  The last epidemic  was so  terrible in
its consequence as  to be known as the Great
Plague, but it was followed by a marked de-
cline, and the deaths afterward became fewer
and fewer, and after 1679 none have been re-
corded in the  metropolis.  During  the eigh- 
PLAGUE
PLAGUE            373
teenth century, although there was a marked
diminution in the frequency and extent of the
epidemic, yet there were several outburts in
Europe.  In Poland and in some parts of the
Baltic, in 1710 ; in Provence, Marseilles, and
other parts of  Southern France, in 1720-71 ;
at Rochefort in  1741,  in  Sicily  in 1743, in
several districts of Portugal in 1757, in Wal-
lachia, Podolia, etc. in 1770, and  at Moscow
in 1771.   In the present century  the  disease
has chiefly broken out in  Egypt,  Syria, Asia
Minor, and  the  coast  of Barbary.  The
" Pali Plague" was first noticed in India, in
Cutch, in the summer of 1815, after a period
of great scarcity  and distress.   From that
time until 1826, it prevailed in different places
in Guzerat, spreading  to  Scinde  in a north-
westerly direction, and also toward Ahmeda-
bad  and other places in the  British  posses-
sions eastward.  After the beginning of 1821,
there was no recurrence of  the  fever until
1836, when it was observed in the town of
Pali,  then the  principal depot of traffic  be-
tween the coast and the north-west provinces
of India.  It spread to numerous places in
Marwar  in that year and in 1837 and for  the
first half of 1838.   In 1849 there was a similar
fever in Grumah and Kumaon, on the south-
ern slopes of the Himalayas, and in  1853 in
Rohilcund.
  Causes.—Certain conditions have  always
been  found to favor  the development  and
spread  of this  disease :  Residence upon
marshy alluvial soils  along the  Mediterra-
nean,  or  near  certain rivers, as  the Nile,
Euphrates, and Danube ; low, over-crowded,
or badly-ventilated dwellings ; a warm, moist
atmosphere ;  decomposing animal and vege-
table  matter ;  insufficient  and unwholesome
food,  and physical and moral wretchedness.
Those who have lived in an elevated situation
have escaped the disease when it has appeared
in the district.  The  plague, like typhus,  has
often followed in the wake  of  famine  and
other  calamities.  In  the  neighborhood of
Bengazi, on the African coast, between Alex-
andria and Tripoli, an outbreak  occurred in
1858-; but  for two or  three years previously
there had been an unusual drought, and  the
cattle had perished in  an unusual degree.   In
1857,  the destitution of the Bedouin tribes be-
came extreme, and then the pestilence com-
menced.   The  plague  has  generally been
preceded by a great prevalence of the ordi-
nary  fevers,   bowel complaints,  pulmonary
affection, and catarrh.  In the spring of 1605,
catarrhs and lung affections were very com-
mon  in  London, and  in  the middle of  the
summer  the plague appeared,  In the third
week  of  September, 1665, no less than 8000
deaths occurred in the  course of the week,
although two thirds of the inhabitants  had
fled by that time from the city. The influence
of season on the  plague  seems to be very
marked.    In  England  the  pestilence  was
most severe, in the four epidemic years above
mentioned, from the middle of  July to the
first or second week in October.  The plague
at Marseilles was most fatal in  the autumn
months, and this was the case  at Moscow in
1771, when more than 1200 deaths took place
for several days  out of a population of 150,-
000.   Cold weather seems to put a stop to
the progress of this epidemic disorder.   The
terrible mortality that ensues from this pesti-
lence renders it very important that quaran-
tine should be strictly enforced,  and that the
most  stringent   rules should  be made and
carried out for the  protection of  other coun-
tries from its introduction by shipping and
other channels of intercourse.
  Symptoms.—This disease seems to vary
in its  character  somewhat in each epidemic,
and even in the same outbreak, but the older
records are not sufficiently clear as to be thor-
oughly trustworthy, and  the  absence  of it
from  England  for  so many years has pre-
vented medical  men in modern times from
observing its  course.   Swelling of glands
comes on  in the groin,  arm-pits, and  neck.
The carbuncles are generally on  the upper or
lower  limbs ; less  frequently  on the chest,
back,or cheek. They mav vary in number from
one or two up to a dozen  ; they  vary also in
size and in their tendency to become gangre-
nous.  The petechiae are small hemorrhages
into the skin, and may be found  scattered all
over the  body.   The fever symptoms are
chiefly those of  shivering, nausea, vomiting,
lassitude, headache, and giddiness ; the coun-
tenance is heavy  and stupid, and the  eyes
suffused and watery.   There is  then heat of
the skin,  great  thirst, frequent  vomiting,  a
coated  tongue,  fetid breath,  a  weak pulse,
and great  prostration.   In some there  is ex-
citement and delirium,  in others  heaviness
and  stupor..  The bowels are generally re-
laxed,  and  the  stools  dark  and  offensive.
The  urine is passed in  less  quantity  than
usual,  and may even be bloody.  Bleeding
may also  occur from  the mouth, stomach,
bowels, and air passages. In some the in-
tellect is clear to the end, and  in other cases
convulsions and coma may come on.
  Treatment.—Not much can  be done when
an outbreak occurs with respect to giving any
medicine wih a beneficial effect. But much
may be done by  avoiding  any over-active
measures, and allowing the patient a pure air
arid  an  equable   temperature.    Bleeding,
active purgation,  and the use  of  mercury
must be carefully avoided. The  diet must be
light  and nourishing,  and   the  patient's
strength supported as far as possible.  The
treatment, in fact, is the  same  as that pre-
scribed for  typhus.   (See Typhus Fever.)
The great  object, however, should, be to carry
out such sanitary measures as may prevent,
and to avoid those unhealthy districts which
favor,  an  outbreak. By these means it seems 
374
PLASTERS
PLEURISY
probable that the  plague will never visit our
shores.
  PLASTERS are of many kinds.  We have
a recognized formula for at least a dozen  dif-
ferent sorts.   They consist of  an  adhesive
mixture spread when warm on leather, linen
or  paper according to requirements.   The
common plaster known as diachylon is made
from litharge or  oxide of lead.  The objects
for which plasters  are  used are to promote
absorption, to support  a part,  or to keep the
two edges  of  a wound together.  (See Dia-
chylon.)  A plaster of resin is  called adhe-
sive plaster, and  another with soap is called
soap plaster.
  PLASTER  OF PARIS is  sulphate  of
lime, known as gypsum, and is found in large
quantities in the neighborhood of Paris. It is
used when mixed with water,  after being re-
duced to a powder by that, for making casts of
any object, and it is a most useful material in
the hands of the anatomist, to  retain casts of
interesting anatomical or surgical  cases for
reference and for study. It has been also rec-
ommended  for  the purpose of  acting as
a splint for fractures.
  PLASMA is the name given  to the color-
less fluid of the blood in which the corpuscles
are suspended.  (See Blood.)
  PLETHORA  is a fulness of blood, which
may arise from many  causes—excess in  the
amount or quality of food and drink partaken
of.   Persons most subject  to plethora  are
those of a corpulent and florid nature,  and
such as are inactive and not willing to take
out door exercise.  Judicious diet, abstinence
from malt liquors, wine, and  spirits, except
under certain restrictions, sponge baths  and
friction of the skin, and daily exercise,  are
the best remedies.
  PLEURA  is  a  serous  membrane  which
covers each lung, and  also lines the  inside
of the chest or thorax.  It is  a  thin fibrous
tissue, covered with a  very smooth layer of
epithelium which in health  secretes a small
quantity of serous fluid, and  by moistening
the opposed surfa:es, causes the lungs to ex-
pand and glide over the chest-wall  with the
least amount  of  friction.   Sometimes  this
membrane is inflamed,  and the patient is then
said to have pleurisy ; or there is an  accumu-
lation of serous fluid in the pleura, as in some
cases of dropsy, from disease of the heart, or
kidneys, causing  hydrothorax ; in these cases
the lung is compressed from the presence of
the fluid in the pleural  bag or cavity.   When
blood is effused  into the pleura, it is called
hemothorax, and this is a very fatal disease ;
it may be caused by a large vessel in the chest
giving way and  rupturing, or by a stab or
wound from the  outside through the chest-
wall.  Air is found in  the pleura in  cases of
pneumothorax, and this condition,  although
of rare occurrence, may come on in the course
of consumption, when a cavity in the lung be-
comes ruptured. Empyema is the name given
to the disease  in which pus is found in the
pleural cavity.
  PLEURISY is an  inflammation  of  the
pleura or serous  membrane, which  covers
the lungs and  lines the greater  part of the
cavity of the chest.  In  health this membrane
is quite  smooth, and  lubricated  by  a small
quantity  of fluid, so that the lungs can move
upon it with the least possible amount of fric-
tion.  When this membrane is inflamed, how-
ever,  it  becomes  roughened, and in most
cases  a large  quantity of fluid is secreted, in
consequence of which the lung on that side is
compressed against  the spine, and there is
much distress in breathing, as the patient has
only one  lung available for the purpose of res-
piration.   In those cases in  which both sides
are affected with pleurisy it follows that there
is imminent danger of suffocation,  as  the
lungs are unable to aerate the blood properly,
and so, unless relief  be afforded, or  the in-
flammation  subside quickly, death  is very
likely to ensue ;  but,  fortunately,  double
pleurisy is of very rare occurrence.
  Causes.—Exposure to wet and cold is the
most  common  cause ; but it may come on
after an accident in which the ribs are broken,
or in  cases of  stabbing in the chest or from
a gun-shot  wound,  and other external inju-
ries. In nearly  all cases of pneumonia, or in-
flammation of the lung itself, there is more
or less pleurisy ; but then very little  fluid is
effused.   If the patient be in bad  health  pre-
viously,  the  effused fluid is apt  to be puru-
lent, and then  the  case is called  empyema.
(See Empyema.)  This  is not uncommon in
children  after  scarlet fever.  In cases of
pyaemia,  pericarditis,  phthisis,  and many
blood diseases, pleurisy is  apt to supervene
and to add to the danger.
  Symptoms.—The patient first complains
of a severe catching pain in  the affected side,
and this  is made worse on taking a deep in-
spiration, or  on coughing ;  the pain  is  usu-
ally confined to  one spot, and on listening
there  one may hear a rubbing sound, due to
the roughened  surfaces moving on each other.
There is  also a feeling of weakness and lassi-
tude,  the pulse  quickens, the tongue is coated
white ;  there may  be headache,  thirst,  and
loss of appetite ; the temperature  is raised,
and the usual febrile symptoms appear.  In
a day or two the breathing becomes worse,
because effusion of fluid is now going  on ; the
sufferer keeps to his bed, and lies on his back
in a diagonal position, so as to enable the heal-
thy lung to expand, while the affected is too
sore to rest on.  These symptoms go on for
several days without much change being ob-
servable ; but they vary in  intensity  accord-
ing to the  amount of  the effusion ;  in some
very  bad cases there is  much  distress  and
anxiety of countenance, the  respirations are
quick and shallow, the face pale, while the lips 
PLEURISY
PLEURODYNIA        3^5
 are livid ;  any exertion, as moving in bed or
 talking, increases  the  discomfort.   In less
 severe cases the distress lessens as the fever
 abates, and the breathing becomes more reg-
 ular.  Then comes the time when the fluid
 begins  to  be absorbed, and when the  lung
 commences to expand again ; but this takes
 up a very variable time, so that  no rule can
 be laid down as to the duration of a pleurisy,
 some  being of a very  slight nature,  while
 others  may take weeks or even months, be-
 fore they are really cured ; but  long before
 this the severe symptoms have  abated, and
 the chief trouble is shortness of breath on any
 exertion being made.  In most cases the pa-
 tient is liable  to pain in the chest afterward,
 and to a recurrence of pleurisy on being over-
 heated, or on exposure to cold  and  wet.  If
 the inflammation  be  due to cancer of the
 pleura, or to an aneurism  of the aorta, or to
 phthisis, the symptoms special  to those dis-
 eases will also be present, and tend to aggra-
 vate the complaint and increase  the  danger.
 There  are, doubtless, many cases  in which
 people  have  dry pleurisy or  inflammation
 without effusion, and in these the chief symp-
 tom will  be pain in the side.   But it must
 not be imagined that  pain  in the side always
 means  pleurisy, as it  may arise  from many
 causes—as shingles, muscular exertion, indi-
 gestion, etc.  (See Pleurodynia.)
   Treatment.—The patient must at once be
 placed  in bed in  an  atmosphere of about
 60° to 65° F., and the air should  be tolerably
 moist.  This can be effected by boiling some
 water in a kettle on the fire, and letting the
 steam occasionally escape into the room.  The
 great thing  is to avoid any great variations
 of  temperature, and especially any chills to
 the surface of the body.  Nor should the pa-
 tient be moved about  from one room to
 another, if such movement cause any distress,
 nor should he be allowed to talk more than
 he  can help.  Three or four leeches applied to
 the spot where the pain is greatest will give
 much relief, and then when the bites have
 finished bleeding,  a large hot linseed-meal
 poultice should be applied to the chest ; but
 care must be taken that the bleeding does not
 recommence on  applying the heat, as too
 much blood may in that way be  drawn, and
 tend to exhaust the patient and make  him
 feel faint.  Cotton-wool may also be  applied
 for a similar  purpose.   It is best to lie on a
 mattress rather than on a feather bed ; as the
 body is then kept cooler, and it is easier to
 get at the patient.  Light food must be given,
 and milk is generally borne the easiest in the
 early or febrile stage of  the complaint ; a
 light pudding,  eggs, beef-tea,   broth, jelly,
 and fish may be given  when the  appetite re-
 turns, and the tongue begins to clean.  Stim-
ulants should be given in much  moderation,
as in the majority of cases they are not much
 needed, and if given in excess,  tend to op-
press the patient and hurry the  breathing.
Restlessness at night is a common symptom,
but this  must be borne as well as possible,
for any anodyne, etc., only tends to increase
the difficulty of breathing, and adds to the dis-
tress.  Blisters should not be applied in the
early stage when there is any fever, but they
must be used later on, so as to hurry the ab-
sorption  of the  fluid ; or  tincture of  iodine
may be painted over the affected side for the
same purpose.   In  cases of double pleurisy,
it  may be  required to tap the  chest and let
the fluid out, and in  some cases bleeding from
the arm  may then be attended  with benefit.
During recovery patients  should be careful
about not going out  too soon, and the more
especially if the weather  is  cold, foggy, or
wet.  They should sit up at first in the after-
noon, and  may  go  from one warm room to
another ; but  they  should not  exert  them-
selves too  much if  the breathing becomes
hurried in  doing so.   Tonics may then be
given to improve the general health, and the
patient may return to  his ordinary diet.  All
cases should be careful  for  some weeks to
avoid exposure to bad weather, should not go
out after sunset if possible,  avoid  getting
over-heated,  and always  wear  flannel next
the skin.
  PLEURODYNIA signifies   pain in  the
sides.  It is a symptom produced  by several
conditions.  It may be caused  by an attack
of pleurisy or  inflammation of  the  lining
membrane  of the chest-wall ;  the pain is then
of a shooting character, increases on  taking
a deep inspiration, and accompanied by a
furred tongue, quick pulse, high temperature,
and the usual  symptoms of a febrile condi-
tion.   The application of four or six leeches,
followed  by hot fomentations, or hot linseed-
meal  poultices,  will relieve,  if  not remove,
the pain in  many  cases.  (See  Pleurisy.)
Pleurodynia is often met with in women who
suffer from over-lactatioH or  leucorrhcea, or
who have borne children fast, or  who, from
any cause,  are in a nervous and  debilitated
condition ;  such women  generally have the
pain on the left side, or under the left breast;
they often  have a headache,  pain on  press-
ing on each side of  the spine, pain across the
loins, and sometimes a choking feeling in the
throat ; they feel weak and nervous and low-
spirited.  This pain is not inflammatory in
its  origin,  and  seems to   depend upon  an
altered nutrition of  the nervous centres ; its
treatment will  consist in  rest, fresh air, re-
moval of any mental  worry,  good and light
diet and tonic  or strengthening medicines ;
often a pill of asafoetida, taken  three or four
times a day, will relieve the distressing nerv-
ous symptoms.  Pleurodynia may come on
when shingles or herpes are present.   In this
disease the  pain  generally precedes the vesic-
ular rash;  and may be persistent for some
time after  its disappearance.   The internal 
376       PLEUROSTHOTONOS
PNEUMOTHORAX
 administration of quinine will do good, while
 locally  an anodyne  liniment may be rubbed
 in night and morning.   Pain in the side is
 also an accompaniment of a fractured rib or
 a blow  on the side.  A wide  flannel  bandage
 or  strips  of plaster passed  half-way round
 the chest, so as to prevent the  affected side
 from moving more  than possible,  will give
 relief.  Pleurodynia is  a  symptom  also in
 those who  have a  troublesome cough, and
 their distress is increased  by the pain which
 each paroxysm of coughing brings on.  The
 pain seems due to the intercostal muscles be-
 coming tired with their undue exertions.  It
 is similar to the stiffness  which one feels after
 a ride on  horseback when not accustomed to
 the  exercise.   The  treatment  must consist
 in relieving the cough, and applying a flat,
 wide flannel belt or bandage round the chest,
 which will support the chest-wall, and give
 great comfort to the patient.    Sometimes
 pleurodynia is caused  by a neuralgia of the
 intercostal nerves, and  is worse  at certain
 points when touched.  The  hypodermic in-
 jection of morphia will give relief, or the side
 many be  rubbed with a liniment containing
 opium.   Lastly, pleurodynia may  be caused
 in some  cases of disease  of the  heart and
 stomach.  When  the  heart is  affected, the
 treatment will consist in  rest, in quieting the
 heart's  action, and in applying  a belladonna
 plaster  to the side over  the seat of pain.  If
 the stomach  is the seat of disease, the case
 has  generally to be treated  as  one  arising
 from indigestion.  Whenever the pain is in-
 flammatory,  leeches, mustard poultices, hot
 fomentations, turpentine, stupes,  and other
 counter-irritants are  useful ;  when it is non-
 inflammatory, and depends upon an  anaemic
 and weakened  state  of  the   constitution,
 tonics,  and especially quinine,  are  useful.
 (See Pain.)
  PLEUROSTHOTONOS  is  a term ap-
 plied to the  lateral  convulsions sometimes
 seen in cases  of  tetanus,  when the patient
 throws himself from  side to side.
  PLUMBER'S  GOUT is so called because
 men working with lead in any shape are more
 liable to attacks of gout  than those  in other
occupations ; it is not a separate disease from
gout, but it  signifies the  mode  in which the
disease  has its origin.  (See also Lead-Poi-
 soning.)
  PLUMBISM is a condition in which the
 individual having been exposed to the action
of lead has brought his system under the in-
fluence  of that poison ;  plumbers are more
liable to gout than painters ; the  latter  are
more liable to colic.  (See Lead-Poisoning.)
  PLUMMER'S PILL.  (See Mercury.}
  PNEUMONIA, or INFLAMMATION
OF  THE LUNGS, may come  on of itself,
or it may  follow in the course of some other
disease, and  the symptoms may then differ
somewhat.  Pneumonia  is often  associated
with many  of the fevers as typhus, typhoid,
and measles, also with pyaemia and some
other bipod disorders, and in these  cases  it
adds to the gravity of the complaint ;  but the
main  symptoms of pneumonia are then either
masked or modified by the associated disease
under which the patient is suffering.   Simple
uncomplicated  pneumonia of one lung,  or
part of a lung, is not a formidable affection,
and about nine-tenths  recover  with  proper
treatment.
  Symptoms.—The first symptoms  that ap-
pear are shivering or severe headache, pain
on one  side of  the chest, furred tongue, and
a high temperature ; in the course of a day or
two the skin  will be hot and burning, the lips
dry, the tongue  covered with a white, moist
fur ; the patient breathes quickly, and is glad
to be  quiet in bed, and not be  disturbed by
talking ; he feels a sense of  pain  and tight-
ness on the affected side of the chest ; he has
a troublesome cough, and  spits up  frothy,
viscid phlegm, tinged with  blood ; the urine
is high-colored  and  diminished in quantity.
In children  the  wings  of the nostril  are di-
lated  at each inspiration, and  they  breathe
very rapidly.  In four or five days the symp-
toms are at about their height ; on the sev-
enth or eighth day, in most cases of recovery
the temperature  falls  rather   rapidly, the
febrile symptoms abate, and the patient feels
much better ; his tongue cleans,  the appetite
returns, and the breathing  is  easier.  For
some time, however, he feels short of breath,
and some  weeks may elapse  before the lung
clears up  and  becomes sound  again.  In
some severe cases, such a favorable termina-
tion must  not be looked for ; the inflamma-
tion may spread to the other lung, and cause
great  distress of  breathing, and  bring on  a
livid condition  of the  lips ; there may be
much  delirium, and  more  so in  those of in-
temperate habits, and at times the inflamma-
tion does not clear up, but passes into one cf
the forms  of consumption.
  Treatment.—The  patient must at  once be
put to bed in a room with a temperature of
from 6o° to  65°  F., and  the  air should not
be too dry. Hot linseed-meal poultices or hot
stupes must be  applied to  the chest, and
changed when they become cool.  If there is
much  pain, a few leeches to the side will give
relief.  For these cases the same rules as to
diet, medicines, and  precautions during con-
valescence may be laid down as are described
in the article on Pleurisy.   In  very severe
cases  the treatment must vary with the special
requirements of the case.
  PNEUMOTHORAX is  a condition  in
which there is air in  the cavity of the pleura.
In consequence of this the lung collapses, and
the patient is unable to use  the lung on the
affected side.  The  most common cause of
pneumothorax is when a cavity in the lung in
a case of consumption bursts into the pleura ; 
PODOPHYLLIN
POISONING           377
 less frequently, an abscess of the lung may
 bring on a similar result.  In addition to the
 symptoms of the disease under which the pa-
 tient 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 col-
 lapse of the vital powers.  In most cases such
 an accident puts an end to the life of the suf-
 ferer.  Pneumothorax  may also be produced
 by external  conditions, as when  a man is
 stabbed between the ribs, or when the chest
 is perforated by a pistol-shot,  etc.  In both
 cases air enters the cavity, the lung collapses,
 and the  patient  breathes with the greatest
 difficulty.  Such cases  are of  a very serious
 nature,  and generally  prove  fatal in  the
 course of a day or two. Very little can be done,
 except keeping  the patient quite quiet in bed,
 and covering over the wound.   In such cases
 surgical aid must at once  be  sought.  (See
 Lungs, Wounds of.)
   PODOPHYLLIN   is  the  dried  under- j
 ground stem of  the Podophyllum peltatum, the i
 American  May apple,  also known as Man- i
 drake.   From  it  is  extracted a resin much
 more extensively used than the native  plant.
 This resin, known as podophylline resin, or
 better as podophyllin,  has also been called
 vegetable mercury, from its influence on the
 liver.   Its powder is grayish-yellow, with a
 sweet odor, and a taste  first sweet, then bit-
 ter.  From the powder  of the root podophyl-
 lin is obtained by exhaustion by means of al-
 cohol.  This strong  tincture is then distilled
 so as to recover the spirit, and the remaining
 fluid added to water containing hydrochloric
 acid.   This effectually throws down  all the
 resin,  which is then collected,  washed, and
 dried.  Besides this  resin, the root contains
 a substance  called Berberin.   The resin is
 used as a powerful purgative, resembling the
 resins of jalap  and scammony.    It seems,
 however, to act  more on the liver  than these
 do  ; at  all events, it usually empties the gall
 bladder, and so makes a show  of acting  on
 the secretions  of the  liver.   It  commonly
 gives rise  to griping, and  for  this reason is
 seldom  used  alone, being commonly  com-
 bined with  other purgatives,  or  such sub-
 tances as belladonna.   It  is best,  however,
 to give  a small  quantity of  this remedy, say
 the eighth of a grain, along with another, say
 the compound extract of colocynth, so as to
 increase the  efficiency  of the former, or to
 continue its action over a longer period, for
 podophyllin is  always long in acting.  It is,
 too, by  itself,  very  uncertain ;  at one time
causing hardly any motion of  the  bowels, at
another an excessive flow.   It is a bad rem-
edy to take habitually, as it very soon seems
to lose  its  influence.  It is commonly used
when it is desired to empty the bowels thor-
oughly,  and so relieve the portal system, and
to empty the gall bladder.   It may be given
along with bitartrate of  potass in dropsy ; a
useful adjunct is an alkali of some kind, such
as Rochelle salts.
  POISONING might be defined as  the un-
toward results of any substance given inter-
nally, or absorbed from the external surface.
More briefly still,  it might be defined as the
evil effect resulting from the  administration
of a poison ; but this necessitates a definition
of the word poison  which it is hard to give.
Almost any substance we can  mention,  if
given in too great  quantity, or if  the  quality
has deteriorated by keeping,  may produce
poisonous effects ; and as these are usually
unmistakable enough,  it  may be best  to con-.
fine our attention  to these.   It is,  however,
generally agreed to limit the  term poison to
such substances as give rise to symptoms of
illness by virtue of their own inherent proper-
ties, and not to qualities merely superadded
for the time being.   Thus, boiling water,  if
swallowed,  would  be  quite  as fatal  as any
poson could be; but this being  no inherent
quality in the water,  but simply dependent
on the heat added  to it, we could not speak of
the evil results as poisoning.  Usually, too,
it is customary to limit the idea of a poison to
such  substances as  give rise to  injurious
effects when taken in small doses ; but there
are substances which, given in considerable
quantity,  are exceedingly fatal, while given
in small quantity they produce no symptoms
of importance.
  The symptoms,  then,  which  constitute
those of poisoning, i.e., the product of a sub-
stance which we agree to call  poisonous, vary
greatly in  kind and character.   Some sub-
stances act almost entirely on the parts with
which they are brought in contact, and the
symptoms which arise from  such we  desig-
nate local; but others have little or no influ-
ence on the  part to which they are applied ;
they only act when they have passed into the
blood, and reached some remote organ, usu-
ally  the  brain.  Such action would  be de-
scribed as remote.
  The local effects  of poisons of  course vary
exceedingly ; some, like strong sulphuric acid
and caustic potass, act on the internal organs
as they would on the external—they burn or
corrode them, and thus  cause their destruc-
tion or death.  But  there are weaker  sub-
stances, chemically speaking, which yet cause
death, though not  exactly in  the  same way.
Thus arsenic, when introduced into the stom-
ach,' sets up much  inflammation, and  the re-
sult of this inflammation  may be death of the
part  and of the individual.  In both cases,
death is due to  injury to the stomach, but in
the case  of  the corrosive substance,  this  is
from chemical action ;  in that of the irritant,
like arsenic, it is due to the inflammation set
up from irritation  by the substance.   There
are, however, certain local effects of a totally
different  kind.   Thus aconite  produces  a 
378          POISONING
POISONING
numbness  and tingling  in the  parts  with
which it  is brought in contact, while opium
undoubtedly allays  pain  and irritation when
it is applied.
  The remote  effects of  poisons  also  differ
among  themselves.   Thus, the  effect pro-
duced by an  injury to such an organ as the
stomach  is  similar to the shock produced  by
a railway injury  to a  limb, and sometimes
kills in  exactly the same way ;  but  in the
case of arsenic there is something more, for
not only does  arsenic set up inflammation of
the stomach—vomiting, purging, and the like
—it is capable of  acting through the nervous
system so as to produce convulsions or para-
lysis.   Here, it might  be said, that we  have
three different kinds of effects—first, the in-
flammation of the stomach and bowels, giv-
ing rise  to  symptoms similar to what might
be produced in many  other ways ; then the
constitutional  depression produced by these
—the  quick pulse, symptoms of  fever,  etc.  ;
and finally, the  peculiar nervous effects  al-
ready alluded to.   It was for along time dis-
puted whether  a poison  acted  on remote
parts by  means of the nerves or  by means of
the blood,  and many experiments were per-
formed  to  settle  the question.   This was at
length fairly done, and now we hold that for
a poison to exert  its dangerous effects upon
a remote part, it  must  be absorbed and car-
ried thither.   It  is  quite true  that a  poison
may kill  without this, as in the case of strong
sulphuric acid, where  the injury  done to the
stomach  causes death ; but to  enable opium,
say, to  produce  more than  a merely  local
effect, it  must pass  into the blood and reach
the brain through that medium.  The  view
that some  poisons  do act directly upon and
through  the nerves is  mainly borne  out  by
the rapidity  with which some  poisons, as
prussic acid, prove fatal.   This is so great as
almost to preclude the  possiblity of its reach-
ing the brain through the blood, but the rate
of circulation  is  great, and even in poison-
ing with prussic  acid, there is time for the
poison to reach the central nervous  system.
There are  many  things  which influence the
action of a poison, perhaps the most  impor-
tant being  the quantity  or dose ; for many
poisons   are   in  small  quantities valuable
remedies, though in larger they kill.   Habit,
too, has  a most important  influence.  Thus,
opium-eaters consume  with impunity quanti-
ties of the drug  which  would kill one not
habituated  to  its  use.  There  is, however, a
notion that certain  drugs prove  cumulative,
as it is  called—that is, when  given for any
length of time, they produce suddenly a poi-
sonous effect.  Digitalis  is said to act in this
way, but our experience  does  not incline us
to take that view.  As a rule, mineral sub-
stances cannot be taken in constantly-increas-
ing doses.   Lead, for  instance, being intro-
duced into the system, tends  to accumulate
there,  and ultimately  to give rise to symp-
toms of poisoning ; arsenic is eaten in quan-
tities  by the Styrian peasantry without evil
consequences ;  while  the stomach becomes
more and more  impatient of antimony as  it
is given, until  at  last, worn out by constant
sickness and vomiting, the patient succumbs.
  Symptoms.—To  the public, however, it  is
of  Iar more consequence to  be able to form
some  idea of  the symptoms  of  poisoning
than to  be acquainted with details of this
kind.   It may be surmised that an individual
is suffering from  the effects of  some poison-
ous substance  if,  shortly after food or drink,
he be  seized wth violent pain in the stomach,
with vomiting  and purging, especially if con-
vulsions or paralysis  is present,  or if the
individual suffer from  great giddiness or de-
lirium,  or  if there be  a great tendency to
sleep.  It is chiefly on a combination of  these
three that we must rely for a certain diagnosis,
and sometimes any diagnosis is impossible
during life, however strong suspicion may be.
Should suspicion  of poisoning enter  into the
mind   of  any  one, it would  be his  duty
promptly to arm himself with further aid and
support, by having recourse to the services
of  the best medical practitioner within reach,
and, if  necessary, to communicate his fears
or suspicious to the gentleman so called in.
This  is  of  the   utmost importance for the
safety of the patient, and, of course, secures
the individual from a charge of officiousness,
to say nothing worse. If any one is suspected,
his conduct is to be narrowly watched, for
that often  gives  the clue desired ; very few
guilty  people  are able to so dissemble as to
give rise to no suspicion—generally their part
is  overdone, whether  that be pretended in-
terest or callousness.   This, of course, refers
to  criminal  poisoning, for in  cases  of  acci-
dental poisoning, as  soon  as  suspicion  is
aroused, aid is most eagerly sought and in-
formation and  assistance eagerly proffered.
Accidental poisoning may occur at any  time,
so many poisonous substances being now
employed in arts and  manufactures, and  a
knowledge even of general principles may be
of  exceeding great value when  life and  death
are hanging in the balance.
  Treatment.—Taking it for granted  that
we have to do with a  case of poisoning, we
shall proceed to lay down certain rules which
apply, more or less, to  all  cases, and  which
may be called  into play by any one. Suppose
an individual  has  swallowed poison,  acci-
dentally or purposely,  and  it becomes neces-
sary for the bystanders to  interfere for his
safety, three things have to be done : ist.  To
get  rid of the poison-; 2d.   To  stop  its
effects; and, 3d.   To remedy the evil it has
done.   One or other must come  first,  but  it
does not greatly  matter which of the first two
really is first attended  to ;  the first always
comes best. When the question arises whether 
POISONING
POISONING          379
*  are we to get rid of  the  poison before stop-
   ping its  action  or  after, one  rule enforces
   itself, that  is to  save  time.  " Whatever is
   readiest is best," is  emphatically the  rule in
   dealing with poisoning.   Better  the poorest
   remedy given at  the moment, than the very
   best  given an  hour later.  A  considerable
   number of all  poisons are what might  be
   styled  self-evacuating ;  having been  taken,
   they set  up vomiting  and purging, and are
   thereby eliminated.  In  such cases, all that
   is  necessary to  be  done  is to aid the self-
   evacuating process,  especially  to aid  the
   vomiting, and so perhaps get rid of the poison
   altogether.   Ordinarily, two kinds of  means
   are employed to get rid of the poisonous sub-
   stance  in  the stomach ;  these  are stomach-
   pump and  vomiting..  It  requires consider-
   able skill  to  use the stomach-pump, and usu-
   ally where one is to be obtained, there is also
   to  be obtained  the skilled aid necessary for
   its employment.  In passing the tube down
   into the stomach, the grand rule is to  use as
   little force as possible, and to make the point
   of the tube slide along the posterior wall  of
   the gullet.  Occasionally, grievous accidents
   have arisen from unskilful use of this instru-
   ment ;  and so any one not acquainted with it
   and attempting  to use it, should  attend im-
   plicitly to this rule.  The great  advantage of
   the  stomach-pump is that it allows you  to
   wash the stomach out.  With a properly con-
   structed instrument, it is  possible to reverse
   the current, and so  to effectually  wash out
   the stomach.  There are, however, certain
   cases—as  where violent corrosives have been
   swallowed—where the  tissues  are so  much
   softened that an  attempt to pass  the stomach-
   pump would very likely end  in  driving it
   through the tissues, and so such attempts must
   be  strictly avoided.   The advantage of the
   stomach-pump is that it requires no action on
   the part of the stomach to empty that organ.
   In cases where the stomach is paralyzed, as
   it sometimes is in  opium poisoning, this is of
   very great importance.
    In  cases where, from whatever cause, the
  stomach-pump cannot be employed, we have
  left to us the self-evacuation known as  vomit-
  ing.  This sometimes is one of the results of
  the poison itself  ;. in others it must be excited.
  If, as most irritants do, the poison have given
  rise to vomiting, it may only be necessary to
  encourage it.  This is best done by tickling
  the fauces with  a feather, and by copious
  draughts of lukewarm water.   This process,
  though  exhausting, must  be continued until
  everything seems expelled from the stomach.
    Sometimes, however, there is no vomiting,
  and then something must be given to cause
  the stomach to get rid of its contents.   Here
  the same rule that the  readiest is  best pre-
  vails.  It is useless, or worse than useless, to
  wait till an emetic is brought from the  drug-
  gist's shop ;  if that be far away, the resources I
 of the  locality must suffice.   Three things
 may be made use of as emetics, which are to
 be  found almost everywhere.   These  are
 mustard,  salt, and smelling-salts, besides the
 stimulation of the fauces with the finger, and
 the use of lukewarm  water.   Smelling-salts
 are not suitable for all cases, but are good in
 a certain  number of cases of poisoning, espe-
 cially  by vegetable substances,  which  give
 rise to narcotic symptoms.  The dose of this
 is a teaspoonful given  in a  pint of lukewarm
 water, and followed up  by  copious draughts
 of the same.   Mustard is a better emetic, and
 is generally to be had ;  its  use is limited to
 those cases where there  is  no  violent irrita-
 ting effect produced by the poison.  Usually,
 it suits best where there is a  sedative effect
 produced  by the poison, and  the stomach
 requires a stimulant to call its action into full
 play.  The dose of mustard is  a tablespoon-
 ful mixed up with a pint of  lukewarm water,
 and followed by copious  draughts of the
 same.   Salt can  always be  had, and a hand-
 ful of this dissolved in water will usually suf-
 fice  to produce copious vomiting, and so the
 evacuation of the stomach contents.  Ipecac-
 uanha is a most useful emetic  in  cases where
 the stomach  has been already irritated, and
 it is desirable to effectually get rid of any irri-
 tant substance which may remain.  It is  best
given as ipecacuanha wine,  half an ounce for
a dose.
  Frequently, however,  the simple plan  of
getting  rid of the poison  will not  suffice.   Its
effects have  to be neutralized or remedied.
That  means, practically, that  some antidote
must  be  given.   Now,  no  one  antidote  is
suited to all emergencies—the  antidote must
be suited to the poison,  and accordingly we
must consider each poison  or  group of  poi-
sons separately  with this view.  The object
of most antidotes is  to render  the active
poison an inert substance, after which treat-
ment may be employed to  remedy  the mis-
 chief  already  done.  Most  antidotes, there-
 fore, are  chemical agents  which attack the
 poison, and render it insoluble, and so inert ;
 but some are of a kind whose virtues seem  to
be opposed to those of the poison—in short,
what used to be called a counter-poison.
  The ultimate end of all treatment is to keep
the patient alive ; much may therefore require
to be done to obviate the tendency  to death
which  we cannot here  recapitulate or even
include in the treatment of  poisoning, being
common rules in  the treatment of all diseases.
To allay sickness and vomiting, if excessive ;
to preserve strength ; to  procure rest in one
set of cases ;  to keep the patient  awake and
from yielding to the sedative influence of the
drug in another ;  in all, to carry him through
the period  of  danger, which varies in length
in the case of many poisons, but which may
be said to be  distinctly limited,  and to consti-
tute  one  of  the  elements of  safety  in all. 
380           POISONING
POISONING
Such are, generally speaking, the ends to be
kept in view in dealing with a case of poison-
ing.
  Kinds of Poisons.—The classification of
poisons  into certain groups has long been
of the crudest description, and is still exceed-
ingly imperfect. Long ago they were spoken
of as mineral, vegetable, and animal.   Even
now some adhere  to that grouping.   It is,
however, desirable to arrange them in some
fashion,  however imperfect, according to the
effects they produce,  and so the old crude
classification  into  irritants,  narcotics,  and
narcotico-irritants, is better than none.   We
have  incidenlally pointed out certain broad
distinctons which  enable us to give  some
better  idea  than  these, however.    Some
poisons  we pointed  out, like sulphuric acid,
when strong,  act  chemically by destroying
the vitality of the parts to which they are ap-
plied.  Such  we  may call  corrosives ; others
act as irritants,  especially to the stomach, and
may be called irritants ;  but of these irritants
there are at  least two  groups : those which
irritate  the stomach, but do not produce any
other symptom than would an  acute  inflam-
mation  of  that organ, however produced ;
others, like arsenic,  not  only give rise to in-
flammation  of  the stomach  and  its  conse-
quences, but  also  produce  certain specific
effects characteristic of  their action.  In the
case of arsenic  these are mainly nervous ; in
the case  of mercury, they  are  salivation or
sloughing about the mouth ; in the case of
antimony, intense  prostration   of  strength,
and so on.   These we may called specific irri-
tants.  After these come a great group which
affect the nervous  system in various ways,
some producing sleep,  others delirium, some
calming nervous action, some exciting it„ and
giving rise to convulsions.  All these had  bet-
ter be classed together, in the first  instance,
as neurotics—substances, that is, affecting the
nerves.   Each  of  these has its appropriate
symptoms, and often an appropriate antidote.
  The Corrosives are  poisons  which  act by
virtue of their chemical  properties.  They,
when swallowed,  destroy the  surface  and
sometimes the deeper parts of all the organs
with which they are brought in contact.   The
consequences of such injury, in short, are as
violent as may  follow destruction of a pair of
limbs.    They  speedily bring  about  death.
The  chief corrosives  are the three  strong
mineral acids,  sulphuric acid, nitric  acid,  and
hydrochloric acid.  The  three  chief alkalies
act in a somewhat similar fashion ;  these are
caustic  potass,  soda, and ammonia.  More-
over, these same substances, if diluted so as
not to give rise to softening and perforation
of the stomach, may yet be sufficiently power-
ful to give rise  to fatal inflammation.  These
poisons give rise to tolerably  characteristic
symptoms.  The symptoms  begin  immedi-
ately after swallowing ; the taste and leel are
 characteristic.   Whatever   they  touch is
 altered, and they commonly occasion a vom-
 iting of bloody matter.   The remedies to be
 applied differ in the case of the acids and al-
 kalies, the one being in point of fact a kind
 of antidote to the other.   The strong mineral
 acids  give  rise  to vomiting,  not  so often to
 purging, and  the lips and tongue are com-
 monly marked.  First of all they  are white
 with sulphuric and  hydrochloric  acid,  and
 afterward they  become black.   Nitric acid
 always gives rise to a yellow mark.
   The best  remedy for  these acids is some
 weak alkali, not caustic potass, or  soda, nor
 even  their carbonates,  but some such sub-
 stance as magnesia,  beaten up with water or
 milk,  and  given in  considerable  quantity.
 The carbonate of magnesia is not so good as
 the calcined magnesia for this purpose, as it
 sets free a large quantity of carbonic acid,
 which might prove troublesome by distending
 the stomach.
   The alkalies must be  dealt with in exactly
 the opposite fashion—they must  be neutral-
 ized by some weak acid : vinegar is perhaps
 the best thing to give, but any weak acid like
 acetic  acid, citric  acid,  or tartaric acid may
 be  given.  Oxalic acid  must not be given,
 being itself a  deadly poison.  For alkalies
 and acids, too, oils may  be given with advan-
 tage.   With neither acids nor alkalies must
 the stomach-pump be used.  The vomiting
 which  commonly  follows the exhibition of
 such substances should be fostered by diluent
 drinks, as linseed-tea, gruel, exceedingly  thin
 arrow-root, etc.
|   Sometimes these poisons attack the larynx
 where it joins the gullet, and may even cause
 suffocation.   Should  such a fate impend, it
 is quite proper to  open the wind-pipe  by
 laryngotomy or tracheotomy. Finally, we must
 note that these substances frequently cause
 death long after they have been  swallowed.
 They  destroy the  tissues  with  which  they
 come  in contact ;  the consequence is that, if
 the patient recovers and these sores heal in
 the gullet,  the coats, as is usual,  contract.
 This goes on, the gullet becoming narrow and
 narrower, till at last the patient may perish
 of actual starvation.   This is a danger not to
 be overlooked, and so the medical attendant
 will do well in a case of this kind  to pass a
 probang from time to time, to make sure that
 the gullet is not contracting.
   Some vegetable acids must not be over-
 looked.  Chief  among  these is  oxalic acid,
 which  is one of our most deadly  poisons if
 given in quantity.   This acid  is  frequently
 used to remove iron stains from linen, etc.,
 or to clean brass vessels,  so that  accidents
 may result  from it  at any  time.   Vomiting
 commonly follows ; if not, a little warm water
 should  be  given ;  but  neither alkalies  nor
 the stomach-pump should be used.  The  best
 thing to give is lime—even common plaster 
POISONING
POISONING            381
knocked down from the wall  and ground up
with milk or water suffices.  For all the acids
hitherto mentioned whiting in water is a cap-
ital remedy—perhaps the best.
  Together, after  this, we may  group nearly
all vegetable irritants and a good many min-
ral ones, including the salts of zinc, tin, silver,
chrome, and iron.   These act  by giving rise
to vomiting  and purging, the common irri-
tant symptoms, and the best  way of dealing
with them is to promote  the vomiting in the
first instance, and afterward giving demulcent
dtinks or eggs beaten up with milk.   Some-
times a substance containing tannin, as oak
hark, catechu, kino, etc., had  better be pre-
scribed,  especially for  zinc and silver ; but
for the last  common  salt furnishes  the best
antidote.  As regards simple vegetable irri-
tants,  including gamboge, scammony, ela-
terium, croton-oil, castor-oil  seeds, euphor-
bium, etc., the grand rule is to  favor vomit-
ing till everything seems got rid of. and then
to treat the case like one  of inflammation of
the stomach and bowels.
  There are some peculiar  substances  to
which a word more is due.  Phosphorus, for
instance, seems a most extraordinary kind of
poison.  It gives rise to symptoms of a most
peculiar  kind,  especially  affecting  the liver.
For it,  unfortunately, there is no true anti-
dote ; the great thing is to get rid of the sub-
stance, and that is best done  by making use
of the stomach-pump ; chalk and water and
magnesia had  also  better  be given.  The
vomited  matters in this  form of poisoning
gleam in the dark.
  Arsenic gives rise, as  we  have seen,  to
mixed symptoms, some dependent on irrita-
tion of the stomach, some on  its peculiar in-
fluence  on  the nervous  system.   It is not
possible here to lay down the marks diagnos-
tic of arsenical  poisoning, but its treatment
consists  in  aiding the  escape of the poison
from  the stomach by  giving diluents and
favoring vomiting.   Raw eggs, beaten  up
with milk, are also useful.  Animal charcoal,
calcined magnesia, and a variety  of other
substances  have  also  been  recommended.
The best antidote of all is the  hydrated oxide
of iron.  This may be prepared by  taking a
druggist's stock bottle of tincture of the per-
chloride  of iron,  and adding to that liquor
potassae  or caustic  ammonia.   The  whole
should then be run through a tow filter (made
by  sticking a morsel of  tow  or hemp in a
funnel), and washing  the filtrate.  The solid
part is to be used.  The same may be given
for  poisoning by prussic acid.
  Antimony is peculiar, in  that it produces
extreme  depression.   The  best remedy for
poisoning by most antimonial  preparations is
some  substance  which  contains  tannin.
Black tea  does so to a  large  extent when
boiled ; in case of difficulty,  therefore, a few
ounces of tea should  be thrown into boiling
water, or better, a small  quantity  of  boiling
water added to it, the whole boiled for a few
minutes, strained,  reduced with cold water
till fit  to drink, and  swallowed.  Magnesia
should be also given, if chloride of antimony
has been the substance used.
  Mercury  is poisonous mainly in one form
—corrosive  sublimate.    This  gives rise  to
symptoms  a good deal resembling those of
ordinary corrosive poisoning  ; but speedily
the mouth  becomes affected,  and salivation
or even  sloughing follows.   For  corrosive
sublimate, albumen is the best antidote.  To
that end  white of egg should  be beaten up
with milk and freely administered.
  Lead differs from most substances of its
class, in that it gives rise to constipation rather
than purging.   This rule is not, however, by
any means absolute.   Should  the bowels be
confined, castor-oil must  be given ;  but acute
poisoning from lead is, comparatively speak-
ing, rare—chronic poisoning is that which we
most   frequently  encounter.    (See   Lead
Poisoning.)
  Of the poisons called  neurotic, opium oc-
cupies the  chief place.   The symptoms  it
gives rise to are totally different from those
alluded to  in  the foregoing section.   Soon
after it is  swallowed  the  patient  becomes
drowsy, and gradually deep sleep creeps  on,
till he  can  hardly be aroused ; if not  roused
in time, he sleeps  the  sle,ep of  death.  It  is
in such  cases that the use  of the  stomach-
pump and emetics is most beneficial.   With-
out them the patient would  almost certainly
sink ; but when the poison is removed from
the stomach, provided  the individual  can be
kept alive  for  a few hours, he will recover
perfectly.  If  any emetic is given, it  should
be mustard or sulphate of zinc.  The  patient
must be kept moving about, for if he  sleeps,
he dies.  Strong coffee and  the galvanic bat-
tery are also useful adjuncts.
  The treatment of opium poisoning is also
the treatment of the great class of substances
which it represents, but some  of  these admit
of special treatment; and even opium poison-
ing itself may sometimes be managed by the
use of a  special  remedy—belladonna.  In
almost every  instance neurotics have got  a
certain period within which they prove fatal ;
that  being  passed, the patient gradually re-
covers.  Now as regards  opium, this is  cer-
tainly  within  twenty-four hours ;  if,  there-
fore, the individual can be kept alive during
that time he is safe. Very often a full  dose  of
belladonna assists greatly in this.
  There is a group of poisons often held to be
allied to opium, but in reality widely differ-
ent ; in point  of fact, they produce delirium
rather than sleep, and have hence been called
deliriants.  These include hyoscyamus, bella-
donna, stramonium, and datura.   All of these
substances  are poisonous, though no death  is
recorded as the result of  hyoscyamus.  The 
3S2           POISONING
POLYPUS
treatment of these is in many respects similar
to that to be  adopted for opium.   Emetics
are to be promptly given ; if the substance
has been given for some  length of time, and
debility has set in, so that the stomach does
not  readily react, then the  stomach-pump
should be used.   The emetics, too, should be
stimulant, as sulphate of zinc or copper, mus-
tard or common  salt, never ipecacuanha or
tartar emetic.   Moreover,  it may be neces-
sary to give something to stop the action of
the poison ; some substance containing tan-
nin, as tea or coffee, is best ; not prepared as
for ordinary use,  but boiled as hard as may
be.
  In some respects the actions of aconite and
prussic acid are alike—both produce speedy
and  deadly results ; both  seem specially to
influence the heart.  The  treatment for aco-
nite is similar  in all respects to that just rec-
ommended for  belladonna  and its  allies,
but  that  for prussic  acid is different.   In
point of fact, prussic acid proves so speedily
fatal that there is seldom time to do more
than give  the patient some ammonia.   Were
there more time, and were any  hydrated per-
oxide of iron,  such as is used in  arsenical
poisoning, at hand, it ought to be given  ; but
such is  the deadly power  of  the poison  that
there is  seldom  time  to treat it ;  not  that
prussic acid is so speedily  fatal as is sup-
posed, for a man  has had time to  run up and
down two flights of stairs, and even then a
considerable time did elapse before death,after
a very large dose.  Cold effusion has  been
recommended, but we fear would be like most
other remedies for the poison—a remedy too
late to be  of any use.   Iron and a free  dose
of ammonia should be the remedies.
  There is another very fatal group of poisons,
of which nux vomica, with its alkaloid strych-
nine, is the type.  These  poisons give  rise
to violent convulsions, similar  to those pro-
duced  by tetanus ; hence  vve conclude that
this poison acts  mainly, if not entirely, on
the spinal cord.  Here, too, vve must try to
get rid of the poison as  speedily as possible
if that be in our power ; but if  the patient is
already fully under the influence of the drug,
any attempt to use the stomach-pump is sure
to bring on  a fit of spasms, which will alike
prevent its passage and exhaust the  patient.
An emetic might be used, or, at all events,
tried ;  but the  patient should be kept as quiet
as possible. There is no antidote.  Animal
charcoal may be used, so may tannin, and a
hundred other things ; but the only hope we
can have is in enabling the patient to weather
the storm by giving him, from time to time,
a whiff of chloroform and ether mixed, so
as to  allay the spasm, to prevent suffocation
in it and to avoid the danger of fatal collapse
from exhaustion in the interval.
  All these poisons are of a kind  with which
we have not much to do ;  but they introduce
us to a fresh group, from which not one of us
is safe some time or other.  Anesthetics and
noxious  gases,  at least  of  one kind,  are
closely allied.   The  anaesthetics  in common
use are chloroform and ether, or a mixture
of the two.  Now, no case whatever of anaes-
thesia from  these agents is absolutely without
risk, and so men ought to be chary of recom-
mending their use,  save  in  serious  cases.
When  it is merely  to  remove a tooth or to
cut  off a bit of skin it is iar better to suffer
the  pain  than  to risk the dangers of  anaes-
thesia.  Recently another anaesthetic, nitrous
oxide,  has  been  reintroduced.   This,  no
doubt,  is very useful for  short operations—
as removing teeth ;  but  it is unsuited  for
more prolonged  ones.  Anaesthesia depends
on  reducing the oxidation of the blood  to a
minimum, or, at all events that  enters  into
the  phenomena of its production,  and so it is
akin to poisoning with gases, like carbonic
acid.  Carbonic  oxide, which is the main ele-
ment in causing death from charcoal fumes, is
a different kind of agent.   Carbonic acid, in-
haled simply seems to prevent the entire evo-
lution of carbonic acid by the lungs ;  car-
bonic oxide, on the other hand, seizes upon
the  blood corpuscles or  coloring matter, fixes
them, and renders them unable to take up or
give off oxygen.   In all cases except  a few
where  the  heart is  paralyzed, as in some
chloroform cases, the danger  is an arrest of
the  respiratory process.  That may depend
on paralysis of the muscular power necessary
to effect the movements of the chest, and to
the  change of the air, or on some other cause.
Be  that as it  may, in  any  danger  from
anaesthesia,  we  have mainly  to  direct  our
attention to  this—to see that the air passages
are  clear, that the tongue  does not occlude
them,  and  to persist   in those  movements
which we know as artificial respiration  (see
Drowning).  Stimulants,  too,  should  be
used.  If  the  heart  has been brought to a
standstill, galvanism  may be used ; but the
grand remedy  is merely artificial  respiration,
which we must  endeavor  to  effect as  thor-
oughly as possible.
  Most of  the  poisons here  treated of  are
dealt with under separate headings, and fuller
instructions are there given as to how we can
obviate their tendency to produce death.
  POLYDIPSIA is a technical term for ex-
cessive thirst ; in some cases of  diabetes an
immense quantity of fluid is taken  in  the
course of twenty-four  hours.   This  symp-
tom, however, is occasionally observed in
other cases in  which there is no sugar in  the
urine.
  POLYPUS is  generally  a  pear-shaped
tumor, attached  by its  thin end  or stalk to
some mucous membrane.  Polypi  are covered
by  mucous  membrane, and  within have a
kind of semi-gelatinous contents.   They may
be detached by  pulling them down  with a 
POLYURIA
POTASS
383
 pair of forceps, and strangling the stem with
 a piece of wire.  They occur most frequently
 in the nose and in the womb, and  in both
 stiuations give rise to troublesome symptoms.
 Removal is the best kind of treatment when
 it is possible.   (See Nose.)
  POLYURIA is  a term to signify an exces-
 sive flow of urine.   (See Diabetes.)
  POMADES. (See Hair.)
  POMEGRANATE-ROOT BARK is  a
 remedy said to be of very great value against
 worms when  it can be obtained fresh.  The
 fruit of  the pomegranate  is  tolerably well
 known.   The rind of the  fruit was  at one
 time used as an astringent, and may yet be
 so  where no  better is  to be  had ; but as it
 owes its efficacy to the  tannin  which it con-
 tains,  we in this country prefer to  use that
 substance.  There  is  an officinal  decoction
 of  the bark of the root ; but it is rarely, if
 ever employed.  Indeed it is mainly of use
 medicinally, as already said, for its  astrin-
 gent properties.
  POMPHOLYX.  (See Pemphigus.)
  POPPY  CAPSULES are the capsules of
 the  opium poppy,  gathered before they are
 quite ripe.   They,  therefore, contain a little
 opium, and the numerous seeds in their in-
 terior, called maw-seeds, contain a bland oil ;
 consequently  a decoction  of  these  capsules
 contains a doubly soothing property from the
 opium and  from the oil.  This decoction is
 the mode in which poppy capsules are mainly
 employed.   A warm fomentation is prepared
 by  boiling  some of these capsules  in water.
 and any injured part  bathed with the fluid
 while  yet warm.   Sometimes a poultice  is
 made from this fluid, and applied to  bruises
 and other injured parts where the skin is
 whole.   The quantity of opium contained in
 these capsules is very small  and very vari-
 able.  No  preparation of the capsules ought
 to  be used internally, though two officinal
 preparations of them still  remain which are
 intended for this purpose, viz., an extract and
 syrup.  This syrup used to be  given  to chil-
 dren, but ought to  be entirely given up—it is
 dangerous.  Far better use laudanum or mor-
 phine, and then vve  know what vve are dealing
 with.
  PORRIGO,  or   SCALD   HEAD,  was
 commonly applied in former  times  to any
 affection of the head where there were scabs,
 and a moist discharging surface.  The term
 is now applied to,cases in which impetigo has
 been irritated, and the small pustules have
 run together, and made an angry, red, and
 raw surface, which  scabs over and discharges
 a watery fluid.   It is  a disease common in
 childhood, and  often occurs on the chin, or
 round  the corners  of the mouth, or on the
 head.  It looks like  an  eczema  eruption.
 The part should be washed  often with oat-
 meal  and hot water, so .as  to remove the
scabs ; then olive oil or zinc ointment should
be freely smeared over the raw surface ; soap
ought not to be used.  The bowels should be
opened by Gregory's powder, or a mixture
of rhubarb and magnesia ; the diet should be
light and nourishing, and since such children
are generally pale and  unhealthy, a little iron
wine  should  be given  two or three times a
day.  (See Impetigo and Eczema.)
  PORT.  (See Wines.)
  PORTAL VEIN is the important vessel
which, receiving the venous blood on its way
from  the stomach,  spleen,  and intestines,
carries  it on to the liver,  to be distributed
through that organ.  (See Liver.)
  PORTER.  (See Beer.)
  POTASS is the hydrated oxide of the metal
potassium, or kalium,  which  itself is only a
chemical curiosity, but whose  salts are of un-
speakable value to mankind.
  Liquor  Potasses, or solution of potass,  is
prepared from  carbonate of potass,  by add-
ing to  its solution quicklime ; when  heated,
after a time carbonate of lime forms, and the
clear fluid is  caustic potass in solution ; this
diluted  to the proper  strength is liquor po-
tassae ; evaporated to dryness, and  cast into
moulds,  it constitutes   solid  caustic  potass,
which  is  used for  a  variety  of purposes.
Liquor potassae  is colorless, very acrid, and
has a soapy feel.  If  kept in glass bottles con-
taining lead it attacks  them,  hence it is usu-
ally  kept in  bottles of green glass.  Large
doses of this substance may do much injury,
and even a small dose, if concentrated,  may
prove  fatal.  The  dilute solution  used  in
medicine is a very valuable antacid, not only
as neutralizing  any free acid,  but as tending
to bring the stomach to a normal condition,
being  a sedative  to its  lining  membrane.
Sometimes a  weak solution of caustic potass
is used as a wash in  certain forms of skin dis-
ease.
  Caustic potass, in the form  of stick, is usu-
ally met in little pieces about the  size of a
pencil.  These should  be quite white, but
usually have  a grayish tinge  : they  speedily
melt when exposed  to  the atmosphere,  and
therefore require to  be  kept in closely  stop-
pered bottles.  This substance speeaily dis-
solves  animal tissues, forming a kind of soap
with them.  Another preparation, formerly a
good deal used for a  similar purpose, was
potassa cum cake—potass and  lime :  this
does not melt  so  readily.   It is sometimes
used for  making  openings  over abscesses
when the patient dreads the knife, but always
leaves  an  indelible scar.  Caustic soda  is
now a good  deal used where caustic potass
used to  be,  seeing that it  is a good deal
cheaper.
  Carbonate of Potash is  made from  pearl
ashes ; these  again from the  ashes of wood.
It occurs in  small white grains,  somewhat
crystalline in  appearance, and strongly alka-
line.   It attracts moisture from  the  atmos- 
384
POTASS
POTASS
phere  sufficient after a time  to  melt it ; it
must therefore be kept in carefully stoppered
bottles.  Carbonate of potash is less alkaline
than caustic potass,  but is too much so to be
freely  used internally ; in point of fact, it is
chiefly used  as alkaline  lotions,  which are
applied to  the skin in certain forms of dis-
ease of that part of the body,  and  in rheuma-
tism and gout.
  Bicarbonate of Potash  is  made by  pass-
ing a  stream  of  carbonic  acid  through a
solution  of the former  salt.  It  occurs  in
large crystals, which do not absorb water from
the  atmosphere, and which  have a mildly
alkaline taste ; the crystals are readily soluble
in water.   Bicarbonate of potash is largely
given  internally, and may be taken in large
doses,  which  speedily make the  urine  alka-
line, and frequently increase that secretion.
This is, perhaps, the favorite preparation  of
an  alkali for internal use, and some  use it
very largely.
  Alkalies  have, indeed, a most extensive and
most  important application   in  medicine.
Thus,  applied to the stomach they induce a
copious flow of the digestive fluid  ; and thus,
though alkaline themselves, give rise  to a
powerful acid secretion in  abundance, thereby
materially  aiding  digestion.   The strong
caustic alkalies,  as already said, may be used,
and often  are used, for  the  destruction  of
warty  growths,  the  hard  edges of  sores
which  will not heal, and soon. It must, how-
ever, be borne in mind that these  substances
readily permeate the tissues,  soak into  them
and destroy them,  sometimes to  a  much
larger  extent than is desired.  The fluid, too,
formed in rubbing into the skin or  other parts
is apt to run, and precautions must  be taken
to avoid that.   It is, perhaps, best  to  use a
piece of blotting paper to surround the part
which  vve desire to destroy ; and  as soon as
we  think the destructive action has gone far
enough it is best to wash the  surface  with
vinegar and water.   It must also be borne in
mind that the parts are destroyed  to a much
greater extent by  using  this caustic   than
would  be imagined.   Sometimes a large ex-
tent of surface sloughs after its being applied
a little too  vigorously.  The carbonate  of
potass, in the proportion of a dram to a pint
of water, is an admirable application in cer-
tain forms of skin  diseases.   In  nettle-rash
and prickly heat there is nothing nearly  so
good, and even in the malady called eczema
there is no  application so valuable.  It  may
be tried in all cases where there is  much itch-
ing, and if  crusts be present,  it will  speedily
remove them.   It is in the stage  where the
whole  skin seems to weep that this applica-
tion is  most beneficial in eczema ;  later when
there  is  rawness  only,  it ceases to  be  of
use.
  In that peculiar  skin disease common  in
young  people about  puberty, where  the  face
is covered over with little  red dots with yel-
low tops, this plan will be  found most useful.
Strong  yellow soap  should  be plentifully
used, or the pustules should be  touched with
rather a strong  solution of  carbonate  of
potass ;  at all events, the  yellow tops ought
to be kept from  forming.   Alkaline  lotions,
similar to those mentioned, are  employed to
remove the chalk stones of gout.  The swell-
ings should be kept enveloped in cotton wool
or lint soaked in such a lotion, and kept moist
by a covering of oiled silk.
   Internally,   besides  being  used to  help
digestion, alkalies may be  given to neutralize
acidity ;  but  as a rule, such treatment is a
mistake.  The cause of  the acidity should be
dealt  with, not the acidity itself.  They are
also employed, mainly  as carbonate  or cit-
rate,  internally, to increase the  alkalinity of
the blood  and urine.    In the system they
seem to  favor  the conversion  and oxidation
of various  substances, and so seem useful in
various ways ; partly  by  helping oxidation,
partly in rendering the products of oxidation
more soluble.
   When there is  excess of uric acid in the
urine, whatever be its origin, bicarbonate of
potass may be, as a rule, given with benefit;
some prefer to give the citrate of potass.   In
any case the  object  will be best attained  by
giving the alkali in the form  of an efferves-
cing draught, say 20 grains  of the bicarbonate
of potass with  a  little sugar, to which, when
dissolved, a tablespoonful of lemon-juice may
be added, and  drank when effervescing.   In
this case the  citrate  is swallowed, but in the
blood it is  converted into a carbonate, and as
such appears in the urine.  The alkaline is,
in the meantime, the favorite mode of dealing
with rheumatic fever.   There is considerable
doubt as to  whether this  plan  enables  the
individual  to recover more  promptly, or saves
him from the risk of heart disease ; certainly
it, as a rule,  diminishes the pain and adds to
his comfort ; 20 or 30 grains should be given
every  three  hours, so as  to  keep the urine
alkaline.   As to  the influence of alkalies  on
the urine in  increasing or diminishing  the
amount of its products we  can say little.  It
is usual to give acetate  of potass and citrate
of potass as diuretics ; but it is usual  to give
many things  the efficacy of which rests on  no
solid foundation.
  Acetate of Potass is prepared by adding acetic
acid to bicarbonate of  potass, or rather vice
versa.  It appears as beautiful white foliated
satiny masses,  neutral quite in reaction, and
very readily absobing water from the  atmos-
phere. When taken internally, it is absorbed,
and appears  in the blood as carbonate  of
potass.  Its action is commonly reckoned to
be diuretic ; in very  large doses it is slightly
purgative.  It  is most frequently used as a
diuretic,  but sometimes also  lo render  the
urine alkaline, which  it does, though itself 
POTASS
POTASS
385
neutral through being converted into a car-
bonate.  The dose is from 20 to 60 grains.
   Citrate of Potass is prepared much as the
acetate by neutralizing carbonate of potass by
citric acid.  It is a white crystalline powder,
which tends to deliquesce, and is slightly acid
to the taste.   Citrate of  potass is pleasant to
the taste, and agrees better with the stomach
than most other preparations of  the alkali.
It is given in fevers as a cooling drink, and
being, like the acetate, converted in the blood
into carbonate, renders the urine alkaline.  It.
is used, therefore, in various maladies when
this  is desired,  especially in the form of an
effervescing drink.
   Tartrate of Potash, which is not often used,
is made by neutralizing the  acid tartrate by
means of  carbonate of  potash.  It exists as
small crystals,  without any  distinguishing
shape.  In small doses  it is diuretic, being,
 like the other  vegetable salts of potash, con-
 verted into the carbonate.  In large  doses it
 is purgative, and is added to vegetable purga-
 tives to increase their action.  To this end it
 is usually  given in doses of  from two drams
 to half an ounce.
   Acid  Tartrate of Potash  is better known
 as cream of tartar.  (See Cream of Tartar.)
   Sulphate of Potass is a waste product in  the
 manufacture  of  nitric acid.   The  residue  is
 the acid sulphate,  so some further steps have
 to be taken to render it neutral and pure.   Tt
 is of no great value in medicine ; from its  ex-
 cessive hardness it is sometimes employed to
 aid in the trituration of  vegetable substances.
 In  this way it is employed in compound ipe-
 cacuanha powder and  compound colocynth
 pill. The  old compound ipecacuanha powder
 (Dover's powder) contained nitrate of potass
 (saltpetre) instead  of this salt, and there is
 some reason to believe  that  it was more effi-
 cacious than the more modern preparation.
   Nitrate of Potash, or saltpetre,  is better
 perhaps known from its commercial uses than
 its  medicinal properties ;  nevertheless these
 are considerable.  It is  procured mainly from
 India by treating the  washings of  the  soil
 with wood-ashes,  after  which the  saltpetre is
 crystallized  out.   It occurs in  crystalline
 masses  or cakes,  or  in  broken  six-sided
 prisms, striated lengthwise.  It  is  tolerably
 soluble in water,  and has  a peculiar cooling
 taste.  It seems, when given in  large doses,
 to act on the heart ; but in smaller doses  it is
 of some value as a cooling remedy.   Some
 authorities value it highly  in acute rheuma-
. tism ; but its efficacy, like those of most other
 remedies in this malady, is more than doubt-
 ful.  It has also been given in dropsies with
 a view to act upon the  kidneys.  The dose is
 ordinarily about  20 grains,  and,  if  intended
 as a refrigerant, ought  to be given while dis-
 solving, not after being made into a solution.
    Chlorate of Potass,  is made  by  passing a
 stream of chlorine gas through a mixture of
carbonate of potass and slacked lime.  In this
way chlorate of potass, chloride of calcium,
and carbonate of lime ate formed.  The salt
occurs as flat transparent crystals, has a cool-
ing taste, and is not  very soluble  in water.
There is an officinal lozenge made of the sub-
stance ;  but if it is to  be used as a  lozenge—
and that perhaps is the best  way of using it
—it is best to suck the crystals, allowing them
to melt  gradually in  the mouth.   Even this
way  they  melt slowly.   Chlorate  of potass
acts as a refrigerant, as does  nitre,  and  it un-
doubtedly does much good used in the fashion
we have just pointed  out  in certain forms  of
ulceration of the  tongue  and mouth, especi-
ally of a syphilitic taint, and due to mercurial
impregnation.   In all diseases of  the throat
of a malignant nature, where there is usually
a tendency  to  the formation of a deep fur,
and of this fur to decompose, a  mixture of
this  salt with hydrochloric  acid is of  great
value.  The notions prevalent as to its action
on the blood, etc., are simply absurd.   Ten
or twenty grains may be  given internally for
a dose ; but it is best given in the way we
have  indicated—that is, by sucking, or com-
bined with hydrochloric acid.
   Permanganate of Potass is made  by heating
chlorate of potass with peroxide of manganese
and caustic potass.   The product has subse-
quently to be boiled, to  convert it into the
 purple maganate.  It occurs in dark-looking
 needle-shaped  crystals,  readily   soluble  in
 water, which takes from them a magnificent
 purple  hue.  Its officinal preparation  is  a
 solution called liquor potassae permanganatis,
 one of the most valuable substances employed
 in medicine, not internally perhaps, but by
 oxidizing and decomposing all the semi-putrid
 substances with which it comes in  contact.
 Hence, as a lotion, it may be applied to foul
 ulcers,  gangrenous  parts, foul mouths,  etc.
 It is, however, chiefly used  as a  disinfectant
 for the  hands, etc., after touching foul sores
 or dead bodies before touching others.  Its
 strength as  an irritant, too, is  considerable ;
 hence it may be used as an injection well di-
  luted, for gleet,  leucorrhcea, etc.  It is  not
 worth while giving  it internally, but diluted.
 so as to be transparent  or  nearly so,  and of
 a fine bluish-purple  hue, it  may be used as a
  wash,  gargle,  etc  ,  with  advantage.  Ten
  grains  to  the  ounce is  about  the  proper
  strength.
    Bichromate of Potass  occurs  in large red
  crystals of a tabular form.  It  is  mainly em-
  ployed as a dye stuff, and in the  preparation
  of some drugs, as valerianate of soda.
    Bromide  of Potassium is made by  adding
  bromine to caustic potash.   It occurs  as
  white cubical crystals, and owes its activity
  entirely to  the bromine it  contains.   It is
  given instead of bromine, especially in epilep-
  tic and epileptiform seizures, and often with
  much success.  The dose is 20 or 30 grains, 
386
TATO
PREGNANCY
beginning  with five,  and  going  upward.
(See Bromine.)
  Iodide of Potassium, like the former, owes
its efficacy to the iodine it contains, and not
to the potass.  It  is made by mixing iodine
and caustic potass.   It is given where iodine
should be given,  being less  irritating.  Its
dose varies from 2 to 30 grains or more, ac-
cording to the purpose to be  fulfilled.  (See
Iodine.)
  Sulphuretted Potass, or liver of sulphur,  is
made by heating sulphur and carbonate  of
potass together.   The salt has a strong smell
of sulphuretted hydrogen.   It is almost en-
tirely used as a local remedy in skin diseases,
parasitic, or otherwise.  Internally it is readily
absorbed, but its influence is not quite clear.
Baths of it are of great use in  chronic skin
diseases  and chronic rheumatism.  There  is
an officinal  ointment, which should be pre-
pared just before use. If required internally,
it is best administered as a natural mineral
water.
  Ferrocyanide oj Potassium and Ferridcyanide
of Potassium are only used as  tests, or in the
preparation of other 1 emedies.  By themselves
they are not administered..
  POTATO  is the name given to the under-
ground stem of the  Solanum tuberosum,  a
plant belonging to the natural order Solana-
ceae.  The  native  country  of this plant  is
South America.   It was first  grown in  the
British islands by Sir Walter  Raleigh, in his
garden at Youghal  in Ireland.  The  part of
the plant used as an article of food is the tuber
or underground stem.   The potato contains
75 per cent of water, and weight for weight
contains  less alimentary  matter than most
vegetable productions.   It contains, how-
ever, starch,  fibrine, and albumen, and min-
eral  matters, which  render it  a very impor-
tant article of diet.  They should  never  be
depended on alone, but as an addition to a
diet with fat or flesh formers they are invalu-
able.   During the potato famine in Ireland
no  substitute was  found equal to them, and
scurvy was the frequent result of their absence
from the diet of the poor.
  Potatoes are  cooked in various ways, but
the best  methods of cooking are those where
the saline matters  are prevented from being
lost  in the medium (as water) in which they
are cooked.  They  may  be  eaten raw as a
salad with vinegar, and this has been found
especially valuable in cases of scurvy, where
uncooked vegetable food has not been pro-
cured for a  length  of time.  The starch  is
often separated from the potato, and used  to
adulterate corn-flour, arrow-root, and other
amylaceous foods.   The scrapings of a potato
may be used as a cold cataplasm with advan-
tage in small burns.  The potato contains
a certain quantity of an alkaloid which is dis-
sipated by heat, but it possesses no poisonous
properties.
  POULTICES are ordered for the purpose
of soothing  pain,  or  promoting by  their
warmth the formation of matter, and it is of
the utmost importance that they  should be
well made  and properly applied, and before
being put on the skin they should be smeared
with sweet-oil  or glycerine, to  prevent any
particle sticking.  As regards bread and lin-
seed-meal  poultices, no better authority can
be quoted than Abernethy, who was singularly
minute, and properly so, in his directions.
  Bread arid-water poultice  he directs to be
made as follows :  "  Put  half a pint of hot
water into  a pint basin ; add to  this as much
of the crumb of bread  as the water will cover ;
then place  a plate over the basin, and  let it
remain  about ten minutes ;  stir  the  bread
about in the water, or, if necessary, chop it a
little with the edge of the knife,  and drain off
the water by holding the knife on  the top of
the basin, but do not press the bread  as is
usually done ; then  take it out lightly, spread
it about one third of  an inch thick on some
soft linen, and lay it upon the part."
  Linseed-meal poultices,  says the same au-
thority, should be made as  follows : " Scald
your basin, by pouring a little hot water into
it, then  put a small  quantity of finely ground
linseed-meal into the basin, pour  a little hot
water on it, and stir it  round  briskly  until
you have  well  incorporated  them ;  add  a
little more  meal and a little more water, then
stir it again.  Do not let any lumps  remain
in the basin,but stir the poultice weli,  and do
not be sparing  of your trouble.   If properly
made, it is  so well worked together that you
might throw it up to the ceiling,  and it would
come down again without falling  to pieces ;
it  is in fact like a pancake.  What you do
next is to take as much of it out of the  basin
as you  may require, lay it on a piece of soft
linen, let it be about a quarter of an inch
thick, and so wide that it may cover the whole
of the inflamed part."
  Bran  Poultices  are  frequently  required,
being useful as fomentations.  A linen or flan-
nel bag should  be  made of the  size required,
and  loosely filled  with bran,  then  boiling
water should be poured upon  it  until it  is
thoroughly moist ;  next it  is to be wrung out
in a coarse towel, and applied as directed.
   Yeast poultices are made by taking one
pound of flour and one ounce of yeast, boiling
them together, laying on linen, and applying.
  PRECIPITATE, WHITE.  (See  Mer
CURY.)
  PRECORDIUM is the region of the chest
which  lies  in front "of  the heart  ; it corre-
sponds  to  the  lower sternal  and left  infra-
mammary  regions.   (See Chest.)
  PREGNANCY may be reckoned to  in
elude within  its meaning all  the changes
which take place in the  ovum after its fertili
zation,  whether these relate to the embryo or
lo the mother.   In  a treatise of this nature  it 
PREGNANCY
PREGNANCY          387
 is not possible to consider all the bearings of
 the subject, so we shall confine our observa-
 tions  to  a few  of the most important and
 practical.  To this end vve  shall confine our-
 selves to  the  subject in two of its aspects
 only  : viz., as regards the signs of pregnancy,
 and the diseases of pregnancy.
   The signs of pregnancy are derivable from
 various sources, more or less accurate, "some
 being of  comparatively  little value, others
 being absolutely certain.   Probably the first
 thing to excite suspicion that she is pregnant
 on the part of a female is the cessation of the
 menstrual flow.   The time  arrives  when this
 should make its appearance, and it  fails to  do
 so.   Other circumstances may  have arisen
 which lead her to suppose that she is preg-
 nant, and this1 confirms  the fact.   Or yet,
 again, it may be that no such suspicion enters
 the mind, but a second period comes round,
 and still no sign of the ordinary flow. By this
 time  other signs have appeared, and  to one
 who  is willing to be convinced,  these will
 probably be  quite  sufficient to satisfy the
 mind.  But this cessation by itself is far from
 a certain  sign.  We have already pointed out
 that such an occurrence is frequent where a
 female becomes the subject of  ill-health,
 whatever the nature of it may be.   We have
 pointed out especially that  such an  event is
 common among women who are anaemic and
 pallid in  their complexion, so that by itself
 alone this indication is, comparatively speak-
 ing, worthless  ; its value is, however, much
 greater in a strong healthy  woman than in a
 weak and delicate one.  There are, however,
 many instances where  this indication is en-
 tirely absent.   Thus,  it not unfrequently hap-
 pens  that for a good number of years a mar-
 ried woman may never see the flow  at all ; for
 no sooner does one pregnancy terminate, and
 the child  is reared to the  stage appointed  by
 nature, than  a new one begins.  Moreover,
 in a considerable proportion of cases the flow
 continues for perhaps a month or  two after
 the commencement of pregnancy.
   Another indication of considerable import-
 tance is morning sickness, especially taken  in
 conjunction with the foregoing.   Generally
 this symptom sets in about the  fifth or sixth
 week of pregnancy, so  that the omission  of
 the second menstrual period and the appear-
 ance  of  this sickness, may, taken  together,
 be considered  fair evidence of the existence
 of pregnancy.  This sickness is peculiar.   It
 usually commences immediately on getting
 up, may be severe foj- the  time, but usually
 it does not last long ; in most cases \t passes
 away  in about half an hour, and the patient
 is well for the rest of the day.  Occasionally
 it lasts longer,  and may even persist for the
whole period  from  morning  to morning ;
when  this is the case  it becomes dangerous,
interfering with nutrition,  for the patient can
take no food, or, if it is taken, is immediately
brought  up again.  This  sickness  generally
disappears about the third or fourth month,
but  may  persist  longer,  while  in  many
women it does not appear at all.  This morn-
ing sickness is  not, however,  an invariable
sign of pregnancy ; notably it may be pro-
duced  by  irritability of  the  stomach, and
extra indulgence in food or drink the previous
evening ; it may likewise be produced by dis-
ease or  misplacement  of the uterus when
there is no pregnancy.  Its great value is as
confirmatory evidence.  Sometimes there  is
in pregnant women an extraordinary flow of
saliva, but that  of course, taken by itself,  is
worthless.
  The cnanges which take place in the female
breast are important.  These begin about six
weeks  or two months after the  commence-
ment of  pregnancy.  The breasts feel fuller
and tenser than usual, seem heavy, and some-
times throb and tingle,  especially about the
nipples.   They increase in size and firmness,
and in their interior  may be felt a kind of
knotted mass.  This is highly important and
characteristic, as this  indicates that the en-
largement is due to the milk-secreting appa-
ratus, and not  to  the  mass  of  fleshy tissue
alone, which is common enough from various
causes if a  woman increases  in  embonpoint.
After a time these contain   milk.  Another
characteristic feature in the breasts is, that
round  about the nipples  they become very
dark, the darkness increasing and extending
as  pregnancy advances.  Round about the
nipples, too, appear little dark prominences
about  the   size  of millet-seed.   These  are
characteristic ;  but the  breasts  may enlarge
from other  enlargements of  the  uterus than
that due to  pregnancy, and some women,
especially those  of  dark complexion,  have
naturally a dark ring round about the nipple.
Milk, too,  may appear  in the virgin  breast,
so that none of these signs are by themselves
conclusive ; like the  others,  they  must  be
taken in  conjunction.  Then their value  is
great,  especially the  enlargement  in thin
women, and the darkening if  in  a  fair-com-
plexioned woman.  The sign most commonly
relied on is the most fallacious of all—that is,
enlargement of the abdomen.  The abdomen
may be enlarged from a score of causes, so
that except there be a strict  and accurate in-
vestigation by a skilled individual of  the cause
of the enlargement, such an  observation may
be  merely misleading.  Once, however, the
uterus  begins fairly to  enlarge,  there  is no
great difficulty to the skilled  practitioner, and
up to that time, of course, the enlargement of
the abdomen will be but slight.
  Between the fourth and fifth month of preg-
nancy there occurs an incident which is usu-
ally convincing to the woman—that is, quick-
ening.  This term  is given  to the  mother's
perception of the first motions of the fcetus.
It has been likened to various things—to a 
388          PREGNANCY
PRESERVED  MEAT
slight pulsation among others.  Slight as the !
motion may be, however, it not unfrequently
gives rise to faintness in the mother ;  gradu-
ally these movements become stronger, until
sometimes  they prove  exceedingly trouble-
some.  The first" perception of these  move-
ments is  by the female commonly laid down
as the half-term of pregnancy, but this is not
strictly accurate.  Not  long after these ar-
rives a period when a skilled  practitioner is
able  to diagnose with absolute certainty  the
presence of a fcetus  in the uterus ;  this he
does by means of the stethoscope. By apply-
ing this instrument over the abdomen of the
female, just between the umbilicus and  the
nearest point of the pelvis,  one may hear the
beating of the heart of the fcetus.  This sound,
which is called the fcetal tic-tac, from  the re-
semblance  to the sound of a watch, is an
absolute sign of pregnancy, nothing can pro-
duce it except the heart of a living fcetus, and
so its detection  implies pregnancy.  There
is, too, no danger of mistaking it  for anything
else, as the only sound likely to be conlounded
with it would be the sound derivable from the
mother's circulation ;  but this fcetal sound is
double, and the heart beats just  about twice
as fast as does that of the mother.
  All these are signs, more or less valuable, of
pregnancy, and there are others  which, how-
ever, we  need not touch upon here.  Not un-
frequently, however,  the pregnancy  is  con-
cealed ;  these  signs  have either  not been
observed or overlooked, and the first  sign of
pregnancy  is the setting in  of labor pains at
the end of the ninth month.  In no case  can
a practitioner say with absolute certainty that
a female is  pregnant until about  the  fifth
month of pregnancy.   He can of course pro-
nounce it highly probable, but nothing more.
Accordingly one should be careful in bringing
accusations of pregnancy, which it might be
difficult to prove or disprove.
   The Diseases of Pregnancy can  hardly be
discussed here ;  one or two more may, hovv-
evei, be  alluded to.   The  salivation  spoken
of may  be  excessive,  and  may   require
remedy ; if so, the usual remedy for  saliva-
tion  may be given ;  perhaps  the  best is to
give  the patient some  pieces of  alum  and
chlorate  of potass, telling  her to suck these
from time to  time. This often has the  desired
result.  The sickness and  vomiting of preg-
nancy are frequently much  more serious mat-
ters  ; they  may, indeed, go so far  as to en-
danger the life of the female from inanition,
for sometimes it becomes  impossible for her
to keep  anything in  her stomach.   Various
plans have to be  tried if the sickness  is
troublesome.  The patient ought to keep the
recumbent posture as much as possible ; the
food should be as light and as easy of diges-
tion  as possible ; the time should carefully be
watched so as to  give  it at any moment the
sickness may go, and then a quantity should
never be given which will endanger the repe-
tition of the vomiting.  Still that  may  not
suffice.   Ice should therefore be given,  and
sometimes champagne will  be kept  down
when nothing else will.   All kinds of reme-
dies have been tried, chief among them being
prussic acid and oxalate of cerium, and some-
times all will prove vain.  At the last it may
be absolutely  necessary  to bring on  prema-
ture  labor to save  the  life  of the  mother.
Ordinarily the appearance of this premature
labor, or abortion as it is commonly called,
requires  to  be  carefully guarded  against.
Certain b'road rules have been laid down al-
ready on this subject.  (See Abortion.)
  Albuminuria is  an accident  which some-
times arises in pregnancy, and  when  it  does
may prove a most formidable  complication.
The  exact cause  of this albuminuria is  not
quite clear : ordinarily it is set down to pres-
sure of the enlarged womb on the renal veins.
Frequently it is not discovered until labor sets
in, when the first  indication  of its presence
may be a violent  convulsion.  If these con-
vulsions  set in during pregnancy before labor
begins it may be necessary to empty the
womb to save the  mother. (See Puerperal
Convulsions.)  There are many other  mal-
adies incident to  the  state of pregnancy,
which  we cannot, however,  discuss.  There
is one  simple  enough apparently,  which,
however, frequently gives rise to a good  deal
of trouble—that is, constipation.   Confined
bowels should be  carefully guarded against,
and  the  best  antidote is an occasional  tea-
spoonful of castor-oil  the first thing in the
morning if sickness will permit.
  Premature birth is said to  take place when
a child is born between  the sixth and ninth
month of foetal life.  It may come on of itself
in some  cases where there is  a constitutional
taint, or from fright, or injury, or habit, and
then the case is like a labor, only less severe.
If a premature birth is induced for the sake
of killing the  offspring, as in the  case of an
unmarried person, the offence is  a criminal
one, and renders  the guilty  parties liable to
severe punishment.   There are,  however,
some rare cases  in which there is such de-
formity on the part of the mother that prema-
ture birth must take place to save the life of
mother and child ; but this procedure is  only
justifiable after careful inquiry into the nature
of the case, and a consultation of skilled and
independent medical men.
   PREPARED  CHALK.  (See Chalk.)
   PRESBYOPIA  is the name given  to  a
defect in the  eyesight, produced generally in
advanced life. (See Eye and Vision.)
   PRESERVED MEAT.—The practice of
preserving animal food was  observed by the
nations  of antiquity, and the feasts of the
 Romans were remarkable for animal products
brought from all parts of  the world.   The
arts of smoking pork and salting  beef  were 
PRESERVED  MEAT
PROGRESSIVE  ATAXY     389
 known to our ancestors in Europe ;  it is only
 in modern times that  the idea has been con-
 ceived of bringing animal food from distant
 parts of the world, so as to supply the demand
 in the increasing populations of Europe for a
 large supply of animal food.  We may date
 the attempt at preserving animal food first,
 for use at a future time, to Polar expeditions.
 At the  International  Exhibition in 1851 this
 subject attracted considerable attention, and
 at that time meat  preserved in tin  cases for
 use in  ships and for  exportation was exhib-
 ited.  From that time the  subject has at-
 tracted more or less attention.
   The process by which the meat is  prepared
 is a very simple one, and consists simply of
 exposing meat, from which the bone has been
 separated, in a tin case to a heat above that
 of boiling water. To do this, the tin with the
 meat is placed in a  tank containing water
 holding in solution  some  salt,  which will
 allow the water to be heated up to 2500 or
 260°  Fahr.  The tin is exposed to this  tem-
 perature for some time ; the tin case  is cov-
 ered  with a lid in which a little hole is made,
 and when the process  is supposed to be com-
 pleted the pinhole is  soldered down, and the
 tin is air-tight.
   Experience has shown that meat preserved
 in  this way can be kept  for any length of
 time. The effect of the cooking seems to act
 in  one  of  two ways.   According  to  one
 theory,  the  exposure of  the meat  lo heat
 drives off all the free oxygen from the tissues
 of  the meat,  which  is the  active agent in
 putrefaction.   According  to  another theory,
 all putrefaction is produced by living germs
 in the air, which by the process of steaming
 are destroyed.
   Besides steaming in tins, many  other pro-
 cesses have been adopted  for carrying meat
 into Europe from America and the Antipodes.
 Dipping the meat in  boiling fat, enveloping
 it in paraffine, covering it with ice, and merely
 salting it, have all been tried with  more or
 less success. The " tinned " process is, how
 ever, the most  successful.
   The question has arisen  whether the meat
 thus preserved retains its digestive  and nu-
 tritive qualities, so as to render it a fit substi-
 tute for fresh meat.  There is no doubt that
 the  " tinned"  meat, from  its exposure  to a
 high temperature, possesses qualities different
 from  those of  meat cooked at a  lower tem-
 perature, but this has nothing to do  with its
 digestible power or its  nourishing properties.
 It does not appear  from any chemical anal-
 ysis  or  experiment   on  its use that  the
 tinned differs  at all  from  fresh  meat.  In
 prisons in England, where it has been tried
 on a large scale, no difference has been found
 in the health of prisoners after having taken
 it for  months.   In work-houses where  it has
 been tried, the old people  prefer it to the in-
ferior fresh  meat often served up to them.
  The same reports  come from  lunatic  asy-
  lums, ships, and institutions where it  is em-
  ployed.  Every now and then a case is found
  in which the occlusion of air or germs has not
  been perfectly effected, and in which decom-
  position has set in, but under no other cir-
  cumstances has any objection to its use been
  substantiated.
    The tinned meat requires little or no cook-
  ing.  It may be taken cold with hot potatoes
  or any other form of vegetable food.  It may
 j be heated and  served up as a stew, but the
  ingenuity of an ordinary cook will  suggest a
  hundred ways in which it may be placed upon
 j the table.
 j   The price of  this  meat will be seen to be
  much less than fresh meat when it is consid-
  ered that it contains no bones and no water.
  It is calculated that one pound of  this meat
  in the  dieting a family will go as far as two
  pounds of fresh meat.
    PROBANG is an instrument formed  of a
  slender  piece of whalebone with a piece of
  ivory or sponge at its extremity, for pushing
  bodies down the  gullet  or oesophagus  into
  the stomach.
    PROBE is  an  instrument for trying the
  depth and extent of wounds.
    PROCIDENTIA is another term for pro-
  lapse of  the womb.
    PROGRESSIVE  LOCOMOTOR AT-
  AXY is  a  disease  which  is characterized
  mainly  by the peculiar  gait the patient as-
  sumes when walking, very much resembling
  the walk of a drunken man.  The disease de-
  pends  upon  a  grave  disease of the  spinal
  cord, by which its functions are  more or less
  impaired, and in consequence of which the
  individual loses in a great measure  control
  over his  movements.  In the ordinary move-
  ments that vve make in locomotion there is a
  certain harmony of action between  the mus-
  cles of our extremities.   It is quite true that
  we can move an arm or leg of one side quite
  independently of the other side,  but it is also
  true that as soon as we  learn to walk we use
  our  muscles  in a  certain  order;  infants
  acquire  this by experience,  as every mother
  knows how awkward their first motions are  ;
  animals seem to have this faculty very'early,
  for most of them can  walk the first day of
  their existence.  Now this faculty of co-ordi-
  nation—this  faculty  of  harmonizing  the
  movements of  independent parts—is lost in
  cases of this disease.
   Causes.—These at present are not clearly
  made out.  It  seems that  exposure to  cold
  and wet  is the most lrequent cause ;  it  seems
  most common in those  who are engaged in
  draining, and in those who work for days to-
  gether in water with large leathern boots on,
|  as those  who are  making docks, etc.   Such
  men get  hot and perspire at their work, while
  they are  very  cold, if not wet, in their feet.
!  It comes on, as a rule, in  middle  life,  and 
390   PROGRESSIVE ATROPHY
PROGRESSIVE  ATROPHY
seldom occurs among the young or the aged.
As its name implies, it is  essentially chronic
in its course, and  when once begun, it pro-
gresses gradually,  and goes on for  many
years.
  Symptoms.—The three most marked symp-
toms are so-called rheumatic  pains in  the
limbs  and chiefly in the  legs, the  want  of
harmony of movement, and more or less loss
of sensibility  in  the lower extremities.  At
first the patient feels a sense of numbness and
tingling  in his  legs, and he has   "flying
pains" about him ; he is able to  work, but
does not feel so  steady as before.   By  de-
grees he  finds that when walking  he loses
partial control over his  movements ; he can
walk several miles  a day,  but finds he is
awkward in starting ; in time his  legs move
incoherently,  and in making  a step  the foot
does not go directly forward,  but is projected
irregularly ; his  gait is  so  awkward that
passers-by fancy he must have been drinking.
If now he is asked to walk with his eyes shut
he is much worse, and would  fall without  as-
sistance ;  in turning round he is awkward,
and also  in starting ;  but once  set going, he
can  walk  a long  distance without  fatigue,
Yet there  is no paralysis ;  for if he sit down
and bend his leg, he can resist well all efforts
to straighten it, and this is not the case where
paraplegia is present.  He cannot always be
certain of  the nature of the ground on which
he stands, nor,  unless he look, can he be
always certain  whether he is on  a wooden
floor or on a  stone  pavement.  His spirits
are usually bad, and at  times he bursts into
tears without any apparent cause.   He may
have a desire to  pass water  frequently, but
he has perfect control over his bladder and
motions.  In some cases there is loss of hear-
ing or dimness of vision,  in  consequence of
some nerve tracts in the brain becoming in-
volved in the disease, but this  is not a marked
feature.  The  intellect  is unimpaired, and
he can read, eat, drink, and sleep well.
  Treatment.—Very  little can be  done, if
anything,  in  curing this disorder.   Various
medicines have  been tried, but without any
marked benefit ; tonics, and  especially iron
and quinine, seem to do  most good by im-
proving the  general health.  The   patient
should be warmly clothed and live well ; he
need not keep in the house, but should walk
out every day.  No local treatment of  the
spinal  cord does  any good.   As these cases
generally occur among the poor, they are, in
consequence,  prevented  from obtaining  a
livelihood, and,  being driven  to the  work-
house, are not always able to  live on  the best
of food.  They should be encouraged to learn
some simple  occupation in  which they can
use their heads, and  which does not involve
anv exercise or much manual labor.
  PROGRESSIVE MUSCULAR  ATRO-
PHY involves, as its name  implies, a grad-
 ual wasting of the involuntary muscles.   It
 is well known that in cases of lead-poisoning,
 wrist-drop is  apt  to  occur  from atrophy of
 some of the muscles of the fore-arm.  In this
 affection,  however, the atrophy or wasting is
 much more general. As a rule it begins in the
 arms,  and is  often most noticeable in the
 upper arm and shoulder, so  that the  patient
 is prevented  from raising  his  hand to his
 head.   It affects both  sides,  and  extends
 pretty equally on each side.
!   Causes.—These, at present, are not under-
j stood ; it  may occur in children  as well  as in
 adults ; it has  been known to  be hereditary
 in families,  so that several  children of the
j same parents have been carried off  in turn.
 It is though a very rare disease, nor is it yet
( determined whether it depends on  an altera-
 tion of the nervous system or of the muscu-
 lar system, although most authors are in fa-
I vor of the former view.  It is a disease which
I is very chronic ; it goes on  gradually  from
 worse  to  worse, until finally the muscles of
j respiration become involved,  and death  may
 ensue from suffocation.
   Symptoms.—The first symptom generally
 noticed is  a wasting of the muscles of the arm
 or leg, but more commonly the  former  ; the
 fingers are  used awkwardly in picking up
 anything ; there is a numbness and  tingling
 in the extremities.,  and occasional twitchings
 of the muscles of the part.  In time the wast-
 ing is more  marked, and the loss of power
 is proportionate to the amount of wasting.
 The patient  cannot raise his arm nor flex it
 properly ; if bent, he  cannot resist any one
 trying to unbend it ; he cannot make his hand
 reach his  head without assistance.  On ex-
 amining the parts chiefly affected great wast-
 ing will be noticed, and the bones can be felt
 through the emaciated tissues ; when  the
 muscles of  the shoulders  waste the  head
 droops forward slightly, and the patient has a
 high-shouldered appearance.   In a similar
 way the  legs  waste, so that  walking is per-
 formed with difficulty, and finally the sufferer
 has to  keep  his bed.   Yet all the while the
 general health is not much impaired ; he can
 eat,  drink, and sleep well ; the  mental facul-
 ties are not  affected, and his chief distress is
 the progressive weakness.  But in time other
 parts get  affected ; as  long  as only the ex-
 tremities  are atrophied, loss of  power alone
 ensues, and locomotion is rendered difficult ;
 after a while  the  muscles of the chest will
 begin to waste, and the patient becomes short
 of breath.  As this goes on the expansion of
 the chest  is interfered with,  and ihe sufferer
 is liable to bronchitis and congestion of the
 lungs ; he has not  strength to spit up the
 accumulated phlegm in his air-passages  ; ex-
 posure to cold or damp air makes him have a
 distressing cough and aggravates  his symp-
 toms.  Hence  it is always  a bad thing for
 them to have catarrh or bronchitis, as it gen- 
PROLAPSE OF THE WOMB
PRURITUS
391
 erally carries them off  suddenly ;  in very
 severe  cases hardly any  expansion of the
 chest-walls occurs, and death really occurs by
 suffocation.
   Treatment.—For this disease, when once
 developed, but little good can be obtained by
 any drug.   Iron,  quinine, strychnine,  and
 various tonics  have been  tried, but none of
 them seem to have any influence in checking
 the onward progress of the disease.   Sham-
 pooing,  electricity, and  friction  should be
 tried, and for a time benefit seems to result.
 The general health should be kept up by a
 nourishing  diet ;  the  body  should  be kept
 warm,  and flannel must be  worn  next the
 chest.  All exposure to cold and wet should
 be avoided,  and although out-door exercise
 should be taken when the weather is fine and
 dry, yet such people should  not go  out after
 sunset nor risk an exposure to the night air,
 as they might catch cold or obtain some lung
 complication.  In the later stages the patients
 have to be propped up in bed, as they are too
 weak to  support  themselves ; in such cases
 all that can be done is to adopt any means
 that may please  or give  comfort  to the pa-
 tient, and sp render more easy the inveitable
 end.
   PROLAPSE OF THE WOMB is  said
 to occur when that organ descends lower than
 usual ;  it may come on after confinements,
 and is chiefly met with in those who stand a
 great deal,  as washerwomen,  etc.,  and in
 those who  get up too soon  after a  labor.
 Mechanical treatment  is best for this condi-
 tion, and the patient should wear a pessary
 for the purpose.  Much discomfort and  dis-
 tress is caused  by a prolapse ; often there is
 difficulty in  passing water and in defaecation.
 (See Pessaries and Uterus.)
   PROLAPSUS is a term applied to the fall-
 ing  down or protrusion  of  any of  the  soft
 organs  of the body,  through their  natural
 passages.  Thus, prolapsus ani is the falling
 down of the  rectum through the anus.  Pro-
 lapsus uteri is the protrusion of  the womb at
 the vulva.   Prolapsus irridis is applied to the
 protrusion of the iris through a wound in the
 cornea.
   PROOF  SPIRIT is made by adding three
 pints of  distilled water to five pints  of recti-
 fied spirit. It contains 49 per cent of alcohol,
 and  its  specific gravity is .920.  It is  em-
 ployed  in making  some  of  the tinctures of
 the Pharmacopoeia.
   PROPTOSIS is  the name given  to that
 peculiar condition of the eye-ball in  Grave's
 Disease.  It is often seen in a much milder
 degree,  and may constitute a kind of deform-
 ity without  at  all  interfering with  vision.
 The cause seems to be a form of swelling of
 the cushion on which the eye rests.
  PROSTRATION.  (See Shock.)
  PROUD  FLESH is a term applied to the
granulations  of a wound  when  healing  by
I suppuration.  (See Inflammation and Gran-
| ulations.)
I   PRUNES or DRIED  PLUMS are sel-
! dom  employed by the physician, though
 sometimes  in  domestic   practice.   The
| smaller and more acid specimens ought to be
| used  if the substance  is to  be used at all.
I These, however, though tending to  relax the
j bowels, are of little  use.  li they do give rise
i to relaxation  they  generally,  too, produce
 griping,  and very  likely  flatulence.   The
 common prunes may be used ad libitum.
   PRURIGO is a form of  skin disease char-
 acterized  by  the appearance of small clear
 blebs or pimples, which may  alter their char-
 acter so as to  become  scabs.  These scabs
 are,  however, more frequently produced by
 the scratching of the sufferers, who tear the
 skin  with  their nails till it  bleeds, and so
 these minute crusts are formed.  The itching
[ which accompanies prurigo is almost intoler-
 able, and is  always aggravated by heat, so
 that the subjects of it dare hardly approach a
 fire or go to bed.   This malady  is peculiarly
I prevalent among old people,  and one variety
| of it is accordingly  characterized as Prurigo
 senilis.   The malady is most obstinate, some-
 times refusing all relief till the  patients are
 weary of their lives.
I   Many assert that  this malady is invariably
| due to those horrid  insects, body-lice, and we
 are not prepared to deny that in a great num-
I ber of cases, especially in elderly people, this
| is so.  Neither are  we, however, prepared to
 deny that some forms of prurigo may arise
 from  nervous  irritation,  without the  agency
 of parasites.   In all cases this rule is impera-
 tive : let the under linen be well searched,
 especially in the morning,  when these para-
 sites are torpid. And let not the rank or posi-
 tion  of the sufferer stand in the way of this.
 In these days  one  never knows with whom
 they are brushing elbows, and  these vermin
 may and do get hold of persons in  a higher
 sphere of life in a wonderful  manner.  It is,
 however, among the lower orders  one sees
 prurigo and  vermin  most commonly asso-
 ciated, and in them ihere is but one remedy.
 They must be stripped, put in a warm bath,
 and well washed with carbolic-acid soap, much
 stronger than that  commonly used,  and their
 clothes must all be baked—boiling often does
 not suffice.  The skin is best anointed  with
 carbolic-acid ointment.or washed with a weak
 solution  of the same.   A  weak  solution of
 corrosive sublimate is frequently of  great use
 in relieving the itching, and in destroying the
 cause of it.  If the malady is  due to other
 than parasitic causation other remedies must
 be used, such as are employed for what is
 techincally known as pruritus, or  itching.
 (See  Pruritus.)
   PRURITUS is  the  name given  to the
 main symptom of the disease prurigo, as well
 as to others of skin  diseases,  i.e.,  itching. 
392         PRUSSIC ACID
PSOAS ABSCESS
It sometimes gives rise to intolerable torments
far  worse  than  actual  pain.  Pruritus may
affect the whole body, but  much  more  com-
monly  it   affects   certain  special  tracts.
Among  these  the  neighborhood  of the
organs of generation is  a somewhat frequent
site, and to this the term prurituspudendi has
been  applied.  It may be due, especially in
children, to the presence of worms, and these
should be carefully  looked  for ; but in a con-
siderable number of instances nothing can be
seen  on  the skin  beyond the  effects  of
scratching.   For such itching various reme-
dies may be tried,  lead and opium lotion be-
ing one of  the best.  Lime  water may be also
tried, and if there is any discharge, magnesia.
Prussic acid is sometimes used  as a lotion,
but requires great caution.   In females  it not
unfrequently depends on uterine disease, and
all remedies will prove useless until that is
alleviated.   Great cleanliness is, of  course,
essential, and stimulating food and hot fiery
drinks must be avoided.  In some cases the
wet  pack locally gives more relief than any-
thing.
  'PRUSSIC  ACID, also known as Hydro-
cyanic Acid, is .one of the most potent poi-
sons known, but used aright it is also a valu-
able medicine.  It  is made by distilling yel-
low prussiate of potash (ferrocyanide of potas-
sium)  with sulphuric  acid.   The ordinary
acid,  which is very dilute, is colorless, and
has a peculiar odor and tastes very slightly
acid,  the marks of  its acidity passing readily
away, it being very volatile.  The ordinary
acid contains only 2 per cent of the anhydrous
acid,  and that known as  Scheele's only 4  ;
nevertheless  both   are powerful poisons.
There is an officinal preparation in the Phar-
macopoeia   called  Acidum Hydrocyanicum
Dilutum.   The acid is now a good deal used
in the form of cyanide of  potassium.  This
is largely employed by photographers, and
has been the cause of several accidents, being
almost  as  dangerous a  poison  as the acid
itself.   The anhydrous acid is probably the
most  intense poison known, destroying life
with  the greatest rapidity, not appearing to
affect anv  one organ, but  apparently arrest-
ing the functions of all.  If the acid be strong,
death may  follow  a dose  in a few seconds,
but under ordinary  circumstances a fatal re-
sult, though speedy, does not follow with the
same rapidity.  The final  act in destroying
life  seems to be paralysis of the heart.
  As  to any antidote, usually death occurs so
speedily that there  is time for no  remedies  ;
sometimes  ammonia is tried with  a view to
overcome the  prostration, but as a rule with
little  avail.    If  the dose  were  small, and
time  permitted, it would be well to employ
the  hydrated oxide of iron, as  in arsenical
poisoning.
  Greatly diluted prussic acid, applied to the
skin,  diminishes sensibility, and so if there is
much pain or  itching in the part,  such an
application often does  good.  In skin  dis-
eases,  where there is much itching and the
skin is  not broken, there  can be no  better
application than a  very weak solution of
cyanide of potassium or  of hydrocyanic acid.
For this  purpose thirty grains of cyanide of
potassium may be added to a pint of water,
or half a dram (fluid) of the acid may be added
to six ounces of water.   This only if the skin
is unbroken.  Moderate  doses allay  irritabil-
ity of the stomach,  and are frequently used
in all painful affections of that organ, in ulcer,
cancer, and especially neuralgia. Sometimes,
too, it is employed with  benefit in vomiting,
but the  exact  cases  in which it is beneficial
are not quite clear.
  So, too,  in  some  chest  affections, prussic
acid is used with advantage.  A certain num-
ber of cases of asthma seem connected with
disease or irritability of ihe stomach, in these
prussic  acid may  be tried with advantage.
In whooping-cough,  too, this remedy is often
successful in allaying the violence of the  par-
oxysm, though  not in shortening the  duration
of the disease.   Some recommend it in func-
tional or other diseases of the heart, when
palpitation is most violent.
  The vapor, which consists of 10 or 15 drops
of hydrocyanic  acid added to an ounce or so
of water  at the ordinary  temperature—the
vapor being inhaled—is an admirable remedy
for some forms of  irritation  of  the  lung,
especially such as induce violent  cough in
consumptive individuals.  Indeed, save  that
it is desirable to give it by the mouth when the
stomach  is  concerned,  this  seems  the  best
way of  administering it.  The  dose by the
mouth is from 2 to 5 drops freely diluted.  It
is apt to  lose strength by keeping.
  PSOAS ABSCESS is the abscess formed
by  the side of the spine in  consequence of
various diseases of the bodies of one or more
lumbar  vertebra; ;  it gravitates  along the
muscles  of the pelvis and points  under the
skin at  the upper  and inner parts of the
thigh.  A  soft fluctuating  swelling is  pro-
duced, which increases raiher rapidly in  size
and extends inward  and downward reaching
in some  instances as far as the knee.   This
constitutes the lower portion of a large abscess
extending as high  as the spinal  column in
the loins, and  which, as it passes from the
abdomen into the  thigh  under the structure
known as Poupart's  ligament, is constricted
to a narrow neck.  This affection, like lumbar
abscess,  is serious in consequence  of  its al-
most invariable  connection with advanced
ulcerative disease of the spine.  When the
swelling  in the  thigh is large and painful, and
when deep-seated fulness can be made out
along the lower part of  the abdomen on the
corresponding  side, and when one finds angu-
lar curvature  and remote symptoms of dis-
ease of  the spine,  there can  be  very little 
PSORIASIS
PUERPERAL CONVULSIONS  393
doubt as to the presence of a psoas abscess.
But where the abscess is small and the symp-
toms  of suppuration extending from the thigh
to the spine are not well marked, the diagno-
sis is  not so easy, and the psoas abscess may
be readily mistaken for a  rupture or  for  an
aneurism.  Very little  can be done  for the
treatment of  psoas  abscess.  So long as the
swelling does not cause much pain and grows
slowly it should be  left alone.   Should, how-
ever,  the abscess attain a large  size, and the
distended skin become  red and inflamed and
threaten to give way, the surgeon will find it
necessary to let out the contained pus, either
by repeated tapping or by making a free  in-
cision, under a veil dipped in  a mixture of
carbolic acid and olive oil.
   PSORIASIS is a dry scaly disease of the
skin ; it is chronic  in its  course and  charac-
terized by slightly raised red patches covered
by white, shining, opaque scales ;  these scales
often come off in great numbers, so  that on
waking  in a morning  the  patient finds  his
bed full of  little  branny particles.  Some-
times the spots are circular, small and  numer-
ous, and scattered over the skin ;  sometimes
they  are  ring-shaped  and  the centre   is
healthy, while  the disease spreads at  the cir-
cumference ; sometimes large patches of  ir-
regular 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 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
formation of  epithelium on the inflamed sur-
face.  The  rash is often accompanied  by
much itching ;  if 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.
  Treatment.—The treatment  consists  in
paying attention to  the state of the stomach,
and regulating the diet carefully; arsenic is the
best remedy, and it may be given in small
doses  two  or three  times in the day, but its
action must be  carefully watched.  In many
cases  the local application of tar or pitch will
suffice for a cure.
  PTOSIS is the term applied to paralysis of
the upper eyelids, so that it falls and covers
the eye, the patient being unable to open that
eye save by means of his fingers.  The con-
dition is mainly of  importance as an indica-
tion of brain mischief, for this more frequently
follows hemorrhage, or  other damage to the
cerebrum, than  any other symptom.  The
muscle  which raises the eyelids is governed
by the same  nerve which guides the move-
ment of most of the muscles of the eyeball.
Consequently, drooping of  the  upper eyelid
is very  often  accompanied by squinting, the
remaining muscles of the eyeball  dragging it
out of its accustomed situation.
  PTYALIN is the active principle of saliva.
(See Saliva.)
  PTYALISM means  an increased and in-
voluntary flow of saliva.  It attends the action
of some medicines,  especially  the  prepara-
tions of  mercury,  also  iodide of  potassium.
(See Iodine,  Mercury.)
  PUERPERAL  CONVULSIONS   are
commonly held to include the convulsions
which  occur  both  before, during, and  after
labor.   Here, however, we must confine our-
selves mainly to the two former, sometimes
termed  the Eclampsia  of the pregnant and
puerperal states.  The convulsions general-
ly occur quite suddenly.  The spasms  arc
violent and intensified,  i.e., of the  kind called
clonic,  and  they, are  attended by complete
unconsciousness.  Most frequently the whole
body is affected, though sometimes only half
of it is so ; and as they pass  away  the  con-
sciousness  does not perfectly  return,   but
stupor,  more or less  complete,  continues.
When the convulsions are partial, conscious-
ness may not be lost.   Such convulsions arc
most common in the later  months of preg-
nancy, and just before labor, and  occur more
frequently in  those in  childbed for the first
time.  The fits usually follow each other in
rapid succession,  and   each one  lasts  from
half an hour to two hours or more, including
the comatose period after each.  By and by
consciousness returns, but there is no knowl-
edge of  what has  occurred in  the  interval.
These  convulsions  are  not unattended  with
danger, and as they not infrequently occur
when no previous appearance of illness has
threatened, they are greatly dreaded by preg-
nant females.
  Nevertheless,  they may  be,  so to  speak,
predicted, and so far  avoided.   Their cause
is  now  known, at  least approximately, and
being known  can be avoided.  The  convul-
sions are generally admitted  to  be due to
renal mischief, most probably setting up al-
buminuria  and  uraemia, and  subsequently
convulsions.   What the kidney mischief may
be is not quite clear.  Sometimes  beyond the
albuminuria which  ordinarily has lasted some
time, there may have been little sign, though
sometimes of  course it  has  been known that 
394       PUERPERAL FEVER
PULMONARY  CONSUMPTION
the woman  has been the subject of kidney
disease before she became pregnant.   Curi-
ously enough, these last are not the most un-
favorable cases, although the kidney mischief
may be greatly aggravated thereby, and ulti-
mately prove fatal.  As far as  the convul-
sions are  concerned,  those are  most fatal
where no previous mischief was known.
  In patients who become the subjects  of
puerperal convulsions there may be signs of
kidney disease beforehand, as swelling  about
the face, and especially below the eyes.   But
something more than this is required  to ac-
count for the convulsions.  It has been sup-
posed by some that the pressure of the en-
larged womb on the veins coming from the
kidneys has  been enough to give rise  to the
uraemia and  the convulsions.  Were that so,
puerperal convulsions ought to be much more
common  than they are ;  but  this,  too,  is
peculiar, that very often the removal of the
fcetus is sufficient to cause their arrest, which
it would not were  they due to uraemia en-
tirely.  If convulsions come on during preg-
nancy, labor commonly begins  too, and the
child is expelled.  If  not, especially toward
the end of pregnancy, it is highly desirable to
evacuate the contents of the uterus, knowing
that this often arrests them should the woman
be  attacked  at a period at which the child
could live.  If labor  has set in, sometimes
the rupturing of the membranes and discharge
of the waters will procure  cessation of the
convulsions.  If they do not cease promptly,
however, no time is to be lost ; the  uterus
must be  emptied, by turning or forceps,  as
the case  may be, and so  both  lives may  be
saved.   Inhalation of choloroform, or a mix-
ture of chloroform and ether, is strongly rec-
ommended by some.
  PUERPERAL FEVER is a continued
and contagious fever occurring in connection
with childbirth.  It comes on within a week
or ten  days  after confinement, and must not
be mistaken for weed or ephemera, which is
a harmless  kind of milk-fever.  Puerperal
fever is a very dangerous  disorder, and it is
one far easier to  prevent than  to cure.   In
some respects  it is allied  to  erysipelas, and
those who have been  attending  such  cases
have at times given puerperal  fever to their
patients.   It is  very important that women
should not go into a large general hospital to
be confined, for it has  been shown over and
over again that in that way many only go in
to die ; and  whereas in the surrounding dis-
tricts no cases may have occurred, yet in a
hospital some  are  sure to  occur, and when
once it has  broken out, it is very difficult to
get rid of it.   It is far better for a woman to
be confined  at home in a dirty  alley than to
go into the most comfortable ward of  a gen-
eral hospital.  Nor are special hospitals  for
women much better in this respect, for the
mere herding of the women together when in
that state is injurious, and if an epidemic of
fever happens to break out it is attended with
dangerous  results.  No one who has been
lately near  a case of scarlet fever, or, in fact,
any fever, or a case  of erysipelas, either  as
doctor or nurse, should go  near a woman in
her confinement, and any  one attending a
puerperal-fever case should not, of course,  go
near another woman in labor.  It is only  by
such strict  rules that you  can prevent the
spread of this fatal disorder.
  Symptoms.—There is headache, with shiv-
ering and rigors ; there; is a diminution of the
supply of milk,  and the usual discharge less-
ens in quantity and even ceases.  The tem-
perature rises ;  the tongue is dry and coated,
and there is much thirst and prostration.  No
spots are, as  a  rule, observable on  the skin,
but in some cases there  may be small pete-
chia?.  The bowels are generally loose, and
the urine is turbid and contains blood or  al-
bumen.   The mind  at first clear,  soon be-
comes clouded, and the  mother will take  no
notice of her  child ; delirium, of a low,  mut-
tering character, comes on, and death takes
place  generally  from  exhaustion  or  syn-
cope.
  Treatment.—Very little can be done when
once the fever is well developed.  The woman
will, of course,  be in bed in a cool,  well-ven-
tilated room,  but without draughts.  The diet
must be light and nourishing, and consist of
milk,  beef-tea,  eggs,  and stimulants as  re-
quired for each  case.  The  bed-hangings
must be removed, and also  any carpet,  etc. ;
these should  be heated in  an oven, so  as to
become disinfected.   Carbolic acid should be
used freely, or chloride of lime may be placed
in saucers  about the  room.  The  patient's
strength must be supported as well as  possi-
ble until the crisis is  passed ;  the treatment
will  be  the  same as  that described  under
typhus.   (See Typhus Fever.)
  PUERPERAL MANIA is a form of  in-
sanity which  comes on after a confinement,
and may sometimes cause the patient to com-
mit suicide.  It is most common in unmar-
ried women,  and it is probably dependent on
the mental distress and anxiety they undergo
in concealing  their  state.    Most cases had
better be removed to  an asylum, as, among
the poor especially, proper nursing cannot be
obtained in these cases.  The mania comes
on within a week or ten days after the labor ;
the milk  ceases, and there is generally  an
aversion for their offspring.  They talk very
wildly, and often use bad  language.   They
may  often hurt themselves unless watched.
Under proper   treatment they generally  re-
cover.   No  lowering  measures  must   be
adopted :  a  nourishing diet,  rest,  a  quiet
room, and moderate stimulation, are the best
for this disorder.  (See Insanity.)
   PULMONARY CONSUMPTION. (Sec
Consumption.) 
PULSE
PUS
395
  PULSE.—If the finger be placed upon an
artery,  such as  that at the wrist,  what  is
known as the pulse may be felt ; this is be-
cause the elastic artery dilates with each beat
of the heart at regular  intervals ;  the pulse
does not quite correspond  to the beat of the
heart in time, but occurs just after it, and the
farther the artery is from the heart the longer
is the interval.   It  follows that the pulse will
be quick or slow, regular or irregular, accord-
ing to the action of  the heart at the time, and
therefore it is useful as a guide in many dis-
eases.  Further, the wall of the artery may
lose its elasticity in old age, or in some cases
of fibrous or atheromatous degeneration, and
then  it  becomes more  rigid and it  is harder
work for the heart to send the blood through
such vessels  ; or, as in some cases  of fever,
etc., the elastic walls may lose their tone and
become relaxed, so that the blood flows faster
through  such vessels, and the  capillaries in
front become fuller  of  blood : this change
takes place  chiefly through the  influence of
the nervous  system.  The  average  rate of a
pulse in  a healthy man is about 75 beats in a
minute.
  PUPIL is the name  given to the  central
aperture in the iris of the eye, by which light
can enter and act upon the retina.  The pupil
dilates in the dark, and contracts by a strong
light.  In man it is circular ; in the  cat it is
oval ; in most animals the iris  is made up of
muscular fibres.   Belladonna  dilates  the
pupil, opium contracts it ;  in most cases  of
debility the pupil is large,  while in  nervous
people it is generally small.  (See Eye.)
  PURGATIVES   are   remedies  whose
special function it is to cause an unloading of
the alimentary canal.   The group  contains
very various members,  some  gentle, some
violent, in their action ;  some acting  mainly
by increasing the motion of the bowel, some
again by increasing its secretion.   Some act
on  one part, some on  another ;  thus aloes
seem to act almost entirely on the great gut,
castor-oil little, if at all,  on it.  Laxatives are
commonly  included  in  the list ; but purga-
tives, strictly speaking, have a wider  action.
Rhubarb, senna, aloes,  and jalap are com-
prehended among ordinary simple purgatives.
More powerful purgatives, also called cathar-
tics, are colocynth,  scammony, castor-oil, and
podophyllin.   Some seem to increase the liq-
uid flow from the bowels.   Most saline sub-
stances are in this group, such as tartrate and
bitartrate of potass, Rochelle salts, phosphate
of soda,  Glauber's  salts (sulphate  of soda),
Epsom  salts (sulphate  of  magnesia), etc.
Many of  these are  combined  with  advan-
tage ; thus jalap and cream of tartar, scam-
mony and the same, rhubarb and magnesia,
senna and sulphate of magnesia, are all fre-
quently given together, the one acting as  an
adjunct to the other's efficacy.  But as many
purgatives, especially the more violent, gripe
severely, or otherwise give rise to unpleasant
effects, it is common to add  to them some
substance to prevent  griping.  These  ad-
juncts are either hot substances, like ginger,
red pepper ;  or aromatic oils, like  pepper-
mint, etc. ; or  they may be sedatives,  like
belladonna, hyoscyamus, etc.
  A few purgatives act specially on the liver,
and  are  called cholagogues ;   chief  among
these are the preparations of mercury, podo-
phyllin, and perhaps taraxacum.  For partic-
ulars with regard to each, see under  the ap-
propriate heading.
  PURPURA is characterized by an erup-
tion of spots called petechiae, or patches called
ecchymoses, which are caused by hemorrhage
into the skin, varying in tint from bright red
to violet.   The small spots are   round, the
larger more irregular in  shape ; they do not
disappear when the finger  is pressed upon
them.  For the first few hours of their ap-
pearance the spots are of a pale pink, and
slightly raised ; they then become level  and
deepen in color, finally becoming orange-col-
ored and yellowish  as they fade away ; while
the old ones disappear, fresh ones  keep com-
ing.  In some  severe cases the hemorrhage
takes place not only into the  skin, but from
the nose and alimentary canal ; blood  may
also appear in the faeces and urine.  In mild
cases there is little  or no disturbance of the
general health ; in severe cases there may be
febrile symptoms, lassitude, and pains in the
limbs.   It occurs in those who live well,  and
it is not produced, like scurvy, from want of
vegetable food ; its cause  is not  known.
Tannin and gallic acid, iron and turpentine,
have been  given in this disease, and gener-
ally with good effect.  Petechial  spots  may
occur in the course of typhus fever and some
other diseases,  but these must not  be  con-
founded with purpura.
  PURPURIC FEVER is a term  used to
designate those fevers in which the eruption
assumes a deep purple color, and which  does
not disappear  on pressure ; it used to  be  a
synonym for typhus fever, but it also may be
used  in  cases  of malignant scarlet fever or
small-pox when the rash is petechial ;  such
cases are nearly always rapidly  fatal,  and
marked  by great prostration  and bleeding
from the organs.   (See Malignant  Dis-
eases.)
  PUS is a term  applied to the fluid  con-
tained in abscesses, and discharged from the
surfaces  of ulcers  and  granulating wounds.
Healthy  pus is of  a white or  pale  yellow
color,  of  creamy   consistence,   free  from
smell, and chemically neutral, being neither
acid nor alkaline.   Its usual specific grav-
ity  is about 1.030.   If  left standing for some
time in a high vessel it separates  into a thin
upper layer of  transparent fluid  and a thick
and opaque yellow deposit.  The  fluid layes
is composed of water, albumen, salts, chiefly 
396
PUSTULES
PYEMIA
chloride of sodium, fatty acids, and extractive
matter.  The deposit is almost  entirely com-
posed of pus-corpuscles or globules, which are
minute spherical  vesicles  measuring from
i-500oth to i-2oooth of an  inch in diameter.
Within these globules are contained three or
four small dark bodies, called  nuclei, and a
number of very minute granules.   If a drop
of acetic acid be added to  a specimen of pus
pi iced under  the  microscope,  the granules
will be seen to disappear  and the nuclei to
become more distinct.   If water be added in-
stead of acetic acid, the globules  swell  and
become less opaque.  These bodies are iden-
tical with bodies existing in the blood which
are called white corpuscles, in contradistinc-
tion to the more numerous  and darker bodies
known as the red-blood corpuscles.  There is
also a close resemblance between pus-globules
and the corpuscular bodies existing in chyle
and lymph. In foul and unhealthy ulcers the
discharge does not consist  of inodorous pus,
but of a thin foetid and dirty fluid, called ichor
or ichorous pus.   When mixed with blood,
pus is  said  to  be  sanguineous pus, or muco-
purulent discharge ; it-is a mixture of healthy
pus  and of an  increased  secretion  from a
mucous  membrane.  This fluid is observed
especially in diseases of the air-passages and
of the lining membrane of the bladder.
  PUSTULES are prominences formed on
the surface of the skin  in some diseases ;  the
epithelium of  the skin is raised, and beneath
is some pus or matter.  It is found in cases
of small-pox, ecthyma, impetigo, and in some
kinds  of acne. When pricked,  the matter
exudes, and the pustule may dry up and heal,
forming a scab, which  falls off in a few days.
  PUTRID FEVER is  a  term  formerly
used- for cases of  typhus  fever ;  it is now
occasionally used to designate very bad forms
of  scarlet or  typhus   fever  or  small-pox,
when those diseases  have assumed  a very
malignant form,  and  are accompanied  by
purple spots on the body which do not disap-
pear on pressure.
  PYJGMIA  is a disease with well marked
constitutional  and local symptoms which is
supp'osed to be due  to the introduction into
the system of pus or the constituents of pus.
It is closely allied to  septicaemia, puerperal
fever,  and erysipelas,  and  is often connected
with inflammation of  one or more  veins.
Some few cases of this disease have been  re-
ported in which the patients were quite  free
at the time of the attack from wound or sore ;
but  usually the pyaemic symptoms  follow a
severe  injury  or  a surgical operation,  or
occur  in the course of some chronic suppu-
rative  affection.  Pyaemia often results from
compound fractures and operations  on   the
bones, especially  amputations, and is one if
not the  chief  of the causes  of death in the
surgical  wards of  large city hospitals.  The
constitutional or general symptoms of pyaemia
resemble those of typhoid fever ;   the local
symptoms  consist  in  the  formation of ab-
scesses  in  the  liver, lungs, and joints,  and
occasionally  in haemorrhagic  and  pustular
affections of  the skin.   The following is the
usual history of a case  of pyaemia following a
severe  compound  fracture:   About  the
seventh or tenth day after the injury the pa-
tient has a severe  attack of shivering, which
is followed by intense  fever, headache,  and,
perhaps, vomiting.  The pulse  then becomes
frequent, and the bodily temperature increases
from 990 to 1030 or 104°.   These  symptoms
persist,  and the patient becomes restless and
at  times delirious.   The attacks of shivering
are frequently renewed, and in the intervals
there is profuse perspiration.   The tongue
is dry and brown, and  there is a peculiar sal-
low or tawny appearance of the skin over the
whole  body.   The  patient  becomes much
emaciated, very prostrate,  and finally sinks
from  extreme exhaustion on  about  the  fif-
teenth or twentieth day after the injury.   The
local symptoms presented in connection, with
this typhoid condition are painful swelling of
one  or more  joints, pain in the region of the
loin, shortness of breath, cough, and persist-
ent  expectoration, irregular patches  of  a
bright red color scattered over the  skin, espe-
cially near the joints,  small pustules on the
skin somewhat resembling those of  small-pox.
The  first  symptom   indicates suppuration
within the affected joints, and the chest symp-
toms, inflammation of  pleurae and  lower por-
tion of  the lungs,  with  formation  of small
pulmonary abscesses.    Suppuration in the
liver is  indicated  by  pain  and swelling on
right side of abdomen, and by jaundice.
  The following are the predisposing causes of
this disease :  exhaustion from  a long previ-
ous  illness, as dysentery or fever, and from
deprivation of  food ; organic disease of kid-
neys ; profuse hemorrhage during  or after an
operation ; unhealthy  employment and  resi-
dence in foul and  badly ventilated quarters ;
chronic  alcoholism, and intemperance both in
eating  and drinking.   The  most  frequent
predisposing causes are  impure air, such as
is  contained  in overcrowded surgical wards
of a large hospital, and neglect of the patient's
wounds leading to the accumulation of decom-
posing and putrid material about the raw sur-
faces.   The duration of  an attack of pyaemia
varies much in different cases.  Death  may
occur on the third or fourth day, or the symp-
toms may continue for a month or six weeks,
and then terminate fatally.  In acute pyaemia
death most commonly takes  place between
the seventh and tenth  days. Cases are some-
times met with in  which  the pyaemic symp-
toms are slight, and are prolonged for a period
of three or four months, or even longer.   To
this  form  has been  given  the  name of
chronic pyaemia.   Pyaemia is  a  very grave
affection, and when acute and associated with 
PYELITIS
QUININE            397
frequently repeated chills and mischief in the
lungs, is, in almost all, if not all cases, rapidly
fatal.   Indeed, recovery from  any  form of
pyaemia is a very rare occurrence.
  Treatment.—The  treatment  of  pyaemia,
like that of other acute and exhausting dis-
eases of a typhoid character,  usually consists
in the free administration of alcoholic stimu-
lants  and  concentrated   fluid  nutriment.
Quinine in large  doses  seems in some  cases
to do good.   Strict attention should  be paid
to the  nursing of the patient, who is gener-
ally quite helpless.  The room should be well'
ventilated,  and  freed of carpet and all un-
necessary articles of  furniture.  Some disin-
fectant   solution  should   frequently   be
sprinkled over the floor, and care be taken to
remove and disinfect at once soiled sheets and
bed-clothing, and to  burn the  dressings at
every change.
  PYELITIS, is a technical  term applied to
a disease of  the  kidney, in which there is a
formation of  pus in that organ or in the
ureter.
  PYLORUS is the  name given to  the end
of the stomach which is directed to the  right
side.  (See Stomach.)
  PYRETHRUM.  (See Peli.itory )
  PYREXIA is a technical term for fever, or
the febrile condition ; it is present whenever
   QUARTAN AGUE is said to occur when
 the fever comes on every third day, as is de-
 scribed  in  the article  on  Intermittent
 Fever.
   QUASSIA is the wood of a tree growing
 in the West Indies, termed  Picrcena excelsa.
 It arrives in logs or billets, is grayish-brown
 externally,  and light yellow internally.  The
 wood  is  tough, but not very heavy, and is
 usually sold as  chips.   Sometimes drinking-
 vessels,  carved out of the wood, are sold.
 These are  to  be  filled  with  water  at night,
 allowed to stand till morning, when  the con-
 tents are consumed.  The quassia  wood is
 intensely bitter, and yields its bitterness very
 readily to water.  Its preparations are an ex-
 tract, a tincture, and an  infusion.  Of these,
 the  infusion  is mainly used, chiefly  as a
 vehicle, for which it commends itself, being
one of the very few bitters which contain no
tannin, and so does not blacken with iron.
Quassia is a pure bitter,  but not an agreeable
one.  It is  used sometimes  in  indigestion,
but calumba has there mostly superseded it.
In indigestion, with loss of power and irrita-
bility of ihe stomach,  it may well be given
along with either an acid or an alkali, accord-
ing to  the period of digestion.   Sometimes,
but rarely, it has been used  as an  antiperi-
odic ; in this  way  it seems  to  be devoid of
efficacy.   It is  probably most  useful com-
the temperature of the body is above 990
Fahr. ; it is generally associated with head-
ache, furred  tongue,  quick pulse, hot  skin,
and  high-colored urine,  with a feeling  of
fatigue and lassitude.  Besides  being met
with in  what are ordinarily called  fevers,
pyrexia is found in all cases of inflammation,
in acute rheumatism, catarrh, etc.
  PYROLIGNEOUS ACID.   (See Acetic
Acid.)
  PYROSIS, also known as water-brash, has
been by some employed to signify heartburn
with or without  eructations of sour  burning
fluid.  The term gastralgia is, however, com-
monly employed  to  signify  heartburn, pure
and  simple ;  pyrosis, the acid  eructations
which  commonly accompany it.  As  to the
causation of  pyrosis, see Indigestion.  Its
remedies  must be considered with reference
to the various sources of its production.  In
a goodly number of cases it is due to  fermen-
tation of the food ; if so, sulphurous acid will
be found  to give relief.  In  some cases  an
alkaline stimulant, like aromatic spirit of am-
monia,  is the  best   thing  for   momentary
relief.
  PYTHOGENIC FEVER is a term sy-
nonymous with typhoid fever  ; it is not, how-
ever, a word in common use.  (See Typhoid
Fever.)
bined with a preparation of  iron and an acid
in recovery from prostrating illness.
  QUICKLIME.  (See Disinfectants.)
  QUICKSILVER.  (See  Mercury.)
  QUININE is the most important constit-
uent of cinchona bark,  and has now, to a
very great extent, superseded  the crude sub-
stance as  a remedy.   Pure  quinine  is not
employed in medicine,being quite insoluble in
water; but the sulphate takes its place.  There
are other alkaloids contained  in these  barks,
especially cinchonine, and  the relative pro-
portions of these vary in certain kinds, cin-
chonine being more abundant than quinine.
The bark  known as  calisaya bark is that
which  contains  most quinine.   Sulphate  of
quinine is   snow-white and crystalline, the
crystals  being  feathery.  It  possesses the
curious property of fluorescence, i. e., certain
rays of light ialling in a solution of quinine,
though themselves invisible, cause  the solu-
tion to yield light.  The salt is neutral, and
requires an acid to dissolve it in  water if a
solution of any strength is to be made.
  The effects of quinine are manifold. Ap-
plied  to the white corpuscles of the  blood,
and all bodies  resembling  them,   it arrests
their motion, and apparently  kills  them ; it
also, within certain limits, arrests  putrefac-
tion even  more powerfully than  creasote.
On the digestive  tract  quinine acts  as  do 
398              QUINSY
QUINSY
most  other bitters ; it  gives  rise to an  in-
creased flow of mucus, and to  a small ex-
tent also that of the gastric juice.  Especially
will it be serviceable to arrest the putrefac-
tive changes in food which has been retained
in the  stomach  without being digested,  and
so gives rise  tu flatulence, acidity, etc.  Qui-
nine, after being swallowed, passes into the
blood,  and in great measure is evacuated by
the kidneys, almost unchanged.
  The  effect of quinine on the sense of hear-
ing is  peculiar.  If taken in large doses, it
speedily gives rise to noises in the head, sing-
ing in the  ears,  and  sometimes deafness ,
sight, too,  may  become dim, or even  blind-
ness for a time ensue ;  headache is also pro-
duced, frontal in site and severe in character ;
generally  the  pain is  of  a dull heavy kind,
the face is  flushed and  hot, and the eyes suf-
fused.  These effects of large doses of  qui-
nine go by the name of cinchonism.  More-
over, in large doses, quinine  has the power
of markedly reducing  temperature ; for  this
reason it  has  been largely given in  acute
rheumatism,  pyaemia,  and  some forms of
fever.  Sometimes quinine in these cases has
been given in enormous doses,  20 grains,
frequently  repeated, being  not  uncommon.
It is true that in these  cases the temperature
has sometimes been reduced, but the patient
has died  all the same.   The most important
use of  quinine seems to be in malarious
fevers, remittent or intermittent.  The best
plan of giving  the remedy in these diseases
seems to be to  wait for a remission, then to
give a full  dose, at least 5 or  10 grains,  and
keep up the effect by  an hourly administra-
tion of the remedy thereafter ; is grains  will
generally  suffice as a dose for this purpose,
but to arrest the  paroxysm it  is best to give
a  much larger quantity.  Certain forms of
neuralgia, of a distinctly  remittent type, are
best treated by quinine. A large dose should
be given  just before the expected attack ; 5
or 10 grains should suffice.  Even ordinary
neuralgias  are frequently  benefited by  doses
of  quinine given  during an  intermission.
Quinine  is commonly  prescribed in most
forms of convalescence from acute disease.  It
is then ordinarily given in a dose of 1  or 2
grains  dissolved in water or orange wine by
a few drops of dilute sulphuric acid.   In this
way it  is  of undoubted  service.
  QUINSY is a common and  troublesome
affection, consisting of inflammation of the
tonsils and adjacent parts of the fauces or
back part of the mouth.  It may  occur at any
age, but it  is most common in young people ;
and when once any one has been subject to it,
it is very likely to recur on exposure to cold,
so  that some  have an attack  every year.
Although  painful  at the time, no  serious re-
sults may  be  anticipated, as  it is a disease
which is very amenable to treatment.
  Symptoms.—The patient feels out of sorts
after exposure to wet or cold ; he has a stiff
and painful feeling in the throat ;  the tongue
becomes furred and white ; the appetite  is
bad ;  there is often headache and pains in the
limbs ; the temperature rises rapidly, and all
the symptoms of a fever come on.  The ton-
sils enlarge, so that the act of swallowing is
made with difficulty, and the tonsils may be
so large as almost to meet in the middle line,
and quite prevent any solid food being taken ;
at the same  time there is swelling outside,
just below the ear, which is painful on press-
ure.   The enlarged  tonsils may become full
of pus, and when they  burst they discharge
much matter, and give at once much relief.
The febrile symptoms  last four or five days,
and then pretty quickly subside ;  in  most
cases  the inflammation  goes  away without
the formation of any matter ; generally, also,
one side  is more affected than the other.
  Treatment.—The patient should  at  once
go to  bed, or at least keep in  a room with a
moist and warm atmosphere ; any attempt
to go  out in the air only increases the mal-
ady, and makes the throat more sore than be-
fore.  No solid food can be taken, and there-
fore  beef-tea,  hot milk, and soups must be
given, and the  thinner  the fluid the more
easily is it swallowed.  Port wine is  very
valuable, and three or four glasses should be
taken every day, and  will be found  to give
great  relief.  Steam should be frequently in-
haled by placing the mouth over a jug full of
boiling  water, but not  over the mouth of a
kettle, as the patient's mouth may be scalded.
Gargles are of no use, as they do not go far
enough  back,  and  the  effort  of  gargling is
distressing to the patient.  A hot bran or lin-
seed-meal  poultice  should be placed  round
the throat at night,  while during the day hot
flannels should be worn.  Sponging the out-
side  of  the throat with hot water will give
great  relief ; the inside  of the throat may be
sponged  with some astringent lotion,as tannic
acid or iron and glycerine, by which  it; may
be kept  constantly  moist.  A mixture con-
taining chlorate of  potass and bark  is most
useful in this affection,  and it should  be con-
tinued for some time  until convalescence is
established.  Puncturing the  tonsils with a
small and narrow knife is very useful, even if
it does not cause matter to escape.  In some
cases a leech or two behind or below the ear
is useful, but  blisters  do no  good.  People
who are  liable to quinsy should be very care-
ful to avoid,  as far as  possible,  foggy and
damp weather,  as  the disease  is then very
liable to  recur.  This affection might at first
be mistaken for scarlet fever ; but the  fever
lasts for a shorter time, and there is no rash,
nor is it followed by dropsy  or swelling  of
the glands.   In diphtheria there is less fever.
but much  more prostration,  while a mem- 
QUOTIDIAN AGUE
RAILWAY INJURIES     399
brane forms over the nostrils  and a fatal re
suit often happens.   (See Sore Throat.)
  QUOTLDIAN AGUE is said to  occur
when the fever comes on every day, although
it may not come on exactly at the same hour.
(See Intermittent Fever.)
R.
   RABIES.  (See Hydrophobia.)
   RADIUS  is a  name  given to one of the
 bones of the  forearm.
   RAILWAY INJURIES are of a some-
 what peculiar nature,  irrespectively of  such
 forms of  accidents  as are mentioned  else-
 where,  such  as fractures  and dislocations.
 These injuries consist  of concussions of the
 spine and spinal cord,  and from  the frequent
 absence of outward signs, and the obscurity
 of the early symptoms, are of a very insidi-
 ous character, and  their diagnosis is of the
 utmost importance to a medical man, as they
 so frequently are the sources of medico-legal
 inquiry.  A  well-known  author, speaking of
 this class of injury,  says : " That in no ordi-
 nary accident can  the  shock be so great as
 those that occur on  railways.   The rapidity
 of the movement, the momentum of the per-
 son injured,  the suddenness of its arrest, the
 helplessness  of the sufferers, and the natural
 perturbation of mind that  must disturb the
 bravest, are all circumstances that of a neces-
 sity greatly increase the severity of the result-
 ing  injury to the nervous  system, and that
 justly cause these cases to  be  considered as
 somewhat exceptional from  ordinary acci-
 dents.   This has actually led some surgeons
 to designate  that  peculiar affection of  the
 spine that is met with  in these cases as the
 ' Railway Spine.'   Injuries of the spine and
 spinal  cord have been already treated of gen-
 erally, and it is hardly to the  purpose to recon-
 sider them specially in  reference to the sub-
 ject in hand,  and we shall therefore pass on
 to such matters as relate to those cases where
 the fact of injury sustained  on  a railway has
 been the cause of litigation."  Concussion of
 the spine from a direct and severe injury to
 the  back may  terminate, according to  the
 same authority, in four  ways :  1.  In  com-
 plete recovery, after a longer or shorter time.
 2. In incomplete recovery.  3.  In permanent
 disease of the  spinal  cord and  its mem-
 branes.  4. In death.  It is a  very remark-
 able circumstance  that, although the patient
 has  apparently sustained in many cases a
 very trifling injury, the result  is widely dis-
 proportionate, the reason of  this being that the
 symptoms  indicative of  concussion of  the
 spine and of the subsequent irritation and in-
 flammation of the cord and its  membranes
are so slowly progressive.  A patient is often
 quite unaware that anything serious has hap-
 pened, feeling perhaps  only violently jolted,
and a little giddy or confused.  After a while,
however,  when he  has reached home,  the
effects of his  apparently simple injury begin
 to declare themselves.  " A revulsion of feel-
 ing takes place ; he bursts  into tears and be-
 comes unusually talkative,  and is excited ; he
 cannot sleep, or if he does, he wakes up sud-
 denly with a vague sense of alarm. The next
 day he complains of feeling shaken or bruised
 all over, as if he had been beaten or  had vio-
 lently strained himself by exertion of an un-
 usual kind.  This stiff, strained feeling chiefly
 affects  the  muscles of the back  and loins,
 sometimes extending to those of the shoulders
 and thighs.  After a time, which varies  much
 in different cases, from  a  day or two to a
 week or more, he finds that he is unfit for ex-
 ertion and unable to attend to business.'' Such
 is generally the early history of a case of rail-
 way  concussion.    Sometimes  the  serious
 symptoms begin to develop immediately after
 the receipt of the  injury, and in  some  cases
 not till long afterward, and most marked and
 distinct changes are visible in the countenance;
 the state of the memory, the thoughts become
 confused, all business aptitude is lost, the
 temper becomes irritable, the sleep disturbed,
 restless, and broken ; there are often loud
 and incessant noises in the head, the vision
 is frequently affected  in  various  ways, the
 hearing, taste, smell, and the sense of  touch
 become  perverted ;  the sense of speech  is
 rarely  affected,  and usually the attitude of
 those afflicted is peculiar.   There is a loss of
 freedom in the efforts of motion or movement,
 and  the individual appears afraid to  make
 such efforts ; the gait  again is very charac-
 teristic : he walks  unsteadily, and  in a strad-
 dling manner ;  the power of walking is very
 limited, and he  is unable to ride ; the nervous
 power  of the  limbs will  be  found  to , be
 affected ;  sensation  and  motion, or   both,
 may be impaired.   Coldness of one of the
 extremities, owing to loss  of nervous  power
 and defective nutrition, is often noticed. The
 prognosis in these cases is  very unfavorable,
 and patients have never been  known  to re-
 cover,  completely and entirely, so as to be  in
 the same state of health  as before the acci-
 dent.
  Treatment.—With regard to the treatment
 of concussion of the spine brought on by such
 injuries, the first thing obviously is complete
 rest, and the patient should be compelled to
 lie on  a prone couch, and  the mind must be
 kept as  much as  possible  at  rest also ; ice-
 bags over the injured  part of the spine ; in-
 ternally the bichloride  of mercury in  quinine
 or bark ; nux vomica, strychnine.and iron are
all of great value in certain  cases.  Salt-water
douches  to  the spine, and galvanism, are 
400              RAIN

recommended in some instances.   The great
thing to be  done is to endeavor  to improve
the general health, and " prevent the devel-
opment,  if  possible, of secondary diseases,
such as phthisis, dependent on mal nutrition,
and a generally broken state of the health."
  RAIN.—When, by the condensation of the
aqueous  vapor which forms the clouds, the
individual  vesicles unite,  so as to  become
larger and heavier, they form regular drops,
which  come down as rain.   The amount of
rain which  falls  in any given  place is meas-
ured by a rain-gauge or pluviometer.   This
consists of a cylindrical vessel, with a funnel-
shaped lid,  at the bottom of which is a small
hole, through  which  the  rain  falls.   A glass
tube by the side of and in communication
with the bottom of the vessel is marked with
a scale, so  as to show the quantity of  rain
which has fallen.  When rain falls  through
moist air, the  drops  will, from their temper-
ature,  condense the  vapor  and  increase in
volume ; when, on the other hand, they  trav-
erse dry air, they tend to evaporate and lose
in bulk.  As a rule, most  rain falls in hot
climates, as there evaporation is  most abun
dant. In London the rainfall is 23.5 inches in
a year, at Bordeaux it is 25.8, at Madeira  it
is   27.7, at Havana  it  is  91.2,  and at St.
Domingo it is 107.6  inches.   The quantity,
however, varies with  the seasons.  An inch
depth of  rain on a square yard represents a
fall of 46.74 pounds, or d.67 gallons of water.
On an  acre it corresponds to 22,622  gallons,
or rather more than  100 tons.
  RAMOLLISSEMENT  is a technical
term for softening of the brain. It is de-
scribed under  Cerebral  Softening.
  RANULA  is a tumor situated below the
tongue, bluish in color, translucent, and cys-
tic in character.   It sometimes attains such a
size as to displace  the tongue and impede its
movements, causing  serious  inconvenience
in mastication, deglutition, and articulation.
It may be caused  either by obstruction of a
salivary duct 01  by the occlusion and dilata-
tion of a mucous cyst, or dilatation of a bursa
mucosa said to exist on the outer surface of
the genio-hyoglossus muscle ;  or  it may be a
new growth of itself, a myxomatous cyst.   It
may be healed by simple incision, or by cut-
ting out a portion and evacuating  the  con-
tents,  and  to prevent premature closing  a
strip of  lint  should  be  introduced ; or fre-
quently the  introduction of a seton  suffices.
In  the  case  of cysts containing  a  thick
putty-like material, the cyst wall must be dis-
sected  out entire.  The injection  of iodine is
sometimes  followed with good results.   The
contents of the cyst are gummy or albuminous
in character, containing simple round mucous
globules as their  only  structural  element.
Occasionally phosphatic  concretions are met
with.
   RATTLE is  a term applied to a  noise  in
                RECTUM

the throat caused by the  air passing through
the mucus in the air-passages ; it  often  pre-
cedes death.
  RECTIFIED SPIRIT is, in reality, alco-
hol with 16  per  cent of water ; its  specific
gravity is .838 ; it  burns with  a blue flame,
without smoke, producing carbonic acid and
water.  From  this fluid,  by  removing the
water by carbonate of potash, absolute alco-
hol may be obtained ; by adding water until
the specific gravity  of the fluid  is .920, proof
spirit is formed.  (See Proof Spirit.)
  RECTUM is the lower portion of the large
intestine, about eight  inches  in length, and
largest  in capacity just  above the anus.  It
commences opposite the  left sacro-iliac artic-
ulation, it descends obliquely toward the mid-
dle line as far as the lower end of the sacrum,
then it bends  downward toward  the peri-
naeum, and turning downward  terminates  in
the anus.  The chief diseases  to which the
rectum is liable are :
  Abscess.—Some young  weakly persons are
subject to  the formation  of abscess in the
areolar tissue, outside the rectum, and some-
times the collection of matter is situated at a
considerable  depth, as is shown  by the tense-
ness and pain at the verge, with considerable
difficulty in passing motions or making water ;
the abscesses usually  " point" at the  margin
of the anus,  and should  be opened at once,
in order to prevent the formation of fistula.
As the general health is  very low  in a  con-
stitution in which  such  collection  of matter
forms, the greatest attention must be paid  to
its  improvement, and this state of things  is
not unfrequently associated with phthisis.
  Fistula.—By the term fistula is meant a
sinuous passage by the side of the rectum, the
result of abscess, opening at the nates, some-
times not having any communication with the
gut (Blind External Fistula), sometimes com-
municating with it, without, however, having
any external  orifice (Blind Internal Fistula).
In some cases the internal and external aper-
tures communicate, in which case  the fistula
is termed complete.  These fistulac are pre-
vented from  healing by the passage of fecu-
lent matters  along  them, and by the contin-
uous state of motion of  the part, caused by
the action of the sphincter ani  muscle, and,
moreover,  from  their inability to contract.
Of all the forms above mentioned, the  com-
plete  is the most common  and the  most
annoying, owing to the great pain and irrita-
tion it causes, and  on account of the almost
constant passing  of faecal mucus  or flatus
along  it.   The internal  opening is  usually
about an inch and  a half from the anus, and
is to be felt as a small papilla, always within
reach of the  finger.  Fistula is frequently co-
existent with phthisis, probably due to tuber-
cular inflammation of the rectum.  The  treat-
ment of anal fistula is comparatively simple,
and it consists in freely laying open the  track 
                 RECTUM

 or tracks, and dividing the sphincter ani, al-
 lowing it to heal up from below.  Before the
 operation, the bowels must be well evacuated.
 In the case of either blind external or blind
 internal fiustulae they must be reduced  to the
 complete form, i.e., an external and internal
 opening  must be  made, by passing a probe
 throughout the tract.   After the operation
 a good opiate is to be  administered, to allay
 pain, and to prevent the action of  the bowels.
 At the end of the third  or fourth day a slight
 aperient should be  given, and care taken sub-
 sequently to prevent the too early closing of
 the wound.   The  operation  should not be
 undertaken in advanced cases of  pulmonary
 phthisis, as the wound in all probability would
 not heal  up,  and  the  pulmonary  symp-
 toms will be aggravated from the fact of
 closing up the outlet of  the purulent and other
 discharges.   However, from the great irrita-
 tion or pain  with  which such a condition is
 sometimes attended, as an  obvious  means of
 relief, the operation is  justifiable.
   Fissure.—Fissures   are  small  chaps  or
 cracks, forming,  just  inside the rectum in
 the mucous  membrane, and usually situated
 at the posterior part.  The affection  is almost
 invariably connected   with dyspepsia.   The
 pain is most excruciating on passing a motion,
 or on any attempt to make an  examination,
 the patient shrinking away, even at  the mere
 approach of the  finger.  A slight operation,
 that of dividing the fissured track with a  bis-
 toury, is all that is  necessary, and  subsequent
 attention to diet and the general health.
   Hcemorrhoids  or Piles are fully treated of
 under. H/EMORrhoids.
   Prolapsus.—By prolapsus is meant the pro-
 trusion of the bowel  at the  anus.   It may
 occur at any age, although complete  prolapse
 is met  with  at the extremes of  age.  It is
 caused  by a want of tone  of the sphincter,
 constipation, or straining, ascarides,  stricture,
 or stone  in  the bladder.   In children,  the
 bowel, after  being  replaced, should be pre-
 vented from  falling again by applying abroad
 pad of lint, and drawing the buttocks firmly
 together with a broad strip of adhesive plas-
 ter,  and children should be  made to pass
 motions lying down.   Bark,  steel,  quinine,
 and cod-liver oil to be  given, and  the parts
 douched after each motion  with cold water.
 In ail cases care must  be taken to  prevent
 constipation ; and astringent injections, such
 as alum, rhatany, or perchloride of iron, with
 suppositories of tannic acid and cocoa butter,
 are very useful.  Medical treatment failing,
 a surgical operation ought to be resorted to.
   Stricture.—Stricture  or contraction  of  the
 walls of the rectum  is dependent upon organic
 or maligant  disease, or in some cases  there
 is  a spasmodic stricture, which, however,  is a
cpncomitant  of some pre-existing condition,
such as piles or ulceration of the mucous coat.
Stricture is rarely  beyond the reach of  the
               RED  POPPY           401

 finger, and  the leading symptom of its exist-
 ence is the fact of the motions, if solid, pass-
 ing as pellets or in small pieces, and if fluid,
 being ejected  as by a squirt.  The treatment
 consists in keeping the bowels  gently open,
 and  in the careful use of a bougie  as directed
 by a  medical  attendant.   In  severe cases
 operation is necessary.   The stricture  pro-
 duced  by malignant disease (scirrhous cancer,
 generally), is of course only to be treated by
 palliation.  (See  Cancer.)
   Irritable Rectum. Pruritus.—Itching of the
 anus is  a very  common  and  troublesome
 affection,generally connected with some irreg-
 ular state of the lining mucous membrane of
 the  rectum,  as for  instance  ascarides,  but
 very often  its cause  may be urethral stric-
 ture (see  Stricture), stone in  the bladder,
 and  in elderly men enlargement of the pros-
 tate  or the existence  of piles, and it is occa-
 sionally due to pediculi.  The treatment most
 successful is the  internal  administration of
 tar in  form  of pill, arsenic, or confection of
 pepper ;  locally, tobacco-water enema, a mild
 mercurial ointment such as calomel and  gly-
 cerine ; cold bathing and plenty of exercise,
 and  avoidance  of spirits, coffee, and highly
 seasoned food.
   Bleeding from   Rectum.     (See HAEMOR-
 RHAGE.)
   Foreign Bodies  in  Rectum.  (See Foreign
 Bodies.)
   RECURRENT TUMORS is a term used
 when a tumor returns  after removal.   (See
 Tumors.)
   RED GUM, or Strophulus, is a  simple
 form of skin eruption  which occurs in infants.
 It may come very soon after birth, and gen-
 erally within the first  year of life  ; it  occurs
 in those which have a delicate skin, and are
 of a  scrofulous habit.   This eruption is much
 allied to eczema,  nor is it uncommon  to find
 red gum on the body and eczema on the head.
 The  disorder  is  a very harmless one,  and
 may be brought out by any local irritation, as
 worms, improper diet,  teething,  etc.   The
 rash is best marked on the back, where it ap-
 pears in profusion as a number of  minute red
 papules, attended by a trifling itching ; some-
 times  the rash may come  on  all over the
 body.  It is a disease of no practical impor-
 tance, and may be treated  by giving a very
 simple diet,  consisting of milk  or milk  and
 lime-water,  without thickening  the food at
 all.  A little rhubarb and magnesia, so as to
 act as  a gentle purgative, should be  given.
 Bathing the  skin with tepid water is very  use-
 ful, and if persisted in, zinc ointment should
 be applied to the  affected part.
  RED POPPY, Papaver Rhceas, though used
 in medicine, can hardly be spoken  of as a
substance of  medicinal  importance.    The
 petals, which are  well known,  are  of a bright
red  color, becoming  dull  red  on  drying.
These petals are gradually added  to boiling 
402      RED PRECIPITATE
RELAPSING FEVER
 water, and the whole allowed to macerate for
 about twelve hours.   After this the liquid is
 strained off and mixed with sugar, the whole
 forming a preparation known as syrup of red
 poppies.   This preparation must not be con-
 founded with the syrup of  poppies,  which is
 much more active. The syrup of red poppies
 is only used for its bright color, which makes
 the medicines with which it is  mixed  look
 agreeable, if they do not taste so.
   RED PRECIPITATE. (See Mercury.)
   REFRIGERANTS  are  what we com-
 monly call cooling medicines.  They include
 saline and acid substances, some  of them
 powerful,  some of them weak.  Refrigerants
 are at least of two kinds ; some have actually
 the power to diminish temperature, some only
 seem  to allay thirst.  Those which can dimin-
 ish temperature  are saline substances, given
 while dissolving.  Some of these, as  is well
 known, possess a power of diminishing tem-
 perature sufficient to  freeze  water.   Others
 again, like acid  fruits, seem  only to possess
 refrigerant powers  by allaying  thirst, for a
 dry parched mouth is one of  the most prom-
 inent  indications of fever, and this being re-
 lieved there is often a belief that the bodily
 temperature is actually lessened.  Of the salts
 which possess the power of diminishing tem-
 perature when dissolving,  saltpetre may be
 taken as a type, though there are  many others
 which are  never given internally.  The juice
 of grapes, oranges, and  lemons, with  the
 acids they yield—viz., tartaric and citric—are
 also useful, mainly, as  already pointed out,
 in relieving thirst and moistening the parched
 mouth.
   RELAPSING FEVER, or FAMINE
 FEVER, is a contagious disease  which is
 chiefly met with in the form of an epidemic in
 periods of scarcity and famine.   It is charac-
 terized by a very sudden attack of shivering
 or rigors ; a quick,  full pulse ; white, moist
 tongue,    afterward  becoming  yellow  or
 brown ; pain at  the pit of the stomach and
 vomiting ;  an enlarged  liver and  spleen  ;
 constipation of the bowels ; hot and dry skin  ;
 no marked rash  on the skin ;  high-colored
 urine  and pain  in the limbs,  with  severe
 headache ; restlessness and often delirium  ;
 then comes an abrupt cessation of the symp-
 toms, on or about the seventh day, generally
 accompanied by copious perspiration.  The
 febrile symptoms are then absent completely
 for a  few  days,  the tongue  becomes clean,
 the appetite returns, and the patient can often
 get up and walk about.  Then comes the re-
 lapse, on  or about  the fourteenth  day from
 the commencement of the fever, running a
 similar course to the first attack, but shorter
 in duration, and generally  terminating about
 the third or fourth day of the relapse ; recov-
' ery generally ensues then, but there may be a
 second, third, or even a fourth or fifth relapse
 in some cases.
  Causes.—Age seems to have very little in-
fluence in this disorder ; it attacks alike young
and  old, while typhus affects  older people.
Sex has very little influence in predisposing
to this disease ; of 4917 collected cases, 2541
were males, while 2376 were  females.  The
season of the year exerts very little influence
on it ; typhoid fever is most prevalent in  the
autumn, and typhus fever during  and toward
the end of winter.   No occupation seems to
have a predisposing influence, but it is always
most common among those who are idle and
have a precarious living.  Overcrowding and
destitution  favor the propagation of relapsing
fever ; those who are exposed to cold and
wet,  to  intemperance, mental and bodily
fatigue,  depression of spirits, etc., are thereby
endered more  liable than  others to catch the
fever.   Relapsing fever is  certainly conta-
gious ; actual contact is not necessary, for the
poison may be conveyed through the air from
one person to  another.  Starvation and desti-
tution are the two conditions which most of
all tend to produce  the disease ; from the
records  of the London Fever Hospital since
1847,  430 or 97.5  per cent of the patients ad-
mitted were paid for by the parish authorities,
and  were  totally  destitute ; all   were very
poor, and  not a  single  patient had been a
servant  in a private family.  A large propor-
tion of them had  been literally starving  for
some time previous.   The disease can hardly
be  mistaken  for any other ; it is chiefly
known  by its  sudden onset ; the  severity of
its symptoms  during  the  first week  ; the ab-
sence of a rash and the  sudden cessation of
all symptoms, followed  in a few days by a
second or even third relapse.  Although most
cases recover with only one or  two relapses,
yet they are left for some time in a very weak
condition, and are liable to bronchitis and a
peculiar form of ophthalmia.  The mortality
from this fever is but slight, not»being more
than 1 in 21 cases.  Most of the  fatal cases
die suddenly from syncope, or  failure of the
heart's  action, or  from  suppression of the
urine followed by coma.
  Treatment.—The  best  treatment to  be
adopted is that which consists in placing the
patient  in  a large well-ventilated room ; in
promoting cleanliness, and in giving milk and
other nourishing diet, such as has been de-
scribed  in the  article on Fevers.  At the com-
mencement of the attack the bowels should
be opened, if  required, by a purgative ; the
skin should be frequently sponged with tepid
water, but only one part of the body should
be exposed at  a time so as not to  causca chill
to the surface. The vital powers must be kept
up by  milk,  beef-tea, egg  and  milk,  etc.
Stimulants are not often wanted, but must be
given with  care when  there is much prostra-
tion and failure of the heart's action.   If there
is any suppression of the urine, the bowels
must be freely opened, the patient put into a 
REMITTENT  FEVER
REMITTENT FEVER      403
  hot-bath, and dry cupping applied to the loins.
  During convalescence tonics must be given,
  and the mineral  acids with  quinine  are the
  best for this purpose.  For some  time after
  the  fever has ceased the patient  requires a
  liberal and generous diet before he will suffi-
  ciently regain his strength.
    REMITTENT FEVER, or Bilious Fever,
  is a malarious fever, characterized by irregu-
  lar  repeated  exacerbations,  the  remissions
  being less distinct in proportion to the inten-
  sity of the fever.   It is accompanied by func-
  tional disturbance of the liver and frequently
  by yellowness of skin. There is a slight cold
  stage, which does not recur  with every ex-
  acerbation ; an intense hot stage, with vio-
  lent headache and gastric irritation ; and a
  slight sweating stage, which may be wanting.
  This disease is also  known as jungle fever,
  bilious fever, bilious remittent, endemic fever,
  marsh remittent, and as gastric  malarious
  remittent.   In  the  article on  Intermittent
  Fever  the  effect of malarious  influences  on
  the human system was described, and it was
  mentioned that whereas in temperate climates
  like  our own intermittent fever of  a mild
  character was met with, yet that the nearer
  we approached the tropics the fever assumed
  a greater severity, while in the tropics them-
  selves  the  intermissions were less distinct,
  and the cases  ran into the remittent form  of
  fever ;  so that there seems to be an intimate
  connection between these two forms  of dis-
  ease.  Remittent fever is the gravest form of
  fever which arises from miasmatic  or malari-
  ous influences, and  it is  most prevalent and
 fatal when high temperature and malaria act
 together.  In intermittent fevers there is an
 absence of fever between the attacks, but in
 remittent fever, while the urgent symptoms
 abate in intensity, there  is not  any absence
 of fever, and the more  severe the case the
 less marked ctre the remissions.
   Symptoms.—The  earliest  symptom that
 comes on is oppression and discomfort at the
 pit of the stomach.  The cold stage is not so
 well marked nor so long as in ague ; some-
 times no rigors or shivering can be noticed,
 but merely a slight feeling of chilliness, alter-
 nating with flushes of heat.   Although the
 patient feels  cold, his  temperature  is at this
 time  higher  than usual, and  may  be above
 ioo° Fahr., rising, as the hot stage  advances,
 up to 1060  F. or  107° F.  When  the hot
 stage comes on there  is generally  vomiting,
 and this continues throughout, causing much
 distress ; the tongue becomes furred and dry,
 and there is still a feeling of fulness and op-
 pression in the pit of the stomach,  the pulse
 rising up to  ioo or even  120.    The counte-
 nance is flushed, the  eyes suffused, and the
 patient  complains  of  violent headache and
 pains in the limbs and bones ; there is much
restlessness  and prostration.    After   these
symptoms have  lasted from  six to  twelve
 hours they begin to abate ;  a slight  moisture
 may be perceived on the brow and neck, and
 then over the body ;  the pulse and  tempera-
 ture  go down ;  the headache  lessens ;  the
 vomiting ceases,  and some sleep may be  ob-
 tained.  This period of remission is not al-
 ways observable  in very severe cases.   After
 an interval of from two to eight or ten  hours
 the fever  returns, and all  the  distressing
 symptoms are gone through  again, to be fol-
 lowed soon  by  a second  remission.   The
 vomited matters at first consist  of any food
 that may be in the stomach, and then a large
 quantity of watery fluid is brought up ; then
 bile becomes mixed with the vomited matters,
 giving them a greenish-yellow  color,  which
 may go on to be  brown or  even black from
 the presence of blood: The  headache, at first
 throbbing, soon  becomes  a constant  pain,
 with a feeling of  tension across the forehead.
 Delirium of a violent form is rare, but  there
 is often  confusion  of thought, and  in  some
 fatal cases a low, muttering delirium  precedes
 the state of coma which ends in death. Some-
 times  petechial spots appear on the skin, and
 blood  is found also in the vomit and in the
 stools.  A slight degree of jaundice  is  com-
 mon in many cases.  The spleen is not often
 found  enlarged.
   The duration of the fever may be from five
 to fourteen days, but the length  of time  is
 much  influenced  by  treatment.   The  fever
 may terminate in recovery, or may pass into
 an intermittent form, or death may ensue.
 Death rarely, if ever, occurs before the eighth
 day, and the  patient sinks  partly from ex-
 haustion and partly from the action of the
 poison on the system.  Sometimes an attack
 may come on in a few hours after exposure
 to  the malarious  influence, but generally it
 takes a week  or ten days before the disease
 develops itself.  For  the causes of this  fever
 further information may be obtained  by read-
 ing the article on  Intermittent Fever.   Few
 could make any  mistake in recognizing the
 difference between  an intermittent and a re-
 mittent fever.   Most  cases of remittent  fever
 recover, if pjoperly treated ; the case is more
 favorable as  the remissions become  more
 marked, but less favorable when there is  great
 prostration and exhaustion.
  Treatment.—Place the patient in bed, and
 secure careful ventilation of  the  room.   Iced
 water,  soda-water, or lemonade may be given
 to check the thirst and vomiting ;  an ice-bag
 may be applied to the head, and great relief
 may be, afforded by packing  the patient in a
 wet sheet, changing.it when it becomes too
warm,,but in some cases it does  not suit, and
then bathing the surface with tepid water will
do good. On the first sign of remission  from
 15 to 20 grains of quinine  should be given,
and this may be done though the tongue  be
foul and the  headache continue.  A  free
action  of the bowels may be gained by giving 
 404        RENAL DISEASE

 a purgative at the onset, or by an injection.
 In the second remission another large dose
 of quinine should be given, and  so on until
 cinchonism is  produced.    Mercury   ought
 never to be given, and its use may prove very
 serious to the patient.  Turpentine  stupes
 and hot fomentations will  relieve the pain at
 the pit of the  stomach.   During convales-
 cence  quinine  and other  tonics  should  be
 given, until the patient's health is  re-estab-
 lished  ; change of climate is then very desir-
 able.   (See Intermittent Fever.)
  RENAL DISEASE.  (See Kidney.)
  RESIN. (See Rosin.)
  RESPIRATION is the process  by which
 the air enters and  emerges from the lungs,
 and in doing so causes the aeration of the
 blood, and converts the black venous blood
 into the scarlet arterial blood.  (See Lungs.)
  RESPIRATOR  is  an  instrument  worn
 over the mouth by those who wish  to avoid
 exposure to the night air in cases of consump-
 tion, winter-cough, etc.  In this way warmer
 air is conveyed into the lungs, and  this pre-
 vents any irritation  of the  windpipe and pre-
 vents a cough.   There are several  patent
 respirators, but a handkerchief  held to the
 mouth will serve all practical purposes,
  RETENTION OF  URINE occurs  in
 hysteria, and in some forms of paralysis, in
 some cases of drunkenness, after a confine-
 ment,  etc.  It  is readily  known by the pa-
 tient not  passing any  water.  The  simple
 treatment  required  is to pass a catheter and
 draw the water off.
  RETINA is a delicate membrane within
 the eye, chiefly made  up of nerve  fibres,
 which  receive the impression of light from
 the external world.  (See Vision and  Eye.)
 It is liable to be affected in Bright's disease,
 in affections of  the  brain,  and from external
 injury,  when there is more or less  loss of
 sight.
  RETRO-PHARYNGEAL   ABSCESS
 is said to occur when the abscess  forms at
 the back part of the pharynx.
  RHATANY, technically'knovvn as Krame-
 ria, is the root of a plant (Krameria  triandra)
 growing in Chili.  As imported  there is  a
 short   root-stock, whence  spring long red
 rootlets,  which, were  it not for the  color,
 would  look  something  like  a  rat's  tail —
whence, it is said, the name.  The powdered
 root  is also red.   This has no smell, but has
 a sweetish taste,  afterward very  astringent.
 This is due to the quantity of tannin which  it
contains,  and  to  which  it mainly  owes its
properties.  Its preparations are  an extract,
a tincture,  and an infusion.  These may be
given whenever it is necessary to use tannin,
 but in practice rarely are so. Sometimes they
are given for diarrhcea or dysentery, but rare-
ly. The main use of the root is as an ingredient
in tooth-powders.   For this it is very useful;
the  powder being astringent, acts  well on
             RHEUMATISM

spongy gums, and at the same time, mixed
with chalk and a  little alkali, promotes the
removal of tartar from the teeth.
  RHEUMATIC PARALYSIS.  (See Pa-
ralysis )
  RHEUMATISM is one of those enigmat-
ical disorders about which  we know much
and know little.  We know  what conditions
give rise  to it, or are most likely to do so,
and we also know too well what its conse-
quences may be ; but as to  the immediate
causation  of the symptoms we know nothing.
Besides, under the same  title  there are un-
doubtedly grouped diseases  in many respects
differing the one from the other ; all are known
as rheumatism, yet among them are some of
the most  serious maladies  to  which flesh is
heir, and  yet again others of the  slightest.
The type of what we call rheumatism is acute
rheumatism, also known as  rheumatic fever.
This malady  is characterized by a high tem-
perature,  profuse sour sweats, and swelling
and reddening of some of the larger joints of
the body,  most frequently the knee and ankle
joints.   These  swollen joints  are  intensely
painful, but  as  a rule the  mischief  passes
away of its own accord.   The great risk in a
case of rheumatic fever is the danger of heart
complication.  Often in the course of the dis-
ease the pericardium, or the lining membrane
of the heart itself, the endocardium, becomes
inflamed.   The pericarditis may not give rise
to any  very dangerous permanent  mischief,
but the inflammation of the other does.   The
portion of the endocardium  most frequently
attacked is that  covering the valves,  so that
these become inflamed  and thickened ;  by
and by, as time wears on, they contract, and
so are rendered incompetent to efficiently ful-
fil their function of. flood-gates, whence arise
in time all the ills due to heart disease.  Most
cases  of  heart disease do,  in  point of fact,
date their onset from  a rheumatic  attack.
Rheumatic fever most  frequently arises from
cold and damp, especially if the individual has
suffered from any cause  of  depression, as
fatigue, improper  food, or  the like.   It be-
gins with  restlessness and fever, with white
or creamy tongue, and  deranged bowels, con-
stipated or relaxed.  Presently the joints be-
gin to  ache,  the pain  increases till  there is
great swelling and tenderness all over one or
more of the large joints of the body ;  the hip
joint is not,  however, very often affected.
There is by this  time in most cases  a very
high temperature, 102° or 103° F., but it grad-
ually increases, and in many cases becomes
excessive  ; this, indeed,  constitutes  one of
the great dangers of the disease.   Excessive
bodily  heat is apt to develop itself, and when
the temperature  rises above  105° F. there is
always more or less danger to the patient, and
every degree  of increase adds to these in far
more than geometrical progression, for by the
time it reaches 108° recovery is as  nearly as 
RHEUMATISM
RHEUMATISM         405
 possibie hopeless, and at 109 ° may be said to
 be quite so.   In those cases where a  high
 temperature develops  itself, the sweat, which
 is ordinarily very profuse and of a strong acid
 odor, disappears, and  its reappearance may
 be said to be the first sign of real amendment.
 The pain and tenderness  in the joints, too,
 are very great.   The patient can hardly bear
 the weight of the bed-clothes, still less can he
 bear the swollen limbs touched ;  he himself
 dares not move,  and even  dreads  the move-
 ments of others.   The  pulse is  quick and of
 fair volume, and except the heart be affected
 it is regular.  The thirst is  extreme,  while
 the tongue  is coated with  a thick white fur,
 which speedily renders  the scanty saliva acid.
 The urine is high colored and full of urates —
 that is  to say,  it deposits on  cooling a thick
 brick-dust-like sediment, which is re-dissolved
 on heating.  It is difficult,  too,  to  say  when
 the patient has fairly seen the worst, for joint
 after joint may  be  affected, and  even when
 the  patient seems fairly on  the road  to re-
 covery he  may suffer a relapse.   But the
 great feature of the disease is  the tendency
 to implicate the heart.  Curiously  enough,
 the right or venous side of the heart is  never
 affected,  only  the  left, or  arterial, and  the
 pericardium, which  is supplied  with arterial
 blood.   Sometimes  the heart affection  pre-
 cedes the joint mischief, but this  is  not the
 rule.  This process of heart implication has
 been described as metastasis. Now metastasis
 implies  a change  of  site,  but there is no
 change of site in rheumatism.   It is  true the
 heart becomes affected, but the joints do not
 improve on that account.   The heart attack
 is as much a portion of the history of the dis-
 ease as are the swollen joints. Another curi-
 ous complication is chorea.   These  irregular
 and uncontrollable  movements make  their
 appearance  generally with the heart compli-
 cation,  or shortly after.  They ordinarily per-
 sist  long after  the  rheumatic  affection has
 ceased, and may even become permanent :
 they are most frequent  in young people.  As
 in the  rheumatic affection  of the  heart, it is
 common to find fungi on the valves, deposited
 either by the blood,  or  formed on the valves
 by inflammatory changes—usually the former
 —these may be  broken up by the blood cur-
 rent, and conveyed to some remote situation,
 as the brain, there to set up fresh mischief.
   Now as to the cause of  rheumatic fever.
 We shall not long dwell on such an unprofit-
 able subject. It was long ago suggested that
 it was due to the  presence of lactic acid in the
 blood, and that theory has been  more or less
 upheld to the present time.  It  is  worthless
 to speculate on the truth of this or no ; some,
 certainly, of the  experiments carried out  to
 support this view have been of the crudest
possible description, altogether  unworthy  of
attention.  The excessive acidity  of all the
secretions has  perhaps aided  the lactic  acid
view, and has given rise to a mode of treatment
which is, with due modifications, perhaps the
best—that is, the  treatment  by alkalis.  To
this end  the  bicarbonate of potass is given,
either by itself, or  effervescing with citric
acid,  in good large  doses—30 grains or so,
every  four hours, continuing it till the pain
begins to abate, and the urine is rendered
alkaline.  This plan is a good  one undoubt-
edly if employed not rashly but with due vigi-
lance, but  there are doubts  that  in  certain
cases it  has  been overmuch employed,  and
has done harm.  This, on the whole, is the
plan we recommend. The joints ought at the
same time to be wrapped in cotton-wool, Dut
in some cases great good is derived by apply-
ing warm alkaline lotions next the skin,  and
placing cotton-wool  over that.   Then,  too,
the perspiration must be provided for—some-
thing must  receive it,  and if  linen  is  next
the skin this  soon becomes cold and unpleas-
ant  with the  patient's  profuse  sweating.
Woollen  cloths should therefore be placed
next the skin, but should not  be allowed to
remain too long,  or they act  as a  kind of
poultice, giving rise to what are called suda-
mina on the surface ; hence there  used to be
a saying that the cure  for rheumatism  was
six weeks in blankets.   A  favorite  plan of
treatment, began of late years,  has been blis-
tering.   Large cantharides blisters have been
placed round the limbs close to the affected
joints, and allowed  to  remain there some
hours ; after  these have been removed large
poultices are to be applied to favor the flow
of fluid.  Better,  however,  it  would be to
apply the blistering  fluid with  the poultices
over that  from the beginning,  especially as
this process is far less painful than the other.
Dr. Herbert Davies, who introduced this plan,
gave no medicine,  but allowed  the blisters to
suffice for everything.   There  can, however,
we think, be no doubt  that  the addition of
effervescing alkaline draughts is an improve-
ment ; this plan is mainly to be commended
for the relief  it gives to the pain in the joints.
Many men like to give large doses of quinine.
Now it is well known that quinine does  ma-
terially reduce temperature, and it will do so
in rheumatism as  in other maladies,  but the
disease is not thereby remedied ; it pursues
its course as before, and when  the real time
comes to use quinine with advantage, it has
lost, by frequent repetition in large doses, its
special virtues.  By all means give quinine,
but not till the pain has passed  away,  and the
temperature is  nearly natural.   In a disease
like rheumatic fever, where pain is one of the
most prominent symptoms, it may readily be
supposed that  opium  has been employed ;
nevertheless, for some reason  or another, it
is not usually had recourse to, there being an
idea that its exhibition, though useful for the
time  being,  would tend  to  prolong rather
than shorten the fever.   This  belief  had its 
406          RHEUMATISM
RHEUMATISM
origin in the notion that the disease was due
to some materis morbi which had to be  elim-
inated, a view which is most probably not the
true one.   At all events, the current of  opin-
ion seems  to set against  the  use  of  opium,
and in  favor of other sedatives.   Nitrate of
potass  has  been used  and commended by
some authorities ; it has been given both in-
ternally and externally—given, ad  libitum,
dissolved in water, internally to slake thirst,
externally to cool the joints.  Lemon-juice is
another remedy which has not, like the last,
received universal acceptation ; it may,  how-
ever, be useful on account of the citric acid
and potass which it contains.  The diet during
the brunt of the malady should be light ;  beef
tea and the like.  By and by, when  the pa-
tient  becomes stronger, fish  may  be given,
but  meat must be reserved  until  a  later
period ; too early use of it may bring on a
fresh attack. The patient should have plenty
of drink supplied to  him  by the nurse, he
himself not being allowed to move.   Lemon-
ade, made of lemons and water with sugar, is
best, or soda or potass water may be given  ;
wine must, as a rule, be forbidden  ; so must,
above all things,  beer.   In convalescence,
quinine or bark  and  ammonia,  afterward
iron and cod liver oil are to be prescribed.
  Chronic Rheumatism is quite a different
affection from rheumatic  fever, since  acute
rheumatism may pass into the chronic stage,
but most frequently the one is  quite indepen-
dent of the other.  Most old people,  espe-
cially if they have led a life of exposure and
fatigue, are more or less affected with rheuma-
tism, sometimes so far as to completely crip-
ple them.   The constitutional disturbance is
slight, but the pain is  sometimes great, both
night and day, so as to wear out the patient
by continual harassing.   Some cases of this
form of rheumatism do  not  suit  well  with
heat, the pain being worst at night in  bed  ;
but most of these cases are better for  heat,
and friction especially.   If the patient has
any syphilitic taint, as is sometimes the case
in the worst instances, the pain at night may
be terribly harassing.  Some special forms of
chronic rheumatism have acquired distinctive
names. Thus there is a rheumatic affection
of the loins we call lumbago.  This is almost
always aggravated by movements.  Stiff  neck,
such  as occurs after  exposure  to   a   cold
draught of air, is another sample of chronic
or sub-acute rheumatism, attacking a special
part.   Myalgia is the name given to pain in
the muscles  not  due to rheumatism, and to
be  distinguished  therefrom.  Myalgia is not
unfrequently found localized in the side, and
there a kind of rheumatic pains are also ordi-
narily located.   It is  of importance  to dis-
tinguish the one from the other, as the  treat-
ment of the two is different.   Chronic  rheu-
matism must not be treated  by rote ; each
case must  be dealt with  on its own  merits.
 Wc must try to improve the general  health,
 and to procure the patient sound rest by sed-
 atives if necessary.  Multitudes of  remedies
 have been  tried,  and  some do better than
 others if the cures are properly selected.   In
 most of them, iodide of potassium with bark
 and cod-liver oil are the most important rem-
 edies. If there is a gouty taint colchicum may
 be given, and  some  strongly recommend
 Actcca racemosa ; in most instances bicarbon-
 ate of potass is useless. Here local treatment
 is of great value, especially the local applica-
 tion of hot  mineral  waters, as douches and
 otherwise. Hot  alkaline waters are, as a rule,
 preferable.  Iodine paint to the affected joints
 sometimes does good, but not so much as hot
 alkaline lotions. Sulphur does good  to many.
 All  should  wear flannel,  and  be careful  in
 their diet.   Beer, porter,  and  full-bodied
 wines should be prohibited.
   Rheumatic Gout, as the malady  is com-
 monly called, is  a most anomalous disease.  It
 certainly has nothing to do with gout and noth-
 ing to do with rheumatism. The affection con-
 sists in an inflammation of the  joints, chronic
 in character, and in some respects resembling
 gout, in others,  rheumatism, but in all essen-
 tial respects totally distinct.  The affection is
 a most troublesome one, and not unfrequently
 cripples the  patient, while defying the prac-
 titioner's  art.   It is said  that  more women
 suffer from this  affection  than  men,  but that
 is doubtful.   There is often no constitutional
 predisposition, hereditary or otherwise,  ex-
 cept some causes of general weakness.  Rheu-
 matic gout—or  rheumatoid arthritis as it is
 also called—seizes  on various joints, some-
 times the large, sometimes the  small ; but
 the  hip,  shoulder,  knees, elbows,  wrists,
 ankles, and hands are its favorite sites.  Often
 it occurs  in females at the turn of  life, or
 about puberty.    When  acute, the disease
 comes on abruptly, something  like rheumatic
 fever ; but more frequently it steals  on grad-
 ually, the bowels being out of  sorts, and the
 urine loaded and  scanty  ; the  joints become
 stiff and painful, and are  more or less swol-
 len.  This gives rise to lameness, and the
 joints may be felt to crackle  as  they move,
 something like a door on  ungreased hinges.
 As the disease  advances  the  stiffness grows
 greater and  greater,  while round about the
 joint are formed  great masses of imperfect
.bone, while the  cartilages covering the joints
 become absorbed : the  joints are thus greatly
 deformed.  The functions of the constitution
 are badly performed ; there is  constant indi-
 gestion, the  rest is disturbed, and the patient
 becomes  painfully sensitive to the  weather.
 No heart complication ever results from rheu-
 matic gout.   The  treatment is very unsatis-
 factory.   The best thing, we believe, short of
 a visit to a foreign spa, is rest and cod-liver
 oil.  The bowels must be kept open by saline
 aperients, and sulphur waters  generally suit 
RHEUMATOID ARTHRITIS
RHUS TOXICODENDRON     407
 well.  Arsenical baths have been very highly
 commended, as  have a hundred other sub-
 stances.  Iodide of potassium internally, and
 alkaline lotions applied so as to act like poul-
 tices externally, sometimes do good, but must
 not be continued too long for  fear of impair-
 ing the  constitution.  So, too, any fixed ap-
 pliance to the limb or joint may bring on fixa-
 tion of the joint, an irreparable mischief.
   RHEUMATOID  ARTHRITIS.   (See
 Rheumatism.)
   RHINOPLASTIC  OPERATION  is a
 name given to an operation whereby a piece
 of skin can be taken from  a  healthy portion
 of the body and adjusted to a surface where
 the skin has been destroyed by injury or dis-
 ease.  By this  method  surgeons have been
 enabled to form a new nose  by removing a
 flap of skin from the healthy forehead.   In
 cases of severe  burn on  the  arm, skin  has
 been taken from the surface of the abdomen,
 and much deformity of the burned surface has
 been saved.  Great skill is,  however, required
 to bring about a successful result.
   RHINOSCOPE  is an instrument consist-
 ing of a small oval or circular mirror fixed on
 a handle about  six inches in length ; when
 introduced into the  mouth   it  should  be
 passed into the back part of the fauces, with
 the mirror looking upward at  an  angle  of
 about 45 degrees.   The observer, sitting  in
 front of  the patient, wears on his forehead a
 large circular mirror, which reflects a strong
 light into the mouth from an  adjacent lamp,
 in the same way as is described in the article
 on the Laryngoscope.  In this -way the back
 part of the nostrils may be carefully examined.
   RHUBARB,  as  employed  in  medicine,
 consists  of the roots of several plants,  the
 species  of which  is  not very accurately
 known, growing in Central Asia.  The root,
 as imported, is always more or less perfectly
 deprived of its bark.   The rhubarb makes  its
 way from this district in two directions—»ne
 by way of Russia, the other by way of China.
 The Russian, commonly called Turkey rhu-
 barb,  occurs in  irregular-shaped pieces,  the
 rind of which has been removed.  Its surface
 is smooth and yellow, its texture compact,  its
 fracture  uneven  and gritty, marbled red and
 grey.  The powder is bright yellow, and  its
 smell rather pleasant,  but the taste is bitter
 and disagreeable. These pieces usually have
 a hole drilled in them for slinging on a cord.
 The East Indian variety has the bark imper-
 fectly removed, so that the surface is rounded
 instead of being angular,  It is red and veined
 externally, not covered with a yellow powder
 like the  Russian.   The root  is altogether
 more woody than the  Russian variety, and
 the powder redder.   Other specimens are  in
 use, but  are of inferior quality.  Some are
brought from India, and some are cultivated
here.  The peculiar purgative principle has
never  been separated from  rhubarb, but  it
 contains  a  beautiful crystalline  substance,
 chrysophanic acid.  This occurs in needles of
 a golden lustre, not very readily soluble in
 water, but  readily in alkalies.   Oxalate of
 lime is found abundantly in some specimens,
 and gives the gritty character in Russian rhu-
 barb.  The best specimens  of rhubarb  are
 the grittiest, and so the quantity of oxalate of
 a lime, though  in itself having nothing to do
 with its purgative action, have come to be a
 kind of test of the quality of the rhubarb.
  The preparations of rhubarb are an extract,
 infusion,  syrup,  tincture, and wine,  with a
 compound pill, and  a  compound powder.
 The compound pill, which is the  pill in most
 general use as  a laxative, contains rhubarb,
 aloes,  myrrh,  hard soap, and  oil of pepper-
 mint.  It is a most useful preparation.  The
 compound powder, better known as Gregory's
 powder, consists of rhubarb, magnesia, and
 ginger.  It is a great and deserved favorite
 in the nursery, and is used with benefit by
 older individuals.
  Rhubarb,  when  taken  into the mouth,
 turns the saliva yellow ; and the urine it turns
 reddish yellow ; if  alkaline,  purple red.   In
 small doses it acts  as a  kind of tonic  to the
 stomach  and bowels ; in larger  doses it is
 purgative,  but  it is apt  to  be followed  by
 constipation, seeing that it  exercises a kind
 of astringent effect, subsequent to its purga-
 tive action.   On this  account rhubarb, espe-
 cially in the form of wine or tincture, is often
 prescribed in the early stage of diarrhcea, in
 order that it may carry off  any irritant sub-
 stances giving rise to the diarrhoea, and  subse-
 quently arrest the too violent  action  of the
 irritated   bowel.    Combined with alkalies,
 rhubarb is of infinite value in many forms of
 indigestion, depending especially on an irri-
 table condition  of the  bowel.  Habitual flat-
 ulence and distension are thus in  many cases
 relieved.  Females who  are most subject to
 this, perhaps from  sedentary habits, further
 reap the benefit of its action  in  habitually
 constipated bowels.
  To children, rhubarb is commonly given as
 Gregory's powder,  or along with a little gray
 powder.   In either form it is  exceedingly
 beneficial, as it also is along with a little bi-
 carbonate of soda.  Children are  apt  to eat
 things which disagree with them,  giving rise
 to diarrhcea and the like.  In such  instances
 Gregory's  powder  is  an  invaluable remedy.
 (See Gregory's Powder.)
  A very  good remedy for certain  forms of
 indigestion, especially among females, is rhu-
 barb and ginger tea.   The two together are
 infused, and a wineglassful of the infusion
taken every morning.  Another  very good
plan is to chew  the two together,  swallowing
the  saliva.   Ten grains suffice for this.  This
plan is highly  rommended for piles.   The
purgative dose of rhubarb is 20 or 30 grains.
  RHUS  TOXICODENDRON, Sumach, is 
•iOci              RIBS                                     RICKETS
 not officinal, but is  used a good deal in med-
 icine, especially by homoeopaths.  The leaves
 of  the  plant,  also  known  as   the poison
 sumach, are  employed.  These contain  a
 peculiar resin  very acrid in character, inso-
 much that the juice  blisters the part to which
 it is applied.  If given in any quantity inter-
 nally, it creates  much irritation of stomach.
 It is said to act on the spinal cord something
 like strychnine,  and has  accordingly  been
 given in paralysis.  The  results  are,  how-
 ever, not  quite  positive.    The  powdered
 leaves may be given in one-grain doses.
  RIBS are the bones  which help to  form
 the chest ; they are twelve in number on each
 side ; behind, they join the spine,  while  in
 front they are continued by cartilage to the
 breast-bone or sternum.  The ribs  are very
 liable to fracture from  external injury.  (See
 Fractures.)
  RICE, a plant belonging to the  natural
 order of grasses.   The common  rice  of
 domestic use is  Oryza saliva, and is  a native
 of the East Indies.   It is the principal article
 of  diet  of  the  Hindoos, Chinese, and other
 oriental  nations.  It is cultivated  in other
 parts of the world, and is produced in abun-
 dance in  the marshy grounds of  North  and
 South  Carolina.   Although  this  grain  is
 largely  consumed by the inhabitants of the
 world, it contains less flesh-forming matter
 than any other.   It can only be the  substan-
 tive article of diet of an  indolent and feeble
 people.   When eaten it should only  be as an
 adjunct to  other kinds of food.  It cannot be
 healthily used as a substitute for potatoes or
 other fresh vegetables for any length of time.
 In  cases of relaxation  of the bowels in chil-
 dren or grown people it  is  a useful article of
 food. The Chinese and Mongolians distill a
 strong fiery spirit from rice, called " arrack."
 Some people mix the spirit called toddy, ob-
 tained from the cocoanut-tree, with the arrack,
 and thus increase its potency and improve its
 flavor.
  RICKETS is the  name given to a consti-
 tutional disease characterized by an unhealthy
 state of the system,  which  precedes for sev-
 eral weeks or  months a peculiar disease of
 the bones,  and of some  other  organs of the
 body ;  there is  curvature of the bones of the
 arms and legs and enlargement of their ex-
 tremities.
  Causes.—Some maintain that this  disease
 is hereditary,  while others are opposed to
 that view.  There seem  to  be, however, pre-
 disposing causes either  on  the part of  the
 parents or  nurse, which have an unfavorable
effect on the healthy development of the child.
The state  of the mother's health seems to
affect the child more than that of  the father ;
there is no evidence to show that syphilis has
any influence in producing a rickety child.
Where the  mother is pale  and anaemic,  and
where without  any  actual  disease there is a
 state of  general debility, and in cases where
 a family has been brought forth in rapid suc-
 cession,  the children  are  liable to become
 rickety.   Deficient or improper  diet, impure
 air constantly  breathed, want of cleanliness
 and sunlight, cold, moisture, and deficient
 clothing seem to be the conditions which are
 generally found to precede the development
 of rickets ; of these causes, improper food is
 by  far the most common.   The children of
 the poor are  fed badly, in many cases, from
 their birth.   Brown sugar and butter, castor-
 oil  and gruel are given them in the first few
 days of their existence, when their stomachs
 are fai too tender to put up with such noxious
 things ; when awake, they are kept constantly
 at the mother's breast, and no time is allowed
 for  the stomach to  digest  the  food.   Too
 often the  food  is thickened with  corn  flour,
 sweetened with coarse sugar and mixed with
 bread or biscuits, within a month after birth,
 while if constipation follow this mode of feed-
 ing, the unfortunate child is  dosed with cas-
 tor-oil.   When it gets a little older and has
 existed four or  five months, it is fed with the
 same food that the parents have :  herrings, a
 piece of  fried bacon,  cheese, potatoes, cakes,
 and even beer are allowed to be swallowed by
 a child,  when  the delicate stomach should
 have nothing else but its  mother's milk.  So
 true is it that women  know how to bear chil-
 dren, but not how to rear them.   Nor is the
 child weaned when ten months old, but  the
 mother goes on suckling it with the idea that
 she may  retard the  next pregnancy. And the
 succeeding offspring are brought up in a sim-
 ilar way when the mother's  health has been
 impaired, and they suffer therefore to a greater
 degree. For  the proper feeding of an infant,
 see  Diet.
  Symptoms.—No child is born rickety ;  the
 impairment of the  general health usually be-
 gins 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.   At first  the
most ordinary symptoms are those which in-
dicate irritation of the intestinal canal ;  there
may be diarrhcea alternately with  constipa-
tion, enlargement of the abdomen, and more
or less emaciation.   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 promi-
 nence ; the fontanelle remains open.  In the
 next stage there are three symptoms  to be
 chiefly noticed,  i. 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. 
RICKETS
ROCHELLE SALT        409
 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 de-
 posits a pale sediment of  phosphates on cool-
 ing.  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 extremities, 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  forward ;  the
 head falls backward and the face looks up-
 ward ; lateral curvature of the spine is not so
 common, and with this  curvature  there is
 generally the deformity  known as pigeon-
 breast.  The back is flattened, there is a hol-
 low under  the  armpit, 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 encroached
 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 pro-
 jecting.   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 pelvis  are sometimes dis-
 torted, 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,  because 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 increase,  and
 generally disease of the liver,  kidneys, or
 spleen comes on.  Death  may occur from
 bronchitis or congestion of the lungs, or from
 diarrhoea, or from waxy degeneration of  dif-
 ferent internal organs, or from general dropsy.
 Children  affected with rickets are liable to
 attacks 'of  spasmodic  croup (Laryngismus
 Stridulus), convulsions,  and chronic hydro-
 cephalus.   So death may end a life which to
 the unfortunate  child has been one of una-
 bated misery.   Yet many cases do recover
 and grow up to  adult life, but the deformity
remains,  and they are never so healthy as
other people.  The favorable symptoms will
be,  an increase in weight, an  animated ex-
pression, and less pain in the limbs ; 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  acquire a powerful develop-
ment.   Many of the dwarfs are examples of
recovery from rickets ;  they may  possess
plenty of strength in spite of their deformity ;
they are 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 thing to be sought after. The
child should be  placed in  a warm and dry
atmosphere, with due ventilation and pure
air.  The diet is most important, and should
be given according to  the rules laid down in
the article on  Diet, adapting it of course to
the different ages of the patients.   On a fine
day the child should be wrapped up warm
and carried out into the open air.   The child
should sleep alone ; the bed-clothes should
be  kept dry and clean.  A warm  salt-water
bath should be given every  morning if  the
child can bear it.  All lowering remedies, as
mercury and  bleeding,  must be  carefully
avoided. Steel wine or the syrup of the phos-
phate of iron, either alone or  in conjunction
with cod-liver oil, are very valuable remedies.
Change of  air and a visit to the sea-side may-
bring about excellent  results  if the parents
can afford it.  Lime-water may be  mixed with
the milk  if the latter  curdle on the stomach.
Cod-liver oil should  be  taken after a meal,
and with orange wine  or  as an  emulsion.
Raw meat, pounded in a mortar,  is a good
thing, but milk must form the principal article •
of  food.  (See Diet.)
  RIGIDITY  OF   THE   BODY  (Rigor
mortis) comes on naturally a  few  hours after
death, and may last two or three days.  Hence
bodies should be laid out as soon  as possible
after the fatal  event has occurred.
  RIGORS, or  SHIVERING,  come  on
after exposure to cold, in the commencement
of   an  ague fit, and  at the onset of many
fevers  ; during this period the temperature
of  the body is always  raised.
  RINGWORM is a skin eruption caused
by the presence of a vegetable  parasite.  For
the nature of this disease, and also its treat-
ment, see Epiphyta.
  ROCHELLE  SALT  is  now  technically
known as tartarated soda, i.e., cream of tar-
tar neutralized by bicarbonate of soda.  How-
ever known, the substance is valuable ; too
little  used  perhaps.  It  exists as crystals,
neutral in  reaction, and readily dissolved in
water.  The taste is something like common 
410        RODENT  ULCER
RUE
salt, but not  so  bitter.  It is most frequently
administered effervescing as a seidlitz powder.
Each of these powders contains two drachms
of this salt with a sufficiency of bicarbonate of
soda in the blue paper to cause effervescence
when mixed in water with the contents of the
white paper (tartaric acid).   Fcr some people
such a quantity of salt is  quite sufficient to
open the bowels, easily and freely ;  others re-
quire more.  This can easily be managed by
telling the druggist to add a drachm  or two
drachms of the Rochelle salt, according  as it
is required, to the  blue paper of  a  seidlitz
powder.  The effervescing  material requires
no addition.
  RODENT ULCER, or noli me  tangere.
(See Lupus.)
   ROSE COLD.  (See Hay Fever.)
   ROSE PETALS  AND  ROSE  HIPS,
the  produce  of the Rosa gallica and  canina,
are introduced into the pharmacopoeia in  the
form of  confection,  as a basis   for  pills.
There  is also an acid  infusion of red-rose
petals containing sulphuric acid,  which  is
useful as an astringent, or as a vehicle  for
more powerful remedies.  In themselves rose
petals are slightly astringent, but  by them-
selves are seldom used as such.  Most com-
monly these preparations  serve as  agreeable
vehicles for more powerful remedies.
   ROSEMARY is only used in the form of
oil.  This oil is distilled from the  flowering
tops of the Rosmarius off cinalis, which mainly
grows in  Southern  Europe.  The oil has the
fragrance of  the  plant.  It is colorless and
soluble in spirit.  The spirit is the only offici-
nal preparation, but the oil itself is most fre-
quently used.  It is a powerful stimulant,
and  may be given in hysteria and nervous-
ness in  females ; some forms of headache are
greatly improved by  it.   It is also used as
a rubefacient.  The oil is contained in  soap
liniment,  and compound tincture of  lavender.
The oil may be given in doses  of  a drop or
two  on sugar, or the  spirit may be  added to
various kinds of medicines as a stimulant and
aromatic.
  ROSEOLA, or rose-rash, sometimes also
known as false measles, in a good  many  re-
spects resembles the eruption of measles, but
is  not infectious nor contagious, and there  is
no watering at the eyes and nostrils,  and no
cough. The skin is mottled of a rose-color, the
patches being of no great size and of  irregu-
lar shape ; sometimes the  eruption appears
as a  cross of small slightly raised rose-colored
spots.   At first  the  eruption is bright red,
but gradually it fades and  finally disappears.
The  constitutional symptoms are slight.  The
rash fades in from three to six days.  Some-
times the throat is affected slightly, as in scar-
latina,  which has led some to believe that the
malady consists of a mixture of scarlatina and
measles, but of that there is no proof what-
ever.
  Various maladies give rise to a roseola ; the
most important of these is syphilis.  Usually
syphilitic roseola is the earliest of the consti-
tutional  symptoms ; it commonly makes its
appearance  within six weeks of the primary
attack, but it may be so slight as to give rise
to no inconvenience, and so frequently escapes
observation.   Syphilitic  roseola ordinarily
consists  of  a number of rose-colored  spots
completely isolated and even with the surface,
but sometimes they are fused together so as
to give  rise to patches which are above the
surface,  and  so  merge  imperceptibly into
the papules  which commonly follow  in  order
of secondary  symptoms.   At the same time
the fauces present a rim of  redness  corre-
sponding to the  external rash.   Belladonna
sometimes produces a roseolar rash, but  not
very often.   In infancy, stomachic derange-
ment or dentition often gives rise to such an
eruption, and it occasionally precedes  the
eruption of small-pox.
  Treatment.—Little treatment is necessary.
The bowels  had better be opened by a saline
purgative (Rochelle or Epsom salts), and  the
diet restricted ; after that a few  doses of any
alterative tonic will suffice to restore wonted
health.
  ROSIN is the hardened exudation of pine
trees, of  which there are three kinds in com-
merce—black, white, and yellow.   It is only
used in pharmacy to give consistence to plas-
ters.
  ROUND  WORMS.  (See Entozoa and
Parasites.)
  ROYAL  OINTMENT.  (See Basilicon.)
  RUBBING.   (See Inunction.)
  RUBEFACIENTS  are  irritant   sub-
stances, which when applied to the skin give
rise to heat,  redness, and other signs of slight
local inflammation.  After removal it may or
may not  happen that the cuticle peels off.   If
applied  for  a longer  period, the cuticle is
raised and blood  or serum forms underneath ;
i.e.,  vve  find a blister.  A  great number of
substances are included in the list of rubefa-
cients, but not many are used on account of
the  intractable character of most.  About  the
simplest  is the compound  camphor liniment.
and weak ammonia, in the favorite form of
hartshorn and oil (freshly prepared) is also
useful.   The best is perhaps a mustard poul-
tice, or Rigollot's mustard leaves ;  volatile
oil of mustard and oil  of turpentine are more
powerful, and require some skill in applica-
tion.   Corrosive  sublimate  and iodine are
still more irritant ; they may be  made to give
rise to severe inflammation.  Rubefacients are
especially useful forgetting  rid of slight local
pains or dissipating slight local inflammation.
  RUBEOLA is the Latin name for measles.
(See Measles.)
  RUE is chiefly employed in  the  form of
oil.  which is  distilled  from the leaves  and
unripe fruit of the Ruta graveolens, a  plant 
RUM
SAFFRON
-ill
which grows  throughout  Europe.  This oil
is greenish yellow in color.   It has a very
disagreeable odor and  an  acrid taste ;  it
turns brown by keeping.   Rue, or its oil, is a
powerful stimulant to the part  to  which it is
applied, and hence it has been  given as a
stimulant in flatulence.  In hysterical affec-
tions especially, where  the menstrual func-
tions have been in  abeyance, it is  sometimes
given with benefit.  In these it may  be em-
ployed as an  enema.   It is  not, however,
largely employed.  It has falsely  obtained a
reputation as  an abortive. The oil may be
used as a local rubefacient, but is seldom em-
ployed for this purpose ; the dose of it inter-
nally is from two to three  drops.
   RUM is a spirit distilled from fermented
sugar and  molasses in the West Indies.   Its
peculiar odor depends on butyric  ether, and
a flavor given by the addition of pine apples.
It is often  used, mixed with honey and milk,
for colds and hoarsenesses.  (See Distilled
Spirits.)
  RUMINATION is the term applied to the
action in a section of the animal kingdom  of
devouring the food rapidly, and then  casting
it up to chew at leisure.  The action is famil-
iar in  many domestic  animals, and is called
"chewing the cud."   Sometimes a similar
kind of process in miniature is seen in man
as the consequence of disease.   Ordinarily, if
the  food be chewed  slowly and swallowed
leisurely, it is speedily attacked by the gastric
juice, and as speedily dissolved, but if bolted
and indigestion follow, it may return into the
mouth in a condition which admits of being
chewed and swallowed again.   It is a sign,
therefore, of an  abnormal  condition,  and
sometimes of serious disease.
  RUPIA is the term  given to the latest and
most disagreeable form of syphilitic eruption.
These  eruptions,   ordinarily,  go  through
various stages, beginning with  roseola, pass-
ing into papules or little hard  masses which
scale off, and leave no mark. Next they seem
to have  a  yellowish  top and  ulcerate,  and
finally they appear as blebs, which disappear-
ing leave a kind of dark-greenish crust on the
surface of a wound. This wound of the surface
ulcerates and forms pus ; this is added to the
crust, which goes on drawing from the ulcerat-


                                          S
S.
  SABADILLA, also known as cevadilla, is
the dried fruit of the Asagrosa officinalis of
Mexico.   From it is obtained the alkaloid
veratria.  The fruit  is light brown  in color,
about half an inch long, and  contains a few
seeds.   These seeds  are blackish  brown and
shining.   They have  an intensely bitter taste,
which is also acid.  The seeds are only used
as a source of veratria,  not being  themselves
employed.
ing surface beneath until they acquire a con-
siderable height.  These crusts go on growing
to a considerable size, and  may  then  break
off, leaving  a raw unhealthy ulcerating sur-
face.   From this surface a new and  larger
scab is formed, and so the process  goes on,
except it be  restrained.
  Treatment.—In dealing with these sores
we must not temporize ; if not got rid of they
may spread  further and further, and even one
leaves behind an indelible white sunk cicatrix
which is  unmistakable.   It is therefore  of
prime importance to get  rid of them early,
especially if, as they oiten do,  they  affect the
face.   Local measures are essential, but be-
fore doing any good these hard and unsightly
crusts must  be got rid of.   That may  be
done, but not effectually, by poulticing ; the
process is tedious and unsatisfactory, so some-
thing better should  be  employed.  Solution
of potass and glycerine mixed  and applied to
the crusts, the whole being kept moist by a
supply  of the same  material  on  lint, will
speedily cause them to soften and fall off.
When they have  thus fallen off and left the
ulcerating surface bare, these  had  better  be
destroyed, and the best thing for so doing is
a  strong  solution of corrosive  sublimate.
This kept applied to it for a time will ordi-
narily suffice to make the part take on healthy
action, after which citrine ointment is the best
dressing.  Cod liver oil and iodide  of  potas-
sia with mercury should be  given internally
at the same  time.
  RUPTURE is a word  commonly applied
to cases of hernia.  (See Hernia.)
  RYE is a grass whose botanical name is
Secale cereale.  It yields  a very nutritious
flour, and when made into bread assumes a
dark, appearance, hence it  is called "black
bread."  Although rye contains more  starch
and sugar than barley, it is not used for fer-
mentation, on account  of the rapidity with
which it passes into  an acid condition.  Rye
bread is sour to  the taste on  this account.
The grain is subject to a disease which gives
it a spined or horned appearance.  This is the
result of a fungus, which  is injurious when
eaten ; but under the name of ergot of rye is
valuable medicinally in uterine cases,  (See
Ergot.)
  SAFFRON is the stigma  of the flower of
the Crocus zativus, growing in Greenland and
Asia  Minor,  but  cultivated  in   Southern
Europe.  This portion  is orange-red in color,
and when dried as collected  constitutes hay-
saffron.  Sometimes it is packed and pressed
into a parcel ; this constitutes cake-saffron.
Saffron readily yields its coloring  matter, so
that when  moistened and  pressed against a
piece of paper it stains it of an orange color. 
412
SAGE
SALICINE
This coloring matter  is  readily soluble in
water and in alcohol, and sulphuric acid turns
it from orange-red to blue.  It is hence called
polycroite.  The only preparation of  saffron
is a tincture, which is little used in medicine
save for its coloring  properties.   Saffron is
contained, however,  in decoction  of aloes,
aloes and myrrh pills, compound tincture of
cinchona, ammoniated tincture of opium, and
tincture of rhubarb.  It is somewhat surpris-
ing that it  is included in so many prepara-
tions, for it is almost useless, and is very ex-
pensive.  It  has   indeed  some reputation
abroad for favoring the menstrual  flow, but
in this country such a belief hardly prevails.
It is very  often  adulterated,  the so-called
cake-saffron frequently containing no  saffron
at all, but only petals  of  marigold, or more
probably safflowers.
  SAGE is a well-known herb, botanically
Salvia officinalis.   It  is in every garden, and
is used  in cookery and as a domestic  remedy
for  sore  throats as  a gargle,  with  honey,
alum, or any astringent.  As a wash for ulcers
about the mouth or lips it is safe and pleasant
and  often very efficacious.
  SAGO is a form of starch obtained from
several  kinds of  plants.   That which  is most
commonly used is the produce of the sago
palm (Sagus Icevis), which grows in the islands
of the Indian Archipelago.  The sago is ob-
tained  from  the  cellular  tissue   in  the
interior  of  the  trunk of the tree.   It  is a
good and pleasant article of diet for the in-
valid.
  SALADS contain  other  constituents be-
sides mineral matters, but their value in diet
is mainly due to these.   It seems necessary,
in order to  preserve health, that the  human
body should frequently partake of the vari-
ous constituents which compose  it, and which
naturally waste  away with daily use.  Thus
fat,  fibre, starch, and other things are  daily
partaken of, and it is not  less necessary that
mineral salts, which preserve  the body in
health,  should also enter into food.  All fresh
vegetables and  fruit  contain  these salts in
large quantities, but in boiling and cooking,
in any  way, they  are  dissolved and  thrown
away, so that it  is  only by eating some form
of uncooked food  that we can  obtain them.
Salads are very desirable on this account, and
it is  very wise to allow all  people in health,
whether children or adults, to partake of fresh
uncooked fruit or salads every day.  Lettuces,
water-cresses, endive,  celery,  beet-root, rad-
ishes,  corn-salads, sorrel, and even dande-
lion, are valuable and pleasant as ingredients
in a salad, and there  are many other plants
which might be  eaten with advantage were it
not for  prejudice.
  SALAD  OIL.   (See Olive Oil.)
  SAL AMMONIAC, also known as hydro-
chlorate of ammonia or chloride of  ammonia,
is a  salt all  whose virtues are not yet exactly
known.  This we do know, that it does good
in some forms of headache almost magically.
It is also of value in some forms of  liver dis-
ease and as a stimulant of the menstrual flow
when that  is in abeyance.  It does not par-
take much of the properties of ammonia.  Its
taste is disagreeable, and it has to be given
in large doses.  Some recommend beer as
the best vehicle. The dose is 20 or 30 grains.
  SALT is a chloride of sodium, and exerts
an extraordinary influence on  animal as well
as vegetable life.  All marine animals seem
to have  their  existence  determined by  this
substance.   It enters into the composition of
the human  body, and all over the world man
uses it, when it can be obtained, as  an addi-
tion to his food.  Salt exists in large quanti-
ties in the bowels of the  earth, and in many
parts of Great Britain and the continent it
is worked  and brought  up  to  supply the
market.  It is obtained  in the form of rock
salt and  in brine springs, and when purified
is sold as " bay salt,"and " fine salt."   Salt
prevents the decomposition of animal  and
vegetable substances.  It is used extensively
for preserving meat in conjunction with salt-
petre (nitrate  of potash).  Bay  salt is often
employed to make artificial sea-water baths,
and the  stimulating effect of  the salt in the
water is frequently  beneficial to those  who
cannot obtain  sea-bathing.
   SALTPETRE.   (See Nitre.)
   SAL VOLATILE is really the carbonate
of ammonia, but the name is most frequently
given to its preparation—the  aromatic spirit
of  ammonia.   This  spirit contains carbon-
ate  of  ammonia,   strong solution  of  am-
monia, volatile  oil of nutmeg, oil of lem-
on,  spirit, and water.   It is an  agreeable
and useful  stimulant where it is desirable that
the effects should not continue too  long.   It
is of especial value in the depression which
follows the use of alcohol in excess, or indeed
in any  form of temporary prostration from
which it is  necessary to rouse the patient.  It
is also of great value in the bronchitis of the
aged.
   SALICINE is an active principle of a bit-
ter nature extracted from willow bark.   The
bark is stripped from the common willow and
allowed  to dry.  It is very tough, and has a
somewhat  aromatic  odor and  a very bitter
taste.  The salicine when pure exists in white
scaly crystals, and  is soluble in water and
alcohol.   This is reddened by sulphuric acid,
and is converted into an odoriferous principle
similar to that obtainable from meadow-sweet.
Salicine has been chiefly commended as an
antiperiodic  in  intermittent  fevers where
quinine was not to  be had.   Undoubtedly  it
has some activity in this way, but nothing to
compare with that of quinine.  It is to be
given  in doses of  from  12 to 20 grains, and
in that quantity may be of use in certain cases
when  quinine does  not suit.   It has  never 
SALIVA
SALIVATION          413
come into general use, and is not likely to do
so, though comparatively cheap.
  SALIVA is the ordinary secretion which
is  met  with  in  the mouth, and  proceeds
chiefly from the parotid  submaxillary  and
sublingual glands, aided by the small glands
in the mucous membrane lining the mouth.
These glands are very active when stimu-
lated, and pour a large quantity of fluid  into
the mouth, and  this is chiefly so during the
process of mastication.  The saliva is a thin,
watery fluid,  and contains a small quantity
of animal matter  called ptyalin.  This  pecu-
liar compound has  the  power  of converting
starchy foods into sugar, and this  is impor-
tant because the  former body is insoluble in
ihe stomach while the latter  is very soluble.
Ptyalin  will not act upon fatty or proteid
compounds.  (See Diet.)  An extreme  flow
of saliva, called salivation or ptyalism, occurs
in some  cases where mercury is taken inter-
nally ; many woods, as betel-wood, etc., also
have this property  of exciting an  increased
flow when chewed.
  SALIVATION is a term applied to a con-
dition in which  there  is  increased flow of
saliva with swelling of the mucous membrane
of the mouth.  In most cases it is caused by the
action of mercury, but it has been found that
many other agents may have the same effect.
Iodide of potassium, antimony, croton-oil,
castor-oil, opium, and  foxglove have  been
known to produce the milder  symptoms of
salivation.  An increased flow of saliva with-
out swelling or  ulceration of the gums and
cheeks may be produced by  irritation of the
mucous  membrane of the mouth and alimen-
tary canal, and by mental influences.  ^
  The mercurial  salivation commences  with
tenderness of the gums and inner surfaces of
the  cheeks,  and pain  when  the  teeth  are
brought  sharply  together.  The patient ex-
periences a metallic taste.  The secretion of
saliva is  so much increased that it accumu-
lates in the mouth, and necessitates frequent
spitting,  and during the night flows from the
mouth and  saturates  the  pillow.  The  daily
amount of saliva, which in health is about ten
ounces, increases to four  or  six pints.   The
tongue   then swells, and  the mucous mem-
brane of  the gums and cheeks becomes red
and   inflamed, and  finally  ulcerates.   The
breath has a very offensive and peculiar  odor.
In bad cases the  ulceration extends, and by
destroying the tissue of the gums exposes the
bone of  the upper and lower jaws.  These
symptoms are usually associated with  those
of gastric and  intestinal irritation, and of
nervous  debility  and excitement ;   with the
exception of the  metallic taste  in the mouth
none of the above symptoms are peculiar to
mercurial salivation,  and a similar  condition
may be presented in  cases of salivation due
to constitutional causes.   Cancrum oris,  a
gangrenous  affection  of the mouth which is
occasionally met  with in  children suffering
from  measles,  is  often  attributed  by  the
parents to the effects of mercury, supposed to
have been administered for the treatment of
the febrile disorder.  Cases of severe  saliva-
tion  produced by the  medicinal use of mer-
cury are  at the present extremely rare, as the
effects of mercury are  seldom allowed  to pro-
ceed beyond slight redness and tenderness of
the gums.  In cases where intense salivation
has been produced by the administration of
large quantities of mercury, other symptoms
of mercurial poisoning are generally present;
of these the most prominent are pallor, trem-
bling, an eczematous  eruption over the sur-
face of the  body, and general debility.   In
some peculiarly constituted patients mercury
may  produce  all  the latter  symptoms, and
not give rise  to  salivation or any affection
of  the mouth.   The . property of produc-
ing  salivation is common to all  the prep-
arations  of   mercury used  in  medicine,
the  most  active  being  calomel  and  blue
pill.   Mercury when introduced into the sys-
tem  in other ways than through the  mouth
and  stomach, as by inunction, fumigation, and
hypodermic injection, does  not fail  after a
certain time to produce similar symptoms of
salivation.   In the treatment of local affec-
tions, especially venereal sores and cutaneous
eruptions, the first appearance of  the symp-
toms of mercurial salivation is generally pre-
sented by  a decided improvement in these
affections,  the indurated  bases of the sores
have commenced  to soften, and the  rash on
the skin  is  less  distinct.  Salivation  may be
produced either by a  very large and  poison-
ous dose of mercury, or by frequently repeated
small doses.  In some cases there is  a long
interval  between  the end of the course of
mercury and  the first appearance of symp-
toms of  salivation, mercury being a cumula-
tive poison which may be  stored up in the
body slowly and gradually until it is  in suffi-
cient force to give rise to salivation and other
affections.   Some individuals are extremely
sensitive to the  action of mercury,  and be-
come salivated after very small doses of cal-
omel or blue pill.   A case has been recorded
in which two grains  of calomel caused sali-
vation, sloughing and ulceration of the throat,
necrosis of the lower  jaw, and death.   Other
individuals, on  the contrary, are so consti-
tuted that they can resist for a long time the
action of large and frequently repeated doses
of mercury, or even  remain quite invulner-
able.  A patient  who has been subjected to
two or more courses  of mercurial treatment
becomes much less susceptible on each occa-
sion to the action of the medicinal agent, and
is less liable to be salivated by the last than
by any  previous course.  The early occur-
rence of salivation during a mercurial course 
414          SALTPETRE

is much favored by a want of attention to the
cleanliness of  the mouth, and  by bad teeth,
and  soreness  of  the  gums.   Catching  cold
and even  a slight exposure to cold and wet
will often cause early  salivation.
  During a course of mercury  great attention
should  be paid to the  state of the mouth.
The teeth should be frequently brushed, and
the patient, in order  to harden the mucous
membrane of  the gums and cheeks, should
wash out the mouth  occasionally with  some
astringent gargle and suck small  pieces of
alum.   In cases of mercurial  salivation the
cause should at once be removed. The swol-
len and ulcerated mucous  membrane of the
mouth  should then  be frequently washed
with a  solution  of chloride of lime, or  of
alum, or with  brandy-and-water.
  SALTPETRE.   (See  Potass,  Nitrate
of.)
  SAMBUCUS, the  botanical name of the
elder tree,  or dwarf  elder,   is  Sambucus
ebulus, while  that of the  black or common
elder  is  Sambucus nigra.   The berries are
often made into wine  ; and from the flowers
is distilled a pleasant fragrant wash for the
skin, called elder-flower water.  (See Elder
Flowers.)
  SANDAL-WOOD is the product of a tree
growing in India and  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 re-
cently come into  use as a remedy for  gonor-
rhoea.   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.
  SANGUINEOUS APOPLEXY  is said
to occur when there  is a rupture of a blood-
vessel in the brain.   (See Apoplexy.)
  SANITARY   REGULATIONS. —The
following simple rules  have been  drawn up
from the  sanitary papers  of  Dr. Lankester,
Medical Officer of Health, St. James's, West-
minster.  They are intended to guide people
in case of an epidemic breaking out in any
town or  village.  It is only  by the  local
authorities actively investigating the cause of
an  outbreak, and then  isolating the cases as
far as possible, that  one can  hope to  check
those ravages  which disease makes at times
over an infected area.
  The following regulations, or some similar
ones, should be printed in large type, and be
posted on the  walls in public places, and also
be distributed  among the people :
      SANITARY REGULATIONS


        When Small-Pox is prevalent.

  I. When this  highly-contagious and fatal
disease  is prevalent in a district, the inhabi-
tants should be made  aware of the danger to
which they are exposed, and the  best means
of preventing the attack of the disease, and of
stopping it where it has already broken out.
  2. In the first place, it cannot be too widely
known  that  vaccination  is one  of  the  best
means for preventing an attack of small-pox.
  3. All  persons  should  be  revaccinated
after twelve years of age.
  4. When small-pox prevails in a family or
in  a neighborhood, every person should be
immediately revaccinated  under the direction
of a legally qualified medical practitioner.
  5. Every child should be vaccinated within
three months after its birth.
  6 When  it has been ascertained  that an
individual has  got  small-pox,  everything
should be done to separate the person attacked
from those around.   Where it  is deemed de-
sirable to remove persons thus affected to a
small-pox hospital,  information can be ob-
tained,  and the  means of  conveying patients
ascertained,  by applying to the health officer
of the district.
   7. Where persons are found  to be laboring
under the disease, a medical man should be
sent for immediately.
   8. The following directions should  in all
cases be carried into effect : The room should
be  cleared of all needless woollen or other
draperies which might possibly serve to har-
bor the poison.   A basin, charged with chlo-
ride or  carbolate of lime,  or  some other con-
venient  disinfectant,  should be  kept  con-
stantly  on the bed for the patient to spit into.
A large vessel, containing water impregnated
with chloride of lime or with carbolic acid,
should  always stand in the room for the re-
ception of all bed and body linen immediately
on its removal from the person of the patient.
Pocket-handkerchiefs should not be used, and
small pieces  of rags employed instead for
wiping  the mouth and nose.   Each piece,
after being  once used,  should  be  at once
burned.   As of  necessity  the hands of nurses
become  frequently soiled by the.secretions,
a good supply of towels and two basins—one
containing water with carbolic  acid or chlo-
rides, and another plain soap  and water,
should be always at hand for the immediate
removal  of  the taint.  All  glasses, cups, or
other vessels, used by or about the patient,
should be scrupulously cleaned before being
used by others.  The  discharges  from  the
bowels and  kidneys should be received on
their very issue from the body into vessels
charged with disinfectants, and  immediately
conveyed away.   No  persons  should  be
, allowed to enter the  room except those who
are attending upon the sick. Persons attend-
ing upon the  sick should  be  scrupulous in 
SANITARY REGULATIONS
SANITARY REGULATIONS   415
cleaning their hands  and disinfecting their
clothes before they go out of the sick-room,
or communicate with those who have not got
the disease.
  9. When persons have had the small-pox,
whether they recover  or  die,  the  room  in
which  they  have  been ill should be disin-
fected.   The floor should be  washed with
chloride of lime and water, or with carbolic
acid and water.  The  paper should  be re-
moved by moistening with carbolic acid and
water.   The room should  then  be fumigated
by burning sulphur in an iron dish, the fire-
place and the crevices in windows and doors
being  closed by  putting  paper over them.
The room  should be exposed to the sulphur
vapor for five or six hours ; or the room may
be fumigated in the same  way with chlorine
vapor,  which is procured by pouring oil of
vitriol (sulphuric acid)  on common salt and
black oxide of manganese.
  10. After the room has been  fumigated, it
should  be whitewashed,  and the doors and
windows kept open for  a week or a fortnight.

      When Typhoid Fever is prevalent.
  This  fever is also called drain fever, from
its constant association with bad and  imper-
fect drainage in houses ; it is also called gas-
tric or enteric fever, from  its chief seat being
in the stomach and bowels.   At one time it
was confounded with  typhus  fever,  but it
differs from that disease in its causes, history,
and  result ;  hence the  term  typhoid (like
typhus) was at first given to it.   It is also
called in some parts of the country low fever,
from the  great exhaustion  and  weakness
which attends it.
  The  means by which this disease may  be
prevented  from spreading are  very simple,
and  depend upon  the fact that the poison by
which it spreads is almost entirely contained
in the discharges from the bowels.   Dr. W.
Budd gives the following excellent directions
for preventing the spread of this disease.  He
says the discharges from the bowels infect—
  1.  The air of the sick-room.
  2. The bed and body-linen of the patient.
  3. The privy  and the  cesspool,  or  the
drains proceeding from them.
  From the privy or the drain the poison often
soaks into  the well and infects  the drinking
water.  This last, when it happens, is, of all
forms  of fever  poisoning, the most deadly.
In these various ways the infection proceed-
ing from the bowel-discharges often spreads
the fever far  and wide.   The one great thing
to aim at, therefore, is to disinfect these dis-
charges on  their very  escape from the body
and  before they are carried from the sick-
room.   This may  be  perfectly done  by the
use of disinfectants. One of the best is made
of green copperas.  This substance, which is
used by all shoemakers, is very cheap, and
maybe had everywhere.  A pound and a half
of green copperas to a gallon of water is the
proper strength.  A teacupful  of  this liquid
put into the night-pan every time before it is
used by the patient renders the  bowel-dis-
charge perfectly harmless.   To disinfect the
bed and  body-linen, and bedding  generally,
chloride  of lime is more convenient.  All
articles   of  bed and  body-linen should  be
plunged,.immediately on their removal  from
the bed,  into a bucket of water  containing a
tablespoonful of chloride of lime, and should
be boiled before being  washed.  The privy,
or closet, and all drains communicating with
it, should  be flushed  twice daily with the
green copperas  liquid or carbolic acid  di-
luted with  water.  In the event of death the
body should be placed, as soon  as possible,
into a   coffin,  surrounded  with  charcoal,
sprinkled with disinfectants.  Early burial is,
on  all  accounts, desirable.   In towns, and
places where the fever is already  prevalent,
the last  rule should be put in force  for all
houses ;  the  drains  of  all houses should be
flushed daily with disinfectants, whether there
be  fever in them  or not.   As  the hands of
those  attending on  the  sick  become un-
avoidably soiled by the discharges from the
bowels,  they  should be frequently washed.
The sick-room should be kept well ventilated,
day and night.  The greatest  possible care
should be  taken with regard to the drinking
water.   Where there  is  the slightest risk of
its having  become tainted with  fever-poison
water should be obtained from a pure source,
or should  at least  be  boiled  before being
drunk.  Immediately after the illness is over,
whether  ending in  death  or recovery, the
dresses worn by  the nurses should be washed
or destroyed, and the bed and room occu-
pied by the sick  should be  thoroughly disin-
fected.   These  are  most  important  rules.
Where they are  neglected  the fever may be-
come  a deadly scourge.  Where they are
strictly carried out, it seldom spreads beyond
the person  first attacked. A yard of thin wide
gutta-percha or  a mackintosh  sheet placed
under the  blanket,  under the breech of the
patient,  is  a great  additional  safeguard  by
effectually  preventing  the discharge  from
soaking into the bed.

       When Scarlet Fever is prevalent.
  Scarlet fever is a highly contagious disease,
and spreads from one person to  another, and
is thus  propagated in families, towns,  and
districts.   It is, therefore, highly desirable
that every one should understand  the  nature
of this disease and  the means of preventing
its spreading.   It is always attended with a
scarlet eruption  on  the  skin, and is mostly
accompanied by a  sore throat.   Whenever
children  have sore  throat, or an eruption on
the skin, they should be separated from  the
rest of  the family  until a doctor has seen
them, or these symptoms have disappeared. 
416   SANITARY REGULATIONS
SANITARY REGULATIONS
  There is every reason  to believe that, dur-
 ing the progress of this disease, not only the
 eruption of the skin, but everything that is
 thrown off from the body of the infected per-
 son, is heavily laden with the germs or seeds
 which are capable of propagating the disease
 in another person.  The discharges from the
 nose and  throat  are   especially  virulent.
 There is also  reason to believe that the dis-
 charges from the bowels  are the same.  The
 kidneys are frequently dangerously  diseased
 in scarlet fever, and the secretion from these
 organs is also highly contagious ;  the power
 of spreading the poison by  means  of these
 secretions is not confined to their immediately
 leaving the body, but continues long after.
 It is on this account that when these secre-
 tions have found their  way to the  cesspool
 and  sewer, they may still give  off  poison  to
 the surrounding air, and  persons breathing it
 may become infected.  Taking these things
 into consideration, it will be  seen  that it is
 necessary,  if possible, to  destroy and annihi-
 late  this poison, before  it leaves  the room
 where the person is whose body has produced
 it.   The following directions,  drawn up  by
 Dr. W. Budd, should in all cases  be carried
 into effect :
  i. The room should be cleared of all need-
 less woollen  or other draperies which might
 possibly serve to harbor  the poison.
  2. A basin,  charged with  chloride or car-
 bolate of lime, or some other convenient dis-
 infectant, should  be kept constantly on the
 bed for the patient to spit into.
  3. A large vessel containing water impreg-
 nated  with chlorides,  or with  carbolic acid,
 should always stand in the room for the re-
 ception of all bed  and body-linen immediately
 on its removal from the person of the patient.
  4. Pocket-handkerchiefs should not be used,
 and  small pieces of rag employed instead, for
 wiping the mouth  and  nose.   Each piece,
 after being once used, should be immediately
 burned.
  5. As the hands of  nurses of necessity be-
 come frequently  soiled by the secretions,  a
 good supply of towels and two basins—one
 containing water  with carbolic  acid  or chlo-
 rides, and  another plain soap  and  water,
 should be always at hand for the immediate
 removal of the taint.
  6.  All glasses, cups, or other vessels used
 by  or about  the patient should be scrupu-
 lously cleaned before being used by others.
  7.  The'discharges from the  bowels  and
 kidneys should be  received  on their very
 issue from the body into vessels charged with
 disinfectants.
  By these measures the greater part of the
germs which are  thrown off  by the  internal
surfaces  may  be  robbed  of  their  power  to
propagate the disease.  The poisonous germs
that  are thrown off from the skin require a
somewhat different treatment. The plan rec-
ommended  by Dr.  Budd for the purpose of
preventing the poison  from the skin being
disseminated through the air, is to put oil all
over the skin.  This practice is to commence
on the fourth day after the appearance of the
eruption, and to be  continued every day until
the patient is well  enough to  take  a warm
bath, in which the whole person is well washed
with  disinfecting   soap and   warm water.
These baths should  be administered every
other day, for four  times, when the  disinfec-
tion of the skin may be regarded as complete.
This  proceeding should   not, however,  be
adopted without consulting the medical man
who is in attendance on the patient.   Speak-
ing of  the  plans above recommended,  Dr.
Budd says : " The success  of this  method in
my own hands has been  very remarkable.
For a period of nearly twenty  years, during
which I have employed it in a very wide field,
I have never known the disease  spread in a
single instance beyond the  sick-room, and in
a very few instances  within it.  Time after
time  I  have  treated this  fever  in  houses
crowded from attic  to basement with children
and others, who have, nevertheless, escaped
infection.  The two elements in the method
are, separation on the one hand, and  disinfec-
tion on  the other."

 Summary of Fads  in favor of Vaccination.

  1.  Persons who have once had  the small-
pox are  not liable  to take it a second time.
In the   last  century, inoculation of small-
pox was practised, because  it was known that
small-pox thus communicated was   usually
milder than when caught naturally.
  2.  Cow-pox is a  modified form of small-
pox, and it has been clearly proved that those
who have had it. are very much less  liable to
take small-pox than others, and are as effec-
tually protected as  those who  have  already
had small-pox.
  3.  Cow-pox is communicated by  vaccina-
tion.   Jenner discovered  that  persons who
had caught  cow-pox from the cow  escaped
small-pox, and thus was led to advise vac-
cination.
  4.  Forty-five millions of the  people of Eu-
rope died from small-pox in  the hundred years
preceding the introduction  of  vaccination at
the beginning  of   this  century ;  while  not
more than two millions have died from this
disease  during the  seventy years in which
vaccination has been practised.  In London,
before the introduction  of vaccination, every
tenth death  that occurred  was  due to small-
pox ; now only one death in every eighty-five
is due to this  disease.   Even  greater differ-
ence has been observed in other towns and
cities  of Europe, as  in Trieste, where  the
deaths from small-pox have been seventy-five
times less since than  before vaccination ; in
Moravia twenty-one times less ;  in Silesia
tzventy-nine times less ; in Westphalia twenty- 
SANTONIN
SARSAPARILLA         417
five times less ; and in Berlin nineteen times
less.   Where vaccination has been stringently
enforced, death from small-pox has  been still
more diminished. In Ireland, where this dis-
ease was once a scourge, it has now become
almost unknown, and  a similar good result
has been obtained in many districts in India.
When small-pox has been rife among the in-
habitants of a city or district,  it has been re-
peatedly  observed  that  the  unvaccinated
have perished, and the vaccinated survived
or  altogether escaped.  Very carefully kept
records in hundreds of places in Europe and
elsewhere have proved this.  Out  of thirty
vaccinated nurses constantly employed at the
Small-pox Hospital, not one ever contracted
the small-pox ; of the patients  admitted to
this hospital,  from 1836 to 1851, thirty-seven
in  the  hundred of those unvaccinated died,
while  only  six in the  hundred who had been
vaccinated (well or badly) died.
  5. In England there is a larger proportion
of  unvaccinated persons  than in any other
country of   Europe,  and  consequently  a
greater number of deaths from small-pox are
shown, by the public registration, to occur.
  6. While  small-pox kills so great a propor-
tion of the unvaccinated whom it attacks, the
inoculation  of cow-pox, i.e., vaccination, sel-
dom or never produces any consequences of an
injurious nature.  The authenticated fatal cases
of erysipelas  so produced are not more nu-
merous than those which follow the prick of a
pin.  There is no proof that those who hasre
been vaccinated suffer from scrofula or any
similar disease as a consequence of vaccina-
tion alone.   According to  the Registrar-
General's returns these diseases have dimin-
ished  in frequency since the introduction of
vaccination.   That which follows after a thing
is not necessarily caused by it.  It is a matter
of  necessity  that persons,  who have  been
vaccinated,  should have diseases  after  this
operation as well as before it, but these can-
not rightly be attributed to vaccination.
  7. Although very rarely the eruptions of
other diseases have, through the  carelessness
of  medical  practitioners, been mistaken for
cow-pox, yet it would be as reasonable to ask
for the abolition of  railways because of rail-
way accidents, as to demand the  abolition of
vaccination   on account of such accidental
occurrences.
  8, The great  means  whereby  small-pox
may be wholly exterminated is universal vac-
cination.
  SANTONIN  is  a  crystalline  substance
neutral in reaction, obtainable from the un-
expanded 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 ob-
tain santonin, these  are bruised and boiled
for  a time with water and lime. To this fluid
hydrochloric acid is added till the whole  be-
comes curd, when it  is set aside for the san-
tonin  to subside.   The  precipitate  is  well
washed and otherwise purified till it is brill-
iantly 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 mod-
erate heat.   These brilliantly white crystals
become yellow  by exposure to light.   San-
tonin, if given in any quantity, colors the field
of  vision yellow,  so that  the  patient sees
everything of that color.   Sometimes green
takes its place.  The substance is a capital
remedy for worms, and being nearly tasteless
is easily taken  by children.    It is  useless
against flat worms, but is valuable as a remedy
for round  worms, especially  cf the larger
kinds.   The  dose is  from 2 to 5 grains.  It
is best given in a little sugar or honey.
  SARSAPARILLA is  a remedy which has
been extolled  to the skies, and has sunk into
almost complete neg'.ect.  Lauded at one time,
it has been despised  at another, both prob-
ably unjustly.  The plant which yields it is a
species of smilax, chiefly growing in  Central
America and the West Indies.  The part em-
ployed  is the underground stem or rhizome,
whence numerous long rootlets are given off.
The preparations of sarsaparilla are a simple
and compound  decoction, and  a liquid ex-
tract.   The  compound  decoction contains
Jamaica sarsaparilla,  guaiacum-wood  turn-
ings, fresh  liquorice-root, and mezereon.
This preparation is that most frequently used,
in doses of from two ounces to a pint.  Sar-
saparilla contains, besides the ordinary root
constituents,  an  oil,  and a  principle called
smilacin.   It  has  never been very carefully
investigated.
  All kinds of properties have been attributed
to sarsaparilla—diaphoretic,  diuretic, tonic,
and alterative—but it has been mainly used
as an anti-syphilitic.  It was early introduced
as a remedy  in  this complaint, and  in the
form  of what was called the  Lisbon  Diet
Drink,  was largely used for a  long  time.
Gradually it fell out of use, and is now sel-
dom used in that complaint.   It is,  however,
said, by some, that it has  so fallen out of use
because improperly used ;  that  only  small
quantities were given, and that in small quan-
tities  it is  useless.   It seems, according  to
some reputable authorities, to do much good
in the skin  eruptions of  syphilis, if given  in
doses of not less than half a pint or pint  of
the decoction  daily.   It has been also used
in some skin diseases, especially in those  of
a scrofulous origin, as a sudorific where the
skin is dry and tending  to  disease, and  in
chronic rheumatism and gout.  In all of these
maladies, however, it has been customary  to
use the sarsaparilla merely as an adjunct  to
powerful remedies, or when  other  good has
resulted, it has not been  always quite clear
that the benefit was traceable to the sarsapa- 
418
SASSAFRAS
SCAMMONY
rilla.   If used at all. it should be used abun-
dantly, and in  the form of freshly prepared
decoctions, simple or compound.
  SASSAFRAS  is  the dried  root  of the
sassafras-tree, growing in the United  States
and Canada.   It is most frequently met with
as chips, which have a peculiar pleasant odor
and a warm sweet aromatic taste.   It is con-
tained in the compound  decoction of  sarsa-
parilla.   Its  action is stimulant, and is sup-
posed to be specially useful in chronic rheu-
matism and skin diseases.  It is never given
by itself.   Sometimes its oil is used.
  SAVIN consists of the fresh  and dried
tops of Juniperus Sabina. which is a native
of England.  From it is distilled  an oil, color-
less  or pale  yellow,  having the odor  of the
tops.  The tops themselves are covered with
minute leaves,  pressed to the stem and ar-
ranged in four  rows.  They  are dark green,
and have a disagreeable odor and taste.  The
oil which is contained in the  tops gives them
activity along  with  some resin.  From the
tops are prepared a tincture and  an ointment.
  Savin acts as an irritant wherever applied,
externally  or internally,  and is reputed to
have special  power  over the womb, and so
is given to promote the menstrual flow.  The
ointment  is  mainly used to  keep a blistered
surface raw, when it is deemed desirable to
do this.  It has been frequently  given to pro-
cure abortion, and as the substance is highly
irritant, this  practice is  attended  with great
danger,  Its use  is to be avoided in preg-
nancy as dangerous and liable to be misinter-
preted.   The ordinary dose of the powder is
four or five grains, and of  the tincture 20
drops to half a drachm.
  SCABIES.  (See Itch ; Ectozoa.)
  SCALD-HEAD.  (See Porrigo.)
  SCALDS.  (See Burns.)
  SCALP  consists  of   those  integuments
which cover the cranium  or vault of the skull.
They are very firm and dense.  The scalp is
covered with a delicate cuticle or  scarf-skin,
and  immediately  beneath this is  a thick
cutis or  true skin ; beneath the  cutis is  a
layer of fat and cellular tissue, containing the
bulbs of the hairs.  This cellular layer adheres
very  intimately to the  subjacent tendinous
layer,  which is the tendon  of  the occipito-
frontalis  muscle ; between this tendinous ex-
pansion and  the bone is a delicate cellular
layer.  The  scalp  is  largely supplied with
blood-vessels and nerves.
  Affections  of  Scalp.  Tumors.—The most
frequently  met  with are the encysted, also
called  Wens.  (See  Wens.)  Fatty  tumors
are sometimes met with, but are rare, and they
seldom grow to any great size ; the treatment
consists in excising them.   Erectile tumors,
i.e., masses composed of a congeries of dilated.
vessels, mostly veins ; these  are best treated
by the ligature.  Malignant  tumors are  met
with in the scalp, but they as frequently as
not originate in the bone.   Medullary is the
most usual form ;  a malignant form of ulcer-
ation is not uncommon,frequently commenc-
ing with a degenerate wen; the only treatment
in either instance  is early  and free removal,
provided the  glands are not implicated.
  Injuries  of Scalp.  Bruises.—Owing to its
exposed condition, the scalp is naturally very
liable to external  injury, and, owing to  iis
aforestated vascularity, the  results may be
very serious.   The ordinary result  is  the for-
mation  of a tumor full of blood, the result of
extravasation, and the  condition is to be
treated  on general principles.   If,  for in-
stance,  the swelling  be over some  largish
artery,  such  as the  occipital or  temporal,
steady  and firm pressure must be maintained
on the   vessel between the tumor and the
heart ;  the application of cold and pressure
will check further  extravasation.   Acute in-
flammation not unfrequently follows these in-
juries,   and if  suppuration occurs, free in-
cisions  must be made.  Constitutional treat-
ment  must be attended to, and  rest,  anti-
phlogistics, and perhaps depletion.  Absorp-
tion may be  accelerated, after all inflamma-
tory symptoms have  passed off, by keeping
the part wet with a  solution  of  muriate of
ammonia or  tincture of arnica.   It may be
mentioned that a  blow upon the back of the
head, may produce a black eye, owing to the
extravasation of blood under the tendon of
the occipito  frontalis,  and  its subsequent
gravitation forward.
  Incised Wounds.—In  the case  of  incised
wounds of the scalp,  no  matter how  severe,
the treatment will  consist in carefully cleans-
ing both surfaces of the wound, and the parts
carefully adjusted  and maintained in position
by  strips of  plaster,  compresses and band-
ages.   It is well not to put any sutures in ;
two or three wisps of  the hair growing on
the opposed edges of  the wounds tied across
make an excellent method of obtaining union,
and act as a  suture without the penetration.
If the  scalp  wound becomes  "puffy," the
adhering lips  of the wound  must be separated
to let out the inclosed fluid, and a warm  poul-
tice and hot  fomentations  must be applied.
Tonics and ammonia  should be administered
at an early period  of any symptom of erysip-
elatous puffiness, and if the patient has  been
in the habit of taking brandy, wine, or spirits,
he should be still allowed  them in modera-
tion.   (See Compression,   Concussion, Ec-
tozoa, Epiphyta, Fractures, and Pityri-
asis.)
  SCAMMONY   is   a gum resin exuding
from the top of the  root  when the stem of
the living plant (Convolvulvs Scammonia) has
been removed.  The root itself is also now
officinal as well as the resin  contained  in
scammony, which  is its active principle.  The
plant grows in  Asia Minor and is chiefly im-
ported  from  Smyrna.  The root  somewhat 
SCAR
SCARLET FEVEP        419
 resembles a carrot.  It is brown without and
 white  within, and is possessed of a peculiar
 odor.   The gum resin, the well-known scam-
 mony, is blackish green in  color, and occurs
 in  irregular  masses, covered with  its own
 powder, but breaks with a  shining  fracture.
 From  the gum which it contains this' sub-
 stance forms  a lather  if wetted and rubbed.
 If spirit be added the resin is dissolved up,
 leaving  the  gum  behind.    This  resin  is
 brownish and brittle.   If prepared  from the
 root instead  of the gum resin it is  fragrant.
 Scammony used  to  te  much  adulterated,
 especially with starch and chalk.  The resin
 forms no emulsion with water, as does scam-
 mony itself.   Its composition is very similar
 to  that of jalap.  The preparations of  these
 substances are confection of scammony, con-
 taining scammony, ginger, oil  of  caraway,
 oil of cloves, syrup, and honey.  The com-
 pound powder of scammony contains scam-
 mony,  jalap,  and ginger.    Of  scammony
 resin is made a scammony mixture, by rub-
 bing  up  the  resin with  unskimmed  milk.
 This  resin  is also contained  in compound
 extract  of colocynth,  and  scammony itself
 occurs  in the compound colocynth pill, and
 the colocynth and hydrocyanus pill.  Scam-
 mony and its resin are  powerful purgatives,
 producing much watery discharge, and if not
 guarded  griping  much.   They  are seldom
 given  by themselves,  but are usually added
 to other and less violent laxatives.   Usually,
 too, it is customary to give  along with them
 some aromatic and stimulant, or some  seda-
 tive substance, to guard against griping.   It
 is  sometimes used  in dropsies, especially
 among children, and the compound powder
 is often used to get rid of worms.  The dose
 of  scammony itself is about 5 grains, of the
 resin 3, and  of  the compound powder  10
 grains.  The confection may  be  given  in
 doses  of 20 grains.
   SCAR. (See Cicatrix.)
   SCARF-SKIN, or the EPIDERMIS,  is
 the upper layer of the skin ; small scales are
 always being shed, but it is abundantly cast
 off after scarlet fever, and some other febrile
 disorders, also in  cases of psoriasis,  etc.
  SCARIFICATION is a term used in sur-
 gery when  the cuticle or external skin re-
 quires to be  cut  or  lanced  through  only.
 Sometimes in case of  dropsy it is necessary
 to do this in order to allow the fluid to escape,
 and in cases of  children's  gums  where the
 tooth presses against  the external skin, and
 is ready to burst through, scarification will re-
 lieve the irritation and cause no pain.
  SCARLET FEVER is an  acute febrile
disease,  producing a  scarlet rash upon the
skin, attended by a sore throat,  and  often
swelling of various glands and sometimes fol-
lowed by dropsy.   Contagion is the main if
not the only cause of scarlet fever ; measles
and whooping-cough are more contagious ;
typhus fever and diphtheria less contagious.
The poison  may be retained in clothes for a
year or more and then give rise to the fever.
Both sexes  are  equally liable to an attack ;
between  eighteen  months  and five  years
is the  most common  period   to  have  the
fever ; no season has  much  influence upon
it, but in this  country it is*, perhaps, most
common between September and November.
Many people confuse the terms scarlatina and
scarlet fever, and imagine the former  is  a
milder and less  dangerous affection ; this is
a great mistake, for scarlatina is  only  the
Latin name  for scarlet  fever and not a differ-
ent form ; the term is too often adopted when
there is some doubt as to the nature of  the
case, and then  it is used to  conceal igno-
rance.  Scarlet fever may be  very  mild,  or
malignant, or latent.   The period of incuba-
tion is generally about a week, but may be
only twenty-four hours.
  Symptoms.—1. Mild Scarlet Fever.—The
onset is sudden  ; there is a sore throat, with
tenderness at the angles of  the lower jaw
and stiffness at the back of the neck ; vomit-
ing  is very common,  and chiefly so  in chil-
dren ; shivering and rigors come on, and oc-
casionally  convulsions in young  children.
The temperature rapidly rises and will go up
to 104° or 105°  ; the pulse is very quick ; the
tongue is covered  with a thin, white  fur ;
there is  thirst  and  loss of appetite. This
stage lasts from twelve to thirty hours, and
then a rash comes out ; sometimes the earlier
symptoms are so slight that  the rash is the
first thing  noticed.   The  rash consists  of
small scarlet dots, almost running  together,
so as to give  a flush all over the skin ; ihe
color disappears on pressure, but rapidly re-
appears  when the  pressure is  removed.  It
generally appears at first on the sides of the
neck and upper  part of the chest, and in the
bends of the joints ; it then  spreads down-
ward and is found  to come  out last on the
legs ; it begins  to fade on the fourth or fifth
day, and is  generally  quite gone  within  a
week.   The sore throat is always present to
a degree ; there is  redness and swelling of
the tonsils and soft palate, so that it is very
painful to swallow, while the glands beneath
the jaw also swell and  are painful.   The tem-
perature is generally higher than in measles,
and much higher than in diphtheria, but  it
rarely exceeds 1050  ; the fall of the tempera-
ture is usually on the sixth or seventh day,
but it may be earlier or it may be prolonged.
In no fever is the pulse quicker than  in this
disorder, and it may be 140 or 160  in a min-
ute.  Moderate  delirium  and  headache  are
often present in these cases.   After the rash
has gone the epidermis is dry and harsh, and
about the ninth or tenth day it begins to peel
and is sometimes cast off in large flakes, and
this desquamation, or peeling, may last a few
days or occupy  several weeks. 
4-20       SCARLET FEVER
SCIATICA
  2. Malignant Scarlet Fever is characterized
by an increased severity of the above symp-
toms ; there  is great prostration, delirium,
and sleeplessness ; the rash  does not always
come  out well ; the face may be livid, and
stupor and coma come on, and end in death ;
the throat  is  ulcerated, and there  is  much
difficulty in swallowing.
  3. Latent Scarlet Fever is when the disease
is so mild that until the sequelae appear one
is not aware of having  had scarlet fever.
There  is no  relation between the abundance
of the rash and  the  danger to the patient.
However mild the disease may be, the sequelae
may come on with great severity : one is just
as liable to catch the fever from  a mild case
as from a severe one.
  Sequelae.—-After the fever has passed there
may lollow  a train of symptoms which are
very  inconstant in their character  and  of
much danger to the patient.  The throat may
continue to be affected and the elands outside
may be inflamed and swell, so that the child's
head seems encased in a " collar of brawn ;"
often  these  glands suppurate and  a  large
ulcerated surface is  then seen.  Deafness
may come on and a discharge from  the ear.
Bronchitis and pneumonia are not so com-
mon  as  in. measles.  Sometimes convales-
cence  is retarded by abscesses  forming  in
various parts  of  the  body ; at  other  times
there is a painful affection of  the joints, which
much  resembles  rheumatic  fever.   Renal
dropsy is also one of the most usual sequelae,
but its frequency varies in different  epidem-
ics ; the face and loose parts of  the skin are
very pale and  puffy,  and this is best  seen
under the eyes and on the insteps ; the urine
is scanty and dark from  containing blood ;
there is often headache, loss of appetite, and
perhaps convulsions ;  this complication often
comes on two or three weeks after  the first
appearance of the rash.   (See Bright's Dis-
ease and Hematuria.)
  Treatment.—Most  cases  recover  in  a
week, except those which are malignant, and
those  where the woman  is at the same time
pregnant ;  the  latter condition much  in-
creases the danger, and hence women should
then be extremely careful not to go near a
case of scarlet fever.  The mild cases  must
be nursed simply, and  there is  no remedy
which will cut short an attack.   The patient
must be put to bed and  have a milk diet, in
the same way as has been fully described in
the articles on Fever and Measles, and need
not therefore be repeated here.  Hot flannels
or cotton-wool should be wrapped round the
throat, and steam may  be  inhaled into the
mouth.   Sometimes  a  compress of  linen
steeped in cold water and applied to the throat
gives great relief.   When dropsy comes on it
shows  the kidneys  are affected, and the pa-
tient must be put to bed again, if he has been
up previously.  A hot bath  and purgatives
must be given to remedy this state of things.
Exposure to cold too soon  after an attack of
scarlet fever is often  a cause of the dropsy.
and so care should be taken to keep the child
in the house for at least three weeks after the
rash and until  the peeling has finished.  In
this way also the child is less liable to give it
to others.  Malignant cases may be knocked
down  at  once and die  within  forty-eight
hours ; ammonia and brandy must be given
when the state is one of  great prostration.
Gargles are not of much use to the throat ;
brushing the  fauces  over  with  tannin  and
glycerine, or with a  solution of  nitrate of
silver, is the best remedy.   In cases of dis-
charge from the ear  this  must be syringed
with warm water three or four times a day,
and a little cotton-wool should then be pushed
in.   During convalescence tonics should be
administered, and for  this  purpose iron and
quinine are the best  remedies.  The reader
is referred to  the article on Sanitary  Reg-
ulations for an account of  the disinfecting
measures to be used.
  SCIATICA  is not  a single disease, but a
group of  diseases  of  various  kinds,  but all
affecting nearly the same region. That region
is  the lower portion of the hip and  thigh,
along which the sciatic nerve  runs, whence
the name.  True sciatica is a neuralgic affec-
tion, but numerous other maladies, especially
of a rheumatic  origin,  have been  mistaken
for it.  The sciatica rarely occurs  in youth,
and rarely begins in old age—most frequently
it commences between  forty and fifty.  One
kind of sciatica—of the truly nervous kind —
is associated, especially in females, with hys-
teria, or other signs  of a  nervous tempera-
ment.  Frequently these suffer from neuralgia
in other situations. The sciatica which occurs
in older persons very often follows on cold,
damp, and fatigue.   It is  especially trouble-
some in  men who have broken down under
their exertions, and show signs of premature
age.  Sciatica occurring in these individuals
is exceedingly intractable, and there are very
frequently spots in the neighborhood of the
great nerve that are exquisitely tender to the
touch.   In this form  of paralysis,  too, the
motion  of the  extremities  is interfered with.
There  is loss of power and  motion, or any
attempt at it gives rise to great pain.   Be-
sides loss of motor power  there may be loss
of sensation  of the ordinary kind.   There
may be greater sensibility to mere touch, but
the power of discriminating possessed by the
skin is diminished.   As the nerve which sup-
plies the lower extremities is concerned in this
affection, not only  is the motor  power im-
paired and the sensory functions  interfered
with, but there is often a  loss of governing
power, so that any stimulus which ordinarily
would have little effect  while the central gov-
erning power  had full  control over the ex-
tremities, may give rise to spasmodic contrac- 
SCIATICA
SCROFULA           421
tions or cramps of the muscles of the affected
extremities.
  In another group of cases  where there is
marked pain in the sciatic nerve, these seem
due to inflammatory or other changes in its
sheath subsequent to rheumatism or syphilis.
These cases belong to  a totally different cate-
gory to the former, and the treatment applied
to them must be as different.  In these cases
iodide of potassium and cod-liver oil are  the
great remedies ;  not  so  with the  neuralgic
affections of the sciatic nerve.  Bicarbonate
of potass, which is  often  prescribed, is quite
useless, and if  persisted in for any length oi
time worse than useless.   Iodide of  potas-
sium ought to be given in good large doses,
larger in syphilitic than  in  rheumatic  sci-
atica. Not less  than 10 grains should be given
three times a  day to begin  with,  and  the
quanlity  should   be  gradually  increased.
Cod-liver oil is to be given as the patient  can
take it, and continued for  a long time.  Small
doses are of little worth.   Now, of the true
neuralgias,  it is especially important to give
in the  first variety—that is,  the one which
occurs in a decidedly nervous temperament,
and is very likely the result of nervous  ex-
haustion— tonics.   Steel  and   strychnine
should  be  given,  and persevered  in ; these
may not suffice to  wholly  get rid of the pain,
but they will strengthen the constitution, and
so  enable other remedies to be used with
more advantage.   The strychnine may  be
given either as liquor  strychnine (solution of
strychnine), from five to ten minims for a
dose, or the tincture of nux  vomica in like
quantity may be prescribed.   Liquor strych-
nine is best when given along with iron.   Of
iron the two best  preparations are the sac-
charated carbonates and the neutral chloride.
The carbonate  may be given in doses of 20
or 30 grains, the chloride in 20 or 30 minim
doses.  The liquor ferri perchloride may  be
used if the other is not obtainable.  Arsenic
is a remedy not to be  overlooked in dealing
with sciatic neuralgia, 'especially if there is
any likelihood  of  malarial  complications.
The  preparation   commonly  employed  is
Fowler's  solution,  of  which the  dose is two
or  three  minims,  given   immediately after
food.  It is true that arsenic is of more value
in other  forms of neuralgia than  sciatica ;
nevertheless its use in  an obstinate case—and
sciatica is very obstinate  sometimes—should
never be overlooked.
  Of the local means of relieving sciatica, chief
among them we would place the hypodermic
injection cf morphia, especially over the spot
where the pain is most severe.   If the spot
be also tender, it may be necessary to  use
ether  spray to alleviate the pain of the injec-
tion.   The  quantity injected should  not in
the  first instance exceed one fifth of a grain ;
but it may be shortly  repeated if successful.
The value  of this  injection lies as  much in
 the rest from pain it gives as in its action on
 the  nerves.   Very  often, however, it is not
 possible for a sufferer to procure this injection
 of morphia at all times when his pain is se-
 vere, and it is hazardous to allow him to have
 the command of the injection, as he is apt to
 increase the dose unnecessarily and speedily.
 When this is  the case  a small blister over the
 pained spot,  with  some  lead and  morphia
 lotion  to apply when the skin is removed,
 will do great good.   Of course such a lotion
 must   be  very weak.  An  ointment  may
 be  made   to  produce  similar effects.  A
 good many physicians like to use atropine in
 small  quantity  along with morphia  when
 given  under the skin ;  and some give it by
 itself in the  same way, frequently with suc-
 cess.   The dose to be given must not exceed
j the  sixtieth part of a grain.
   The local use of electricity in sciatica is a
 recent introduction, but already it has at-
| tained wide  popularity.   The  kind of  elec-
 tricity is, however, important.  That in ordi-
 nary  use—induced electricity, whether the
 original current be magnetic or chemical, it
 matters not—is useless.   The current  must
 be  continuous, and  it is important  that  it
 should be  as nearly as  possible  constant.
 (See Electricity.)
   All forms of  sciatica are apt to return, and
 co if a patient has once suffered  from the
 malady he  ought  to  take great care that it
 does not, or  the consequences  may be dis-
 astrous.  To this end over-fatigue,  bodily or
 mental, should be avoided, and flannel con-
 stantly worn next to the skin.
 ■  SCIRRHUS, a name applied to one variety
 of cancer.   (See Cancer  and Tumors.)
   SCORBUTUS.  (See  Scurvy.)
   SCRIVENER'S  PALSY,  or  WRIT
 ER'S CRAMP.  (See Paralysis.)
   SCROFULA is a constitutional  condition
 generally inherited from one or both parents,
 and  increased  by bad feeding in early life.
 The most characteristic features of  a scrofu-
 lous  individual  are: a  heavy figure, dull
 pasty complexion, with a prominent upper lip
 and  a coarse mould  of  countenance ;  mind
 and body lazilv disposed, nostrils  expanded,
 and  nose  rather turned  up.   When children
 they  are very  liable to  inflammation of the
 .eyelids, giving a red, angry look  to the part,
 while  most  of the  eyelashes are absent ;
 often, too,   the glands  enlarge,  and  more
 especially those under the jaw  and in  the
 neck  ; this swelling comes on from a common
 cold, or in the course of an illness, and some-
 times the gland breaks up  into  an abscess,
 which points and  leaves, after  recovery,  a
 nasty  seamed  scar ;  such  people  generally
 have  several of these scars, from  abscesses
 having formed at different times.    Eczema is
 another condition to which scrofulous people
 are very subject when young ;  it appears on
 the  head  and  behind  the ears.   Discharge 
4:22
SCURF
SCURVY
from  the ear, earache, and deafness are not
uncommon symptoms.    Bronchitis, inflam-
mation  of the lungs, and perhaps consump-
tion,  may  ensue.   Nor do  the intestines
escape,  for on any slight irritation diarrhcea
is apt to come on. Sometimes the mesenteric
glands in  the abdomen swell, and this may
be  associated with dropsy and  chronic in-
flammation of the peritoneum.  Nor are dis-
eases of the joints uncommon, and these may
go on for  months or years, and be very dis-
tressing to the patient, being accompanied by
discharge of matter and disease of the bone.
Scrofulous people are, therefore, liable to  a
great many diseases in  consequence of their
constitutional malady.  As a rule,  persons
subject to this affection ought not to marry,
as  their  offspring. will  be  more  or less
affected ;  marriage between  cousins  thus
affected should be strongly prohibited.  The
general health of such people may be much
improved  by careful  feeding in childhood,
cod-liver oil, sea-bathing,  and an  out-door
country life.  (See Knee-Joint.)
  SCURF is a popular term applied to those
cases in which  the epithelial scales of the
skin are shed.  It is often so in the heads of
children,  where  branny scales are  shed.
Washing, once or twice  a.„week, tne Part with
camphor water is a good thing.  On a larger
scale it is seen  in cases of psoriasis and in
some cases of eczema.  Sometimes it is called
scurvy, but this is quite  a wrong designation.
  SCURVY or SCORBUTUS depends upon
a state of malnutrition, following the  use of
a diet which is deficient  in  fresh vegetable
matter,  and tending to death unless the causes
producing it are removed.  Scurvy has been
known for many  years.   In the long sea voy-
ages  of the navigators  of the fifteenth and
sixteenth centuries the crews suffered most
terribly from this disorder, and  many lives
were lost.   It was looked upon in  former
times as  an infliction of Providence,  as  a
warning against  those  who presumptuously
strove to seek after  unknown   lands ;  yet
now we know that it is a disease which can
be  readily cured by adopting proper  meas-
ures, and by means which every habitable
country affords.  Scurvy only occurs  when
fresh vegetable nutriment has been  for some
time completely or partially withheld.   It  is
most common among sailors,  because on
long voyages they  have so much salt  food
and no fresh vegetables.  Yet it may occur
among landsmen. In the Crimean war the al-
lied armies suffered very severely in the win-
ter  of 1854 and in 1855.   As soon as the sup-
ply of fresh vegetables and lime-juice became
more plentiful the disease gradually  disap-
peared.
  Symptoms.—First, there is a change in the
color of the skin, which is  pale  or  sallow ;
then the mind  becomes listless, and the pa-
tient is  averse to taking exercise and  seems
apathetic.  There are pains about  ihe limbs,
and so the sufferer is  glad to  lounge  about
and rest himself.  Gradually purplish spots,
or petechias,  are observed, especially  about
the legs and  thighs ;  they are not usually
raised  above the surface of  the skin ; then
larger  patches  form, as if  numbers of these
small spots had run together ; and often there
is an appearance as  if the  patient had been
bruised.  The lips are pale, the face becomes
bloated, the conjunctivae of the eyes become
swollen and  red.  The  gums, at  first  pale,
begin  to swell at their free  margins, so as to
encroach upon and almost envelop  the teeth :
they then become spongy, dark-red,  or livid,
not painful, but disposed to bleed  when irri-
tated.  Sometimes the teeth are loosened and
fall out ; there is also  a sickening fetid odor
from  the breath.  Chewing is now rendered
impossible, and even fluid  food is swallowed
with difficulty.  Often swellings occur in vari-
ous parts of ihe body, and chiefly near the
bend  of  a  joint ; the  most common seat of
this condition is the ham, and next the elbow,
or beneath  the jaw.   There is often breath-
lessness and  attacks of syncope or fainting,
and this is dangerous, as sudden death may
in this way take place ; therefore, any one
who is bad  with scurvy should be kept in the
recumbent  posture,  and not  be allowed  to
sit erect.  In bad cases ulceration of the skin
often comes on, and may spread rapidly, and
be attended with dangerous bleeding:   Very
little difficulty can occur in making out a case
of scurvy,  and  especially  if  the antecedent
conditions be known.
  Treatment.—This must  consist  in supply-
ing the patient with the  material, by the de-
ficiency of which his disorder has been pro-
duced.  It is wonderful how, in a very bad
case,  an immense  improvement  will take
place  in a few  hours  by giving lime juice :
among  the vegetables  which  may be  given
are oranges, lemons, limes, cabbage, lettuce,
potatoes, onions, mustard, and cress, dande-
lion, sorrel, scurvy-grass,  and grapes.  An
ounce  of lemon-juice should be issued daily
when vegetables are short.  The other articles
of diet must be so arranged  in a case of scurvy
as to  be easy of digestion.  The  following
suggestions have been issued by the London
Board of Trade for  the information of ship-
owners and shipmasters :
  " Every ship on a long  voyage  should be
supplied with a proper quantity  of lime  or
lemon-juice.
  " The juice having  been received in bulk
from  the vendors, should  be examined and
analyzed by a competent medical officer. All
measures adopted for  its  preservation are
worthless,  unless  it be clearly ascertained
that a pure article has been supplied.
  " Ten per cent of  brandy (specific gravity.
930), or of  rum  (specific gravity, 890) should
afterward be added to it. 
SCYBALA
SEA-SICKNESS         423
   " It  should  be packed  in jars or bottles,
 each containing one gallon or  less, covered
 with a layer of oil, and closely packed and
 sealed.
     Each man should have at least two ounces
 (four tablespoonfuls) twice a week, to be in-
 creased to an ounce daily if any symptoms of
 scurvy present themselves.
   "The  giving out  of  lime  or lemon-juice
 should not be delayed longer than a fortnight
 after the vessel has put to sea."
   SCYBALA is a term applied to the faeces,
 or contents  of the bowels, when  they  are
 passed not in a natural and proper form,  but
 in hard small  masses,  more like marbles or
 excretions of  sheep than what is ordinarily
 considered healthy.  This condition denotes
 a costive  habit of body, and  should be cor-
 rected by gentle purgatives or by diet.
   SEA-BATHING.  (See Bathing, Sea.)
   SEA-SICKNESS   is  a  condition  well
 known as  one  of surpassing discomfort, and
 one, too, which seldom  induces that sympa-
 thy which enables us to meet far more serious
 ills with greater equanimity.   Much has been
 written on sea-sickness, but the exact mode
 of its causation  is not yet quite manifest,
 though some of its causes are identical with
 those which  produce nausea on  shore. Some
 delicate people cannot ride with their back to
 the horses of a carriage  or to the engine of a
 train.  If they  do they speedily become giddy
 and faint,  with a tendency to sickness, though
 that  is rarely  induced.   We have  seen  the
 same cause come into play more forcibly in a
 boat but a little way off  land.   The waves
 running past the boat and the course of the
 boat in the opposite  direction tend to make
 an individual  giddy, and  so  to  favor  the
 advent of sea-sickness in its aggravated form.
 Under such circumstances a fixed look on the
 shore at a distance may preserve the individ-
 ual from being actually sea-sick, though  he
 may be faint.   Even on  shore  unpleasant
 sights and smells may cause nausea and sick-
 ness.   It is no uncommon thing for a young
 student to  get sick at his first operation, espe-
 cially if his  stomach is irritable, and, as is
 well known,  evil smells are even more power-
 ful than foul  sights  this way.   To  an indi-
 vidual with a tendency to nausea, the  smell
 of bilge-water and tar, or of grease, oil, and
 the like on ship-board, still  more the sight of
 others in the act of being sick, are powerful
 inducements  to go and do likewise.
   But these  things, at least some  of them,
 persist ; sea-sickness  does not.    It either
 passes away  on landing, or, if the voyage is
 one of some  duration, it gradually leaves the
 traveller hungry as a hawk.  It is quite plain,
 therefore,  that the immediate cause of  the
 feeling  of sickness   is  the  unaccustomed
 motion of the vessel ; once the individual has
become acclimatized to that, the feeling passes
away,  and the benefit of the sea air is felt.
Under ordinary circumstances an individual
goes on board ship without any preparation ;
as soon as the vessel begins to feel a little the
motion of the sea the passengers begin to feel
queer, especially if they have been eating and
drinking more than has  been good for them
before putting to sea.  If to this the  individ-
ual superadd giddiness,  induced by  looking
at the sea rushing past, there is speedily an
end to it: the sea claims her own. There can
be no question of the fact that  the motion is
the main cause of  the nausea, for it  is much
worse in a small boat dancing freely on the
water than in a large vessel, which  is com-
paratively steady, and it is worse in  what is
called a chopping sea than in a  regular, even
swell, especially if the vessel be small enough
to respond to all the motions of ihe waves.
The motion  communicated to  the vessel is
communicated to the passengers ; the crew
have their sea legs on board.  To them the
motion  is nothing ; they balance themselves
as easily as on  land.  But the freshly em-
barked passenger cannot do this ; he cannot
balance himself; he is in constant danger of
falling, or seems to  be  so, and his  body is
agitated  in  endeavors  to  support himself.
These violent efforts induce motion in the
organs contained in the abdomen, and doubt-
less also the nerves which supply these.  Of
course,  if these viscera  are  overloaded, the
evil comes all the more  speedily.  A sudden
feeling of nausea causes the entrance  to the
stomach to relax, the  motion superadded to
contraction of the abdominal walls speedily
causes evacuation of its contents, and one act
of vomiting  begets another.  Meanwhile the
original cause of the mischief, the motion of
the vessel, continues, and the stomach, now
rendered irritable, responds  more easily  to
this  stimulus, and  so the  sickness  is kept
up.  Just behind  the stomach  and  liver lie
an  important group of  nerves  which  partly
control the heart's action, the motion of the
organs in the abdomen much affect that, arid
so perhaps the feeling of nausea as well as
the attempts at vomiting are kept up.   But
vomiting always ends in producing intense
depression ;  it tries every muscle in the body
■—nothing exhausts  like it, and  when to the
former nausea and retching  are superadded
this feeling of exhaustion, the full misery of
sea-sickness is developed ;  but by and by, as
the system becomes habituated to this motion,
the new sensations pass away, perhaps to re-
turn no more.
  Prevention  is better  than  cure,  and  of
nothing is this truer than sea-sickness.   As,
moreover, many of us cannot stay at  home
forever, it is better to try to understand the
best method of avoiding the scourge if we
can.   Should we desire to avoid the  terrible
nausea and depression, it is best to have the
bowels well  opened the day  before,  so that
they shall not be  loaded.  We should also 
424     SEBACEOUS GLANDS
SEPTICCEMIA
take care that the stomach is not overloaded,
but as retching  on an empty stomach is not
pleasant, it is desirable to  take a little food
an hour or two  before embarkation.   Drink-
ing or smoking, especially in those not accus-
tomed to either, are strenuously to be avoided,
as tending to render the  stomach irritable.
When  the individual goes  on shipboard he
should select a spot where the motion is likely
to be least, that will be as near the centre as
possible, and then as the motion of the body
standing is greater than sitting, and sitting
than lying, it is best for him to lie down flat
on the deck if possible.
  Treatment.—As to internal remedies,  all
kinds of things have been tried ; none do so
well as spirit of chloroform,  which  used to
be  called chloric  ether.  Thirty drops,  or
even a teaspoonful, of this may be taken in a
little water as soon as the traveller  goes on
board and has lain down.  For it is not given
with a view to cure, but with  a view to pre-
vent the nausea. Certain it is that in a goodly
number of cases the spirit of chloroform either
enables the stomach to meet the shocks better
by  stimulating  it, or by soothing it ; at  all
events,  in a short  voyage  there is a good
chance  of escaping.  In  a longer  voyage,
when the  sickness is  passing  away, drachm
doses of aromatic spirit  of ammonia, with a
little spirit of  chloroform, should be given ;
but a still better " pick-me-up" is iced cham-
pagne.  Fortunately,  the two are not  incom-
patible.
  SEBACEOUS GLANDS. (See Skin.)
  SEDATIVES are medicines which depress
the vital powers without inducing any previ-
ous excitement.  The only  remedies  of this
class that can be trusted in the hands of non-
professional persons are tobacco and  diluted
hydrocyanic acid.   The effect of tobacco  is
attained by smoking, which  even if injurious
as a regular  practice  may sometimes be  in-
dulged in with advantage.   Hydrocyanic acid
is a deadly poison in large doses, but in very
small doses (2 or 3 drops of the diluted prep-
paration)  it may be given without risk in t e
sickness which  accompanies pregnancy,  or in
other ordinary  cases  in which a sedative  is
required.
  SENEGA is the root-stock and rootlets of
the Polygala Senega, growing in North Amer-
ica.  The rootlets have a peculiar heel on one
side; their color is grayish-yellow. The taste
is sweetish and acrid, causing flow of saliva.
The active  principle, senegin, also  causes
sneezing when  applied to the  nostrils.  Two
preparations of senega are in use, viz., an  in-
fusion and tincture.
  Senega seems  to  act mainly on  mucous
membranes, especially on those of the lungs.
It also acts on the skin, and sometimes on the
kidney.  Some esteem it to possess a certain
influence  over  the heart and womb.   It is,
however,  used  almost  entirely  in   chest
disease,  as  a remedy in chronic bronchitis,
whooping-cough, and  the  like.  Here it  is
seldom prescribed alone, generally other sub-
stances,  as  paregoric and carbonate  of am-
monia, are combined with it.   It has  been
used in renal dropsy and in painful menstrua-
tion.  The dose of  the tincture is a drachm,
of the infusion half  an ounce to an ounce.
  SEIDLITZ   POWDERS   are   cooling
powders, which  do  not appear in the  phar-
macopoeia, but  are  nevertheless  useful as a
gentle  aperient.  Each  dose  requires two
powders  to  prepare it, the  white paper con-
taining an acid, the blue an alkaline powder.
The latter consists of  Rochelle salts,  tartrate
of potass and soda and  bicarbonate of soda,
the acid being  usually tartaric acid.  These
are mixed together with water and drunk
while effervescing.  (See Rochelle Salt.)
  SENNA, as  used in  medicine, is  of two
kinds, the so-called  Alexandrian or Egyptian
senna, and East Indian or Tinnevelly senna.
The substance  is the leaf of various species
of cassia.  They all  have a peculiar odor, and
all, if examined, will be seen to have one side
shaped differently to the other at the base of
the leaf  where  it  joins the   stalk.  Senna
readily yields its virtues to water.  Its  prep-
arations are a confection, infusion, mixture,
tincture,  and syrup.   The confection  is  a
good, useful preparation, consisting of senna,
coriander, tamarinds, cassia pulp, prunes, ex-
tract of  liquorice, and  sugar.   It is useful in
piles.   The mixture, best known  as  black
draught,   contains  sulphate   of  magnesia
(Epsom salts), extract of liquorice, tincture of
senna,  tincture of  cardamoms, and  infusion
of  senna.   The  tincture  contains,  besides
senna, raisins,  caraway, and coriander ; the
syrup, coriander and sugar.   Senna is hardly
ever given as powder ; the infusion  is  most
commonly employed, except among children,
where the tincture  or  syrup takes its place.
About an ounce may be given of  the  infu-
sion, the same of the mixture, and of the con-
fection a drachm or more. The syrup  is  given
to children in the dose of a drachm or more.
  Senna, as  is  well known,  is a purgative.
stimulating the motion of the bowels, and also
aiding slightly in promoting their flow, but a
salt of  some kind, Epsom or Rochelle,  is
generally added to increase its  efficacy in this
way.  Senna is seldom given alone, as it is
apt to  gripe, and for  this reason spices are
usually  administered along with it.   Senna
is more generally used than any other purga-
tive when it is simply desired  to have the
bowels cleared out,  as  it is apt  to leave no ill
consequence behind.   It  should not,  how-
ever, be  given if there is any tendency  to in-
flammation of the bowels.
   SEPTICCEMIA is an acute disease which
resembles pyaemia very much  in its  general
characters,  and  which  is supposed  to  be
caused  by the  absorption  into the  blood of 
SEROUS APOPLEXY
SHOCK
425
 putrid material  from the surface of  a wound
 or  ulcer.  It generally occurs after  phleg-
 monous erysipelas, sloughing,  or other forms
 of unhealthy action about a wound which has
 been caused either by accidental injury or by
 the knife of the  surgeon.   The following are
 the  most prominent symptoms of  this  dis-
 ease : great prostration ; the patient lies help-
 lessly upon  his back, as in bad typhoid or
 typhus fever, and at  last falls  into a state of
 intense collapse ; this prostration is increased
 by profuse perspiration and obstinate  diar-
 rhcea ; the  tongue is  dry and brown,  and
 there is often much irritability of the stomach
 indicated by nausea  and frequent vomiting.
 The nervous symptoms are very characteris-
 tic ; the patient appears drowsy and apathet-
 ic, and sensibility seems to be lost.  There
 is low muttering delirium with short intervals
 during which the patient seems quite conscious
 and discourses  rationally.   There  is rarely
 much restlessness or violent delirium.   The
 frequently repeated fits of rigors or chills so
 characteristic of pyaemia are generally absent
 in  this disease.  The  patient  sinks slowly,
 and during the  last twenty-four or  thirty-six
 hours of life is in a state of coma and collapse,
 during which the actions  of  the heart  and
 lungs are  carried on very feebly and almost
 imperceptibly.
   SEROUS APOPLEXY is a  term often
 used, but it is a  wrong expression ; such cases
 are nearly always due to chronic Bright's dis-
 ease, and should be called renal coma.   (See
 Apoplexy and  Coma.)
  SERPENTARY consists of the dried root
 of the Aristolochia Serpentaria, a native of the
 United States.   It also goes by the name of
 Virginia snake-root,   and must not be  con-
 founded with the black snake-root.   The part
 employed  is the root or root-stock with the
 rootlets attached.  These are of a pure brown
 color, and have a peculiar  odor and  taste,
 something resembling camphor.  It contains
 bitter matter, a volatile oil, and some resin.
 Its  preparations are an infuson and a tinc-
 ture.  Serpentary acts  as a  stimulant, but
 some men think much of  it, some little.  It
 seems in the hands of some to do  good in
 certain forms   of indigestion and certain
 conditions of bowels.   It  also acts on the
 skin as a stimulant, though not very power-
 fully.   It seems to do good in chronic  rheu-
 matism and subacute gout.  The tincture is
 commonly employed  in doses of a drachm.
 The powder and infusion are not often given.
  SERPENTS, BITES OF.   (See Snakes,
 Bites of.)
  SERUM. (See Blood.)
  SETON  means a  long wound artificially
made  under the  skin,  the  walls oi  which
wound are kept  in a state of  irritation and
suppuration by the presence of some foreign
body.   It differs from an  issue in being a
tubular wound under the skin and not an open
ulcer.  A seton may be established by trans-
fixing a  pinched-up fold of skin by a large
flat needle armed with a strand of cotton or
silk thread, or by passing  a bistoury through
the base of the fold and  then carrying the
thread through the canal thus made, by means
of a small-eyed probe.  After the  thread has
been  allowed  to  remain at rest  for two or
three  days and has set up irritation and some
discharge, it is pulled a little  further through
the wound so that a fresh portion may be in-
cluded and  the  soiled  portion be cut away.
This manoeuvre  is repeated every second or
third day, and when the strand is almost used
up  a fresh strand is attached  and substituted
for it.  Instead of cotton or silk thread many
surgeons use a small flat band  of india rub-
ber, which is less liable to become clogged by
dry  and  offensively  smelling   discharge.
Setons are established for the  purposes of
setting up counter-irritation, and of causing
a chronic discharge so as to  produce a drain
upon  the system.   With the former.object in
view  they are often  useful when applied to
the temple in some affections of the eye, and
to the back of the ear in cases of deafness.
As a means of producing  a constant drain
upon  the system  a seton is often established
in old people who are threatened  with an at-
tack of apoplexy, or who suffer from consti-
tutional  disturbance in consequence of the
closing  by cicatrization of a large chronic
ulcer.   Chronic abscesses and tumors with
fluid contents are often treated by the intro-
duction of a long strand of silk  thread.  As
the fluid  flows slowly away from  the  orifices
of the seton irritation is set up in  the walls of
the sac, which contract, and are finally glued
together  by inflammatory  condition's.  (See
Issues.)
  SHAKING PALSY, also known  as  Pa-
ralysis Agitans, is a malady most common in
advanced life.  (See Paralysis.)
  SHAMPOOING.  (See  Turkish Bath.)
  SHERRY.   (See Wine.)
  SHINGLES.  (See Herpes.)
  SHIVERING.  (See Rigors.)
  SHOCK, which is also called  Collapse and
Prostration, is an immediate  result of severe
injury, and consists in general depression of
bodily power, and in  partial  or  complete
arrest of the heart's action consequent upon
an intense and violent impression upon the
nervous system.  A similar condition is pro-
duced by the action of certain poisons.
  The following are  the symptoms  of  well-
marked shock : The surface of the body cold
and very pallid ; the  bloodless condition of
the skin is most evident in  the face and lips,
presenting a strong contrast to  the  usually
florid  appearance of this portion of the body ;
the forehead  is  covered  by drops  of cold
clammy  perspiration  ;  the breathing almost
imperceptible ; the pulse weak, irregular, and
in extreme cases  imperceptible ;  great  mus- 
426
SHOCK
SHOCK
 cular  debility—prostration ; the patient is in
 a state of stupor, and  the sensibility  is be-
 numbed.  The symptoms of shock vary very
 much  in degree in  different cases, according
 to the nature of the injury and to  the bodily
 or mental  condition of  the patient.   Their
 intensity is  much  increased in cases where
 there has been much hemorrhage, then there
 is more  mental  disturbance, and the patient
 presents all the symptoms of severe syncope.
 In some cases there are nausea, hiccup, and
 vomiting.   In cases of  injury to the head re-
 sulting in compression or laceration of the
 brain, the symptoms of shock may be associ-
 ated with convulsions and palsy.
   The duration of shock varies very  much.
 In less extreme  cases the symptoms subside
 in the course of one or  two hours ;  in  severe
 cases they may last for thirty-six hours or two
 days.  In cases of recovery the patient  passes
 from a state  of shock to one of perfect or im-
 perfect reaction.  W'hen the reaction  is per-
 fect the  pulse becomes stronger and  fuller,
 and the  breathing  deep  and well  marked.
 The  most  favorable  signs  are  returning
 warmth of the surface of the body,  and slight
 restlessness  on  the part of the patient, with
 an inclination to lie on his side. In the  course
 of a few  hours there may be some fever indi-
 cated by a hot skin, a flushed face, and bright
 eye, and a  rapid pulse.   These symptoms,
 however, in  favorable  cases soon  pass off,
 and the   complete  recovery is established,
 With imperfect  reaction,  on the other hand,
 the febrile symptoms  increase  in  intensity,
 and then after a time give way to symptoms
 of nervous  excitement  and general exhaus-
 tion.   There are  great mental excitement,
 with or without delirium, muscular trembling,
 and much restlessness.   These  symptoms
 are associated with others indicating  rapid
 exhaustion,  such as vomiting,  a  cold  and
 moist  skin,  and a low  fluttering  pulse.  In
 bad cases these symptoms increase in inten-
 sity, and finally the patient dies in a state re-
 sembling coma.   In children  convulsions
 often occur during the states of shock and of
 imperfect reaction.   Patients who  have been
 accustomed to take large  quantities of  beer,
 wine, or spirits, generally present during this
 state of imperfect reaction  all the  symptoms
 of violent delirium tremens.  In individuals
 who are naturally weak  and delicate, reac-
 tion,  though favorable in its  course,  and
 steadily progressive, may be very  slow, so
 that complete recovery is not  attained for
 several days after the occurence of the in-
jury.
  By far the  most frequent cause of shock is
injury.   Cceterisparibus, the more important
and necessary to life the injured  organ may
be, the more intense are  the symptoms of
shock.    Severe and even fatal shock may be
caused by injuries which produce no morbid
appearances  in any part of the body.   A
 blow over the pit of the stomach or compres-
 sion of the testicle  may often give rise to in-
 tense and  alarming symptoms.   In  railway
 accidents  shock is  often  produced  without
 any visible injury  or  subsequent  symptoms
 of injuries to internal  organs.   Sudden and
 violent injuries to limbs, with extensive crush-
 ing of the  soft parts, and compound fractures,
 are always followed by shock.   The most in-
 tense shock resulting from visible injuries is
 probably met with after  burns and  scalds,
 either when a considerable depth of soft struc-
 ture has been destroyed, or when the injury
 though superficial has involved a considerable
 extent  of  the surface  of the body.  A very
 superficial scald  is almost  always fatal  in
 children, when a considerable portion of the
 skin covering the front  of the chest and abdo-
 men has been thus  injured.  Intense pain in
 connection with any kind of injury generally
 causes much shock.  With gun-shot wounds
 there is generally  well-marked  shock, which
 is favored  or intensified by the circumstances
 under which the injury was received.  Profes-
 sor Longmore,  of the Army Medical School at
 Netley, remarks on this point that panic may
 lead to severe  symptoms of shock, although
 the wound is not of a very serious character.
 " A soldier," he says,  " having his thoughts
 carried away from himself, his whole frame
 stimulated to the utmost height of excitement
 by the continued scenes and circumstance of
 the fight, when he  feels himself wounded is
 suddenly recalled to a sense of personal dan-
 ger,  and if he be seized with doubt whether
 his wound is mortal, depression as low as his
 excitement was high may  immediately fol-
 low."   In all cases of shock following injury
 the symptoms are modified by the mental and
 bodily condition of  the patient, by the nature
 of the accident, and the circumstances under
 which it has taken place, and by the amount of
 disturbance to the  nervous system, and the
 organs of the chest.  Much loss of blood in-
 creases to  a considerable extent the intensity
 of shock. Symptoms resembling those of trau
 matic shock may be produced  by the action
of narcotic and corrosive  poisons, and also
by intense pain caused by disease.
  Treatment.—The chief indications  in the
 treatment of severe shock are to keep up the
action of the  heart and lungs, and to maintain
the  temperature of the body  until the full
effects of the sudden and violent  impression
upon  the brain  and nervous   system have
passed  off.  In  a case where  there  has not
been much hemorrhage, and where no large
wound is present  from  which bleeding might
be likely to occur before the arrival of a med-
ical man, the patient should at once be placed
in bed between warm  blankets ; a bottle  of
hot water should be placed near the feet, and
one under each  armpit ; if suitable stone
bottles are not at hand, bricks  or any other
bodies  which will retain heat for  a time 
SHORT-SIGHTEDNESS
SKELETON
427
 should be used.  Care must be taken to pre-
 vent burning  of  the  patient's  skin  by wrap-
 ping the heated  bottles  or bricks in flannel.
 Brandy should be administered  frequently,
 and in small quantities,  the spirit being
 slightly diluted with  hot water.   If there be
 much nausea or vomiting, an injection should
 at once be made  into the rectum  of beef-tea
 and brandy, or milk and brandy.  When the
 shock is so intense that the breathing ceases
 or becomes almost imperceptible,  an attempt
 should  be made  at artificial respiration  ac-
 cording to the methods described in the article
 on  Drowning.
   In cases of shock  associated with profuse
 hemorrhage, brandy  should not be  adminis-
 tered very freely,  nor should  much warmth
 be applied to the surface  of the  body until the
 bleeding vessels  have been closed either by
 ligature or by pressure.
   The treatment  of the serious symptoms in-
 dicative of imperfect  reaction  should consist
 in supporting the system and preventing fatal
 exhaustion on the one hand, and  in allaying
 nervous  irritability and producing  sleep by
 large  doses of sedative drugs on the other
 hand.
   SHORT-SIGHTEDNESS.     (See  Eye
 and Vision.)
   SHORTNESS OF BREATH is a com-
 mon symptom  in  many diseases of the heart
 and lungs.  (See  Dyspnoea.)
   SIALOGOGUES  are substances  which
 promote the flow of  saliva ; they  are hardly
 used in medicine.   Chief among sialogogues
 is horse-radish, which is used mainly as a
 condiment.  Pellitory is also  powerful  this
 way,  as  is  ordinary mustard.  The mere
 motions of the gums in chewing acts  this
 way, so that masticating  a bullet or a piece
 of india-rubber frequently excites salivation.
   SICK-HEADACHE.  (See  Headache.)
   SICK-ROOMS should be  as capacious as
 possible, because  then the patient has 'more
 air to breathe, and it does not require renewal
 so often as the air in a small room does, and
 thus a draught is prevented.  A fair amount
 of ventilation is carried on by the  door, win-
 dows, and fireplace, but  at least twice a day
 the windows should be opened so as to cleanse
 the room.   If the  patient can leave the room
 for a short time, so  as to  allow  of a free cur-
 rent of  air. so much  the better ;  if  not, the
 patient should be  lightly  covered over, so as
 not to feel  any  draught.   In cases of fevers
 and  any contagious disorders, it  is best  to
 remove from the  room all unnecessary arti-
 cles, as curtains, hangings, carpets, etc., and
 let there be disinfectants about.  (See Dis-
 infectants.)   In  chronic cases  the sick-room
should be  made as  cheerful as  possible, and
the amount of light should be regulated so as
to  please  the  patient ; in  cold weather the
fire should  be  kept  nice  and bright ; when
possible, flowers should be placed in  the room.
 But  there are  a hundred little details  and
 comforts which a practised nurse  will look
 after.  A thermometer should be in the room
 so as to have the temperature  properly regu-
 lated.  (See Nursing.)
   SIGH A1 is a  special function of  the optic
 nerve,  by which we  become acquainted with
 the  world   around us.   (See Eye,  Color
 Blindness, and Vision.)
   SILK, OILED, is a very useful preparation
 of silk, which renders it impervious to water
 or grease, and  is chiefly used in  surgery to
 lay over dressings of  wounds so as to keep
 the lint, saturated with water, from becoming
 dry by evaporation.  Less expensive textures
 are prepared from india-rubber, but they have
 all a disagreeable smell, which does not ex-
 ist in oiled silk.
   SITZ-BATH is a form of  the bath much
 used in the hydropathic  practice,  and occa-
 sionally prescribed by the regular physicians.
 It consists  in the immersion  of the hips in
 cold water,  by sitting down in  a tub contain-
 ing a moderate quantity of the water.   Tubs
 designed especially for the purpose may be
 had, but an ordinary tub will answer for the
 purpose, unless the patient is  feeble.  The
 sitz-bath is unquestionably a powerful remedy
 in certain diseases of the head and digestive
 organs, and usually braces the entire system ;
 but; it is not advisable to take the bath except
 under medical advice.
   SKELETON—The  skeleton  of a  full-
 grown human  being  consists of 200 distinct
 bones,  exclusive  of  the  little bones  in  the
 internal ear.  They are thus distributed :
     The spine..................... 26 bones.
     Skull..........................  8   "
     Face .......................... I4   "
     Ribs and breast-bone........... 26   "
     Upper extremity................ 64   "
     Lower extremity___ ........... 62   "

   These bones are divided into four classes,
 known  as Long, Short, Flat,  and Irregular.
 The long bones are those which exist  in  the
 limbs,  and  are  employed in  locomotion ;
 tiieir characteristics are, that they  consist of
 a  shaft and two  articular extremities,  these
 extremities being covered with what is termed
 articular  cartilage, and  being  capable  of
 mutual  movement upon each other by one or
 another form of joint, the gliding movements
 of such joints being assisted by the  presence
 of bags  containing joint oil (Synovia), which is
 placed  between  these articular cartilages.
 The shaft of  a long bone is cylindrical,  or
 nearly so, and  its extremities  are expanded.
 The shaft consists of compact tissue, while
 the extremities are composed of spongy, hav-
 ing a thin layer of compact tissue coated over
 them.  The long bones  are the cubit, the two
 bones of  the forearm, the thigh  bone, the
 shin and splint bones,  the  bones of the fin-
gers and toes, and the collar bone.
  Short Bones are compact,  strong bones, 
428
SKELETON
SKIN
having several  articular  surfaces for mutual I
adaptation, and are found in  those  parts of
the body where strength and  limited motion
are required, such  as  in the wrist, bones of
ankle and instep.   They  consist of  spongy
tissue, with a coating of compact structure.
  Flat Bones afford broad flat surfaces for the
attachment of muscles  and for the protection
of cavities ; they consist of  two layers of
compact tissue, containing a layer of spongy
between them.  They are  the  skull bones,
blade bones, haunch bones, breastbones, and
ribs.
  Irregular  Bones are  those which, as their
name would suggest, cannot be grouped with
the previously named,  such  as the  bones of
the spine,  jaw  bones, and  several  of those
bones which make up the skull.
  The natural position of the human skeleton
is erect, and  this is in great measure due to
combined muscular action ;  moreover, the
natural architecture of the skeleton adjusts its
own centre of  gravity, which tends greatly
to this end : thus all those joints which trans-
mit weight to the ground lie in  one vertical
plane, and such a line would be  described as
passing from the top of the head, through the
joints between  the head and first bone of the
spine, through  that between the last bone of
the vertebrae and the' sacrum,  and through
those between the sacrum and haunch bone,
the hip, knee, and  ankle.   The spine, con-
sisting of a great number of bones, peculiarly
articulated  together  by  interposed elastic
cushions, increases in size from  above down-
ward, and moreover, possesses  several well-
marked curves.  The object of these cushions
and curves is to receive the  shock  of sudden
blows and falls, and to disperse their effects ;
again, the  curves are arranged alternately,
so as to distribute  the weight with  greatest
advantage  to the  centre of gravity of the
body, which  passes  through all the curves,
and falls on the c;ntre of the base of the col-
umn.  It will be observed that all the bones
of the limbs are slightly curved, thus assist-
ing in the individual  and  mutual transmis-
sion  of shock.   The  pelvis (sacrum  and
haunch bones) is very  broad  and  strong in
man, and the plane of  its arch is in such a
direction that the weight is transmitted verti-
cally  from the  sacrum to the heads of the
thigh bones.  The thigh bone being curved
inward, allows  of  the weight  of the  body
being brought under the pelvis, and transmit-
ted to the broad expanded ends  of the bones
forming the knee-joint.  The foot, in its turn,
consists of an arch, or  rather  a  double arch,
which receives the  transmitted weight, at its
crown directly through the leg bones.   Thus
it will be seen  that the upper limbs take no
part in the maintenance of this natural up-
right  condition,  the composition of the skele-
ton being so arranged as to  be subservient to
it.
  SKIN forms the external covering  of  the
body ;  there is an upper layer called the epi-
dermis, or cuticle, which is made up of flat,
rounded cells, and which  are being always
shed off gradually and replaced by new ones ;
beneath this is the tough cutis, or true skin,
which  is  chiefly  made  of  fibrous tissue ; in
the skin are numerous hair-follicles and seba-
ceous  or  sweat glands.  The skin  not only
serves  as  a coat to protect internal organs,
but serves other  useful purposes ;  it elimi-
nates a large quantity of water daily, which is
called perspiration or sweat, and this is always
going on, although, unless violent exercise be
taken,  it is insensibly carried on.  Carbonic
acid, urea and fatty matters are also excreted
by  the skin  to a certain  degree.  When a
blister is applied, it is the epidermis which is
raised  up, while  a serous fluid  is beneath ;
so  again, when the skin  peels after scarlet
fever, it is only the upper layer of the epider-
mis that is shed.  To enable the skin to act
properly, it must  be kept quite clean,  although
this is  very seldom done ;  cold water bathing
is not enough, but an occasional  hot bath
must be taken so  as to thoroughly cleanse the
pores.   The skin is liable  to many  diseases,
but ihe names only need be mentioned here,
and the reader must refer to the articles on
those subjects for further information.
  i. Those diseases  which begin or appear
as  pimples or papules :  strophulus, lichen,
and prurigo.
  2. Those diseases  which are  vesicular at
first, or begin  with a little blister or watery
head :  eczema, herpes,  miliaria, sudamina.
  3. Those diseases  which are  pustular, or
contain a little matter : impetigo, ecthyma,
and small-pox.
  4. Those depending  on the presence of a
parasite,  either animal or vegetable :  ring-
worm, itch, etc.  (See Ectozoa,  Epiphyta,
and Parasites.)
  5. Those diseases attended with tubercles,
or raised  lumps, larger  than a pimple :  acne,
molluscum, keloid, lupus,  cancer, yaws, ele-
phantiasis.
  6. Those attended by too much or too little
coloring  matter  in  the skin, and  forming,
therefore, white or dark-colored spots : leuco-
derma, freckles,  vitiligo,  xanthelasma, Ad-
dison's disease.
  7. Those diseases where the skin  is  harsh
and rough : ichthyosis,  xeroderma.
  8. Those   diseases  in  which there  are
hemorrhages  under the skin, and so  purple
spots or patches are seen which do not disap-
pear on pressure  : purpura, scurvy, bruises,
malignant disorders.
  9. Those diseases which are attended with
fever,  and where there is a rash, as in the ex
anthemata ; scarlet fever, measles, erysipelas,
etc.
  Skin-grafting consists of  removing  some
scales  of epithelium from a healthy portion of 
SLEEPLESSNESS
SLEEPLESSNESS        429
skin, and applying them to an old ulcer which
will not heal readily ; these scales thus grow
and form new centres  from which a healthy
cicatrization will presently ensue.
  SLEEPLESSNESS,  technically known
as  insomnia, is one  of  the most troublesome
conditions with which we are called upon to
deal.  Sleep is absolutely essential to all, for
the repose and repair of the nervous centres,
which during waking hours are constantly,
though unknown to us, engaged in  the ful-
filment of certain important  functions.  In
early life the greater part of time is  occupied
in  eating  and sleeping.  In adult life, as a
rule, about one third of our time is passed in
this manner, but elderly  people often  suffer
from sleeplessness.
  Sleep is  ordinarily preceded by a feeling of
languor and heaviness, during which we see
some  of  the  unobserved  functions of  the
nervous system making themselves apparent.
Thus, first of all, the eyelids droop—vve  are
not aware of any  strain in  keeping them
open,  yet the moment our attention, involun-
tary though it be, is  taken off, they  grad-
ually  sink.  So too  the  head,  ordinarily
held erect,  falls  forward,  and the  limbs,
fall into the easiest posture.  Even if the in-
dividual lies down, it will be noticed that, as
sleep  comes on, a  different  posture is as-
sumed, one which allows  of the relaxation of
all  his limbs and all his  muscles.   The res:
pirations too are slower, gentler, and  more
prolonged ; they are carried out with the least
possible amount of work, and the same may
be  said  of the heart.  Sleep  then  might be
defined as the condition of least action in the
human body, mentally and physically.
  It is quite plain that interfering with this
repose, which is  absolutely necessary for the
perfect nutrition of the body, must be fear-
fully exhausting, especially if there is continu-
ous bodily and mental exertion.  Indeed death
may result from continuous want of sleep,
and this is  sometimes had recourse to as a
punishment in China.   Continued  sleepless-
ness is  therefore a most  serious thing  ; it is
often the first  indication of insanity, and is
one of the most troublesome  symptoms  of
violently  insane persons.  Mental  anxiety
frequently  banishes sleep, but when  the body
is worn out,  sleep comes and relieves the suf-
ferer.  Violent  passions, though for a time
dispelling sleep, ultimately bring it on in the
same way through bodily exhaustion.
  To procure sleep, especially of a sound and
refreshing  kind, is often of the very highest
importance.  If any one is about to undergo
severe  mental or bodily exertion,  a  good
sound  sleep is of even greater importance
than a good meal.  Indeed sleep is of essen-
tial importance to enable all to perform their
allotted tasks, and so a few words on the best
means for procuring sleep may be of value.
  Dyspeptics are seldom sound sleepers, and
in many cases the first thing to be done is to
get the digestion in good order.   This little
fact  shows  the importance of dealing with
every case on its own merits,  and not by
mere routine.  Thus,  we have known an in-
dividual who passed sleepless  or worse than
sleepless nights, and  was troubled with evil
dreams  and  nightmare  as soon as his eyes
were closed, have chloral  administered.  As
a  consequence, the dreams and  nightmare
were worse than ever, but a blue  pill and  a
black draught speedily secured sound and re-
freshing sleep.   Constipation and interfer-
ence with the functions of the  liver are seri-
ous enemies to satisfactory repose.
  To many a due amount of exercise  in the
open air is absolutely  indispensable, if sleep
is to be procured, and it is often observed
that a buffeting with  the  wind causes sleep
sooner than any other form of exertion.  The
diet too must be attended to, if sleep is to be
refreshing ; here every man must be a law to
himself, for  what sometimes  soothes and
comforts one man may excite another, and
altogether prevent sleep. There is, however,
one great rule, and that is never to go  to
sleep with an undigested  meal in the  stom-
ach, if it be at all a heavy one.  To this end
many do much better  by making their  chief
meal early in the day,  and only taking a light
meal in the evening.   Tea and coffee  taken
late in  the  day are  particularly prejudicial
to sleep.  The influence of these, however,
differs in different individuals ;  to some tea
is more stimulating than coffee, to others the
reverse  is the case.
  Going to bed at a certain regular hour, be
that what it may. is powerfully conducive to
sleep ;  habit here, as in other things, becomes
all-powerful.  It is, too,  advisable to  have
thoroughly done  with the work of the day,
some time before going to bed.   If that work
has been of a bodily description, the rest will
often be enough of itself ; if it has been head-
work, a change is often best.  For many in-
dividuals  there is no preparation for sleep
equal to a  pipe and  a  novel, to  others this
would be poison.
   For refreshing sleep, it is essential that the
bedroom be  well ventilated, and  many who
make it a regular practice lo sleep with the
windows open find it of great value.  Un-
doubtedly the refreshing nature  of the  sleep
is enhanced  by fresh  air.  Then,  too,  the
bed should be in the middle of the room, not
in a corner  of it;  no  curtain of any  kind
should surround i t. Feather beds are an abom-
ination, a  good firm  mattress is  best.  The
pillows  should be adjusted to the height of
the shoulders, so  that when  one lies in the
natural  position On one  side, the head is in a
line with  the rest of  the body—the  neck
straight, not  to be bent  either  upward or
downward.
  To many a " night  cap" is essential, be  it 
430
SLOUGH
SMALL-POX
a glass of wine, a tankard of ale, or a tum-
bler of grog.  If indulged in with discretion,
there is nothing to be  said  against the prac-
tice, except this, should the individual be so
situated as to have to  go without his  accus-
tomed stimulant, he will most probably pass
a sleepless night.
  The great thing, in most  cases to procure
sleep, is  to  obtain  absolute rest  of mind,
To  men  of active brain this  is sometimes
singularly  difficult,  and  many  plans have
been proposed  to overcome the  difficulty.
They all consist in this, in attending to some-
thing of absolutely no  interest, and which  is
of a dull uniform nature.
  Of course all these things  fail, especially in
the presence of pain, and then  more  power-
ful means must be tried.   Chief among these
are opium, morphia, and chloral hydrate, but
no man ought to take either or  any of these
on his own  responsibility, for thereby habits
are  readily acquired  which  may be hard or
even impossible to get  rid of.  If ordinary
means and ordinary remedies do not  suffice,
the  sufferer ought to  consult  some  one of
skill, in whom he has full confidence ;  that is
important.
  SLOUGH  is the dead part of the tissue of
the body which  is separated and thrown  off
by the healthy part  after inflammation.   It
often becomes necessary, when this process
is taking place, to assist  nature  by  removing
this  source of annoyance, and to prevent the
foul odor that arises from it  by the use of dis-
infectant lotions—such as weak solutions of
carbolic acid.   (See Mortification.)
  SMALL-POX, or Variola, is  a  febrile,
eruptive,  and contagious disorder, which in
past times raged  with much  violence,  but in
recent periods has been  vastly controlled by
the  discovery  of vaccination.   The  most
common varieties are : the discrete, in which
the  pustules are distinct ; the  confluent, in
which the pustules run together ; the  malig-
nant, which is often associated  with purpura
and  an eruption resembling  measles—a very
dangerous form ; the modified, which  comes
on  in those partially  protected by vaccina-
tion, and a kind that runs a very mild course.
In cases of small-pox  there is :  i. The stage
of incubation, which  lasts twelve days, from
the  date of  receiving the  poison.   2. The
stage of eruptive fever and  invasion, lasting
forty-eight hours. 3.  The stage of matura-
tion  wherein  the rash  is  fully developed,
lasting about nine days.   4. The  stage of
secondary fever or decline, lasting a variable
lime, according to the severity of the disease.
Discrete small-pox is the  simplest form of the
disease, and is rarely attended with  danger to
human life ; confluent small-pox destroys the
greatest number of lives, and may prove fatal
to as many as 50 per cent.   In the distinct or
discrete form,  the primary fever  is  less in-
tense than in the confluent form ; in the lat-
ter, there is often delirium,  and more espe
daily in those who are intemperate, such as
draymen, potmen,  tailors, compositors, etc.
The malignant variety is terribly fatal ; the
blood seems profoundly  poisoned from the
first, and is more fluid  than  usual ; bleeding
from the mouth, nose, and bowels is not un-
common ; in women, there is  also bleeding
from the womb, and  if they are pregnant,
abortion will ensue.  In modified  small-pox,
the patient is often able  to go about the whole
time, and the rash may suddenly decline on
the fourth or fifth day, and recovery follow.
  Symptoms.—The disease begins with shiv-
ering or rigors, pain in the  back, vomiting,
thirst, headache, and a general  feeling of in-
disposition ;  in  children,  convulsions may
come on.  In many cases the rash of  small-
pox in vaccinated cases  is preceded by a more
or less  scarlet or  roseolous  rash which  is
mottled  over  the body.   If the  finger be
pressed  on the forehead, a shotty feeling may
be noticed, for the rash of small-pox generally
commences there ; at first a pimple forms, but
afterward a pustule, and then  it dries and
scabs over, and leaves a pit or depression be-
hind.  When the rash comes out, the temper-
ature falls, but rises again about the eighth or
ninth day ; in mild cases, however, this sec-
ondary  fever  is  hardly  perceptible.    The
eruption usually appears first on the forehead,
face, and wrists, and then on the rest  of the
body, coming out on the legs and  feet  about
two days later.   The  eruption  takes  about
eight days to arrive at  its full development ;
during this time there is much swelling of the
face and eyelids, so that the patient cannot
see for  a few days ; in bad confluent cases
the face seems  covered with a  mask,  and a
disagreeable odor proceeds  from the  body.
Boils are apt  to form  in cases of confluent
small-pox ;  they  are   also very  subject to
pleurisy, pneumonia, and bronchitis ;  some-
times the tongue is much  swollen and  dry,
and the  patient may be unable to close the
mouth or to speak ; this is a  very bad  symp-
tom.  Inflammation of the ear, followed by
an abscess, is not uncommon  in this disorder.
Erysipelas, gangrene, and pyaemia are  now
and then met with in the course of  this dis-
order.   Inflammation of the  eye and ulcera-
tion of  the cornea may  add to the general
mischief.  For a pustule to form on the eve
is very rare, but it is very common to see one
in the  soft  or  hard palate.  Smallpox may
be mistaken for measles, but  in the latter dis-
ease there  is running  at  the eyes and nose
and sneezing, and the  rash comes out about
the fourth  day ;   it may be  mistaken for
chicken-pox, but in this disease  there is little
or no fever, the rash comes out  in twenty-
tour hours, is  vesicular and  not shotty, and
more abundant on the trunk,  and not so
much on the face and forehead.
  Mortality.—The  death rate  of confluent 
SMELL
SOAP
431
small-pox  is  50  per  cent, and of discrete
small-pox  four per cent.   Confluent  small-
pox is very rare in those who are vaccinated.
Age has an influence on the disease, for it is
most fatal  in  children and old people, but
least fatal between 10  and  15  years of age.
Small-pox is  decidedly  an  infectious  and
contagious disorder ; riding in a cab or omni-
bus in which a patient has  been recently, or
even passing them in the street, will give the
disease ; a mild case may give rise to a severe
one, and vice versd.  It may attack an indi-
vidual a second time, but this is a  very rare
occurrence.
   Treatment.—There is no medicine which
can check this disorder.  The  patient should
be at  once isolated, and it is  best when an
epidemic is about that small hospitals should
be built away from  other  dwellings  where
these cases can be treated, and the spread cf
the disorder diminished.  For diet, they may
have  milk, tea, gruel  and beef-tea, chicken-
broth, and, in fact, the treatment which has
been laid down for fevers generally.  There
should be gieat pains taken to ventilate the
room without having too much draught, and
keeping it about a temperature of 60°.  Great
cleanliness  must be  observed,  and all linen,
clothes, etc., must be disinfected after being
used.  Bed-curtains, carpets, and hangings of
any kind must be dispensed  with.   Flour,
starch, or hair-powder  may be abundantly
peppered over the face and body  to relieve
the itching and discomfort, and to absorb any
acrid discharge.   It is doubtful if  any good
will arise from  using  anything to prevent
pitting ; gutta-percha in chloroform does no
good, but if the face be washed over  in the
early stage with nitrate of silver, it may les-
sen the marking ; olive oil, cold cream, and
glycerine and water will relieve the patient
when  they are  locally  applied.   After  re-
covery, the stains are shallow and of a brown-
ish color, becoming paler after a few months.
   In the article on vaccination, the subject of
the prevention of small-pox  has been very
fully entered into, and therefore need not be
repeated here ;  the latter  article  should be
read with this one, if the reader is anxious  to
understand the relations of the two disorders.
For information  with regard to disinfection,
etc, see Sanitary Regulations.
   SMELL is a special function of  the olfac-
tory nerves, which are two in  number, and
are distributed over the lining membrane  of
the nose.
   SMELLING-SALTS.  (See Ammonia.)
   SMOKING.   (See Tobacco.)
   SNAKES, BITES OF.—The more rapidly
the symptoms of  poison  appear after the bite
of a snake, the more dangerous they are likely
to be.   The  two fangs of  the reptile com-
monly enter and produce two minute wounds,
from which only  one or  two drops of blood
may at first issue.  A smarting, severe burn-
ing pain is immediately perceived, the part
begins to swell, and a puffiness almost  to the
bursting of the skin spreads in a short time
over the whole limb.  There is  fever,  often
with delirium, small pulse, pain in the region
of the heart, and convulsions.  These symp-
toms are attended  with a feeling of anxiety
and  lassitude, laborious respiration, thirst,
nausea, vomiting, and syncope.  Death from
the bite of  a viper has been known  to  occur
in thirty-six hours.  If the individual survive
the first effects, the wounded part  may be-
come livid  and gangrenous, and  he may sink
under the irritative fever set up.  According
to Fontaine, out of more than sixty cases of
viper-bites  only two were fatal, and in one
of these gangrene commenced in the wound
in three days, and the person died in twenty
days.
  Treatment.—The  treatment in  case of a
bite from a poisonous snake should first be
the application of a ligature between  the part
bitten  and the heart, or of a  cupping-glass,
in order to prevent absorption.  The wound
should be enlarged, and well washed.   If ab-
sorption has taken place,  and the limb  be
swollen, the whole of the skin may be smeared
with oil, and attention directed to the consti-
tutional symptoms.   Brandy  and ammonia
should be given to prevent depression. Strong
acetic acid, which coagulates the poison, may
be applied  when the person is seen soon after
the accident.  There is no known antidote to
the poison  of the cobra.  The serpent-charm-
ers of  the East appear to secure themselves
from   injur}' by extracting  the  poison-bags
under  the  fangs, or by  causing  the snake to
exhaust itself by biting other animals, before
handling it.
  SNAKE-ROOT.  (See Actea  and  Ser-
PENTARY.)
  SNEEZING is a convulsive action of the
respiratory muscles, caused by  irritation  of
some part of the lining membrane of the nos-
trils, either by the presence of some particles
of matter, such as dust or snuff, or owing to
the congestion  of  the membrane induced by
what is called a cold in the head.
  SNUFF is usually composed of dried and
powdered  tobacco, but many herbs are used
in the  same way, and are sold under the name
of cephalic snuffs,  for headaches and the like.
A pinch of snuff may sometimes be useful in
relieving the irritation of the lining membrane
of the  nose and head by sneezing, but when
taken to excess, snuff is extremely injuricus.
  SOAP,  as used in  medicine, is of  two
kinds, hard and  soft ; both are made from
olive oil, but into hard soap soda enters as an
ingredient; into soft soap, potash.   Olive oil
consists mainly  of two  substances,  olein and
palmetin ;  these being made up  of  oleic acid
and  palmetic acid, combined with glycerine.
If now to either of these an alkali be added,
what is called saponification takes place,  the 
432              SODA
SODA
 acids combine with the alkalies, and glycerine
 is set free.  The substance is no longer a fat,
 it is a soap.   Hard soap  is grayish white in
 color, but that commonly used, called castile
 soap, is veined and marbled.  Soft soap again
 is a semi-fluid mass  resembling honey.  It is
 yellow and semi-transparent, often showing
 white points  where crystals  have begun  to
 form.  These soaps ought to be well neutral-
 ized by the alkali so as to have no greasiness
 about them.
   Hard soap is employed in making soap cer-
 ate plaster and soap plaster.and in the prepara-
 tion of a useful liniment commonly known as
 opodeldoc. This liniment contains hard soap,
 camphor, oil of rosemary, spirit, and water.
 Soft soap is used in turpentine liniment. The
 intention of the soap in this, and its addition
 to many other liniments, is to enable the part
 to which it is to be applied to be well rubbed
 without suffering from the results  of friction
 on the skin.   In these cases it is the rubbing
 which does the good, not the  liniment.
   Hard soap is often used as  a basis for pill-
 making, but the other ingredients ought to be
 carefully selected.   Thus, some substances,
 as resins of a purgative kind, are best given
 with an alkali ; substances of an acid nature
 again should not be  given with soap.  Soap
 and water is a favorite injection with some
 practitioners,  but the  soap  in  that case is
 nearly useless ; it is the mechanical result of
 the water which produces the  desired motion,
 only the  soap  may soften  the  parts con-
 cerned.
   SODA, as an alkali, is used as liquor sodae,
 i.e., solution of caustic soda.   This is made by
 heating carbonate of soda with  slaked lime,
 when caustic soda is set free.   This liquid is
 colorless,  and has an intensely burning taste.
 The solution,  when evaporated to dryness,
 constitutes caustic soda,  or hydrate of soda.
 The solution is powerfully alkaline, and might
 be used in a good  many cases  instead of  liq
 uor potassae,  but this last substance seems to
 be preferred  for internal  use.  The  caustic
 soda in a solid form may be used in the same
 way as caustic potass for destroying the edges
 of ulcers, etc.  It does not melt so readily,
 and so is not apt to run on  to places where
 it is not desired, but it is not so much used as
 the other.
   Carbonate of Soda, or washing soda, is of
 great importance  economically,  not  much
 medically, save for cleanliness.   It is now
 made from common salt, but used to be made
from sea-weed ashes. It occurs in large irreg-
ularly crystalline masses,  which, when  dried,
 yield up their water of crystallization and fall
 into  powder.   This  is  dried carbonate  of
 soda.  Neither  is  often used  internally.
 The soda salt, mainly used for its alkalinity,
 is the
  Bicarbonate cf  Soda,  which  only occurs
 in   powder.  It  is  only slightly alkaline,
and is  not at  all  caustic.  The prepara-
tions are an effervescing solution—medicinal
soda-water, and a  lozenge.  Ordinary soda-
water contains no  soda, only carbonic acid ;
if  it is desired to have soda  in  it, the spe-
cially prepared soda-water must be used.  Bi-
carbonate of soda is much used as an antacid,
and to render other substances alkaline.   It
sets better on the stomach than  bicarbonate
of potash.   It  does not act so much on the
kidneys, and is not given  in  acute rheuma-
tism.   For ordinary antacid purposes, espe-
cially to allay heartburn, it is more used than
the potash salt.  The dose of  bicarbonate of
soda is from 5 to 30 grains, but more may be
given, though seldom necessary.
   Sulphate of Soda, better  known as  Glau-
ber's  salt, is a substance which  most  unde-
servedly has fallen out of repute.  It is  a
waste process in making hydrochloric acid, is
also found  abundantly  in  certain mineral
waters,  as  well  as in sea-water.  The salt
occurs,  when pure, in prisms, and is  color-
less, transparent,  and neutral.  Its  taste  is
exceedingly bitter,  and given internally acts
as  a purgative, producing  copious  watery
motions.   It is the most important purgative
constituent of many mineral waters.   It may
be  given  in doses of  2  drams  to half an
ounce.  It  is best given mixed  with  some
other purgative.
  Acetate of Soda is only used in the prepara-
tion of arseniate and phosphate of iron.  By
itself it can hardly be said to be used, acetate
of potash  taking its place.
   Sulphite of Soda is much  more  important,
not for  its soda,  but for its  sulphurous acid.
In  making  it  sulphurous  acid  is  passed
through carbonate of soda to saturation.  It
exists in prisms which have a slight odor of
sulphurous acid, readily soluble in water.   It
is  given internally in  the same cases  as sul-
phurous, especially to arrest vegetable growth
in the form of sarcinae,  etc.  Externally  it
may be used as a lotion, where the acid would
nor, be desirable.   The dose is 20  grains to a
drachm.
  Hyposulphite  of  Soda is frequently em-
ployed in the same way as the sulphate,  but
in the pharmacopoeia it is only introduced for
analytic purposes.   It occurs in crystals readily
soluble in water.   Sometimes it  is used as a
mouth-wash.
  A'Urate of Soda  is a very deliquescent salt,
and so cannot be made use of for gunpowder.
It is only used  in making arseniate of soda.
  Phosphate of Soda, or tasteless purging salt,
is got by adding to  a solution of bone earth  in
sulphuric  acid,  carbonate of soda to neutrali-
zation, or more.   The salt then  formed ap-
pears in fine large crystals of a saline taste.
In good large doses it purges,  and having no
disagreeable taste is very useful  for children
and delicate persons.  It requires  to be given
in doses of half an ounce or  so.  It is be:t 
SODA  WATER
SPASM
433
given in soup or broth, in which it is as nearly
as possible tasteless.  In smaller doses it acts
on  the  kidneys, but is  not much  used  this
way.   The dose is 20 or 30 grains.
  Chlorinated Soda owes its efficacy not to the
soda  it contains, but the  chlorine.  It  is a
bleaching solution constituted in the same way
as bleaching powder, and used for similar pur-
poses.  It is alkaline  in  reaction,  and  is
sometimes made  into a  poultice.  Internally,
it has been given to get rid of foetid  sloughs
in the alimentary track, but is better  used as
a gargle,  as in ulcerated  mouths  and  sore
throats.   Externally it may be used much di-
luted as a wash to fcetid sores. It is not much
given internally.  The dose is 10 or 20 drops
freely diluted.
  Chloride of Sodium,  or common  salt,  is
more important as a food than a  medicine.
If not used ill-health  follows, the bowels get
disordered, and worms fcrm.  In large doses
it is  emetic, and it may  even  give  rise to
dangerous consequences.  It  is chiefly used
as an emetic in cases of poisoning where no
other remedy is at  hand.   Two  or  three
tablespoonfuls may be given well stirred about
in  lukewarm water, followed  by copious
draughts  of  the same.   Warm   salt-water
baths are frequently useful in chronic rheu-
matic pains.  (See Salt.)
  Citro-Tartarale of Soda  is  a  salt in many
respects similar to Rochelle salt, which con-
tains tartaric acid only.  It is this  substance
in  the granulated form which is commonly
called citrate of magnesia.   If well prepared
and well kept, it constitutes a good laxative
and sets well on the stomach.   If not kept in
carefully stoppered  bottles, the carbonic acid
is gradually given off and it  will not effervesce.
The dose  is about a drachm or two drachms.
(See Rochelle Salt.)
  SODA  WATER  is  a  well-known effer-
vescing beverage, containing properly a weak
solution of bicarbonate of soda with carbonic
acid gas, which is pumped in  till the water is
well  charged with  it.   It is then bottled.
tightly corked, and wired.   In many cases of
fever and  thirst  this is a very pleasant and
grateful beverage ;  and when mixed with a
little brandy or wine it  forms  an  exhilarating
draught in periods of exhaustion  and depres-
sion, often being  preferable to champagne, as
it contains no sugar.
  SOFTENING OF THE BRAIN.  (See
Cerebral Softening.)
  SOLUTIONS in medicine  are substances
that have  been dissolved in water, alcohol, or
some other liquid.  Every substance is soluble
in something, and that something is called its
solvent or  menstrum. Thus limestone will not
dissolve in water, but it  will in  strong acid ;
all the metals are insoluble in water, but solu-
ble  in some acid ; resins are  not soluble in
water, but are'in alcohol.  Salt is soluble in
water, but water can dissolve  only a certain
quantity of it, and then the solution is said to
be saturated.   Hot  water dissolves more of
some acids than cold, but when the hot water
cools, it lets fall all the salt above  the quan-
tity that it could hold in solution when cold.
Solutions  are said to be concentrated or in-
spissated when some of the water is driven off
by evaporation.
  SORE EYES. (See Ophthalmia.)
  SORE THROAT is a common symptom
in many diseases.  1. It  may accompany an
attack of scarlet fever, when  there will also
be the usual rash on the  second day.  (See
Scarlet Fever.)  2. It  may come on with
an attack  of diphtheria, in which case there
will be an ashy gray membrane on  the fauces
and  back  part  of the mouth,  without much
swelling.   (See Diphtheria.)   3.  It may
come on in the  course of  a common cold, and
be slightly relaxed, or the throat may be in-
flamed and quinsy produced.  The best plan
is to wrap  some  warm  flannel  round the
throat, inhale steam by  putting the mouth
over a jug of boiling water ; keep  in  bed or
in a warm room, so  as not to  breathe  in  a
cold  atmosphere, and have something warm
at bed-time, so  as to encourage a  good per-
spiration.   (See Quinsy.)  4.  Relaxing  and
damp weather, or living  badly  and working
hard, will  in some people produce a relaxed
condition  of throat.   For this two or three
glasses of good port wine, and swabbing the
throat with a solution of tannin and glycerine,
or tincture of steel and glycerine, is the best
remedy.   5.  Sore  throat  is common with
those who have to be exposed to all kinds of
weathers : they should be treated  as  if they
had  quinsy.  6. Sore throat now and then
comes on in clergymen, but it is very doubtful
if it is caused by speaking too much.  Cold
bathing, out-door exercise and  tonics, with
regular living,  will generally cure the  case.
They are generally at the time pale, thin, and
out of health.   7. Sore throat is common in
those who have had syphilis,  and in  them
there is no swelling of the part, but generally
ulceration of the tonsils.   These ulcers have
a grayish surface, are generally symmetrical,
and  have a rounded outline ; there  may bt
also other general symptoms  of the disorder,
but those who have once  had a bad throat are
very liable to another slight  attack on taking
cold.  Iodide of potassium and mercury form
the best remedy, while  the  throat should be
brushed over with some astringent solution.
   SPACE is important,  because it allows  a
due  amount  of air  for a person  to breathe,
nor is anything worse than to continuously
work in a close atmosphere.  Each man re-
quires at  least 800  cubic feet of air.   (See
Ventilation.)
   SPANISH FLY. (See Cantharides.)
   SPASMODIC CROUP.  (See  Laryngis-
mus Stridulus.)
   SPASM means the violent and uncontrol- 
434          SPEARMINT
SPEECH
 lable action of some particular set of muscles.
 Spasms  are  generally described  as  of two
 sorts, viz., tonic and clonic.   In tonic spasms
 the muscles of a part contract violently.and re-
 main rigid and immovable by the will of the pa-
 tient for a greater or less length of time. Such
 contractions  occur in  letanus and in ordinary
 cramp.  Clonic spasms consist in sudden con-
 tractions and relaxations  regularly alterna-
 ting. The jumping of the legs and arms, which
 occur under certain conditions, are examples
 of this.  Spasms, again, in the ordinary sense
 of  the word  as used by the  vulgar,  mean
 gripes, and commonly depend on indigestion
 and  constipation.   In  most cases they are
 best relieved by a  purgative, containing a
 good deal of stimulant substance, such as the
 essential oils.   In  children  the so-called
 spasms depend almost invariably on imperfect
 digestion of  food, which  ferments  in the
 bowels,  and so give  rise  to diarrhcea and
 gripes.  To  do any permanent good in these
 cases, it is  necessary to completely reform
 the  diet, as they are perhaps most commonly
 due to  giving starchy  food too early, or the
'milk given  turns sour.   Lime-water  given
 along with the milk  is a good thing.   One
 particular form of spasm, called trismus nas-
 centium, is very fatal to children when newly
 born.  It seems due to a foul atmosphere.
   SPEARMINT,  which grows  naturally in
 marshy  places in this country, is only officinal
 in the form  of  oil.   This  oil is colorless,  or
 pale yellow, and is distilled from the fresh
 herb.  There is an officinal preparation of  it,
 viz., spearmint water, which may be  used  as
 a vehicle for  other  remedies.   The  oil  is
 stimulant and carminative, and is given along
 with purgatives, to prevent them from grip-
 ing.  The dose of the oil is about one or two
 drops.
   SPECULUM means a mirror or looking-
 glass.   In surgery  it is an  instrument  which
 is used  for widening  the natural passages and
 discovering the nature of disease  which can-
 not be seen  by the naked eye.  It is  chiefly
 used in  cases of disease of the uterus.
   SPEECH, as the main  means  of commu-
 nicating our ideas one to another, must  be
 looked upon as one of the  most important of
 human  faculties.   The same faculty is pos-
 sessed by some of the lower animals, especial-
 ly parrots, but in them it is merely imitative.
 The mechanism of  speech is peculiar—not
 confined to  any one organ, though  mainly
 depending en movements in those situated at
 the upper part of the windpipe, called the
 larynx.   In  it are situated two bodies, which
 unite the properties of cords and membranes.
 These move from before backward, and can
 be so adjusted by  direct and  indirect action
 of muscles that almost any part of them may
 be permitted to vibrate, or certain parts only.
 The cords commonly called the vocal cords
 are set in motion  by  means of air  ejected
from  the lung, and according as a greater or
less extent of each cord is allowed to vibrate,
so a grave or a shrill note is  produced.   But
this,  though  the origin of voice, is  only a
small part of speech ;  most animals possess
power of emitting sound so  originating, but
entirely want the faculty  of speech.  After
the sound is produced by the vocal cord it has
to be  modulated in the upper portion of the
throat and mouth, some sounds being pro-
duced in  the   throat,  some  by the tongue,
some by the teeth, and  some by the lips, the
ultimate product being articulate speech.  But
speech  also implies a  language, if ideas are
to be  communicated, and here enters a totally
new element.
   It has been  noted that in certain forms of
brain disease the faculty  of speech is lost.
Sometimes this would seem to be due  to a
want  of articulating power  ; but in others it is
a real want of language.   This  is known as
aphasia, and  is  commonly  associated with
disease  of one particular portion of the brain,
and paralysis  of one side.  The  individual is
capable apparently of forming  ideas ; but he
cannot  express them  either by  reading or
writing.   As far as the organ of voice is con-
cerned,  that is perfect as ever ; but the faculty
of language is gone,  and to articulate speech
is impossible.   (See Aphasia  and Aphonia.)
   Some forms of language  cannot be spoken.
Thus the emblematic language  of the ancient
Egyptians and Mexicans,  commonly called
hieroglyphics, i.e., sacred carvings,was of this
kind,  while many savage languages are in an
unwritten state.  In this way we see that the
faculty of speech is something very complex.
Into its idea both the function of voice and
the power of framing a language  which shall
contain a sufficient number of symbols to in-
dicate daily wants, may enter.   The part of
the brain where the faculty of language seems
to be centred  is commonly assumed to be the
left posterior frontal convolution.  Injury or
disease of this part gives rise in most cases
to the condition spoken of as aphasia ; but
any  injury or disease  which may intervene
between this spot and the motor nerve centres
which  control the  motions  of the organ  of
voice may also interfere with the communi-
cation  of  the ideas, elsewhere framed,  and
commonly  conveyed  through   speech.   In
this case, however,  the individual would  be
able, if originally educated,  to communicate
his ideas in writing, which an aphasic individ-
ual cannot.   There seems to be still  another
form of loss of speech where  the individual
forgets words and letters  necessary to com-
municate ideas.   This is commonly spoken
of as amnesia, while  loss of  the power of
written language is called agraphia.  These
different faculties have yet to be studied more
carefully ; but the knowledge we even  now
possess enables us to understand the com-
plexity and difficulty of the whole subject. 
SPERMACETI
SPINAL CORD          435
  SPERMACETI, which is a  nearly pure
form of a fat called cetine, is obtained from
the head of  the sperm whale.  The head of
this animal is of enormous size, and in cavi-
ties in its upper jaw are lodged this substance,
mixed with oil. When it cools the spermaceti
crystallizes,  and  the  oil  is poured  off.   It
occurs in white  crystalline masses, and has
little  odor or  taste.   It consists of palmetic
acid combined, not with glycerine, but a sub-
stance named ethal.   Its only preparation is
the well-known spermaceti ointment, consist-
ing  of spermaceti, white  wax, and  almond
oil.  This is largely used as an emollient, and
applied to coverings of various kinds to keep
them from adhering to sores.
  SPIGELIA, the root of the Spigelia Mari-
landica, or Carolina pink,  a native of North
America.  The root consists of  a kind  of
head, whence are given off many rootlets  of
a brown  color.  It contains some oily and
bitter matter, and used to be much employed
for destroying worms.  It is still used for that
purpose in the United  States.   In large doses
it  purges considerably, and sometimes pro-
duces  peculiar effects of  a  narcotic  kind.
Usually  this  substance  is combined with  a
purgative when administered,  which it may
best be in the form of infusion. The dose ordi-
narily given is from a drachm to two drachms.
  SPINA BIFIDA is a congenital swelling
situated  over some part of the  spine.   Its
most frequent seat is  in  the  region  of  the
loins, but it  is occasionally met  with at  the
back of the neck, and less frequently on  the
back.  It is due to arrested 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 malform-
ation affects several  of the vertebral bones
the base of this tumor is broad, but when only
one  or two  of the arches  are  deficient,  or
merely fissured,  there is more or less of  a
pedicle or stalk.   The size, conformation,
and appearance of the tumor, and the symp-
toms 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 dis-
tended skin.  At the base of this tumor a fiss-
ure,  or  large hole, can  generally be  felt in
the posterior part of the spinal column.  When
the  child is placed  upon its belly the tumor
shrinks to a slight extent,  and the skin  be-
comes 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  convul-
sions and palsy of the lower extremities,make
 their appearance.  In most cases spina bifida
 terminates  fatally,  and the patient  dies  in
 convulsions, which in some instances are im-
 mediately 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 attained
 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 oc-
 casional termination of cases of this kind  is a
 closure, through adhesive  inflammation,  of
 the walls of the orifice between the spinal
 canal and the tumor.  A closed and compara-
 tively harmless cyst is thus formed, which  is
 called a false spina bifida.   The walls of  the
 tumor formed in cases of spina bifida are com-
 posed of the skin and extended membranes of
 the cord,  and sometimes  a  portion of  the
 cord itself spreads out into a thin  membrane.
 The contents 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 re-
 sult of such interference is acute inflammation
 of the cord and its  membranes, causing con-
 vulsions, palsy, and finally death.
   In cases, however,  where the tumor is in-
 creasing very  rapidly, and is attended  with
 severe symptoms of nervous irritation, which,
I if allowed  to  persist, would most certainly
 prove fatal, the  surgeon generally feels dis-
 posed to give relief by puncturing the  dis-
 tended skin with a fine needle, so as to allow
 the fluid contained in the sac to flow away in
 drops.  This proceeding has in some instances
 been attended   with success.    When  the
 tumor grows slowly, and while the child re-
 mains in good health and free  from acute
 nervous symptoms, the  treatment should be
 limited  to  affording  mechanical  support by
 means of a bag-truss, air-pad,  elastic band-
 age, or some suitable contrivance of  the like
 kind, and to covering the surface of the tumor
 every evening with  a layer of collodion.
   SPINAL CORD may be looked upon as
 a prolongation of the brain downward.    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 body.  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-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 para-
 plegia is said lo occur.  The  cord is liable  to 
436
SPINE
SPLINTS
inflammation, and the patient is said  to have
myelitis ;  to  chronic  degeneration,  causing
progressive locomotor  ataxy ; to cancerous
and  other  tumors,  causing  paraplegia ;  to
destruction, 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.  (See
Meningitis, Paraplegia, and Progressive
Locomotor Ataxy.)
  SPINE, or spinal column, is composed of
a number of strong pieces of bone called ver-
tebrae ; they are twenty-four  in  number, and
are divided into the cervical, dorsal, and lum-
bar vertebrae.   Each piece is  provided with a
central hole or cavity, and when one fits over
the other, a long  canal  is formed  with  bony
walls, in which the spinal cord can lie with
safety under ordinary conditions, and is pre-
served from harm.   The spine,  like other
bones, is liable at times to fracture and dis-
location, and such accidents are dangerous in
proportion  to the injury done to the  delicate
cord within.  (See Lateral Curvature and
Railway Injuries.)
 "SPIRITS.   (See Alcohol.)
  SPITTING BLOOD. (See Haemoptysis.)
  SPLEEN is an organ which lies  on  the
left side of  the abdominal cavity.  It  is con-
nected with the lymphatic system, and plays
an important part in the formation of  the
blood ; nothing  certain, however,  is   yet
known  about  its  functions.   It is much
enlarged in some cases of leucocythaemia and
in ague ; in the latter disease it is  called  the
ague-cake.   It is  liable also to waxy degener-
ation.  (See Degeneration.)
  SPLINTS  are  requisite  in cases where
fracture or severe  sprain  necessitates   the
keeping of a limb or member in absolute rest,
and in the present article such appliances will
be treated somewhat in detail, both as  regards
their  form   and uses.  In the article Acci-
dents, a rough-and-ready method of main-
taining rest and extension is  described, such
as improvised  splints,  made  with walking-
sticks, band-boxes,  newspapers,  etc.,  but
when proper materials are at hand it will be
much to the comfort of the patient if  they be
employed.   Whatever  material  splints  are
made of, it is of the greatest  importance that
they be well padded,  and such paddings may
be made of  cotton-wool, tow,  strips of  old
blankets, lint, or soft linen.   They should be
maintained  in  position by  strapping, band-
ages, or fillets, i.e., broad tapes secured by
buckles. The test of a fracture being in prop-
er position,  or  of  a sprained  limb being in
the best position of rest, is the feeling of ease
on the part of  the patient.   In applying  the
retaining materials, care  of course must be
taken to make them firm,  but not tight.
  Fractures  and severe sprains,  moreover,
may be treated by the application of ' 'splints,''
which are applied in aplastic condition, allow-
ing of  their subsequent setting firm,  thus :
pasteboard or gutta-percha, softened in boil-
ing water,  and accurately moulded to  the
limb ; these should be lined with wash-leather,
and  perforated with  a  gun-punch in several
places to allow of  the escape of perspiration.
Again, a solid casing can be made with gum,
starch,  or dextrine,  or plaster of  Paris ; an
ordinary flannel bandage being first applied,
a jean roller bandage is to  be evenly applied
and its surface thoroughly smeared with these
materials in solution during adaptation.  Stiff
shoe-leather soaked in boiling water is an  ex-
cellent  material.   As  these bandages  or
" splints" set very quickly and very hard, it
is well to guard  against cedema or swelling
of the limb, so that before the  application of
the solidifying material a tape must be laid
lengthwise on the  limb, with its ends project-
ing above and below the bandage ; then, if
the apparatus require removal, a pair of stout
scissors or shears  can be insinuated between
it and the skin and thus avoid wounding  the
flesh. Splints may also be made of perforated
sheet-iron, zinc, tin, or  wire gauze, etc.
  Special Splints for the Upper Extremity—
Angled Splints.  These  consist of  some light
material, generally perforated metal having a
movable joint, the various positions in which
it can be fixed being obtained  by an arrange-
ment of slots  and screws, such splints being
necessary in fractures of the bones entering
into the conformation of the  elbow-joint, or
after operations, such as resection, or the re-
moval of dead bone or tumors.
  The Pistol-shaped Splint is used for fracture
of the lower end of the radius (Colles'  Frac-
ture), and consists of a piece  of board,  cut
straight at first, and then bent downward in
its  own plane, being  made  of a suitable
breadth to fit the  forearm and hand, being in
form somewhat like a pistol, its object being
to fix the arm in such a position that the hand
is  bent  toward  the ulnar side.    Gordon s
Splint for this fracture is sometimes used, and
consists of  an anterior and posterior splint,
having  on the outside  of the front splint a
rounded,  tapering,  projecting margin,  and
the posterior splint tapering toward the hand.
  Special Splints for  the Lower Extremity—
Liston's  Splint.   This  consists of  a narrow
deal board, having at its upper end two holes
through which a band passes, for the purpose
of gaining extension from the  perinaeum, and
at  its  lower extremity two  deep  notches,
through which pass the  turns  of the bandage
which bind it to the limb (foot), with a hollow
on  its side for the outer  ankle ;  its length
should be from just  below  the axilla to four
or five inches below the foot.  Its  use  is for
fractures of the thigh-bone.  Its  method of
application is as follows : The splint must be
thoroughly padded with wadding, tow, or old
blanket, the ankle carefully  bandaged, and
the perinaeal band adjusted, then  the instep 
SPONGE
SPRAINS            437
 and ankle should be secured by means of the
 notches at the extremity.  Then the requisite
 extension is made by tightening the perinaeal
 band through the holes in the upper extremity
 of the splint.
   Dr. Smith's Splint " consists of a couple of
 light iron rods, bent at such an angle as to
 suit the  shape  of  the  thigh and  leg when
 slightly flexed.   The rods are connected to-
 gether at their lower end, and an interspace
 is left between them sufficient  to receive the
 limb.   From one rod to the other strips of
 bandage are fastened transversely, side by-
 side,  so as  to form  a trough, fitted to the
 shape of  the  leg and thigh ; upon this the
 limb is laid, and  then  the  rods are attached
 to cords, which are suspended  from a point
 above the bed, and which are regulated by
 pulleys."  This form of  splint is remarkably
 simple, cheap, and clean.
   Mclntyre's Splint is a convenient fcrm of
 apparatus for fractures of the leg,  or for use
 after operations on that limb.   It consists of
 a concave iron splint, with a thigh-piece and
 foot-piece, and a joint at the knee  regulated
 by a screw, so that it can be fixed at any angle
 and the  limb kept perfectly  at rest.   The
 splint requires to be very carefully padded, as
 the sharp metal  edges  are liable  to cause
 severe sores unless properly protected.
   Dupuytren s Splint  is  in  shape very  like
 a long Liston's splint, only much shorter.  It
 is useful in fractures or injuries of the lower
 limb, especially fractures of the fibula.
   It would be impossible to mention every
 form of special splint which has been devised  ;
 moreover, they  have been adverted  to  and
 their method of  application detailed in the
 article   on  fractures.   (See   Fractures.)
 Suffice  it to say, that the general principles
 for their manufacture  and adjustment,  and
 some slight mechanical knowledge,  and ordi-
 nary common-sense, will suggest a contriv-
 ance suited  to an emergency until medical
 advice can be obtained.
   SPONGE is organic  porous marine sub-
 stance, in reality the skeleton of a motozoon,
 found in the seas of the southern parts of  Eu-
 rope and America in large quantities. Though
 now  generally used  only for purposes of
 cleanliness, burned  sponge was  at one time
 employed largely as a remedy for goitre and
 other scrofulous  tumors, its  efficacy depend-
 ing on the large quantity of iodine it contains.
 The subsequent discovery of other sources of
 iodine set it aside as an article of medicine.
 Sponges require great care and cleanliness if
 used in surgery, or in the cleansing and dress-
 ing of  wounds and sores.  They should be
 rinsed well and dried after each occasion for
use, and great care should be taken that the
same sponge be not used for two patients or
for two  purposes.  On  this   account  the
use of lint, which  can  be thrown  away after
every dressing, seems preferable.
   SPONGIOPILINE is an invention of Mr.
 Markwick, for which he obtained a prize at the
 Great Exhibition of 1851.   It is  intended  to
 be used for fomentations and  poultices, and
 consists of a mass of shreds  of wool  and
 sponge, backed by india-rubber, so that while
 the  thick substance retains the moisture and
 heat,  the water-proof back may prevent its
 escape.   It is a very useful and cleanly sub-
 stitute for a more elaborate poultice when
 such an application is quickly necessary.
   SPONTANEOUS COMBUSTION. (See
 Combustion, Spontaneous.)
   SPRAINS—Of the   Back.—These  are
 usually caused  by a fall from  a height, or
 from a weight coming down suddenly on the
 neck or shoulders.  The  structures suffering
 are  the fibrous ones generally,  such as the
 muscular  fascia,  tendons,  and  ligaments.
 There  is  considerable swelling in the loins
 soon after the accident, and great pain on any
 attempt at motion.  The  inconvenience aris-
 ing 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 giving a mercurial
 purgative,  followed  by  Dover's powder,
 poppy fomentation to the back, made  with an
 old soft blanket covered with  thin oil-cloth,
 and  with  dry  blankets ;  or the part  may be
 covered with thick compresses of cotton-wool
 soaked in a solution of tincture of arnica, in
 the proportion of an ounce to a pint, and lay-
 ing gutta-percha  tissue  or oil-skin over it.
 When the person can sit  up, some stimulating
 liniment,  or compound  tincture  of  iodine,
 may be used, and a warm plaster applied to
 the loins.
  Knee.—Sprains or ricks of  the knee are
 very  common  and very  painful, setting  up
 great swelling in the articulation.  The treat-
 ment of course depends upon the severity of
 the injury.   If  there be  much pain  and in-
 flammation, leeches,  hot fomentations, and
 poultices.    In  all cases perfect  rest. Cold
 lotions, lint soaked in tincture of  arnica, and
 well-applied bandages are the  best methods
 of curing the results of  the accident.  The
 patient must not get about too soon.
  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 dimin-
 ished, is a frequent cause of the accident.  In
 the slighter sprains of the ankle the ligaments
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 
438       SPRAY-PRODUCER
STAPHYLOMA
 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.
   SPRAY-PRODUCER. (See Fluids, At-
 omized.)
   SPRINGS.   (See Mineral  Springs.)
   SPURIOUS CROUP.  (See Laryngismus
 Stridulus.)
   SQUILL  consists of the bulb of the sea-
 onion (Urginea  scilla  or  Scilla  . maritima)
 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 over-
 lapping like those of the lily. The outer ones
 are membranous, the inner white and  fleshy,
 these being cut across.  Squill is commonly
 seen  n small white pieces, consisting of trans-
 versei sections of these scales.  Squill has a bit-
 ter taste and is not easily powdered until well
 dried ; in that state they may easily be con-
 verted into powder, but if allowed the powder
 speedily absorbs moisture from the atmos-
 phere,  so that  the powder becomes a solid
 adherent mass.  Squill seems to owe its effi-
 cacy  to a resinous substance,  which is  not,
 however, separated for use. Its preparations
 are, vinegar of squill, oxymel of squill, made
 by mixing squill vinegar with honey, a  syrup,
 and a tincture.  There is also a compound
 squill  pill, a very useful preparation ;  it con-
 sists  of squill,  ginger, ammoniacum,  hard
 soap, and treacle.   To this a little opium may
 be added.  Squill is also contained in the ipe-
 cacuanha  and squill pill.    Given  internally
 squill acts mainly, at least in ordinary  doses,
 as  an  expectorant and diuretic.   In  larger
 doses it may produce vomiting and purging.
 It is chiefly given in lung diseases, to favor
 the secretion of a normal mucus and to render
 the secreted matters less viscid.  This kind of
 secretion is mainly seen in advanced cases, so
 that squill is  rarely given in acute  cases.  In
 these  it seems probable that the irritant action,
 or stimulant action, might be a  disadvantage,
 and so foster the malady  we desire to cure.
 Squill  is often  given as a  diuretic, but here
 too rarely by itself.  Most frequently it  is
 combined with  mercury and digitalis.   Some-
 times it seems to be of special  benefit in  this
 form in dropsy from heart disease, but seems
 less likely to be of value  where the kidneys
 are affected.  The dose of  powdered squill is
 about two grains, or the compound pill from
 5 to 10 grains, of the  tincture  20 drops, and
 of the oxymel half a drachm to  a drachm
   SQUINT.  (See Eye.)
  STAPHYLOMA means an unnatural pro-
 trusion of the tunics of the eyeball.
 _ Staphyloma of the Cornea.—-Of this condi-
tion there are two varieties. In one the cor-
nea, rendered soft and weak in consequence
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  subsequently thickened by the
 formation of delicate scar tissue on  its sur-
 face,  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 attack of purulent
 opnthalmia, which has caused sloughing, and
 removal  of nearly  the whole of the  cornea.
 Patients afflicted with the latter form of staph-
 yloma usually suffer from frequent attacks
 of ophthalmia, and of pains and  inflammation
 in the displaced iris.  Distension of the staph-
 yloma by accumulation  causes much pain
 and irritation,  which is generally relieved for
 a time by rupture of the protruded membrane.
 This,  however, is always followed by closing
 of the orifice and reaccumnlation of the aqe-
 ous humor. Sympathetic inflammation 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 recur-
 rent attacks of ophthalmia.  When  there is
 painful distension of the staphylomatous cor-
 nea and  iris in  consequence of a great ac-
cumulation of  aqueous humor,  considerable
 though temporary relief may  be effected by
making a small puncture into the thinnest and
most  prominent part of ihe projection. When
 the opposite 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 eyeball,  or slow
inflammatory changes, resulting  in a loss of
firmness  and   diminished  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 contrast 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 staphy- 
STARCH
STOMACH-PUMP       439
 loma of the lateral portions of the sclerotic.
 This  affection,  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 yel-
 low spot.  This  is frequently a  congenital
 condition, and is the cause of  that defect of
 vision  known as myopia,  or  short-sighted-
 ness.
   STARCH  is  a  substance  found  very
 abundantly in the  vegetable  kingdom.   Its
 presence was at one time thought to be char-
 acteristic of plants, but  it has recently  been
 found in animals.  It occurs in the form of
 irregularly  shaped granules,  which vary in
 size from -t^ to tbW of an inch in diameter.
 These  granules  are simple  or  compound.
 They  vary in size and shape, vVith  every
 species of plant,  and are insoluble in water,
 but are easily diffused through it.   They are
 thus  separated from the insoluble cellulose
 among which  they are  deposited in  plants.
 In.order to separate the starch, the plant is
 bruised  or  crushed, and put  into a vessel of
 water,  when  the cellulose  sinks, and  the
 starch  diffused through  the water, which is
 decanted and set aside till the starch has  de-
 posited.  On being  mixed with  water,  and
 exposed to  a  temperature of 1800, the starch
 gelatinizes, and mixing  with the water thick-
 ens it.   This occurs in the cooking of  starch,
 and lies at the foundation of pudding making.
 Starch is turned  blue by iodine, which is the
 best test of its presence.  It  is composed of
 carbon,  hydrogen, and oxygen, of which car-
 bon constitutes  one half by weight, and  the
 hydrogen and oxygen are in the  proportions
 to form  water.   When starch  is taken as an
 article  of diet,  the carbon is  burned  in the
 system in contact with the oxygen of  the air,
 and carbonic acid gas  is formed and  heat
 given out.  Starch is readily converted  into
 glucose, or  grape sugar, by  the action of
 nitrogenous substances,  especially the  sali-
 vine of the saliva, and it is in the form of
 glucose that it enters the blood of animals.
 All starch in food not converted into glucose
 is waste. Starch  is therefore less readily con-
 vertible into aliment than sugar.
  Starch is abundantly present in all the com-
 mon forms of vegetable diet ;  it exists  almost
 in absolute  purity in arrowroot, tapioca, and
 sago.   These  substances are  therefore not
 nutritious or flesh-forming, simply heat-giving
 to the  human body.  Potatoes and rice  can
 never form the staple food of a vigorous peo-
 ple,  because they consist chiefly  of  starch,
 and contain little or no flesh-forming matter.
  During the growth of plants, starch  is con-
 verted  into dextrine, gum, and sugar ;  it also
assumes different properties in certain groups
of plants ; thus  it exists in  an amorphous
form in  seaweeds and lichens, and is then
called licnenine ; and there  are other varie-
ties, as inuline, found in the elecampane.
  Starch is extensively used  in  the arts, and
in surgery for making stiff bandages, which
are put on wet, and dry hard and firm.   It is
also useful in  a finely powdered state to dust
over a delicate skin  after washing, to dry it
perfectly and prevent chapping.
  STAVESACRE  is  the seed of the  Del-
phinium  Staphisagria, a plant growing in the
south of  Europe.   The seeds have a  curious
cocked-hat shape, dark  brown color, and are
pitted on the surface ; they contain an al-
kaloid called  delphinia.   Stavesacre is no
longer officinal.  The seeds have considerable
irritant properties, and  give  rise to vomiting
and purging ; sometimes,  also,  they seem to
have some stupefying  effects.   In ointments
the powder has been  a good deal employed
for destroying vermin  in   the heads  of dirty
children.  Internally it has been rarely used.
  STERNUM.  (See Breast-Bone.)
  STETHOSCOPE is a wooden instrument
which conducts the sounds in the chest to the
ear of the listener.  It is very useful, and one
can hear better with it than by placing the
ear to the wall of the chest, and it is obviously
more convenient in many cases.
  STIFF NECK.  (See Neck.)
  STIMULANTS mean  something  having
power to excite the organic action of  an ani-
mal,  or  to  increase  the  vital energy of an
organ.  A stimulant may be either local or
general,  as  it is applied to a part or taken
into the system.
  STINGS.   (See Accidents and Insects.)
  STINKS.   (See Deodorizers.)
  STOMACH.—The  stomach, from its im-
portant functions,  controlling the whole sys-
tem of nutrition, merits 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
preclude, in great  measure, their proper ful-
filment.  Even the functions 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 irritant
swallowed.  On the other hand, the  slighter
form of inflammation, commonly called gas-
tric 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.   (See Indigestion.)
The two  most important maladies  of the
stomach  are simple and   malignant  ulcera-
tion, the  latter commonly going by the name
of cancer. These two diseases are fully treated
of under  Cancer and Gastric Ulcer.
  STOMACH-ACHE. (See Gastrodynia.)
  STOMACH-PUMP is an  apparatus by
means of which, in cases of poisoning, fluids
can be introduced artificially into the stomach. 
440        STOMACH-PUMP
STONE
or be withdrawn from this organ.  It consists
in a  small pumping  apparatus,  to which is
attached a long elastic tube of sufficient length
to be passed  down the gullet into the stom-
ach.   This tube, at the  point where it passes
into  the mouth, is usually guarded from  the
action of the  patient's  teeth by a perforated
gag  of  wood. The stomach-pump,  though
not used so frequently and indiscriminately as
in former days, is, however,  an  invaluable
and  indispensable aid  in  the  treatment of
cases of poisoning by opium and other nar-
cotics, and of extreme drunkenness caused by
poisonous quantities of spirits.   It may be
laid down as a general rule that the stomach-
pump ought always to be used when the pa-
tient, under  the  influence of a  narcotic  or
alcoholic  poison, is  too much exhausted or
too insensible  to swallow emetics or antidotes,
or where, as in cases of  attempted suicide, he
obstinately refuses to swallow.  One or two
pints  of  lukewarm  water  should  first  be
pumped into  the stomach, and then be with-
drawn with part of the  contents  of the stom-
ach and of the poison.  This process should
be repeated until the  injected water, when
pumped back again, is found to  be clear and
colorless.  Very  often,  however,  the  simple
introduction of the  stomach-pump,  or  the
presence of a  small quantity of warm  water,
will cause vomiting ; but in cases of  intense
narcotic poisoning the  stomach  is generally
insensible to  the presence of the  tube, and
requires to be well  washed out.   When in
cases of poisoning the patient is able or will-
ing to swallow, and vomiting can be produced
by the   frequent  administration  of  warm
drinks,  the stomach-pump ought not to  be
used.  This instrument  is not always a harm-
less  one,  and  when used  by inexperienced
hands,  and  in circumstances  exciting haste
and confusion, may do considerable mischief.
The mucous membrane  of the throat,  gullet,
or stomach may be wounded by the violent in-
troduction of  the tube, and some bleeding
from the raw  surfaces may be produced.  A
more serious  accident  is the introduction of
the tube into  the  air-passages  instead  of  the
gullet and stomach.  A case has been  re-
corded in which, after death from sulphuric
acid  poisoning treated by the stomach-pump,
the windpipe,  bronchi, and large portions of
the spongy  tissue of the lungs were  found
choked  and   plugged  with chalk mixture,
which it had been intended to introduce into
the stomach.   Another  danger attending  the
use of the stomach-pump is laceration of  the
mucous membrane of the stomach, strips of
which are drawn into the orifices  of the tube
as the fluid contents of the stomach are being
withdrawn.  This occurs only in cases where
the inner coat of  the stomach has been soft-
ened  by some corrosive agent, and on  this
account it has  been laid  down as  a rule that
the stomach-pump ought not,  except under
special circumstances, to be used in cases of
poisoning by the mineral acids.
  STONE.—The solid precipitates of the urine
give rise  to the formation of concretions in
the urinary passages, which are known under
the names of gravel, stone, or calculus.   The
conditions of  the  constitution of individuals
in whom they occur are termed diatheses, and
the presence of gravelly  or  sedimentary de-
posits in the urine passed, together with any
irregularity  causing irritation in  the urinary
organs,  should be  most carefully  attended to.
with a  view of preventing the  formation, if
possible,  of calculus.   In order to discover
the condition  of  the  urine, a microscope, a
urinometer,  test tubes, test papers,  and re-
agents, to be afterward mentioned, are neces-
sary.   Urinary  calculi are  formed  from the
following  salts : (i) uric  acid, urate of am-
monia, lime, magnesia, or soda ; (i) oxalate
of lime ; (3) phosphates of lime, magnesia, or
ammonia  ; (4) cystine ; (5) uric  or  xanthic
oxide.   The  existence of  these  several  de-
posits  may be detected as  follows : (1) The
lithic or uric acid  deposit has, to the naked
eye, a pink  or reddish sandy appearance  as
sediment, the  urine having  been originally
passed clear.  The urine  itself is acid, turn-
ing blue  litmus paper red,  and has a high
specific gravity.  The  existence of urates  in
the urine denote a weak state of  the system,
and frequently some irregularity of the diges-
tion, or error in diet will cause a  deposit.   It
is most  irequently met with either  in  child-
hood or between the ages of 40  and 60, and
is hereditary.  The symptoms of a fit of gravel
are pain in the loins, spasmodic  retraction of
the testicle, frequent painful micturition, some
fever, and derangement of the digestion.   (2.)
The oxalate  of lime is deposited from  urine
which is highly acid, containing much lilhate ;
it appears under the microscope as minute
octahedral crystals.  (3.) The phosphates arise
either from excessive mucous secretion in the
bladder, or from an insufficiently acid condi-
tion of the urine. (4.) Cystine is rare, the urine
being of a yellowish-green color, and having
an  aromatic or foetid odor.   (5.)  The uric or
xanthic oxide  is the rarest of all the  deposits,
and has been  chiefly discovered  in children
in  the form of a calculus ; it appears  to have
much the same chemical character as cystine.
Calculi are formed as follows :  there being a
nucleus  in some part of the urinary passages,
the prevailing deposit  forms round it, gener-
ally concentrically  ; this nucleus (see Lithot-
omy) may either exist within the body or be
introduced from without, but most frequently
it is found to  consist of uric acid or oxalate
of  lime.  These small masses may enlarge
and remain within the kidney (renal calculi),
or they  may pass  by the ureter into  the blad-
der, where they receive additions, constituting
vesical calculi, frequently becoming fixed in
some pouch  in  that viscus, or in the  pros- 
STORAX                                STRICTURE            441
 tate  gland.   The  stones  when  found have
 characteristic appearances, and can be readily
 enough recognized by their  external aspect,
 or, of course, more thoroughly after section.
 Thus, (i) the uric  or lithic  acid,  by far  the
 most common, is  generally oval, flattened,
 fawn or mahogany colored, and its section
 shows its formation in concentric laminae.
 (2.) Phosphate of lime is rare as a stone ; it is
 pale  brown, friable,  and  laminated.   (3.)
 Triple phosphate  forms white or pale gray
 stones, composed  of  small brilliant crystals.
 (4.) The fusible stone, formed of triple phos-
 phate of lime, is  a white friable mortar-like
 mass.  (5.) The mulberry calculus is com-
 posed of oxalate  of lime, and  resembles  the
 fruit of a mulberry,  being  dark red,  rough,
 and covered with tubercles.   Alternating cal-
 culi  are composed of alternating  layers  of
 deposit.
   Renal Calculus,  or Stone  in  the  Kidney,
 usually  consists  of uric  acid  or oxalate  of
 lime.  The symptoms of stone existing in  the
 kidney are well marked ; there is a dull ach-
 ing and feeling of  weight  in  the  loins, and a
 sharp pricking feeling in the region of the kid-
 ney.   The urine is occasionally bloody, and
 there is frequent desire to pass water, great
 pain in the  lumbar region  generally,  and a
 violent spasmodic retraction of  the testicle of
 the  side  affected.  The passage  of such a
 stone down into the bladder should be expe-
 dited by diluents or diuretics, such as Vichy
 water,  or  solution of bicarbonate of potash,
 warm baths  and fomentations, and  cupping,
 and  leeches  to  the loins.   Calculi  will  fre-
 quently remain impacted in the kidney,causing
 abcess or wasting of the gland.   The passage
 of a stone  from the kidney into the bladder is
 very much the  same as  the  preceding, only
 there is violent sickness and shivering, faint-
 ness, and often collapse.   Warm baths, large
 doses of opium, and diluents are the remedies.
 (See Gravel.)
  STORAX, or Styrax, is a kind of liquid
 balsam obtained  from the  bark of a tree,
 Liquidambar orientate, growing in Asia Minor.
 This  balsam  is afterward purified.   It occurs
 in two forms : a thick liquid of the consistence
 of  honey,  and  brownish  red,   nearly solid
 masses, softening with heat.  Storax if pure
 should be soluble  in alcohol or ether, and is
 by chemical means capable of  being broken
 up into a variety of products.  Storax  is not
 nowadays  much  used  in  medicine.  It  be-
 longs to a group  of substances  which have
 fallen into  disrepute.  It is contained in com-
 pound tincture of benzoin, commonly  called
 Friar's balsam.  The whole group of balsams
 were at one time much employed  as  applica-
 tions  to cuts and wounds, and doubtless were
 of service,  but with an  improved system of
dressing they went out, and are now little used
 in regular practice.
  STOUT.   (See Beer.)
   STRABISMUS.  (See Eye.)
   STRAMONIUM commonly  implies  the
 leaves of the  Datura  Stramonium, or Thorn
 Apple, growing in this country, but the seeds
 of the same plant are also now officinal.  The
 leaves  are large and  much  indented at  the
 edges, with a peculiar rank, disagreeable odor.
 These should be gathered when the plant is
 flowering.  The seeds are very small, kidney-
 shaped, and  rough on the surface, and have
 a peculiar taste.  All parts of the plant con-
 tain an alkaloid identical with that contained
 in  belladonna, but called daturia instead of
 atropia.  This may be obtained in white crys-
 tals,  which yield  a peculiar  odor on being
 moistened by sulphuric acid.  The prepara-
 tions are made from the seeds only, and  are
 an extract and  tincture.  The   leaves  are
 mainly used for smoking.
   The  properties  of stramonium  are much
 like those of belladonna, as might be expected
 from their similarity of composition.  Never-
 theless, stramonium, more perhaps from habit
 than anything else, is  most  frequently given
 for maladies which are not usually treated by
 belladonna.  Stramonium is in point of  fact
 prescribed almost entirely for spasmodic lung
 affections, especially asthma.   For this mal-
 ady, whether merely spasmodic or partly  de-
 pendent on disease  of the organ itself, stra-
 monium  is usually prescribed in the form of
 tincture, or the leaves are given for smoking.
 These generally  do well, and  procure relief
 for a time at all events.
  Stramonium is  sometimes  given with  the
 intention of  relieving  pain.   An ointment
 may be made of the leaves and spread over a
 painful part, but this plan is not often adopted.
 For smoking,  twenty grains of the dried  leaf
 may  be made into  a cigarette and smoked,
 taking care to inhale the smoke. This at first
 gives rise to cough, but by and by profuse  ex-
 pectoration follows,  and  then comes relief.
 Some mix stramonium with  tobacco, but  the
 smoke of this is more irritating, and cannot
 well be inhaled.  In some cases stramonium
 fails altogether, and  in all the  dose must be
 increased. The Datura tatula  has been used
 for smoking like the Datura Stramonium.  A
 quarter of a grain to half a grain  of  this  ex-
 tract, and 20 minims of the  tincture, are  the
 ordinary doses.
  STRANGLING.   (See Choking.)
  STRANGULATED  HERNIA.   (See
 Hernia.)
  STRICTURE, or contraction of any of  the
 natural passages in  the body, may occur as
the effects  of  disease  or  injury ;  but  by
the term  stricture,  in its general sense, is
meant that affecting  the urelhra,  or channel
by which  the  urine  passes  from  the body.
Stricture of the  urethra may be either spas-
modic or permanent.
  Spasmodic Stricture is of frequent occurrence
in persons who have an irritable urethra, so 
442          STRICTURE
STUMPS
rendered by repeated attacks of gonorrhoea,
or who may have some slight organic stric-
ture, and the symptoms are liable to come on
after too much drink, irritation of the lower
bowel  from piles, etc., getting wet, horse ex-
ercise, or  some unnatural condition of  the
urine.   An inability  to pass water after a too
long voluntary retention of the urine in the
bladder must be distinguished from  perma-
nent stricture, as it depends upon spasm of the
neck of  the  bladder or urethra  from  some
such cause as above.  The symptoms are as
follows : the individual has a great desire to
pass water,  and on  straining  finds  himself
unable to  do so ; the bladder becomes dis-
tended, and  appears  as an increasing tumor
above the pubes, and, if not relieved, the con-
tinued efforts at evacuation may terminate in
rupture of the urethra and extravasation of
the urine.  (See Extravasation of Urine.)
In  such  cases of  stricture, especially  those
arising from  debauch of any sort, and when
such symptoms have not previously existed, a
hot hip-bath  and a good dose of opium cause
speedy relief.  The  tincture of iron, in 10
drop doses every 10  minutes, is often of use.
If the  symptoms still continue, the catheter
must  be passed, and a large  one used ; for
choice, a No. 8 or 9.
  Permanent  Stricture,  or,  as it  is  called,
Organic Stricture,  is a contraction  of the ure-
thral  canal in one or more places, owing to
the infiltration of plastic effusion, and fibroid
degeneration of the  tissues.  A constriction
is thus produced, varying in  tightness, in
some cases almost completely blocking up the
canal, while  in other and simpler ones it is
very slight.   Occasionally  a fibrous band is
found stretching across  from one side of  the
canal to the other, forming what is termed a
bridle stricture.  Organic strictures are gen-
erally situated in that portion of the  urethra
just in front of its  bulbous  portion ;  fre-
quently they are found nearer the orifice.  The
most frequent cause  of stricture is  neglected
gonorrhoea, and perhaps the ill  effects of im-
proper remedial agents : patients  frequently
treating themselves, or getting into the hands
of the quacks.  Stone in the bladder and in-
juries of the  urethra,  may also be  cited as
causes.   The symptoms of an  organic  stric-
ture are, difficulty in micturition, small stream
of urine, generally forked  or dribbling, pain
during the act of making water, and frequent
desire to do so.  This form of stricture is fre-
quently complicated with abscess, terminating
in fistulae or sinuses in the perinaeum.
  Treatment.—The  treatment  consists  both
of constitutional and mechanical means.   As
far as  regards the constitutional, any stom-
ach disorders, irritating urine,  or  inflamma-
tory tendency must be removed, and temper-
ance, rest, early hours, warm baths, and alka-
line remedies will do much toward assisting
such mechanical  means  as may from the
nature of the case be deemed necessary.  The
mechanical treatment of stricture is  of  such
importance  that experienced surgical advice
must always be taken as early as possible ;
and we can do little more in a work of this
nature than  refer to some of these methods.
In the first place the stricture may be dilated
by bougies, expanding instruments, a  catheter
retained in  the  bladder, caustics,  incisions,
or external division.  The bougie is frequently
advised to be used  by the patient   himself,
after having been instructed in  the method of
using it ;  it  must be  flexible  and  strongly
made,  to  avoid  its breaking in the passage.
By the introduction of bougies of gradually
increasing thickness,  distension is combined
with compression, and by this means the ring-
shaped cicatricial constriction of the  urethral
canal is frequently overcome ; and, if  applica-
ble to the case, this constitutes by far the
most satisfactory course of treatment.
  The treatment by expanding  instruments
consists in the introduction of some appliance
whereby  mechanical distension is obtained,
either  sudden and forcible, or gentle and
gradual.   Many  ingenious methods are  in
use,  and are  more or less effective in differ-
ent cases and in different hands.  Treatment
by the retention of a catheter in the  bladder
is of value  in cases of  hard  gristly cartilagi-
nous strictures, and in cases of false passage.
It  consists in tying  a  small catheter in the
bladder, and subsequently a  larger one, until
the stricture suppurates and becomes dilated.
Caustics are occasionally applied to the canal
by instruments specially adapted, called porte
caustiques ;  lunar caustic, or nitrate of silver,
is the agent  employed.  Division of the con-
stricting portion is effected in some instances
by internal  section, some  contrivance  being
introduced carrying a cutting  edge,  such  as
the urethrotome.  The  urethra has in  some
cases of complication to be opened from with-
out,  in order that the urine may come away ;
the  operation  by means  of  which this is
effected is termed perineal section—an opera-
tion  requiring   great skill and considerable
patience on  the  part of the surgeon.
  STROKE is the popular name for one who
is  struck  down  in an apoplectic fit.   (See
Apoplexy and Hemiplegia.)
  STROPHULUS.   (See Red Gum.)
  STRUMA.  (See Scrofula.)
  STRYCHNINE is an alkaloid of a most
potent character obtained  from nux  vomica
or St. Ignatius's Bean.   (See Nux Vomica.)
  STUMPS.—After amputation of a limb or
of  portion of a  limb, the  resulting stump is
liable to several  affections, and of these neu-
ralgia is one of the most frequent ; it is most
commonly met  with after amputation below
the knee  and in  the  arm or  forearm.   In
such cases the part must be carefully defended
from pressure in the adaptation of an artificial
limb.  It  depends on  some change-in  the 
STUPOR
SUFFOCATION         443
 structure of the nerves in the stump, but if
 such change  cannot be clearly detected, the
 treatment to be adopted is that used for neu-
 ralgia generally, such as iron  internally, and
 Ihe light application  of lunar caustic to the
 part.   In the case of the formation  of neuro-
 mata, or nerve tumors, the course of treatment
 lies in  their excision, or in a refashioning of
 the stump.
   Exfoliation, or necrosis of the  end of the
 bone or bones in a stump, occasionally occurs
 after an amputation, and the sequestrum may
 consist merely of a  thin scale  of  bone, or in
 severe  cases  of  a portion of bone  involving
 the whole thickness of its extremity, tapering
 upward,  of a  cancellous texture.    In some
 instances, when the  stump has  been badly
 formed, or the flaps have sloughed, the end
 of the bone projects, forming what is called a
 "conical stump."   The treatment of  such
 cases is obviously a repetition  of  the original
 amputation higher up in the limb.
   Bursce sometimes form over the ends of
 bones  in stumps, generally occurring  after
 blows on them.  The fluctuation and general
 character of these  swellings  closely  resem-
 ble abscess.  In  the  case  of  abscess early
 incision is necessary,  and in the case of the
 bursae rest and fomentation are  generally suffi-
 cient.
   Hemorrhage occurs  usually  a  few  hours
 after the stump  has been formed,  wnen the
 patient is warm in bed and has  fully recovered
 from the state of shock.  The treatment of
 such cases consists in  the opening up of the
 flaps and applying  ligatures or styptics, or
 both, to  the  bleeding  points.  Pressure in
 slight cases is  often sufficient—at all  events
 should be employed in the course of the main
 arterial trunk, until  medical aid arrives.
  STUPOR is that state of partial insensibil-
 ity which often  precedes coma ;  it may be
 caused  by a stroke, by drink,  by opium, or
 carbonic acid poisoning, in cases of  renal dis-
 ease, etc. ; the treatment depends of  course
 upon the cause.  (See Coma.)
  ST. VITUS'S DANCE.  (See Chorea.)
  STYE.  (See Hordeolum.)
  STYPTIC3 are substances  applied  to  a
 part to arrest bleeding.   Most of these are
 astringents,  and  seem to act by causing the
 minute  bleeding vessels  to  shrink, and  so
 prevent  further  hemorrhage.   Cold  is  the
 best and simplest styptic, especially  if applied
 as  ice.    That will arrest  most  bleedings.
 Astringent substances, like galls  in powder,
 catechu, etc., which contain tannin, matico
 in powder, alum, especially burnt,  may all be
 employed.   Perchloride  of iron is also a
 powerful styptic ; but one of the most power-
 ful of all is solid  nitrate of silver,  applied so
as to touch  the  bleeding  orifice.  If a large
vessel bleeds, it  must be tied  or  twisted, or
otherwise secured.
  STYRAX.   (See Storax.)
   SUBCUTANEOUS INJECTION.  (See
 Hypodf.rmic Injection.)
   SUBINVOLUTION is said to occur when
 the womb does not return  to its usual size
 after delivery, but is larger and  heavier than
 it ought to be.   Such women  are  liable  to
 menorrhagia, pain in the back,  and  inability
 to walk far.  Tonics  must be given, and a
 liberal diet and rest in the horizontal  position.
   SUCKLING.  (See Lactation.)
   SUDAMINA are minute vesicles, or little
 bladders, containing fluid,seen in profusion on
 the chest in cases of rheumatic  fever and
 some other diseases ;  they require no  treat-
 ment.
   SUDDEN DEATH  is generally caused
 by disease of the heart and large vessels.  It
 may be caused by an accident, as falling from
 a scaffold,  or by being run over ; drowning
 generally takes at least five minutes  to  kill a
 person, and  one may be  resuscitated  after
 having been in the water ten minutes, or even
 a little longer.   Strangulation  and  hanging
 make a  person insensible in  a  minute ; but
 death will not  take place for three or four
 minutes  if the person die by suffocation.  If,
 however, the person breaks his  neck in fall-
 ing,  he will die immediately.  Poisoning very
 rarely causes sudden death,except where prus-
 sic acid is used,and then death may supervene
 in a  minute or a minute and a half.  Deaths by
 chloroform  are also  sudden.  Cases  of apo-
 plexy generally die within twelve  or twenty-
 four hours  ;  rarely, if ever, in less than three
 hours.   Aortic disease and fatty heart are by
 far the most  common causes Of sudden  death
 which occur  in  this  country ; apoplexy or a
 stroke  is never a cause ;  syncope or  fainting,
 rupture of an aneurism, ulceration of a vessel,
 profuse haemoptysis are  more rare causes of
 sudden death.  In all cases an inquest must be
 held, and a post-mortem  examination made.
  SUDORIFICS are  remedies  which  cause
 and  promote perspiration.   They  are also
 called diaphoretics.  Of course  the  simplest
 is heat ;  but  sometimes  that alone does not
 answer well ; the skin does not open, and the
 heat becomes very disagreeable.  If therefore
 heat alone be used, as in the Turkish bath, it
 is advisable to bathe the surface in water if
 the perspiration  does  not come freely.  Of
 the sudorifics in common use  only one or
 two deserve mention.  These are the acetate
 of ammonia, which some esteem as a diaph-
 oretic, others despise.   But undoubtedly the
 two most important  are  the  compound ipe-
 cacuanha powder, or  Dover's powder, and
 the antimonial  powder, or James's  powder.
 Sometimes tartar emetic and  laudanum are
gi"en.   Sudorifics are very useful in certain
stages  of certain  complaints.  Thus,  if an
ordinary cold be caught, at the early stage,
with  shivering, dry skin, and discomfort, a
good perspiration may completely dispel it.
  SUFFOCATION means  simply death for 
444       SUGAR OF LEAD
SUTURES
want of air, and this may be produced by any ,
cause which  prevents the  free access of at-
mospheric air to the lungs ;  thus hanging,
drowning,  choking,  and  inhaling  noxious
gases,  ail induce  suffocation.   A frequent
cause of suffocation in very young children is
the anxiety of the mother to prevent cold air
getting to them, and  covering  them up, head
and  all, to  keep them  warm.  This  often
takes place in bed, when the infant sleeping
with the mother slips down into the bed under
the clothes, and breathes only  the impure air
Which  is confined there  till it becomes as-
phyxiated and dies.   These  sudden deaths
are often said to occur from  fits  or  convul-
sions, when in reality they are simply cases j
of suffocation.  (See  Apncea.)
  SUGAR OF LEAD.  (See Lead.)
  SULPHUR is  employed in medicine  in
two forms—sublimed sulphur and precipitated
sulphur, or milk of sulphur.   Sublimed sul-
phur is commonly used.   It  is  prepared by
fusing   virgin sulphur, and conducting the
vapor into a cool chamber, where it  consoli-
dates into bright yellow powder without taste
or smell.   It  burns  with a blue flame, and
produces the unpleasant fumes of sulphurous
acid.  The precipitated  sulphur  is pale yel-
low,  and its powder is much finer.  The prep-
arations 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 strict-
ures  of the rectum.  It is  mainly, however, as
an external  application  that Sulphur is em-
ployed.   Sulphur ointment still  remains the
great remedy  for the itch, but  it is useful in
other forms of skin disease.  (See Itch.)
  SULPHURIC ACID is the most power-
ful of all the  acids.  It  is made by  burning
sulphur, and afterward 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 vege-
table substance 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 cinnamon 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 di-
lute sulphuric acid is mainly used as an astrin-
gent.  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 im-
portance as an astringent in dianhcea, espe-
cially if combined with opium.  The ordinary
dose of  dilute or aromatic sulphuric acid is
 about 10 or 15 drops, well diluted with water
 or  some  such  vehicle.  In diarrhcea 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 ob-
 tained by reducing sulphuric acids by means of
 charcoal. It is most easily prepared by burn-
 ing sulphur.in the open air.  It has the  well-
 known odor of burning sulphur.  Sulphurous
 acid is a powerful deoxidizing reagent, and is
 powerfully destructive of vegetable life.  Ap-
 plied 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 tenden-
 cy to fermentation,  and if fungi are present
 in the stomach, it does  great good.   Used as
 spray in certain forms of sore throat.sulphur-
 ous acid is also of great use.  It. may be freely
 applied, and  subsequently  used  somewhat
 diluted as a gargle.  Sulphates and  hydrosul-
 phates,  especially of  soda,  are frequently
 given internally in its stead.   (See Soda.)
   SUMACH.  (See Rhus Toxicodendron.)
   SUMBUL, or Musk Root, is the root of a
 plant growing somewhere in Central  Asia.
 It reaches us  mostly by way  of Russia, partly
 also by way of Bombay.   (See Musk.)
   SUN-STROKE.   (See Heat-Stroke.)
   SUPPOSITORIES  are forms of remedies
 similar to medicated pessaries.  They consist
 of some basis, most frequently called butter,
 which, while  taking shape and possessing a
 certain consistence, shall  yet melt  gradually
 and  so expose the medicated materials they
 contain to  gradual  absorption.   They are
 generally introduced into  the rectum before
 rest, and allowed to remain there.   Most fre-
 quently  they contain  some'  sedative,  as
 opium, morphia,  or belladonna ;  but  occa-
 sionally also  astringents.
   SUPPRESSION OF THE URINE  takes
 place when the kidneys do  not secrete their
 proper amount of urine, and then  the blood
 becomes poisoned, because those substances
 are retained in the blood which ought  to be
 voided ; there is thus an important difference
 between  these cases and those of retention
 of urine, which may arise from a stricture, or
 from paralysis of the bladder, and which are
 relieved by passing a catheter.  In cases of
 suppression the loins must be cupped, and a
 sharp purge must be given.   It often comes
 on at the end of old standing kidney disease,
 and hastens ihe termination  of the illness.
    SUSPENDED   ANIMATION.   (See
 Drowning.)
    SUTURES.—The edges of wounds or sur-
| gical incisions are approximated by what are
I termed sutures, and these sutures are applied
1 by different  modifications  of  needles and 
SYMPATHY
TABES MESENTERICA     445
 threads.  The  needles  are various  in  shape
 and size, straight and cylindrical, straight and
 triangular,  or  curved  and  double-edged.
 Hare-lip pins are of great use in many  forms
 of wound.  The threads are either hempen,
 silken, catgut, horse-hair, or metal.   It must
 be borne in mind  that no suture should be
 used until all bleeding has ceased, and  every
 foreign substance removed, and exact apposi-
 tion attained.   The needle should be passed
 through the integument so deeply that it does
 not give way on the natural tension of the
 parts, and the thread and its knot should not
 be drawn so tightly that they cut  the pierced
 tissue, or strangulate it.
   The different forms  of suture are the in-
 terrupted, which consists in the approximation
 of the edges of a wound by entering a needle
 armed with a thread on one side of the wound
 or incision, and bringing it out through the
 other.  The edges  of the wound being held
 in apposition, either a double knot or a  single
 one with a bow  is tied, and the suture is  fixed.
 In the uninterrupted suture  the  armed needle
 is passed continuously  from one side to the
 other, until the  whole length of  the  wound is
 traversed.
   The quill suture  is of use in cases where
 some degree of  force is necessary to keep the
 edges of a wound together,  and also for ap-
 proximating the deeper parts ; it is applied by
 passing a double ligature and inclosing por-
 tions of quill, rolls  of strapping, or pieces of
 bougie, as " points d'appui."
   The zigzag suture is much  on the above
 principle, is applied by thrusting the armed
 needle through the  lips  of a wound in the first
 place, and then entering it a short distance
 on, on the side  of its emergence,  then  again
 passing it through the lips of the wound, and
 repeating the proceeding on  the  opposite
 side.
  The twisted suture  is applied with the as-
 sistance of  hare-lip  pins ;  the  pins transfix
 the lips of the  wound  at intervals, and  the
 thread is twisted around each in succession
 as a figure of  8,  passing from one to the next
 in order.
  Metal sutures are  preferable in some in-


                                          T

  TABES  MESENTERICA is strictly a
 disease of childhood, and is a sure  sign of a
 scrofulous constitution.   It is in reality tuber-
 cular disease of  the mesenteric glands, and is
 better recognized by general symptoms than
 by  any  discoverable  enlargement  of  the
 glands, which seems to be the origin of  the
disease.  Emaciation,  loss  of appetite,  and
 relaxation of the bowels are among the  earli-
est symptoms, and tenderness and distension
of the abdomen suggest the existence of dis-
eased glands.  The condition of these glands
 stances, as they give rise to less local  irrita-
 tion.
  Sutures should be removed  at an  interval
 of  a  day or  more, and  those  causing the
 greatest  irritation should  be  removed  first.
 As soon as irritation to any extent, in fact, is
 seen at their points of passage,  they should
 be removed.
  Adhesive plaster  should  be  removed  from
 a wound when it gets black ; it is then useless
 and irritating, and its place of course should
 be taken by a fresh piece of strapping.
  SWEAT.   (See Perspiration.)
  SWELLINGS.  (See Anasarca.)
  SYMPATHY is an awkward sort of term
 applied to the evils which  result from the in-
 fluence of one  kindred  diseased  organ on
 another.   This same  influence may  be  seen
 also in health.   One of the best examples is
 the filling out of the breasts, which commonly
 takes place in  women just befqre the monthly
 period.   The  breasts  may  also  become
 swollen, hard  and knotty in ovarian  disease,
 as if the  female were  pregnant.  The head-
 ache  of  indigestion is another  familiar in-
 stance of  sympathy.  So  too  is the pain ex-
 perienced in the right shoulder when the liver
 is  diseased, the pain extending down  the
 thigh when passing a stone from the kidney.
 The  vomiting,  which  is  one of  the most
 troublesome things accompanying the  pas-
 sage of a gall-stone, is commonly spoken of as
 sympathetic, though it may not really be so.
 In short, the curious alliance  between parts
 brought about either by an alliance  of func-
 tion or by a common origin of nerve-supply,
 might be  illustrated by numerous examples,
 but by none more telling, save, perhaps, the
 aptness of one eye to become  diseased when
 the other is.
  SYNCOPE is a technical term for a faint
 produced  by shock or excitement,  or by the
ailing power of a weak heart.  It often is the
proximate cause of  death  in  heart disease.
 Brandy, ether, and other stimulants, should
be used to rouse the heart to act more vigor-
ously.
  SYPHHJS.  (See Venereal Disease and
 Nodes.)
can only be ascertained by very careful ex-
amination, and requires a  practised hand to
undertake.  (See Mesentery.)  The course
of the disease  is slow, but  its duration is
difficult to estimate on account of the obscu-
rity of the earlier symptoms.  It seems  to
occur more frequently in boys than  in girls,
and is seldom found  in children under three
years of age,  most  commonly between the
fifth and  tenth  years.  The children do not
necessarily die, they  sometimes recover.
  Treatment.—The treatment should consist 
44G   TAENIA  MEDIOCANELLATA
TAR
in relieving, if possible, the oppressed glands. !
An ointment of iodide of lead may be rubbed j
into the body twice a day,  and the syrup of j
the  iodide of iron  given  internally.   The i
diarrhcea, which is so frequent a symptom of
this disease, should  be  arrested as soon  as
possible by small injections of warm starch j
and opium.   Unfortunately this diarrhcea is ]
so often the result of tubercular ulceration of
the  bowels that all efforts  prove unavailing
to arrest it.  A light farinaceous diet, with a
little boiled mutton or fish for dinner, but no
bread,  salt,  or solid food.   Change of air,
moderate exercise, and daily sponging of the j
body  in tepid  salt  water  contribute to the j
cure.   The practice of  thoroughly but gently
rubbing the  body, legs, and hips, and secur-
ing an amount  of reaction after  the bath is
desirable ; and,  as recovery proceeds,  small
tonic doses  of  quinine and tincture of iron
may be given.   Cod-liver oil  is also a most
valuable remedy in this  disease  from  its
earliest stages.
  T.ENIA  MEDIOCANELLATA, a tape-
worm.  (See Entozoa.)
  T.ENIA  SOLIUM, a tape-worm.   (See
Entozoa.)
  TALIACOTIAN OPERATION is a name
applied to the operation of forming a new
nose, invented  by  Taliacotius, a celebrated
Chinese surgeon, who lived about the begin-
ning of the Christian era.   He was the first
who ever attempted to restore a lost nose,
and his original idea was to  cut a pear-shaped
piece of cuticle or skin from the  patient's
arm, all but a small  pedicle, or stalk, which
remained  attached to the original  limb and
supplied nutrition  and  life  to the excised
piece.   This was spread over the framework
of the nose, the edges of the cheeks being first
scarified, and the arm  bound  up to the head
and tip of the nose, where  it  remained until
union had taken place between the new piece
of skin and the surrounding edges,  when the
little point of union was severed, and the arm
set free.   When the patient objected to sup-
ply his own cuticle, Taliacotius was in the
habit of obtaining the  needed material from
the arm, leg, or thigh of some one else.  Mr.
Liston, the great surgeon,  revived  this long-
neglected  operation, and formed new  noses
for his disfigured patients by cutting a piece
of skin out  of  their  foreheads,  leaving it
attached by a small kind of foot-stalk, and
then inverting it on to the frame of the nose,
when it was carefully plastered over and left
to unite.  In several cases  this operation has
been very successful.
  TAMARINDS,  though  contained in the
pharmacopoeia,  can  hardly be  said  to  be
remedies  of  importance.   The pulp of the
fruit of the tamarind-tree, which  grows both
in the East and West Indies, is the part used.
This pulp is sweetish  and at the same time
sour.   The fruit as preserved and  sent over
to this country is used in confection of senna.
The pulp is slightly laxative, and is rather
pleasant.
  TANNIC ACID, or Tannin, is a power-
fully astringent substance contained in  oak-
bark and a great variety of  other vegetable
products.  It is obtained by exposing  pow-
dered galls to damp air for a short time ;  next
ether is added, and squeezed out of the mass ;
the  mass is again pulverized,  and again ether
is added  ; this is squeezed out  and added to
the  other, and the tannin is obtained by evap-
oration.   Thus prepared, the  acid is a yel-
lowish white  powder, of a  very astringent
taste.  It turns all iron  salts blue-black, and
throws down gelatine.  Tannin is a powerful
astringent, as may be seen by applying it to
the  lips.   It then causes the vessels to con-
tract and the parts turn white.  In the  body
it is converted  into gallic acid, so that  sub-
stance is more frequently given internally
instead of tannin.   Generally  its effects are
astringent and closely allied to  those of gallic
acid.
  TANSY is an herb which grows wild in old
fields in many parts of the United States, and
is also cultivated to some extent in gardens.
The whole plant has a  stong  and aromatic
smell and a  very bitter taste.    The leaves
were formerly much used for flavoring soups
stews, etc., but other herbs  have superseded
it for this purpose, and it is seldom employed
now except in domestic  medicine.  An  infu-
sion of  the  leaves  will expel worms  from
children  ; but the  popular idea that  a decoc-
tion of its leaves will act as an abortive is  a
delusion. Tansy is best in the spring months,
when it  is young and green ; it is sold also at
the drug-stores in cakes dried and pressed.
  TAPE-WORM.—There  are  three  kinds
of tape-worm which infest the intestinal canal ;
these are fully  described in the articles on
Entozoa and Parasites.
  TAPIOCA is the starch obtained  from the
Jatropha or Janipha Manihot.   The juice  of
the  root is acrid and  poisonous,  but  it  is
washed away, and the starch collected.  From
this starch is  made in the country cassava
bread ;   after it has  been perfectly purified it
constitutes tapioca.  Abroad,  tapioca is some-
times used for a poultice ; here, only as an
article of food.
  TAPPING  is the  common  or  popular
name for the operation known  to surgeons as
Paracentesis (which sec).
  TAR  is obtained by the destructive distilla-
tion of various species of pine.   It is a thick,
black, treacly-looking substance, with a strong
and peculiar odor.   If water be shaken  with
it the water smokes up, some of its substance
becomes brown, and has something of the
smell of tar.   This water was at one  time
much extolled as a medicine.   The composi-
tion of tar is very complex ;  its only prepara-
tion is anointment consisting cf tar and bees- 
TARAXACUM
TEA
447
wax.  From the various substances it contains,
tar is a stimulant of value,  especially  for
outward application.    In some incorrigible
forms of skin disease, especially in  the hands
and feet, tar  has done good, especially if  the
disorder be  of a  scaly  kind.   In  many  of
these cases it may be given internally as well
as externally.  Tar itself, or its vapor, has
been  used  with great advantage in certain
cases of lung disease, especially in chronic
bronchitis  and  diseases  complicated by  it.
The dose is about  30 grains made into a pill.
An ounce or  two of tar-water may  be taken
at a dose.
  TARAXACUM. (See Dandelion.)
  TARTAR is the deposit on the teeth which
occurs in those who do not brush their teeth
properly ; it  may be scraped off ; cleanliness
will prevent it from forming.
  TARTAR  EMETIC, or  Tartarated
Antimony, is  the most  important prepara-
tion  of antimony.  It is a powerful emetic
and depressant, and in small doses  it acts as
a diaphoretic ; two grains often suffice to pro-
duce vomiting.  It is mainly used for its  de-
pressant effects.  It is  not now so much em-
ployed as formerly.
  TARTARIC  ACID  is  procured  from
cream of tartar, a natural  deposit from wines.
First  of all a  tartarate of lime  is formed, and
from  this the tartaric acid is set free by means
of sulphuric  acid.   It  exists in transparent,
rather irregular crystals ; its taste is sour, but,
on the whole, agreeable ; it is freely soluble
in water.   In the   system, tartaric acid and
the substance with  which  it is combined  are
converted  into carbonates.   Tartrates  are
nearly neutral or  even   acid salts, but this
property of  conversion  enables us to give
them where  alkalies are  required,  and they
sit on the  stomach very  much better.  The
acid   may  therefore be given as  a cooling
drink, and yet apear in  an alkaline form in
the urine.  Most frequently this acid is used
for the production of effervescing drinks :  10
grains or so is the quantity ordinarily  used.
(See  Effervescing Draughts.)
  TAXIS  signifies an attempt to  return  or
reduce a rupture by simple manipulation.   In
cases of reducible  and moderately-sized rup-
ture,  the contents of  the hernial sac may
under ordinary circumstances  be readily re-
placed by slight pressure, or slip back  spon-
taneously whenever the individual lies down.
But when the rupture is strangulated, and the
neck of the protrusion  is  tightly compressed
by the opening in the abdominal walls, care-
ful and delicate handling is required in order
to overcome  the resistance, and at the same
time  to  avoid  injury and rupture  of the in-
flamed coats  of intestine.  The patient should
then be placed in an easy recumbent position,
with the hips and  knees  bent, and  the  thigh
on the side of  the rupture rolled inward in
order to relax the muscular and  tendinous
 structures about  the  neck of the sac.   He
 should be charged to abstain as much as pos-
 sible from moving the body and lower limbs,
 and to keep his head in one position  and the
 mouth wide open.  The surgeon, by gentle
 compression and kneading of the rupture, and
 by moving  the  parts at the neck of  the sac,
 then endeavors to direct the distended intes-
 tine and  other  contents of the sac, through
 the canal leading to the  abdominal cavity.
 The direction of the pressure is made to  vary
 according to  the  anatomical  nature of  the
 rupture.  In  umbilical rupture, the attempt
 is made to pass the contents of the sac directly
 backward ;  in inguinal hernia,  outward and
 upward ; and in femoral  hernia, first down-
 ward and backward and then upward and in-
 ward.  In successful taxis, the rupture, when
 it contains intestine, generally first shrinks a
 little, and then suddenly  disappears with a
 gurgling  sound.  When the sac contains much
 omentum, it is reduced slowly and gradually.
,The duration of the manipulation, in cases of
 obstinate rupture, should  be adapted to the
 nature of the case, and  the probable condi-
 tion of the contents of the hernial sac.   In
 cases where the rupture is indolent and free
 from pain and inflammation, and no remote
 symptoms of strangulation are present,  the
 surgeon generally feels justified  in continuing
 his manoeuvres for twenty minutes or  half
 an hour.  In cases of strangulation, however,
 and  especially  after vomiting,  the  rupture
 ought to  be handled with  the  utmost gentle-
 ness,  lest the walls of the inflamed and prob-
 ably gangrenous  intestine be   ruptured.  If
 the strangulated intestine  cannot be reduced
 by gentle taxis, the patient may be placed in
 a warm  bath, and the attempt be repeated.
 This, however, is not in all instances a safe
 proceeding, as  the  patient may have  been
 much exhausted by  vomiting,  etc.  At the
 present day,  after the failure of  the first at-
 tempt at reduction, and in the presence of
 undoubted  symptoms  of  strangulation,  the
 surgeon places the patient  under the influence
 of choloroform, again  tries  the taxis,  and
 then, in case  of a second  failure,  proceeds at
 once, while the patient is  insensible, to per-
 form  a cutting operation.  (See Hernia )
   TEA consists of the leaves of several varie-
 ties  of a small shrub found  in  China  and
 India.  The leaves are gathered in the fourth
 year of the growth of the plant, which is gen-
 erally dug up  and renewed  in its tenth or
 twelfth year.   The  leaves are cropped with
 care by gatherers, who wear gloves, wash fre-
 quently,  and  avoid  eating things likely to
 affect the breath.   The differences  between
 teas  result from the  varieties of soil  and
 growth, and also from the  mode of curing and
 drying the leaves. Black tea consists of leaves
 slightly  fermented,   washed,  and  twisted.
 Genuine green tea is made  of  exactly the
 same leaves, washed and twisted, without fer- 
44-S
TEETH
TETANUS
mentation;  but commercial  "green"  teas
are often  black teas  colored with Prussian
blue.   Probably five  hundred  millions  of
men, or half the human race, now use tea.
The chief action of tea depends  firstly on its
volatile oil (less in old than in new tea), which,
is  narcotic and intoxicating ; and secondly,
on  a  peculiar crystalline principle  called
theine.   Theine excites the brain  to increased
activity, but soothes the vascular system by
preventing rapid change or waste  in the fleshy
parts of the body, and so economizes food.
Four grains of theine, contained in  half an
ounce  of  tea,   act in  this way ;  but if  one
ounce of tea, containing eight grains of theine,
be taken in a  day by  one person, then trem-
blings,  irritation of temper, and wandering
thoughts ensue.  When  the system  is  thus
saturated with theine,  it is useful to resort to
cocoa as a substitute for a few days, when the
symptoms subside, and the use of tea can be
renewed ;  but  it is unadvisable ever to take it
in such quantities as to occasion  such symp-
toms.  Tea contains also a quantity of tannic
acid, which, being an astringent,  is useful as
a gargle in sore throat, and as an injection in
some cases.
   TEETH,   CARE    CF   THE.    (See
Toothache.)
   TEETHING.  (See Dentition.)
  TEMPERAMENT  is a  term used  by
physiologists to distinguish a peculiar organi-
zation  of the system in different  individuals,
and  they  are  usually  grouped  into  four
classes.  Physiologists recognize—
   i.  The  Sanguine temperament,  character-
ized by plumpness of  body, fair  or red hair,
blue eyes, a soft, thin  skin, active circulation,
and a full, quick pulse.
   2.  The  Phlegmatic temperament is distin-
guished by a  round body, soft  muscles, fair
hair, pallid skin, and slow, languid circulation
and pulse.  All the functions,  mental  and
bodily, are torpid.
   3.  The  Bilious  temperament, known  by
firmness of muscle  and flesh, defined sharp
features, black hair and  dark  complexion, a
full, 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 nervous 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
inflammatory  diseases ;  the  phlegmatic  in-
clining to scrofulous complaints ;  the bilious
to affections of the liver and digestive organs ;
and the nervous to mental disorders  and dis-
eases of the nervous system generally.
   TEMPERATURE.—The temperature of
an ordinary adult  when a thermometer  is
placed in the armpit is 9S.40 ;  in  the mouth,
99.5° ; the  blood is about ioo°.  In fevers
this is much exceeded, and the heat of the
patient may rise to 1050 or 106° ;  a higher
temperature than this  will generally  prove
fatal,  unless it  descend soon ;  the highest
temperatures recorded  have  been in  some
cases  of rheumatic  fever,  when  the  body
rose to 1090, and even to iii°. The temper-
ature  of  a  hot bath is about 9S0 ; of a tepid
bath 700—75°.   In  describing the fevers, the
value  of the temperature as a symptom is no-
ticed in each case.
  TENDO ACHILLIS is the longest tendon
of the body, and the great leverage of the
heel, being  the  extensor muscle  of  the leg.
The ancients gave it the name  from the fable
that Thetis held the boy Achilles by the heel
when she dipped him into the Styx, and made
all the rest of his body invulnerable.
  TESTICLES, the male secreting organs
in the human body, two in number, situated
in the scrotum, and containing  the procre-
ating  fluid of the male.
  TETANUS  is an  affection  characterized
Dy painful and rigid contraction of the volun-
tary muscles, which is persistent and aggra-
vated  from time to  time  by very severe
spasms.  The two chief forms of tetanus are
the traumatic, when it  occurs after wounds,
and the idiopathic, which comes on in the ab-
sence of  any manifest cause.   In the former
the spasms  are  usually severe and acute,  in
the  latter   they are  milder and  chronic.
Traumatic  tetanus, however, is sometimes a
subacute or even a chronic  affection.  The
following are the symptoms that may be pre-
sented in a severe attack of tetanus following
a wound :  After certain common symptoms,
such as a feeling of  general uneasiness, head-
ache, and feverishness, have been experienced,
the patient complains of stiffness of the jaws
and at the  back of the neck ; swallowing is
difficult,  the voice is low and husky, and there
is a peculiar expression of the face due to con
traction of the muscles which move the lips
and eyelids ;  the patient  next  suffers from
painful cramp in the muscles of the face and
neck, and,  in consequence of permanent rigid-
ity of the muscles of mastication and spasms
of the gullet, is unable to take any food ;  to
this stage, in  which  the  mouth  is  firmly
closed, has been applied the  name  of locked
jaw; the  spasms then attack the muscles of
the abdominal  walls, and  violent pain is felt
at intervals at  the pit of  the stomach ;  the
front of the abdomen is retracted, and  the
muscles  during the severe paroxysms feel to
the hand like  a hard  board ;  the  voluntary
muscles  of the back and limbs finally become
affected  and very painful, cramps are felt over
the whole  body, which as the affection pro-
gresses are divided by shorter and shorter  in-
tervals ; the bowels are generally bound, and
 there  is often retention of urine ;  the symp- 
TETANUS
TETANUS           449
 toms increase in  intensity, and at last death
 occurs either from pain and exhaustion, or in
 consequence of spasms of the diaphragm and
 other muscles of respiration ; the mental fac-
 ulties generally remain unimpaired, until very
 shortly before death.    The  usual  duration
 of  an attack  of  severe and  fatal  tetanus is
 from three to six days.  Cases, however, have
 been recorded in which death occurred within
 a few hours after the commencement of the
 symptoms.   The  symptoms  of  acute trau-
 matic tetanus vary much in different cases ;
 the  spasms may  be  restricted to  a certain
 region or  a certain set of  muscles, or they
 may commence at the seat of the wound, and
 not, as is usually the  case, in the muscles of
 the  jaw.    The ordinary tetanic symptoms
 may be  complicated  by epilepsy,   delirium,
 and coma.
  There is no injury  to the surface of  the
 body, however slight it may be, of which acute
 tetanus might not be a result, and there is no
 relation between the extent and degree of the
 injury and the intensity of the tetanic symp-
 toms.  It  has been  known to  follow slight
 contusions  and blows with a stick or cane.
 It rarely occurs after clean cuts, and is mostly
 connected  with contused  wounds involving
 nerves and the fibrous structures, as  fasciae,
 tendons, and  ligaments.  With  regard   to
 locality, it  has been stated that tetanus occurs
 more frequently  after wounds of the hands
 and feet and their respective digits.   The in-
 terval between the receipt of the injury and
 the commencement of the tetanic symptoms,
 the  so-called  period  of incubation, varies in
 different cases.  In the majority, the symp-
 toms come on between the  fourth and  the
 tenth day ;  the period in many lasts from ten
 to  twenty  days,  but is extended  over  the
 twenty-second day in only ten  out of every
 hundred cases.  It has never been  known  to
 exceed a month.   The symptoms sometimes
 come after  an  interval of only  a few hours,
 and one instance has  been  recorded in which
 a negro was attacked with tetanic  spasms in
 a quarter of an hour after his hand had been
 punctured  with  a fragment of chinaware.
 The shorter the interval the more severe are
 the symptoms.  Tetanus, when  it occurs  be-
 fore the tenth day after the injury,  is usually
 fatal ; in cases occurring after the  tenth day
 the mortality is much  reduced.  Tetanus  oc-
 curs much  more frequently  in males than  in
 females, and  in the latter its symptoms  arc
 less severe. Tetanus may occur at any period
 of life, but in  more than half the number of
 recorded cases the patients were between ten
 and thirty years of age.  It has been asserted
 that tetanus is most  fatal  in patients under
 ten years of age, and  least fatal in patients
 between  ten and twenty years of age.  The
accession of traumatic tetanus docs  not seem
to be influenced in any way by morbid condi-
tions of  the body, or  by previous  states  of
 bad health.   The healthy and the unhealthy,
 the strong and  weak, are equally affected.
 Negroes and Asiatics are much more liable
 to attacks of tetanus than the white  races.
 Europeans are not rendered more disposed to
 tetanus by residence in  the tropics.  It has
 been stated that tetanus is met with moie fre-
 quently at periods of the  year in which ihere
 are frequent and sudden  changes of tempera-
 ture.
   The course and symptoms of an attack of
j idiopathic tetanus resemble very much those
i of the acute traumatic form, but are rarely so
 intense.   The chief causes of the  so-called
 idiopathic tetanus  are exposure to  cold  and
 wet, and intestinal irritation.  It is rarely met
 with in this country, but  occurs frequently in
 the tropics.
   The symptoms  of tetanus  may  resemble
 very much at first sight those of hydrophobia,
 and in some cases the medical  attendant ex-
 periences considerable  difficulty in establish-
 ing a  perfectly satisfactory diagnosis.  The
 following are the chief points of difference in
 these two dangerous affections ;  in tetanus
 the muscular spasm is persistent, and perfect
l relief never occurs for a single instant until a
I short time before death ; in hydrophobia the
j spasms are always of brief duration, and alter-
 nate with periods of complete relaxation and
 relief ; the persistence of the muscular con-
 traction in tetanus is most marked in the lower
 jaw, which in almost all  cases  remains fixed
! and immovable.   In hydrophobia  there is a
 constant flow of saliva, and the patient com-
 plains  of great thirst ;  in tetanus  these  two
 symptoms are  usually absent ; the counte-
 nance in tetanus is generally expressive of in-
I tense suffering ; in hydrophobia, not so much
 of physical suffering as of excessive restless-
 ness and mental excitement  ;  in  the latter
 affection the mental faculties are always much
 disturbed, and the  patient often falls  into a
 state of violent delirium and maniacal excite-
 ment ; in tetanus,  on the other  hand, the
 mind  usually remains  undisturbed  until the
j termination of the attack ;  in hydrophobia
 there is an aversion to fluids, the very thought
' of which very much excites the patient ; in
j tetanus there is no mental aversion to fluids,
 but when an  attempt is  made  to administer
I them  the patient   endeavors to express by
I action  his inability to  open the jaws and to
 swallow.  Any reliable history as to the bite
 of a dog about six weeks or two months pre-
I viously will  at once establish  the diagnosis
| in doubtful cases of hydrophobia.   Tetanus,
! though a very dangerous affection, is not al-
i ways fatal ; in acute cases, where  the symp-
' toms commence shortly after the receipt of a
I wound, recovery seldom  occurs, but when the
I attack  comes on after the tenth day from the
! receipt of the wound, and the tetanic symp-
j toms last over fourteen days, recovery is the
I rule and death a rare exception. No case of 
450
TETTER
TIN
 recovery from hydrophobia has been hitherto
 recorded.   Symptoms  somewhat analogous
 to those met with in severe cases of tetanus
 are produced by poisonous doses of strychnia
 or strychnine.  The symptoms of poisoning
 commence  soon  after the  strychnine  has
 been swallowed, and set in with shortness of
 breath, rigidity of the muscles of the neck and
 back, and painful tetanic spasms of the ex-
 tremities ; the  body is  usually arched back-
 ward so as to  rest on the  head  and  heels.
 The muscles of the face are much convulsed,
 so as to produce a characteristic grinning ex-
 pression called the risus sardonicus.  All the
 voluntary muscles are attacked at about the
 same time, and there is no persistent contrac-
 tion of the muscles of the  jaw ;  in these re
 spects,  and also from the prominence, among
 the  symptoms, cf backward arching of the
 body, and from the occurrence of intervals of
 complete  intermission, Ihe  phenomena of
 strychnine poisoning differ from those of acute
 traumatic and idiopathic tetanus.
  Treatment.— No continued  success has yet
 attended the administration of any one of the
 numerous medicinal  agents  that have been
 tried in cases of  severe  tetanus Calomel,
 opium, chloroform, belladonna, aconite, qui-
 nine, Calabar bean, and Indian hemp have
 all been extensively used, in some cases with
 undoubtedly good results, in others with sig-
 nal failure.  No drug is yet known which has
 the power of arresting the  course of the dis-
 ease, and of  controlling its severer symptoms.
 So long as tetanus is to be regarded as a dis-
 ease which  must run  a certain  course, the
 chief indications of treatment will be the sup-
 port of the patient's strength and  the relief of
 suffering and pain.   Fluid and easily digested
 food, with wine or spirits, must be freely sup-
 plied, and when the patient is unable to open
 the mouth or to swallow, should be adminis-
 tered by injections or through an elastic tube
 passed through the nose into the gullet.  Pain
 may be relieved by the internal administration
 of opium, by subcutaneous injections of mor-
 phine,  or by  inhalation of  chloroform.  In
 many  cases  painful  and  violent muscular
 spasm has been much allayed  by  the applica-
 tion,  along  the spine,  of  bladders of  ice.
 Great care must be  taken to guard the patient
 from all causes cf excitement  and irritation,
and the room in which he is confined should
 be kept darkened and at a uniform temper-
ature.   It is very important that there should
 be a speedy and free evacuation of the bowels.
 In cases  of traumatic  tetanus following  a
 wound, the  injured part, if painful and in-
 flamed, should be poulticed and kept as much
 as possible at rest.
  TE3TT3R, a disease of the skin which often
 appears on  the face and  the  side  of the
 mouth,  and  requires simple treatment, such
 as an  alkali like  bicarbonate of potash cr
 soda, internally, and  the  application  out-
wardly of powdered oxide of zinc  occasion-
ally.
  THEINE.  (See Tea.)
  THERMOMETER is  an instrument for
measuring  the temperature  of  a room.   A
lube of glass, with a bulb  blown at one end
but open at the other, is  filled  partly with
mercury  ; on  heating  the  mercury, ihe bulb
and tube become filled with mercury, and the
vapor of mercury and all the air  is driven
out ; the open  end is then hermetically sealed
in the flame of the blow pipe.  The freezing-
point and the  boiling-point are the two stand-
ards taken, because under ordinary conditions
at the sea-level these are fixed points.   The
thermometer is immersed in  melting ice, and
then the  point at which the mercury stands is
scratched on the glass ;  it is then  placed in
boiling water and the level of the mercury is
noted.   On the Fahrenheit scale this distance
is divided  into  180 degrees  ; on the Centi-
grade scale into 100 degrees,  and on the Re-
aumur scale into 180 degrees.  The freezing-
point is  called zero on the  last  two scales,
but 32 on the Fahrenheit scale.
  THIGH, BROKEN.   (See Fractures.)
  THORACIC  DUCT is  a narrow  tube,
lying in front of the spine,  which conveys the
chyle and lymph from the receptaculum chyli
into the  blood by its communication with a
vein at the  root of the neck.
  THORAX,  an  anatomical name for  the
chest.  (See Chest.)
  THORN-APPLE.  (See Stramonium.)
  THREAD-WORMS, or Oxyurides,  are
often found in children.  (See Ascarides.)
  THROAT.  (See Sore Throat  and  For-
eign Bodies.)
  THROMBUS  occurs when a plug is form-
ed in a vessel during life  ; it  is generally met
with in veins, but may occur  in the heart or
in. an artery.
  THRUSH is a  common affection in chil-
dren. It  may be  seen in  the  mouth as small
white specks  on the  lining  membrane, but
this may be so also in various parts of the in-
testinal  canal.  For causes  and treatment,
see Aphth.e.
  TIC, the common and short  term for tic
douloureux,  is that form of  neuralgia which
specially affects  the  fifth nerve, the sensory
nerve of  the face.  Either of its three branches
may be affected, but in pure neuralgia it is
most likely to  be the uppermost.   The other
two, namely, the superior maxillary and in-
ferior maxillary, are much more likely to be
affected with a kind  of counterfeit  neuralgia
or reflected pain, caused by bad teeth or gums.
In all of these  cases the jaws must be carefully
examined ; and if any good is to be done, all
bad stumps are to be removed and  the gums,
as far as  possible,  rendered free  from tender-
ness. (See Neuralgia.)
  TIN is a metal  found in  the form  of
various ores, of which tin pyrites and tinstone 
TINCTURES
TONGUE
451
are the most important.  It was  first intro-
duced as a medicine by  Dr. Alston, the first
professor of Materia Medica in the University
of Edinburgh, and it has since been constantly
employed as a vermifuge.  The mode of ad-
ministering it is to give at least half an ounce
of the  powder every morning for three suc-
cessive days, while the stomach is empty, and
then to carry it off with a brisk purgative.  It
is given in the form of electuary, made up with
treacle or orange confection.  It is undoubt-
edly effectual in cases  of ascarides and  lum-
brici, but is  less  so in taenia.  Its  action is
probably  mechanical  only, for there  is no
property in the intestinal secretions or other
contents, in consequence of which tin  could
be  dissolved ; and,  besides, the worms are
alive when discharged.  A chloride of  tin is
a good disinfectant.
  TINCTURES are solutions of any colored
substance  in spirits of  wine ; when not col-
ored the solution is called a spirit.
  TOBACCO consists of the leaf of the Nico-
tiana tabacum,  or tobacco-plant, growing in
America.   Another  variety of the plant, the
A7. Rustica, is cultivated in  Asia Minor for
Turkish  tobacco.  The  leaves are large and
oblong, covered with short downy hairs and
emit a heavy odor when they begin to dry.
The dried leaves only  are used.
  Tobacco contains  a peculiar and  powerful
alkaloid  called nicotine.   This, when freshly
prepared, is colorless,  but grows brown when
older.   It  is exceedingly powerful and  very
poisonous.   Tobacco is  a powerful  sedative,
and causes, perhaps,  through  the  faintness it
induces,  general relaxation of all parts of the
body, especially of the muscles.   It is hardly
ever given internally, and the  injection which
used to be employed to  procure relaxation in
parts concerned  in  strangulated  hernia has
been displaced by chloroform.
  Tobacco, in the form of snuff, may act as a
powerful irritant,  especially to the eyes and  I
nose.  But tobacco  is almost invariably em-
ployed in the form of  smoke,  as from a pipe
or cigar.   Used thus  there can be  no doubt
but that it produces a powerful sedative effect,
calming  and soothing, if used in the proper
dose.  This  is easily  known, as  a dose too
strong speedily turns the individual sick and
faint.  This may sometimes be useful in pro-
curing relaxation of parts under the  influence
of muscular  spasm,  as in asthma.  It  is an
important  question whether tobacco used in
moderation does  good  or harm.   Used im-
moderately, like everything else, it is a great
evil ;  used in moderation it is often of good
service.  It has been said that it is apt to give
rise to a certain form of blindness ;  that would
only arise from  immoderate use.  Its use by
young people is  not desirable ; they should
not want soothing.
  TOE-NAIL;INGROWING. (See Nails.)
  TOLU  BALSAM  is  one  of   those  sub-
stances allied to storax and balsam of Peru.
They all contain cinnamonic acid, and possess
very similar properties.   Tolu is lighter in
color and denser than is the Peruvian balsam.
It is seldom or never used  except as  com-
pound  tincture of benzoin, or Friar's balsam,
which contains  the substance.
  TONGUE in structure consists essentially
of muscular tissue covered by mucous mem-
brane.   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 mucous  membrane, and the
latter passing  vertically  from between the
horizontal layers, leaving intervals which are
occupied by gland  structure.   The  mucus
membrane  is furnished with papillae.   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  scattered  over  the
tongue, and are specially observed at the sides
and tip.  3. The  conical or filiform are dis-
tributed 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 appears to tie
the organ down to the underlying structures  ;
its  division, by means  of a  pair of blunt-
pointed scissors, readily remedies  the de-
fect.
  Inflammation of the tongue (glossitis) may be
caused by wounds, or stings, or by the appli-
cation of some acrid substance ; occasionally
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 pur-
gative  usually afford relief.   If the  inflam-
mation be very sudden,  its  progress  rapid,
and suffocation threaten, then  a few longitu-
dinal 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 treatment in such cases con-
sists of purgatives,  astringent  lotions,  and
careful bandaging of the organ, and full doses
of chlorate of potash internally.
   Ulcers of the  tongue  may  have  their
origin  from  several  causes; either  from
local   irritation,   such  as  decayed  teeth,
or from  some  derangement  of  the  diges-
tive  organs,  in fevers, or from syphilis, or
from the  prolonged and  maladministration
of mercury.  In all  cases there is a marked 
452             TONICS
TONSILS
 foulness of breath.  The constitutional treat-
 ment of course varies with  the case, and  re-
 moval  of  all obvious irritation, attention to
 the bowels, and locally the application of a
 solid stick of lunar caustic, the sucking a few
 crystals of chlorate of potash, and in syphil-
 itic ulceration, the application of a little calo-
 mel powder diluted with flour, are about the
 best remedies.  Those connected with second-
 ary or tertiary syphilis  are the  most intrac-
 table, and  frequently defy all treatment.  Ma-
 lignant ulcers of the  tongue are epithelial in
 their character, and their development is fre-
 quently 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  ul-
 timately involving the glands at its base; under
 the jaw and in the neck they are  attended
 with great pain, and  are usually deeply ex-
 cavated.   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 protrudes from  the mouth, be-
 comes 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,  bandag-
 ing the organ,  and astringent lotions.   In
 cases where this  treatment is of- no use, re-
 moval of a portion or the whole of the pro-
 truded 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 submaxillary, are  sometimes the seats of
 concretions  composed of phosphate of lime and
 animal matter, oval in shape, of a brownish
 or yellowish color, and of variable size, some-
 times being as  large  as a small egg.  Occa-
 sionally they come away of their own accord
 by ulcerating through  their confines, but the
 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
 stypics  will arrest  the hemorrhage,  or occa-
 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 elas-
 tic band.  The edges of  a severe cut or lac-
eration should be approximated with sutures.
All pain, swelling, etc.. should be allayed by
iced drinks and astringent and  disinfecting
gargles or washes.
  TONICS are a class of remedies supposed
 to give  strength and tone to the  system, of
 which quinine and iron are examples.
   TONSILS are  two glandular  structures,
 situated between the anterior and posterior
 pillars of the fauces,  one on each side.  (See
 Fauces.)  They are somewhat oval in shape,
 varying in size in different individuals.  They
 consist of a congeries of mucous glands, and
 their internal surface is  marked with  small
 holes ;  there are ducts leading from the cells
 in which the mucus is secreted.  The use of
 the  mucus  is to lubricate  the fauces during
 the passage of food, and it is expressed at the
 moment of  deglutition.   The tonsils  lie in
 close  proximity  to   some  very  important
 blood vessels—viz., posteriorly,  the internal
 carotid artery and ihe jugular vein, while ex-
 ternally are  the  trunks  of  the temporal  and
 external maxillary arteries, and  between the
 vessels and the tonsil is the superior constric-
 tor of the pharynx.  Hence any operation upon
 the tonsils must be conducted with great care.
   Diseases  of  the Tonsils.— Tonsilitis,  or
 quinsy, is an inflammation  of the  tonsil and
 tissues immediately surrounding it, generally
 due to cold,  exposure, or some peculiar con-
 dition of the body, sometimes to cutting the
 last molar teeth,  the swallowing of some irri-
 tant, playing on wind instruments, etc.  It
 commences  with shiverings,  feverish symp-
 toms, redness, swelling,  heat, and dryness of
 the fauces and tonsils.  There is great pain
 in  swallowing and attempts at  articulation.
 It sometimes ends with  a  tardy ulceration,
 or suppurates, or by  becoming erysipelatous
 spreads  down the  air-passages.  Sometimes
 small pustules or follicular abscesses appear,
 forming a yellowish ulcerated  surface ; again,
 a most formidable symptom is the  formation
 of a thick, tough, whitish pellicle, resembling
 wash-leather, on the  surface of the tonsil,
 pointing  to  diphtheria.   (See Diphtheria.)
 The treatment consists, in mild cases, of the
 internal administration of minderus spirit, the
 external application of linseed-meal or hem-
 lock poultice, and  a  gargle' of warm water.
 The application of lunar caustic is of  great
 value.  In the severe diphtheritic cases, swab-
 bing with glycerine and  perchloride of iron,
 tonic treatment,  good living, fresh air, and
 stimulants are necessary.  If abscess occur, it
 requires  to   be  actively  treated  at once, as
 respiration and deglutition are impeded, and
 the matter  should be evacuated.   The  left
 forefinger is to be introduced into the mouth,
 the tongue depressed, and a  straight sharp-
 pointed  knife', with its back resting on  the
tongue and its point direcetd backward, is
plunged into  the centre of the exposed tumor.
The edge and point of the knife must be car-
ried inward toward the middle line, and never
outward, lest the vessels  already mentioned
 be wounded.  If bleeding be very  severe, a
 strong solution  of  the perchloride of   iron
 must be applied to arrest it. 
TOOTHACHE
TRACHEOTOMY        453
    Ulceration of the tonsils is frequently caused
 by the irritation of carious teeth, or cutting
 the wisdom teeth.   Again, a frequent cause
 is  syphilis, and  in  such cases constitutional
 treatment with iodide of potass, or some mer-
 curial combined with a tonic, and the local
 application of lunar caustic, or in severe cases
 nitric acid, is indicated.  A  disinfecting gargle
 of carbolic  acid  or chlorinated  soda  is  of
 great value in all  such cases, as the  odor of
 the brealh is most offensive.
   Enlargement of the Tonsilis often the result
 of quinsy, and is frequently met with in scrof-
 ulous children or adults of  weak habit.  The
 tonsils in such cases are greatly enlarged, pro-
 jecting, as  fleshy excrescences, into the back
 of the fauces, and sometimes almost entirely
 closing them, interfering greatly  with  deg-
 lutition, speech, and breathing, producing a
 peculiar guttural tone  of  voice, and causing
 snoring during  sleep.   In  young children
 cod-liver oil  and other antiscrofulous treat-
 ment may be of great service, but in adults
 nothing is  of any  permanent good  but  re-
 moval, or partial removal,of the hypertrophied
 gland tissue.  The gland is seized with a pair
 of long-clawed forceps, dragged out, from its
 bed,  toward the middle line of the fauces, and
 a blunt-pointed  curved bistoury (with its edge,
 all but an  inch or so, covered with lint or
 plaster) is passed behind  it and made to cut
 its way toward the middle line of the fauces,
 and away from its pillars.   The bleeding and
 pain  are very slight generally, and any bleed-
 ing can be controlled with iced water or tinc-
 ture  of perchloride of iron.  The enlarged
 gland tissue hardly ever returns.   In  remov-
 ing tonsils in  children it is as well to admins-
 ter chloroform.
   TOOTHACHE is a most distressing ail-
 ment, too well known  to  need description,
 and is  apt  to attack any one, though some
 families and constitutions  seem more subject
 to it than others.   It  is a sort of neuralgia,
 and frequently  depends on the condition of
 the general health, which reacts on the nerves,
 and especially on any susceptible nerve which
 may be exposed  to contact with the air in a
 decayed tooth.  Decay in teeth is occasioned
 chiefly by the collection of  particles of food,
 which set up a fermenting action and extend
 the process of decomposition gradually to the
 bone  of the  tooth,  and so  wear  away  the
 enamel, and form a little point of opening for
 the nerve to  become affected.  In order  to
 avoid this, great care should be taken to keep
 the teeth well  cleaned, and  when possible  to
 brush them after every meal.  When any tiny
 speck of discolorization is perceived, it is wise
 at once  to go to the dentist  and have the de-
 cay removed, and the aperture  filled with
gold.   Any  accumulation  of tartar  on   or
around the teeth should be carefully removed.
When, however, toothache  has really seized
hold of a victim, the only chance is either to '
 summon up courage to have the offender ex-
 tracted at once, or to try  one of the  many
 remedies which exist, and have in some cases
 been found beneficial.  Creosote, chloroform,
 eau-de Cologne, or  brandy on  wool will
 often  cause a  cessation of  pain for a  time ;
 but these  are simply stimulants, and  often
 sedative measures are more effectual.  When
 the gum is much inflamed, a leech applied to
 it and allowed  lo draw freely will often give
 relief, and  a poultice of bread-and-milk held
 in the mouth is sometimes  comforting.  Ex-
 perience, however, goes to prove  that endur-
 ance is the only remedy to be relied on  in
 toothache—that in  time the pain  will cease,
 and that if the sufferer cannot make up his
 mind to bear it, the only effectual  cure is ex-
 traction.
   TORMENTILLA is the root of an indig-
 enous plant belonging to the  rose tribe.  Its
 properties  are  astringent, and the substance
 may be used as an  astringent when no more
 powerful remedy is at hand.
   TOURNIQUETS are instruments for the
 mechanical compression of  a vessel in  order
 to prevent  hemorrhage.  The first tourniquet
 was used in 1674, and  was the invention  of
 the French  surgeon Morel,  and was a rude
 contrivance, and consisted of a stick passed
 beneath a fillet or band, and twisted round so
 as to constrict the limb to the requisite degree
 of tightness. A great improvement was made
 upon this  in the early part of the following
 century,  by J.  L.  Petit, also a French sur-
 geon, and his tourniquet consisted essentially
 of two metallic plates, which could be  sepa-
 rated from  one another by means  of a screw,
 so as to tighten a strap  which was connected
 with them,  and also encircling the limb.  The
 common tourniquet now in  general  use is
 based upon that just described, and it consists
 of a firm,  narrow, flat  pad to compress the
 artery, a strong piece of webbing  or band to
 pass round the  limb, and a  bridge furnished
 with rollers over which the  band passes, and
 a  screw  which raises  the  bridge and thus
 lightens the band.  The pad must always be
 so  arranged that it  compresses  the  artery
 against the bone.   On  applying it the  band
 should first of all be buckled tightly, when by
 turning the screw, great pressure is obtained.
 Care should be taken that the screw be oppo-
 site the buckel  of the band.
  Tourniquets are very useful in the absence
 of assistance, for, if properly adjusted, they
 at all events stop hemorrhage ; but they have
 this disadvantage, that  when applied  to  an
 artery they  also compress the vein or veins of
the limbs, rendering the venous hemorrhage
more profuse.
  TRACHEOTOMY  is the  operation of
opening the trachea, or windpipe, to save the
patient's life.   It is sometimes necessary in
cases of croup,  diphtheria, and when suffoca-
tion is  imminent from the pressure of a for- 
454        TRAGACANTH
TRUSSES
eign body in  the air-passages.  (See Laryn-
GOTOMY.)
  TRAGACANTH is  a kind of  gum ob-
tained from a plant growing  in Asia Minor.
It is allied to gum  acacia.  The gum exists
in flakes, not easy to powder  till well heated.
Part of it is  soluble in water, and  this sus-
pends the rest, so that it forms a thick tena-
cious mucilage, much denser than that formed
by gum  arabic.  This mucilage is  used for
suspending heavy  powders.  A  compound
powder consisting of tragacanth, gum acacia,
starch, and sugar, mixed with hot water and
allowed to cool, is useful in the same way.
  TRAINING,  that is to say  a system of
physical  education, is too much  neglected
among us.  It is quite true that for boating
and the like  training is  looked to,  but  then
the exercise  is excessive, and  likely in the
long run to do harm rather than good.  The
systematic use of  certain exercises and the
regulation of  food  and diet are calculated to
do good, but  they must be sensibly conducted,
or the reverse is the case. (See Gymnastics.)
  TRANCE, a curious and  interesting phe-
nomenon, presented occasionally in what is
understood by  cataleptic conditions of the
body.  The symptoms are so  peculiar, and so
often connected with deceptive action on the
part of the patient, that they are most difficult
to investigate.  (See Catalepsy.)
  TRICHIN2E1  are animal  parasites which
find their way into the muscles of the human
body, and may prove  fatal.  (See  Entozoa
and Parasites.)
  TROCAR, a surgical instrument used for
the purpose  of perforating the abdomen or
chest when fluid has to be drawn  off by tap-
ping, as it is  called.
  TRUSSES are mechanical  contrivances for
the support or for the prevention of the pro-
trusion  of any  viscus, but most  usually for
the support of the parts concerned in abdom-
inal rupture or hernia.   If a hernial protru-
sion occurs in either sex, it should be advised
that mechanical treatment be  adopted at once,
for no matter whether in infancy,  youth, or
middle age  judiciously-applied trusses fre-
quently effect a cure, without further surgical
interference,  and at all events cause but little
trouble or annoyance.   A physician should
always be consulted as to the form of  truss
needed, and  should himself  take the neces-
sary measurements, and himself apply the
apparatus in  the first instance.   It  is a great
mistake, and  one productive of  the  worst re-
sults, to leave the advice of a truss  to  an in-
strument-maker, and we often see instances,
especially among the poor,  of ill-fitting, ill-
shaped  contrivances, which  not  only do no
good at  all,  but in many cases do absolute
harm, by increasing the mischief they are de-
signed to alleviate.  A truss should be firm,
light, and elastic, and preserve its shape, and
the strength of  the  spring should always be
equable,  so that it may  retain the rupture
without irksomeness.  A truss consists  es-
sentially of a pad attached to a  metal spring
having straps so arranged that it may be kept
in the desired position in any of the various
movements  of  the  body.  There  are  many
different  forms, whether single or double,
named after their  inventors, for the general
principles of which see Hernia. The lollow-
ing hints on trusses  are of value,  as the  ex-
perience of an authority on the matter :
  " In the  majority of  cases, the circular
spring truss  is the best form. The curve of  the
spring and  the relative position of the  pad
with it should be appropriate to the configu-
ration of the wearer.  A single piece of metal
should form the spring and foundation of  the
pad.  As far as practicable the spring  of  the
truss should pass around the bony rim of  the
pelvis, fitting closely to the figure, and should
lie out of the region  of  the great  muscles of
the buttock  (glula-i).   The form of the spring
may be designed after the French model or
the German.  The former resembles the coil
of  a watch-spring,  and is very elastic and
clinging ; the latter  almost exactly fits  the
outline of the  body in its state of  repose  : it
is almost   inelastic,  and  very hard.   The
French is always pressing inward,  even when
the wearer  is  at rest ; the German scarcely
presses at all when the abdomen is soft,  but
resists with  power when any expulsive force
makes the  abdomen  swell.  The best shape
for the spring is one which forms  a medium
between  the two.   The  pad  should  be  of
moderate dimensions.  For the adult it should
not exceed  two and  a half inches in  length
and two inches at the widest part. Its superior
edge  should follow  the  upper line of  the
spring, which  falls a Utile from the shoulder
or bend,  where it lies in contact with the hip.
The inner surface should  be  directed slightly
upward.   The proper shape for the pad, and
the materials of  which  it  should be con-
structed, may be varied to accommodate par-
ticular cases.  The wearer generally discovers
afler a while which  kind of pad is most free
from  annoyance ; that pad, however,  is  the
best which maintains perfect and unintermit-
ting retention  of  the hernia.   Every  pad
should have attached to it two studs, one near
its  junction with the spring, and  another at
its lowest point.  To the upper one the trans-
verse strap, passing from the free end of the
spring, is attached : the lower  stud is used
with the thigh strap, which should be always
worn.  It is loosely fastened on to the spring
of the truss near its shoulder, and should fall
along the  hollow beneath the buttock.   In
the erect posture of  the  wearer  this  strap
should be  moderately tight ; it prevents the
pad from shifting, and should  never be  dis-
carded."   The  pad may be prevented from
fretting the skin by covering it with fur, or by
the interposition of some soft substance. 
TUBERCULAR MENINGITIS
TURPENTINE
455
    Trusses for ventral, umbilical, and femoral
  hernia are also  constructed.  In the case of
  crural or femoral hernia " the spring should
  fall somewhat suddenly from the point where
  it passes around the hip, and lie along the fold
  of the groin (Poupart's ligament).  The pad
  should be  rather  small  and  convex.  The
  cross-strap should fasten  high up on to the
  shoulder  of the spring, in order to keep the
  pad well down on the thigh. The thigh strap
  should start from near the pad, and  return,
  after  encircling  the thigh, to the pad itself."
  In large hernia, or those which have become
  irreducible, a  bag truss  is   indispensable.
  Trusses are also in use for the support of pro-
  lapse of the womb or rectum, and constructed
  of various forms  by different  makers.  (See
  Hernia.)
    TUBERCULAR MENINGITIS.  (See
  Meningitis.)
    TUBERCULOSIS is a name applied to a
  form  of fever  which is accompanied by the
  formation of small bodies called  tubercles in
  various tissues ; when  they are deposited  in
  the membranes  of the brain they give rise to
  the disease known as  tubercular meningitis,
  or acute hydrocephalus.
    TUMORS, or new growths,  are divided by
  pathologists into two  main groups : one  of
  innocent or benign growths, the other  of ma-
  lignant growths.  The latter are distinguished
  by the following common characters : rapidity
  of growlh, tendency to infiltrate and to re-
  place  the tissues  of the affected  part, tendency
  to recur after removal by operation, tendency
  to multiply locally and to infect other and re-
  mote  parts of  the body ; a  tendency  to de-
 structive and progressive ulceration, inducing
 fatal exhaustion  through pain, continuous dis-
 charges, and occasional loss of blood.   To
 any tumor presenting these so-called  charac-
 ters of malignancy, the  term cancer was ap-
 plied  by pathologists  of a  past  generation,
 but at the present time, in consequence of the
 extensive use of  the microscope in pathologi-
 cal research, there is a tendency to  classify
 tumors with regard  more to minute structure
 than to clinical characters.   The tumors con-
 stituting the malignant differ much in consis-
 tency  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 resembling 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 sarco-
 mata or fleshy growths, to the latter belong the
 true cancers or carxinomata.  Structurally the
 two are distinct ;  with regard to clinical char-
acters  and malignancy,  their resemblance is
very close,  the chief distinctions in these re-
spects  being the facts that  cancer  almost in-
 variably, and sarcoma seldom, affects second-
 arily the lymphatic glands, and that the latter
 usually appears at an earlier period of  life.
 (See Cancer.)
   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 classi-
 fication of tumors,  as any properly devised
 system would be unintelligible to 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 mal-
 ady, 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 all  cases  proper
 medical advice must be taken before recourse
 is had to removal.  (See Floating Tumors.)
   TURKISH BATH.  (See Bath.)
   TURMERIC is the underground stem of
 a plant (Curcuma) growing in Ceylon. It con-
 tains  a substance bright  yellow  in color,
 which alkalies readily turn brown.  A solution
 of this material in alcohol or paper smeared
 with it may be used as litmus, or as a test for
 alkalies.   Turmeric  itself  is something of a
 stimulant, and is used as a condiment.   It is
 turmeric which gives the bright yellow color
 to curry powder, into whose  composition it
 enters.
   TURPENTINE is a mixture of  oil  and
 resin obtained from various species of pine,
 and mainly produced in America. This sub-
 stance is separated by distillation ; the oil of
 turpentine passes over, the  resin is left be-
 hind.  Turpentine as it flows from the tree is
 of a pale yellow color, about the consistence
 of honey ; but gradually, by exposure, be-
 comes harder, the oil passing  off  and the
 resin  remaining  behind.   Oil of rurpentine,
 which  is alone used  internally, is a colorless
 fluid, with the peculiar odor and taste of the
 above  liquid ; the resin is semi-transparent
 and yellow.  The preparations of oil of tur-
 pentine are a confection, an  enema, a  lini-
 ment, an  acetic  liniment,  and an ointment.
 The resin figures in a plaster and an ointment.
  Applied  to  the skin, turpentine acts as a
 powerful stimulant ; if used along with heat
 it may redden the part, or if its vapor be con-
 fined, even blister it.  Its liniment is of value
for stiff joints and chronic rheumatism.  Tur-
pentine stupes arc valuable applications.  A
piece of flannel is wrung out of  hot water as
hot as  the hands will  bear, turpentine  sprin-
kled on the surface, and so applied to the skin. 
450         TYMPANITES
TYPHOID FEVER
 This application is of exceeding great  value
 in  inflammation of  internal organs near the
 surface, as in slight peritonitis and pleurisy.
   Interna ly,  turpentine may be given either
 as  a  stimulant  or  for destroying  worms.
 Often turpentine is given as a stimulant to
 the kidneys, but it may produce much irrita-
 tion in the urinary tract.  It is  also valuable
 for arresting hemorrhage, especially if that is
 partly due to debility.   It is frequently given
 as  an injection, when  it not only moves the
 bowels but also acts  as a  stimulant to the
 system at large.  When swallowed, turpen-
 tine may likewise act as a purgative, but it is
 common to combine it with castor-oil.   It is
 perhaps the most valuable  remedy for  tape-
 worms wc  possess,  provided the patient is
 not made sick  by the dose. If retained, it
 speedily  causes  the  worm  to be  expelled
 dead.   The  dose of oil of  turpentine  as a
 stimulant and diuretic is half a drachm  or a
 drachm ; to  destroy worms half an ounce is
 given.
  TYMPANITES  is the term  given to flat-
 ulent distension of the abdomen.  The  exact
 origin  and  nature of  the gases which cause
 the bowels to swell up and resound like a
 drum  has been  often  made the, subject  of
 speculation, but  not very often of careful in-
 vestigation.   Undoubtedly in certain diseases
 a period often comes when  the  bowels, from
 no very ostensible cause, swell up from wind,
 which apparently has  been  secreted by their
 walls.   This commonly occurs  only in very
 exhausting diseases, or in which  there is great
 prostration.   In  typhoid fever,  and in  peri-
 tonitis  of whatever  origin,  it is found and
 dreaded.  It is  as a rule of very evil omen.
 When tympanites does occur, the best appli-
 cation outside is  turpentine in  the  form of
 stupe ;  many, too, prefer to give  turpentine
 internally, but that is a question to be settled
 in  each  individual  case.   Stimulants  as a
 rule are first given, and sometimes passing a
 long tube up the rectum carefully and gently
 may enable the gases to escape, and so afford
 unspeakable relief to the patient.  In the last
 resource the bowels must be punctured with a
 fine hollow needle or trocar.
  TYMPANUM. (Sec Ear.)
  TYPHLITIS  means  an   inflammation of
 the cascum.   (Sec Intestines.)   It  may be
 caused by eating nuts or some other indiges-
 tible food, which sets  up an irritation when
 lodged  there.   There  is much pain,  a  little
 fever, some vomiting,  and constipation.  Hot
 fomentations should be applied, an anodyne
 given,  and the bowels should be opened by
 injections.
  TYPHOID FEVER is  a continued  and
 infectious fever, caused  chiefly by the influ-
 ence of bad drains and sewer-gas, lasting an
 uncertain period of  from four to six weeks,
and sometimes followed by a relapse.   It  is
also known  by the names low,  enteric,  gas-
 tric, pythogenic, drain,  cesspool, bilious, in-
 fantile, remittent, and  slow nervous  fever,
 also as abdominal typhus fever.
   Causes.—The exciting  causes arc conta-
 gion  and spontaneous degeneration.   Num-
 bers of cases go to  prove that those nursing
 the  sick  from  this disease  very frequently
 catch it, and  they  probably  do so from the
 emanations of the stools. Whenever any drain-
 age  soaks from the surface into a well used
 for drinking purposes, or when  sewer gases
 escape into a house by a leaky pipe, or When
 the traps  are out  of  order, or when one
 drinks foul and stagnant water into which any
 drainage  from manure can enter, then arise
 the  conditions  which  excite the  disease.
 Very few houses  are  properly  drained, and
 whenever a storm occurs and the sewers are
 suddenly  flushed, the   gases  escape upward
 into the waste-pipes of  the houses along the
 route and overcome  the  resistance of the
 traps,  so  that a most  noxious smell arises
 whenever the pan of a water-closet is raised.
 It is of the utmost importance that all water-
 closets should be outside the house ;  that the
 waste-pipe should not  communicate with the
 main sewer unless there be first a communi-
 cation with the  open  air, so that the  back-
 ward pressure will never cause  the gases to
 regurgitate into  the house ; that just beneath
 the  pan  of  a  water-closet   the waste-pipe
 should communicate with the open air and
 be carried up above the house-lop ; that a
 cistern with  a  continuous supply of  water
 should be  supplied  close to and above each
 water-closet, and that  the  cistern  for the
 drinking water should  be quite distinct from
 the other  cisterns.   In small  places the dry-
earth  system  should be  adopted,  and care
must  be taken that no leaking  from an old
cesspool can escape into the well for drinking
purposes.
  Symptoms.—The onset of typhoid fever is
always very gradual and imidious ;  it begins
with feeling out of sorts, aching pains in the
limbs, headache, loss of appetite, and chilli-
 ness ; for  many days the  sufferer is able  to
go about and think that there  is not much the
 matter.  Sometimes there is  diarrhoea,  or
 some intestinal  disturbance ; then ihe pulse
 is quicker, the skin  hot, and  the tongue red
and dry.  The nights are disturbed and rest-
less, and he does not  care for any exertion.
At the end  of the first week, or  often  later,
he takes to his bed, and it is found that he is
feverish, has no appetite,  is  thirsty, and his
bowels are generally relaxed.  The urine  is
scanty and high-colored ; there  is still  more
restlessness at  night ;  there is no stupid,
heavy  expression as in  typhus,  nor are the
eyes suffused ; on the  contrary,  the face  is
often  pale and the cheeks have a pink flush,
and the eyes are clear  and bright.   Between
the seventh and the twelfth day  the peculiar
eruption appears on the chest, abdomen, and 
TYPHOID FEVER
TYPHUS FEVER        457
back, and it consists of a few slightly raised
rose-colored spots, which disappear on press-
ure  under the finger and fade away in two
or three days, but in the mean time others ap-
pear, so  that  several  crops  are noticed, and
fresh ones may  be seen every  day ;  these
spots are  never petechial.   If now the hand
is pressed over the right side of the abdomen
there may be a feeling or expression of pain,
and one  may also  feel a gurgling under the
fingers. About the middle of ihe second week
delirium comes on, at first  slight and only
noticed at night, and then more constant, in-
tense, and noisy.   The tongue  is dry, red,
and glazed, and often  cracked in  various di-
rections ; in children,  however, it may some-
times remain moist and white the whole time,
and in very young cases  also  you do not al-
ways see any  rash at all.   As the disease ad-
vances the patient  loses flesh  and strength ;
he lies prostrate and perhaps unconscious of
what is going on around, and if it end fatally
he will become quite insensible, have a mark-
edly high  temperature, and fumble  at  the
bed-clothes.  If the disease progress favorably
the amendment is  very gradual, and lor this
the temperature is a pretty good guide.  The
temperature  rises from the first, but not so
suddenly as in typhus and relapsing fevers ;
at the end of the first week it may be 104° or
1050, Deing generally  highest toward even-
ing ;  it keeps high with slight oscillations for
about twenty-one days, and  then a fall may
often be noticed in  the morning,  although it
ascends again at night, and these daily varia-
tions are very marked and  may cover three
or four degrees ; at about  the thirtieth day,
or a little later, the  symptoms arc decidedly
less  severe  in ordinary cases ;  the tongue
cleans ;  there is less prostration and delir-
ium,  and a  general improvement is mani-
fested.   But  then  a relapse may ensue, and
the temperature  will  again  rise,  and  the
patient  go through a  second attack, but this
is much shorter than the first.
   Complications.—Typhoid fever is a very
dangerous  disease,  because  there  are  so
many accidents to which patients are liable.
Diarrhcea may be  very profuse and  exhaust
the patient, but as a  rule  diarrhoea is not a
very bad symptom, and should be left alone,
unless very   profuse.  Bleeding from   the
bowels, when it occurs in any large quantity,
is a very dangerous  sign ;  it is  due to the
ulceration of  the intestines.   Bleeding from
the nose is not often a bad symptom.  Per-
foration of the bowel  is very likely to occur
between  the  twenty-fifth and thirty-second
day, and even later, an 1 this may be brought
on by any error  of diet ;  it is attended by
collapse, and  is very fatal.  Inflammation of
the peritoneum, cither with or without perfo-
ration, adds  greatly to the danger.  Bron-
chitis and pneumonia may supervene and in-
crease the general mischief.  Some cases arc
very mild, others  very severe, and there  is
perhaps  no fever  which  varies more in its
forms, nor about which so much anxiety and
uncertainty must exist with regard to a suc-
cessful issue, nor is one safe until recovery is
fully established.  In many cases it is most
difficult to be certain of the nature of the case
in the first week.   It  is most likely to be
mistaken in children for acute tuberculosis ;
or it may  be  looked upon  as the  so-called
gastric fever  or gastric irritation ; or it may
resemble the symptoms of arsenical poison-
ing.   It  may be as well to say here that there
is no such disease  as gastric fever; it.  cither
means typhoid fever or it is a disturbance of
the stomach  and  intestines from poisoning
or eating unripe fruit.   Whenever three or
four cases  occur together this fever may be
suspected,  and if  any one  die  of  similar
symptoms  within   a week or two,  and the
cause is not clearly made out, an examination
of the body must be made to settle the point,
for many cases of arsenical poisoning have in
this way been overlooked.  In typhoid fever
the main appearances after death are ulcera-
tion  of  the   bowels,  and chiefly near the
caecum  and toward the end  of  the ileum,
with enlargement  of the spleen and mesen-
teric glands.
  Treatment.—As regards ventilation, good
nursing, cleanliness, and  quiet, and  with re-
spect  lo disinfectants, etc.,  nothing more
need here  be  said than is laid down in the
article on Typhus  Fever, and it need not be
repeated.  Yet there arc some special points
of importance.  The diarrhcea need seldom
be checked unless  one is purged more than
twelve or fifteen times a day,  and then a lit-
tle starch injection may be given ; if there is
much bleeding  it  may be requisite to give
turpentine.  It is a mistake lo give medicines
containing acids, as  they  often increase the
purging and the bleeding.  In fact, there is
no medicine which can cure the fever.   The
diet must be  very light,  and  no solid food
should be  taken  under  six  weeks or two
months, because, in consequence ot the ulcer-
ation of  the bowels, the coats are very thin
and liable to burst.  Eating  an orange or a
piece  of potato, or drinking an effervescent
draught  will cause distension of the  bowel
and rupture it, just when the patient is other-
wise doing well ;  the  greatest precautions
should be  taken during the third and fourth
weeks, as  then it is most  liable to  occur.
Milk must  form the main article of  diet, and
then an egg or two may be beaten up in it, or
a custard may be given and beef-tea ;  then a
small  piece of  mutton and sole, and  so on,
gradually to  more solid  food.   If there is
much  distension of  the bowels, hot  flannels
on which is sprinkled a little  turpentine will
be found very useful.  For information as to
disinfection, see Sanitary Regulations.
  TYPHUS FEVER is  a highly contagious 
45S        TYPHUS FEVER
TYPHUS  TEVER
 fever, attacking  people of  all ages, which
 occurs in an epidemic  form, and generally in
 periods of  famine and destitution.  It has
 been known at different times under various
 names ;  thus  it has been  called pestilential
 fever, petechial fever, brain fever, putrid con-
 tinual fever, camp fever, jail fever,  etc.
   Causes.—In the individual,  sex  and age
 have no  influence in determining an attack ;
 nearly equal numbers  of both sexes catch it,
 and children,  as well  as adults  and old peo-
 ple, are liable to  it, but more cases have it
 after fifteen than before.   Of 3456 cases ad-
 mitted  into  the  London  Fever  Hospital,
 nearly one half of the cases were thirty years
 of age or upward, one eighth were  fifty or
 upward,  while  less  than  one sixth  were
 under fifteen.   Depressing mental influences,
 overwork, and  anxiety render the  system
 more liable to contagion ;  those  who are
 badly fed, and those who suffer from loss of
 a  harvest ;  people who have  suffered the
 hardships of  war, of  civil strifes, and  com-
 mercial distress, are often its chief victims.
 Overcrowding, dirt, and bad ventilation are
 important predisposing causes to this affec-
 tion. Typhus is chiefly met with in cold and
 temperate climates, but not  in the tropics.
 The chief cause  of typhus is contagion,  or
 the transmission of the disease from one per-
 son to another ; the other causes only render
 the system  more liable to the action of the
 poison.   Nearly all the evidence goes to  show
 that typhus is essentially  a disease that  is
 caught by a healthy person coming in contact
 with one previously affected, and it  is easily
 caught during convalescence.  It is  very rare
 for a person who  has  had the fever once to
 have it a second time.
  Symptoms.—It is difficult to say how long
 the disease  may be incubating in the system
 before it appears,  but the period is certainly
 not constant, and  seems to vary from a few
 hours to several days.   The onset is marked
 by  a severe headache, loss of appetite, and
 languor, and aching of the limbs ; the invasion
 of the symptoms  is not so sudden as in re-
 lapsing fever, but  much better marked  than
 in typhoid fever.   For three or four days ihe
 patient gets worse,  being unable to go about,
 and feeling  chilly and prostrate ; he then is
 worse at night and  restless ; the skin is hot,
 the tongue coated ; there is thirst and some-
 times vomiting ; by the third day of the dis-
 ease most are obliged  to take  to their  bed,
 while this is not the case  in  typhoid fever,
 which is  a much more insidious  disorder.
 There is a  general aspect of a typhus case,
 which an experienced  person  will at  once
 recognize ; the patient  lies prostrate on his
 back with a  dull and weary, if not stupid, ex-
 pression ; the eyes are  suffused and watery,
and a dusky flush overspreads the face.   As
the disease progresses the eyes are  half shut
and the  mouth open ;  he lies moaning and >
 unable to move himself or answer questions ;
 the lips and teeth aie dry and  covered with
 sordes and  look black ; the mouth is  dry ;
 the tongue dry, brown, or black, and marked
 with  cracks.  The temperature  rises from the
 first,  and reaches 1030 or 104°  Fahr.  by the
 middle of the first week ; 'the highest temper-
 ature reached in the fever is seldom less than
 1050,  although  it may  be  higher,  but the
 higher the  point reached  the greater  is the
 danger ; the fever  may  slightly   abate  in
 favorable cases about the ninth or tenth day ;
 no marked fall,  however, takes place until the
 end of the second week,  and generally on the
 fourteenth day,  when defervescence may take
 place suddenly,  and the normal temperature
 (98.40) be reached in twenty-four  hours, but
 more  commonly it  takes  two  or  three days
 for the descent to be accomplished.  The tem-
 perature generally is highest of an evening ;
 when  defervescence occurs, the temperature
 always goes below  the  normal line so as to
 mark 97°, or even 960, and in  a few  days it
 becomes natural.  This fall is a  very good
 sign,  and then the patient is generally out of
 danger.  A  very high  temperature (106°  or
 107°) is a sign of serious  gravity.   In mild
 cases the fever begins lo leave on the  twelfth
 day in  many cases.  The pulse is  generally
 120 in a minute,   but  is  very easily com-
 pressed under the finger ;  the  heart  sounds
 in very severe cases are feeble, and the first
 sound may even be inaudible.   A rash ap-
 pears in nearly every case, and  is  very char-
 acteristic ;   sometimes  it  looks as if there
 were a general mottling just beneath the skin,
 or distinct spots may appear of small size and
 purplish color ;  they are irregularly rounded ;
 at first may  disappear on pressure, but soon
 become petechial ; oftentimes the  two kinds
 occur  together,   but sometimes separately.
 The rash appears on the fourth or  fifth day,
 rarely later ;  it  comes on  the  back  of the
 wrists first,  in the armpits, and  over the epi-
 gastrium ;  then  it more  or less covers  the
 trunk ; it  seldom comes  on the   face and
 neck ; the rash  has something  of  a measly
 look,  but the other symptoms are much more
 severe than  are seen  in measles ;  the  ras>h
 lasts a variable  time, but generally until the
 fourteenth  or fifteenth day.  No solid food
 can be taken,  but  the  patient  is always
 thirsty.  The bowels in some cases are con-
 fined,  in  others they are open too  much.
 There may often be heard rattling  or wheez-
 ing noises in the chest, and the more so when
 the face is very dusky.  The nervous  symp-
 toms  are well marked ; restlessness, loss of
sleep,  and  confusion of thought first come
 on ; then headache, giddiness, a buzzing in
the ears, and deafness ; in most cases there
 is delirium, and  the patient is beset  with hor-
rid fancies.    In  bad  cases he lies picking the
bed-clothes,  twitching his hands, sr-d mutter-
ing to himself or moaning ;  or he may be 
TYPHUS  FEVER
ULCERS
459
quite unconscious with wide-open eyes,staring
vacantly.  Loss of the power of swallowing and
insensibility are very bad signs, and generally
precede death.   The urine  is passed invol-
untarily, as well as the motions in most cases,
so that great cleanliness has to be observed.
  The duration of typhus may be from three
to twenty-one  days,  but about  fourteen or
fifteen days is the average time ; if a case live
more than this  time it will generally recover.
The termination  in recovery is sometimes
quite rapid,  and  the  tongue will clean, the
temperature fall, and  the delirium cease in a
day or two, but generally the improvement is
more gradual and lasts over three or four days.
Unlike  typhoid fever, there is no relapse, so
that when once  the  temperature has  come
down the best hopes may be  entertained ;
nor is he  liable to peritonitis or perforation
of the bowel, as in typhoid fever.
  The death-rate  varies with the epidemic,
being generally greatest  at  the commence-
ment.   Of children under ten years of age
about 5 per  cent  die ; of those over sixty
years of age, 66 per cent die ; the  older the
patient  the greater is the danger ;  between
thirty and forty. 21.5  per  cent die ;  between
twenty  and  thirty, 15.6 per cent die ; be-
tween  ten and twenty,  8.6 per cent die.
Habits of intemperance increase the danger
in those attacked ; bulky people die  more
frequently than thin ones, black  people more
than white, and those  who  are  overworked
and  have mental  worry, etc., have  the dis-
ease with  the most severity.  -
  Treatment.—The pitient  must be placed
in a well-ventilated and large room, so that
draughts will be avoided ; he should have his
bed so situated that the light from a window
will not fall on his face, as this is annoying ;
all curtains, carpets, and bed-hangings should
be at once removed ;  the  bed should not be
too soft, and a draw-sheet or mackintosh must
be put under the patient.   He should not be
allowed to exert  himself  at  all,  but  try and
husband all his strength. The greatest clean-
liness must be observed and all excreta re-
moved at  once, and carbolic  acid or chloride
of lime  should  be mixed  with them, or any
soiled linen may be put in a tub of  water in
which is some carbolic  acid.  Bed-sores are
very liable to form on the back, and so the
nurse must always be on the lookout, and try
and  prevent  them coming by smoothing the
sheets, drying the patient, and rubbing brandy
or balsam of  Peru over the part ; better still,
to have a water-cushion  or a water-bed.   The
skin may be sponged  down with tepid water,
the nurse drying and sponging one part at a
time, so as to prevent any undue chill to the
surface  from  exposure ; this  relieves  the
patient and partly removes that disagreeable
smell so common from the  skin in typhus
cases.  None but the nurse and doctor should
see the  patient ; all  noises must be stopped
and great quiet enjoined ; at night time  there
may be a small light in  the room, but placed
so as not to disturb  the patient.  Milk must
be the chief article of diet, and is best given
cold ; an egg or two may be beaten up in it,
and three or four pints of milk may be given
in the twenty-four hours ; this must be done
regularly every two hours in equal quantities,
and  more  especially must this be done at
night or in the early  morning when the pros-
tration is the greatest.   Beef-tea and broths,
jellies, extract of beef, custards, etc., may be
given if the patient can take them and wants
them, but in very bad cases they will not do
so.  For drinks in the early stage, lemonade,
cold tea, soda-water, etc., may be given,  but
do not let  them have too much effervescent
drinks ; when  very bad the nurse will have
plenty to do to get the  milk  down.  Stimu-
lants are very useful, but the quantity must
vary with each case,  and be left to the medi-
cal man's judgment ; brandy is the best stim-
ulant, and  may be given with iced milk ;  too
much must not be given at  first, as  it causes
oppression and inability  to take nutrient
food ; but  aflerward, in the  stage of  great
prostration, its proper and  careful adminis-
tration may save the patient's life.
  Albumen is often present in the urine in
these cases, but  calls for  no special treat-
ment.  Much  care must be taken that there
is no retention of urine in the bladder in these
cases, as that organ is very liable to be para-
lyzed.   When the crisis has  passed and  the
tongue cleans, some  boiled  mutton may be
given ; also jellies, light puddings,  custards,
etc.  The stimulants may then be diminished
and  beer  given if preferred.  If, however,
convalescence  be retarded by bed-sores, or
by the formation of abscesses, the stimulants
must be continued and solid food given spar-
ingly.  In some cases the mind is childish for
some time after recovery.   A trip in  the
country, plenty of good food, and fresh air
will complete a cure.   For the prevention of
typhus spreading, isolation must be adopted,
and  if a case  occur  in  a crowded court,  it
should be removed to a fever hospital.   For
the measures to adopt with regard to disin-
fecting the clothes, room, etc., see Sanitary
Regulations.
U.
  ULCERS consist  in the gradual  disinte-
gration and separation of tissues, the healthy
nutrition of which has been disturbed  by local
inflammatory changes, by impoverishment or I
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 particles, or  undergo 
460
ULCERS
ULCERS
liquefaction ; in gangrene, to which ulcera-
tion is closely connected,  the  open sore is
formed  by the separation of the dead tissues
in sloughs or  large and visible  masses.   Ul-
ceration  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-increas-
ing 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 vis-
ion, by resulting in opacity or perforation of
the membrane.  Within the body ulceration
very frequently occurs  in some  part of the al-
imentary canal.  Ulcer of the stomach, ulcer
of the duodenum, after severe  burn, typhoid
and tubercular ulceration of the small intes-
tine, syphilitic and dysenteric  ulceration of
the colon and rectum, and fissure or painful
ulcer of the rectum are all well-known affec-
tions.  The favorite scats of ulcers  on the
surface of the  body are the legs ; here the ul-
ceration  is  generally due  to local  irritation
and obstruction in the circulation.  Ulcers,
when present  in parts  of the body above the
knees  are  usually  dependent  upon  some
constitutional  affection, such as syphilis  or
scrofula, or are connected with some form of
cancer.   The  face is often attacked with ob-
stinate and spreading  ulceration,  of  which
the most common examples are epithelioma,
lupus, and  the  rodent ulcer.   Ulcers  vary
much in. their form and appearance, in their
rate of increase, and  in the severity of the
symptoms to which they give rise.  Some, as
the sloughing  and phagedosnic  ulcers, spread
very rapidly, and  are attended  with bad gen-
eral symptoms ; others, as the  so-called cal-
lous ulcers, observed on the legs of old peo-
ple, undergo very  little change, and usually
cause very little pain,  and rarely any consti-
tutional reaction.   Some  are quite  indolent,
and others  give rise  to excruciating  pain  ;
there is also much  variety in  their shape, the
general  tendency,  however, being to form
round or oval  ulcers.   These differences gen-
erally disappear when the  ulcer  takes  on
healthy  action  and begins  to cicatrize ;  a
healthy   granulating  surface  is then  pre-
sented, which  closes by contraction, and the
formation of  a gradually extending zone of
delicate  scar-tissue  at  its  edges.  Some
ulcers, and especially those formed in cancer-
ous affections, obstinately resist local treat-
ment, and continue to increase in size  and
invade surrounding tissues until the patient
sinks from pain and exhaustion.
  The following remarks apply only to ulcers
formed  on  the  surface of the body.   For
information concerning the ulcers of internal
organs, the  reader is referred  to articles on
Cancer,  Gastric   Ulcer,    Dysentery,
Phthisis, Typhoid Fever, etc.
  The Inflammatory Ulcer is met with gener-
ally in front of and on the lower half of  the
leg, and is usually due to slight  injury, such
as a grazed or broken shin.  As a  rule,  the
patient is either a plethoric individual, whose
health has been impaired by excesses in diet,
or one advanced  in years, and exhausted in
consequence  of hard work  and insufficient
nourishment.   The sore is small and circular
and  usually single ;  its  base is  covered  by
small granulations of a brownish-red color.
from which there  is  a  profuse discharge of
thin and acrid  ichor ; the edges of  the sore
are sharply cut, and  the surrounding skin is
hot  and red.  The patient complains   of
severe burning pain in the ulcer and over  the
inflamed  skin.  The  development   of  this
troublesome and painful affection is favored
and in many cases caused by  negligence on
the part of ihe patient, or in consequence of
inability to discontinue active work.  A slight
abrasion on the shin of an unhealthy individ-
ual suffering  from congestion  of the liver,
piles, and distension of the veins  of the lower
extremities, will almost certainly degenerate
into a painful and inflamed ulcer if the part
affected  be not kept at complete rest  for a
few days.  The prevalence of the inflamma-
tory ulcer among  the laboring  classes is no
doubt due to  the frequent  occurrence   in
individuals of this class of wounds and slight
injuries to the lower limbs, and lo the, neces-
sity under which  they lie of continuing work
and  active exercise,  even though   suffering
from acute pain.
  The treatment of inflammatory  ulcer should
consist of complete rest of the affected limb.
The patient should  remain in bed  with  ihe
limb elevated on a pillow.  The ulcer should
be dressed with a light bread poultice, warm
fomentations,  or  a weak lead lotion.  When
the pain has subsided, and the ulcer presents
the appearance of a healthy granulating sore,
water dressing or a weak solution of  sul-
phate  of zinc should  be applied  and  the
limb be bandaged from the toes as far as  ihe
midd'e of the thigh.  Local applications alone
are quite useless.   The patient must remain
in bed, or in the recumbent position,  until  the
ulcer has changed into a rapidly-closing and
healthy sore.
  Irritable Ulcer is the name applied to any
small sore which  has an unhealthy appear-
ance, obstinately resists treatment, and gives
great pain when touched at a certain point of
its  surface.   According  to some, the acute
pain in this affection depends upon the  ex
posure of a nerve on  the surface  of the ulcer.
This pain is always limited to one  spot,  the
rest of the raw surface being free  from tender-
ness.  This variety of ulcer may be  much re-
lieved by a poullice or poppy-head  fomenta-
tions.   The  only effectual means  of  cure, 
ULCERS                                   ULCERS            461
 however, is division of the exposed nerve, by
 making a small  incision across its  track at a
 short distance above the painful spot.
   Chronic,  Callous,  or Indolent Ulcer is of fre-
 quent occurrence among old  and debilitated
 individuals, and in  most instances affects the
 lower part of the leg.   It is usually of consid-
 erable extent, and  in  some  bad cases  com-
 pletely  encircles the limb.  The surface is
 smooth and glassy, is much depressed below
 the surface, and is  surrounded by hard and
 white edges.   The skin surrounding the  ulcer
 is thick and callous  ; the leg below the  ulcer
 is hide-bound as it were, and  the foot is  often
 swollen.  This ulcer, though large and for-
 midable in  appearance, is generally free  from
 pain and   remains  indolent, except  when
 much irritated.  The hard edges then rapidly
 sink down, and a large and painful sloughing
 ulcer is formed.
   The essential  point  in  the treatment of
 chronic ulcers is to establish healthy and active
 granulations, and at the same time  to reduce
 the thickening and  induration  of the parts
 around, so  that  these may yield  to the con-
 tractile force of  the scar-tissue formed over
 the granulating surface.  The patient should
 keep in the recumbent  position, and  take
 good diet and a  moderate amount of alcohol-
 ic stimulants.  The  ulcer should be poulticed,
 and afterward, when its surface is moist and
 bathed by  a purulent discharge,  should, to-
 gether with the  surrounding hard  skin, be
 strapped and bandaged.  By this treatment
 an indolent ulcer of an oval shape and not
 very large will generally, in the course of a
 month  or six  weeks,  be completely closed.
 In cases, however,  where  the ulcer is  very
 old  and large, and  involves  a  considerable
 extent of the circumference of  the limb, al-
 though considerable improvement  may be
 produced, and the raw surface be much re-
 duced, it will seldom be possible to make the
 limb sound.  There is always a tendency for
 the scar formed over a chronic ulcer to break
 down and  to  slough  whenever the patient
 commences to walk  about again  and to  take
 active exercise.  The general idea  that it is
 dangerous  to close an  old  indolent ulcer is
 not an unfounded one, as the cicatrization of
 a chronic ulcer in a person of advanced age
 is often followed by symptoms of  constitu-
 tional disorder and slight apoplectic strokes.
 In cases of this kind it is often thought neces-
 sary to establish a drain upon the system by
 making an issue or a seton wound.
   Varicose Ulcer  is met with in the lower ex-
 tremity in  connection  with  distended  and
 varicose veins.   It generally commences as a
 small simple or inflammatory sore, and then,
 in consequence of the congested state of the
 limb, persists and acquires the characters of
an indolent  ulcer. The varicose ulcer is sel-
dom single ; usually one may observe about
the ankle two or  more  torpid ulcers of  oval
 shape and varied size.  The surface of each
 ulcer is smooth and a brownish-red color, and
 the edges  are  hard  and somewhat elevated.
 The skin around and between the ulcers is
 generally  swollen  and  red,  and sometimes
 raw, in consequence of a chronic eczematous
 eruption ;  the  foot is swollen, and about the
 ankles are  unnatural  swellings caused by
 distension of the superficial veins ; the veins
 of the leg are much swollen and varicose, and
 the  small subcutaneous veins  form large pur-
 ple patches of an arborescent appearance.  A
 prominent cord,  formed of one or more vari-
 cose veins,  may generally be  seen  passing
 upward from the superior margin of  each
 ulcer.   A vein is sometimes laid open by the
 extension  of a varicose ulcer, and bleeding
 takes place,  which persists and causes much
 trouble and alarm, so long as the patient re-
 mains erect,  and  no means are applied locally
 in order to arrest the flow.  As soon, how-
 ever, as the patient is placed on his back and
 the  lower  limb is elevated, the bleeding  is
 arrested.   In cases of this kind a small pad
 of lint or linen rag should be placed over the
 bleeding point,  and be  retained  there by
 plaster and a few turns of a bandage.
   The  varicose ulcer may usually be much
 reduced in size,  or even completely  closed,
 by rest in the recumbent position, by  the ap-
 plication of mildly stimulating lotions to the
 raw surface, and by  firm  bandaging of the
 affected leg.   The ulcer, however, will gen-
 erally break  out again if the patient becomes
 careless and takes active  exercise without
 taking measures to afford support to the var-
 icose veins.  A bandage ought lo be  applied
 every morning, and  be carried from the toes
 to the middle third of the thigh,  or, what is a
 much better plan, the limb should be encased
 in an elastic stocking. In cases where several
 large and obstinate ulcers exist in connection
 with an extremely enlarged and varicose state
 of the veins  of the leg and thigh, it will be
 necessary for the patient, before he can ob-
 tain any relief,  to submit to a surgical opera-
 tion, by which  the larger superficial  vessels
 may be obliterated.
   Strumous or Scrofulous  Ulcers usually re-
 sult from the enlargement and suppuration of
 a lymphatic gland, or from  the bursting of  a
 small subcutaneous abscess.  They are gen-
 erally  multiple and closely  clustered,  and
 most frequently affect the neck.  They are
 very irregular  in  shape,  and often run to-
 gether.  The individual ulcers are small, and
 show no tendency to increase  much in size ;
 the edges are irregular and formed  of  thin
 and  undermined  skin of a pink or light pur-
 ple color.   The surface of each ulcer is com-
 posed  of  large  pulpy   granulations, from
 which  there  is constant  discharge of   thin
yellow pus.   In old and severe cases there is
 much thickening  of  the  surrounding  integu-
ment.   These ulcers are  usually  associated 
4G2          UMBILICUS
URINE
with enlarged glands, pustular eruptions on
the scalp and face, and with other manifesta-
tions of the morbid  disposition  known as
scrofula.  In these cases no relief can be ob-
tained,  except  by a  proper constitutional
treatment (see Scrofula).  The local treat-
ment should  consist  in  the application of
mildly stimulating lotions, such as a weak
solution of tincture of iodine, or a lotion con-
taining  blue-stone  (2 grains  to  1 ounce of
water).   (See Phagedena.)
   UMBILICUS,  the central  spot of the
abdomen, marked by a depression ; it is  now
and then protruded in infants, and may re-
quire a  pad and bandage to keep  it in its
place ; it is commonly called the navel.
  UNGUENTS.  (See Ointments.)
  UNLEAVENED BREAD. (See Bread.)
  URATES,  or  Lithates, form the com-
mon deposit in  the urine known as sand or
gravel.   They are usually of a pink or drab
color, and consist of uric acid in combination
with  potash,  soda,  and  ammonia.  They
often appear after an ordinary cold, in many
cases cf fever, and  from too much drinking.
In such cases the urine is often more acid and
more scanty than usual. (See Urine.)
  UREA.   (See Urine.)
  URETER, a narrow tube passing down
from each kidney into the  bladder, and allow-
ing of the passage of the urine.
  URETHRA  is the tube which allows of
the passage of the urine  from the bladder.
It is liable to be hurt  by accident or disease,
and may be the seat of stricture, so that one
cannot pass water readily.  (See  Stricture.)
  URIC ACID  is one of the constituents of
healthy  urine ;  it now and  then  forms the
nucleus of  a stone or  calculus.   It is found
in excess in the blood in cases of gout.  (See
Urine.;
  URINALS should  be  thoroughly clean
and amply supplied with  running  water.
Night and morning they should also be well
flushed  down.   It  is  usual  to  have some
chloride  of  lime placed about, so as to re-
move any noxious odors.   Great pains should
be taken at all times to remove any accumu-
lation of fluid.   It is desirable that the walls
should  be  made of glazed tiles rather  than
metal,  wood, or  slate, and the  roof should
freely communicate with the open air.
  URINE is a secretion which is  constantly
going on from the kidney, and in  this way a
large quantity of water and various inorganic
and organic  matters  are continually being
taken from  the  blood ; and it is important
that this should be the  case,  for  if these
materials were retained they would  be pro-
ductive  of  serious  consequences.  Urine is
generally of a light amber color,  of an acid
reaction, turning blue  litmus-paper red,  of a
peculiar odor, and saline taste.   Its specific
gravity on  the average is  1.020, pure water
being taken as 1.000 ; but this will vary with
the time  of   day and  with the amount  of
liquid food absorbed into the system.   The
quantity of urine passed during  the twenty-
four hours varies a  good deal,  but on an
average may  be estimated  at  forty to  fifty
ounces.   An  average healthy man excretes
about fifty ounces or 24,000 grains of water
in a day.  In this are dissolved 500 grains  of
urea and  from  ten to twelve grains of  uric
acid.  The following table shows ihe compo-
sition of healthy urine :
Water.................... 956.80
Urea....................  1423
Uric acid...........,.....   0.37
Alcoholic extract.........  12-53
Watery extract...........   2.50
Vesical mucus...........    0.16
Chloride of sodium.......   7.22
Phosphoric acid.........   2.12
Sulphuric acid............   1.70
Lime...................   0.3 r
Magnesia.................   0.12
Potash...................   1.93
Soda.....................   o 05
In 100 parts of
 solid matter.

    33.00
     0.86
    29.03
     5.80
     0.37
    16.73
     4.91
     3-94
     0.49
     o 3^
     4-47
     0.12
  In addition the urine contains carbonic acid,
oxygen, and nitrogen in a gaseous form, but
very small quantities of the two latter sub-
stances.   Urea is a nitrogenous product, and
nearly all the nitrogen which daily enters the
blood in such food as the proteid compounds
passes off in the urine after being used :ip in
the system.  By  taking an animal  diet the
urea is increased  in amount, and diminished
by living upon  a vegetable diet.  When uric
acid is not properly eliminated  by  the kid-
neys it will be retained  in the blood,  and  it
is  always present  in that fluid  in  cases of
gout.  In many cases the constitutents of the
urine,  instead of  passing away  in a soluble
form, may become deposited in the solid
state on their way from the  kidney  ; at first
very small, they  may increase in size,  and
form what is commonly known as a  stone or
calculus.   Stones are chiefly formed  in the
bladder ; but they are met with in the kidney
as well.  (See Obstructions ; Stone  ) Uric
acid or urates  and phosphates  are  the sub-
stances most commonly forming the greater
part of a  stone.  In ordinary cases there is
no sediment in the  urine, but merely a faint
cloud of mucus.  Often, however, when one
has a cold, or has had an excess of  beer, or
from various causes, there may be a pink or
drab sediment  when the  urine cools.   This
is composed of urates, or uric acid in combina-
tion with  the  alkalies, potash, soda,  and am-
monia, which  are daily passed in the urine.
This  sediment is of slight practical impor-
tance, and will disappear  by drinking  plenty
of bland fluids, as tea, water, etc.  The color
of urine varies much : when a small  quantity
is passed, it is of  a high color ; when  plenty
is voided, it is  paler.  This is seen in cases
where a person has had two or three glasses
of hot gin and water. This fluid rapidly runs
through the kidneys, and the urine is ihen al- 
URTICARIA
UTERUS
4G3
 most colorless and of low specific gravity.  A
 large quantity of urine daily passed, associa-
 ted  with great thirst and  dryness of skin,
 should make one suspect that diabetes is pres-
 ent.   When a stone is present in  the blad-
 der, or when the patient suffers from stric-
 ture, the urine may be ammoniacal and smell
 disagreeably.  There will most likely be also
 a deposit of phosphates.  Retention of urine
 is said to occur when the urine is secreted by
 the kidneys  but not voided  from the bladder.
 It is at once relieved  by passing a catheter.
 Suppression of urine is of much more serious
 import, and is due to mischief in the kidneys,
 and if not relieved  soon will cause death by
 poisoning the blood.   This often  forms the
 last stage of Bright's disease, and  commenc-
 ing with  drowsiness and often convulsions,
 passes through stupor into coma and death.
 The  urine is of immense importance to the
 physician in finding out the slate of a patient,
 and in making out clearly the nature of many
 disorders.  Albumen, pus,  blood,  and sugar
 are the four impurities most  commonly met
 with in the urine in cases of disease.   Albu-
 men may be known by healing a small quan-
 tity of urine in a test-tube, and adding nitric
 acid, when a white flocculent precipitate will
 come  on.   The patient is  then said  to be
 suffering from albuminuria.  Albumen may
 be present in cases of Bright's disease, em-
 physema,  chronic bronchitis, heart disease,
 most of the fevers, and chiefly in those which i
 take on a malignant character, and  in several J
 other  disorders.  (See Albuminuria.)  Pus
 gives a greenish-yellow deposit in urine, and
 it turns very tenacious when heated with a so-
 lution of potash.  It may be  caused  by disease
 of the kidney  or  bladder, or by an abscess
 bursting into the bladder.  Paralysis of the
 bladder in cases of paraplegia, a stone in the
 bladder, and old-standing  strictures are the
 conditions most liable to favor the  formation
 of pus in the urine.   Blood is present in the
 urine  in cases of acute Bright's disease, in
 heart  disease, many fevers, blood  poisoning
 ing   by  turpentine,  cantharis,  etc.    (See
 H/EMATURIA.)  Sugar is present in the urine
 in cases of diabetes ; but the importance of
 this as a symptom varies much with the age
 of the patient, being far more dangerous in
 young than in old people.   Elderly persons,
 and  those who are consumptive,  now and
 then pass slight amounts of sugar without its
 producing any symptoms.   (See Diabetes).
 For  pain  or difficulty of passing urine, see
 Dysuria,
  URTICARIA.   (See Nettlerash.)
  UTERUS is the technical name for womb,
and  is situated in  the pelvis.   It  is chiefly
composed of muscular fibres, which increase
enormously in size  in cases  of  pregnancy,
and aid in bringing forth the child into the
world. It contains a narrow cavity about two
inches and a half in length, and it is lined by
a mucous membrane.  From this membrane
is secreted the fluid which comes away at the
ordinary monthly periods.   On cither side
of the uterus  is an  ovary,  which  at certain
times is connected with the womb by means
of the Fallopian tube.  The uterus is liable to
many diseases—a polypus or a fibroid tumor
may grow in its walls, or project into its cav-
ity.   The symptoms will probably be occa-
sional hemorrhage,  or bleeding in excess,
pain  in the back, and  perhaps difficulty in
passing water.  The uterus may become bent
upon itself, and sometimes  cause distressing
symptoms  of  pain,  difficulty  in micturition
and defecation, and excessive menorrhagia.
Sometimes there is ulceration of the womb,
accompanied by leucorrhcea.  After delivery
the uterus does not always return to its nor-
mal size, but  is  larger  and  heavier  than
usual.  Subinvolution  is then  said to have
occurred ; menorrhagia is then very likely to
supervene, and the patient feels weak, and is
unable to undergo much  exertion.   Prolapse
or  procidentia of the  uterus comes  on in
those who have  to  stand about much, and
who get about too soon after their confine-
ment.  The common symptoms of disease of
the womb are pain  in the back, and gener-
ally across  the  loins, of  a bearing-down
character, weight  or  discomfort in the pelvis,
difficulty  in  micturition   and defecation,
with menorrhagia or lecuorrhoea, and inabil-
ity for walking or any exertion.  Cancer of
the womb is known chiefly by the  excessive
pain, a profuse and often  foetid discharge,
occasionally  menorrhagia  and  a  marked
cachexia.
  Treatment.—Many diseases of the uterus
occur in nervous women,  and the constant
pain  and  inability to go about much are apt
to produce a sense of depression and melan-
choly, and to fix  the patients'  attention  too
much on their disorder.   And this is perhaps
intensified by  their coming under the care of
medical men who, devoting  themselves  to  a
special  line of practice, are apt to unduly
estimate the local malady, instead of looking
at the constitution and general health of the
patient.  Most affections of the womb are to
a great extent  curable.   Rest in the horizon-
tal  position, a moderate amount of out-door
exercise without causing fatigue, wearing an
abdominal belt, and the use of a cold or tepid
hip-bath, will do  much  to alleviate  any dis-
eased condition  that may  be present.   In
cases of prolapse pessaries are very useful
but nothing is more to be condemned than
a mere  mechanical treatment of these affec-
tions.   The patients'  attention should  be
diverted from their malady by having some
light  employment,  as   needlework,  fancy
work, etc., by cheerful companionship, and
by  reading useful books—by anything,  in
short,  which  prevents  them thinking  too
much about their complaint.  Most women 
4G4
UVULA
VACCINATION
improve much, and may quite recover, when
the child-bearing period is past.  Riding and
driving seldom  do much good, as  they  arc
attended with so much jolting, and often ag-
gravate  any pain.  Tonics and astringents
must now and  then be given  to improve  the
general  health and alleviate  any  excessive
hemorrhage.   The chief thing to be done,
however, is to improve the  physical health
of  women  during  girlhood—in   allowing
them  out-door exercise and  more freedom
in running about ; in altering any absurd
fashion  of dress, as tight-lacing etc., so as
to develop  the chest  and not compress any
internal organs;  in teaching  them  to swim
and ride ;  in preventing them from keeping
late hours  at  balls  and parties,  and irom
breathing  impure air ; in  changing the arti-
ficial system of education of the present day ;
  VACCINATION is a process by which a
peculiar specific disease, known as the cow-
pox or vaccinia, is introduced into the system
with the view of  protecting it against an at-
tack of small-pox.
  The cow-pox is a disease which never oc-
curs spontaneously in man, but it may be
readily  communicated to him  by inserting
some  of the matter into the system.  Vac-
cinia,  or the cow-pox, is not always prevalent
in this country, but occurs casually and some-
times  appears almost as an epidemic.  When
affecting the cow, the rash appears as a small
vesicle or  blister, and comes out on the teats
and udder.  The disease runs its course in a
precise and definite manner, and lasts about
three  weeks.   About four days after  the in-
vasion of the disease the animal may become
slightly indisposed, and small red papules or
pimples appear on the teats or near the udder.
These soon become vesicular, and the top of
the  pimple becomes raised and pellucid, as if
a little blister were present;  this is due to the
epithelial covering of the skin being raised by
the  effusion cf some clear lymph, so that the
spot has a pearly look.  When these vesicles
are  well developed, the margin  is raised and
there  is a  central concavity, or cup-like de-
pression ;  at first  the  skin  around  is  of a
natural color, but about the  eighth  or ninth
day a  pink blush or areola is seen around the
vesicle, which  extends  gradually, so that in
two or three days more the areola forms a
zone  half an  inch wide, and there is some
thickening and hardening of  the skin around ;
at the same time the vesicles lose their pellu-
cid, pearly look and become more opaque.
By  the twelfth day the lymph or fluid in the
vesicle becomes  more  turbid, and the whole
becomes drier and  a crust  begins to form ;
many  vesicles burst, and as their contents
escape they become dry and form scabs ; the
in allowing them  to read sensible books, and
not  inferior  literature ;   and,   finally,   by
letting them learn the elementary principles
of health  and diet, so as to enable them to
become intelligent  and  efficient wives and
mothers.
  In cases of  cancer of  the womb, nothing
can be  done beyond alleviating any symp-
toms that may arise, and  in rendering a pain-
ful disease as easy as possible to be borne.
  UVULA is a  muscular prominence cov-
ered with mucous membrane, which projects
from  the centre of  the  soft  palate, hanging
down like a tongue.  It  may be relaxed in
cases of ordinary  sore throat, or destroyed in
some cases of syphilis, or it may be habitually
too long,  and  cause a  tickling cough.  In
such cases  the end  may  be snipped off with
advantage.  (See  Sore Throat.)
scabbing is complete in six or eight days, and
from the  twentieth  to the twenty-fourth day
these crusts fall off  spontaneously and leave
slight depressions  or pits behind, which re-
main permanent.
  Such is a short account of the cow-pox, and
it will be seen presently that the disease, when
given to man, runs a precisely similar course.
When cows affected  in the above manner are
milked, the  vesicles burst,  and the lymph
which exudes from  them is  often  found to
produce sores of a definite and  similar char-
acter on the hands of the milker, and they,
in their turn, are  the  means  of causing the
disease  lo spread  to  other  animals in the
dairy.   Among the dairy  districts in  the
fertile vales of Gloucestershire there existed,
more than a centuiy ago, a popular notion
that milkers  who were thus infected with the
cow-pox were incapable of taking the small-
pox.  This singular fact attracted the notice
of Edward Jenner, in  the year  1768, who at
that time was an apprentice  to  a surgeon at
Sodbury, near Bristol.   At an  eatly age he
satisfied himself, by inoculating with small-
pox several people who had had the cow-pox,
that this notion had  in  it  the elements of
truth, and  by dint of perseverance and accu-
rate reasoning he  at length disclosed to the
world  that  discovery which has made the
name of Jenner for  all time  illustrious, and
saved thousands of his fellow-creatures from
a painful death or a life-long disfigurement.
He conceived the  happy  idea of giving man
the cow-pox  by  inoculation, and  then  of
transmitting it to others  by inoculation from
one  human  subject  to  another.  Thirty
years afterward (a.d. 1798), he  published an
" Inquiry into the Causes and Effects of the
Variole Vaccinae ;  and in  this work he estab-
lished  the following propositions :  1.  That
this disease (cow-pox), casually communicated
V. 
VACCINATION                            VACCINATION         465
 to man, has the power of  rendering  him in-
 susceptible of small-pox. 2. That the specific
 cow-pox  alone,  and  not other  eruptions
 affecting the cow which might be confounded
 with it, had this protective power.  3.  That
 the cow-pox might be easily communicated to
 man whenever it was requisite to do so.  4.
 That the cow-pox,  once  engrafted  on  the
 human subject, might be continued from in-
 dividual to individual by successive transmis-
 sions, conferring on each the same immunity
 from small-pox as was enjoyed by the  one
 first infected  direct from the cow.   It is but
 seldom now that a child is  vaccinated directly
 from the cow, although it is an open question
 whether it is not advisable  every few years to
 obtain matter directly from that animal, as
 it is possible that lymph from the human sub-
 ject may deteriorate by time.
   Great as was the discovery of  Jenner, it
 met with great prejudices  in  his day ; some
 looked on small-pox as a scourge to humanity
 which Providence occasionally sent as a be-
 neficent warning for its sins, and they saw in
 an attempt to stop its ravages that man was
 impious  enough to thwart the  Divine will.
 Others objected that any matter from an in-
 ferior animal  like the cow should be allowed
 to enter the  human system.  Many similar
 foolish statements were made to prejudice the
 people against vaccination, and years  elapsed
 before it came into repute ; still  more years
 elapsed before the Legislature enforced com-
 pulsory vaccination.  As has been the case in
 every other scientific advance, ignorance and
 credulity have ever opposed what  afterward
 has proved to be a vast benefit to humanity.
   The symptoms observable in men after vac-
 cination closely  resemble  those which  have
 been above described  as occurring in a cow
 affected with vaccinia.   If  a child  be vaccin-
 ated with pure vaccine  lymph taken from the
 arm  of another child, nothing will be  seen
 locally  during the first two days,  but at the
 end of the second or on the third day a small
 red pimple appears, which gradually increases
 in size, and on the fifth or sixth day it has be-
 come a  vesicle or little blister of a pearly
 color, with well-defined  raised edges, while
 the centre is depressed and  concave.  On the
 eighth day the vesicle has become perfect ; it
 is round and plump,  and the edges are more
 defined and pellucid, while the centre is more
 concave.   About this time also a red blush or
 areola is seen  round the vesicle, and this con-
 tinues to  spread for a zone of from  one to
 three inches ; the skin looks red and angry,
 and  becomes hard and painful from an affec-
 tion of the tissue  of  the skin.  When this
 areola appears, the  child generally presents
 constitutional   symptoms ;   sometimes  they
 are very slight and pass by unnoticed ;  others
 may be peevish and restless, and  have some
derangement of the bowels or enlargement
and inflammation of the glands in the arm-pit.
   On or about the tenth day the areola be-
 gins to fade, the  vesicle  dries in  the centre,
 while the lymph gets  opaque and turbid, so
 that by the fourteenth or fifteenth day a dark
 brown scab is formed, which dries, blackens,
 and  falls  off between  the  twentieth  and
 twenty-fifth  day ; a cicatrix  or  scar is left
 which becomes permanent, is  generally cir-
 cular, and marked with  minute  pits.   Such
 are the stages  through which  the vesicle
 passes, but it is important to note that only
 on the eighth day is the vesicle in perfection,
 and it  is  then  only that lymph  should  be
 taken.  Thus, if the child be vaccinated on a
 Monday, matter should be taken  on the fol-
 lowing Monday, but not later, as after that
 time the lymph is not  so  protective.   It hap-
 pens  occasionally that  parents  are  much
 alarmed by  skin eruptions occurring  after
 vaccination,  and they often lay it down heed-
 lessly to the  fault of the physician for intro-
 ducing  bad  matter ; this is a great  mistake,
 for in  some  children any constitutional  dis-
 turbance will bring out an eczematous erup-
 tion, as is  indeed often seen  when  they are
 teething.   No  alarm  need be felt  on  this
 score, as  the mischief  is soon cured, and  it
 depends upon some  peculiarity in the child's
 constitution.  At  times a rose-colored  rash
 may appear on the body, or a crop of papules
 or vesicles ;  these are  generally very transi-
 tory, and  disappear when the scab  falls off
 the arm.  The shape of the scar,  and also its
 size, will depend upon  the way in which the
 vaccination  is  performed ;  some  make one
 puncture in three or four places on the  arm,
 about  an  inch   from   each other ;  others
 scratch or scarify the  skin, and some make
 punctures very close together, so  that when
 the vesicles  form they coalesce  or run to-
 gether and form a large irregular  scab.   All
 these methods are equally efficacious, and are
 adopted according to the  fancy of the opera-
 tor.  The  course  of the  vesicle  in  the soft,
 smooth skin  of a child is  more characteristic
 than in an  adult who has not before been vac-
 cinated.  If  the lymph inserted be taken di-
 rect from the cow, the course may be acceler-
 ated or retarded ;  sometimes the vesicle is de-
 layed only for a day or two, and  it has been
 said to lie dormant in  the system for many
 weeks ; if now the child be again vaccinated,
 the original vesicles will resume their course,
 and the two will run on together.   Should the
 child be incubating measles or scarlet fever,
 the areola may not form until these  diseases
 have gone.   Mere delay in the appearance of
 the symptoms will not hinder the protective
 influence, so  long as the red areola  appears
 before the  child  is exposed  to  small-pox.
 When acceleration of  the symptoms occurs,
the vaccination is generally useless and spu-
rious ;  if any doubt exist,  the child should be
done again after a short  interval.  The  im-
portant  rule  to remember is  this: "that  if 
4 GO         VACCINATION
VACCINATION
 there is any deviation  from the perfect char-
 acter of  the vesicle and the regular develop-
 ment of the areola, the vaccination is not to
 be relied on as protective against small-pox."
  If the arm becomes  much inflamed, a little
 cold cream  spread over the red surface will
 give relief ; the child should not be allowed
 to rub the places, and any source of irritation
 should be avoided.  As a rule, the refgular
 phenomena of vaccination only occur once in
 a lifetime ; if  lymph is introduced  into  the
 system of a person  who has once been suc-
 cessfully  vaccinated, spurious effects result ;
 a papule will at first form, to be followed by
 a little vesicle ; this is surrounded by an an-
 gry red areola, which  may cause great irrita-
 tion and itching.   The symptoms begin early
 and  arrive at their height on the fifth or sixth
 day,  when  they  begin to  decline ;  on  the
 eighth day the scab generally forms and soon
 falls off.  Severe constitutional symptoms are
 more common  in cases of revaccination than
 in primary cases, and in  a very few excep-
 tional cases erysipelas  has supervened,  while
 in others the lymph has acted as a poison and
 caused death by pyaemia.
  Every child should be vaccinated in  early
 infancy ;  out of 20,590 deaths from small-pox
 in England  during the six years 1856-61, no
 less  than 5010 were in children under one
 year  of  age, so  that  there is great risk  of
 catching small-pox if any delay occurs  ; this
 observation more especially applies to  those
 living in large towns, where the danger of in-
 fection is greatest, and it is still more need-
 ful in periods when an epidemic of small-pox
 is raging.  Plump, healthy, well-fed children
 should therefore  be vaccinated  before they
 are three months old ;  they are then free from
 the disturbances  often caused in the system
 by teething.  But there may be  reasons why
 vaccination  may  be  delayed ;  the  child may
 be suffering from acute disease, as measles
 or scarlet fever, or bronchitis, or from mal-
 nutrition  and diarrhcea ;  the  general health
 should in such cases be first attended to, and
 then the operation may be  performed.   For
 similar reasons delay  may  take place if any
 skin-eruption  be  present ;  herpes,  eczema,
 and  intertrigo, or the  chafing which is  often
 seen in the folds of the skin, have an injuri-
 ous influence.
  Should small-pox, however, be near at hand,
discretion must be used, and it will be need-
 ful to perform  vaccination in spite  of  these
 circumstances ; all such cases must therefore
 be left to the judgment of the medical man in
 attendance.   No age is too early for vaccina-
 tion  if there is direct exposure to small-pox,
 and many infants  have been saved who have
 been operated upon immediately after birth.
 The  incubation  of  small-pox  lasts twelve
 days, and the time needful for the develop-
 ment of the areola in vaccination is only nine
days.  Hence it is  obvious that, although a
person has been exposed to and has actually
imbibed the poison of  small-pox. yet, if he be
vaccinated within the first three days immedi-
ately following the reception of the infection,
its protective influence will be felt in modify-
ing the  disease.  Hence,  then, we have this
fact of great importance—that if the vaccina-
tion  can  be got to  the stage of areola before
the small-pox appears, life may be  saved ;  the
loss in such cases of a single day may be most
disastrous.  Lymph should always be taken
from healthy children, and from well-marked
vesicles,  just before the aroela commences,
or at any rate within a very few hours. After
the eighth day the vesicle  may yield more
lymph, but it is weaker and not so  protective ;
if on the eighth day several  small punctures
are made in the pellucid, pearly  vesicle all
round  the circumference,  minute drops  of
clear lymph will readily exude.  Care should
be taken  not to  draw the slightest trace  of
blood, nor to use  any pressure  in squeezing
out the lymph ; this simple operation is unat-
tended with any pain to the child.
  It is best for  lymph to be inserted from the
arm  of one child to the arm of  another, but
as this cannot always be done,  it  is usual to
adopt various means for preserving the lymph.
For this purpose ivory points may be dipped
into  the lymph,  and  when  the latter dries
upon it, the point  may be kept until required
for use,  or the fluid may be preserved in cap-
illary glass tubes,  from which air  can be ex-
cluded, and this is a valuable and efficacious
measure.   In very rare' cases children may
be insusceptible to the influence  of cow-pox ;
a few cases fail to take the first time, but are
successful on a  second trial ; those incapable
of taking cow-pox are probably incapabie  of
catching small-pox.
  If  people are successfully vaccinated they
are, as a rule, forever protected against small-
pox ; yet there  are some cases in which some
persons are liable  to it, but  even  then they
take it in a very mild and modified manner ;
very rarely indeed  does it leave any marked
disfigurement or prove fatal.   It was never
maintained by  Jenner that those  who were
successfully vaccinated were absolutely  safe
from an attack of small-pox ;  but just as some
who  have had  small-pox  once may now and
then have a second attack, so those who have
once suffered from cow-pox may in like man-
ner have the small-pox at some future time.
These cases, however, occur so seldom, and
when they do happen  are so mild and harm-
less in their manifestations, that vaccination,
when well performed, may be  considered a
most effectual  safeguard  against  small-pox.
Jenner himself  saw cases of this kind,  and in
his own writings he has thus stated his opin-
ion of the value of vaccination : " Duly and
efficiently performed, it will protect the con-
stitution  from subsequent  attacks of  small-
pox, as  much as that disease itself will.   I 
              VACCINATION

 never expected it would do more, and it will
 not,  I believe, do less."   To  have  its due
 protective influence, the operation  must  be
 properly performed, and the phenomena must
 develop themselves in a due and regular man-
 ner.   Experience has shown that, in order to
 thoroughly infect the  constitution,  a certain
 amount of local affection is as  essential as a
 perfect character of the vaccine vesicle.  The
 benefit derived from vaccination may be seen
 in the faces  of  the  children of  the poorer
 classes ; fifty years ago one child out of every
 three was marked with small-pox, while now
 hardly one in forty can be found to  have any
 traces of that  disease.   From ignorance and
 carelessness there will always be a good many
 persons in a community who are unvaccin-
 ated, and this will be more especially the case
 when there  has been no epidemic  of small-
 pox for some  time ;  apathy and indifference
 are then felt .for the operation,  and when  an
 epidemic again appears, these are the first to
 fall victims to their rashness.  It is not un-
 common to  find  that in a family of four or
 five some have  been vaccinated and some
 have not and when small-pox  appears, the
 death or disfigurement of  those who are un-
 vaccinated is a proof of the dangers of delay
 and a strong argument in favor of the simple
 operation.  For a  convincing  summary  of
 facts in  favor  of Vaccination, see Sanitary
 Regulations.
   Revaccination.—Whenever  an  epidemic
 of small-pox is prevalent, a panic takes place
 among the  people, and every one is  in a
 hurry to be revaccinated ; now, although it is
 no doubt of great importance  that those who
 have been imperfectly vaccinated in infancy
 should again resort  to this  operation for fur-
 ther  safety, it certainly is  not  wise to give
 way to panic, for at such times so great is the
 application for fresh  lymph that the demand
 exceeds the supply, and thus persons are has-
 tily and insufficiently  done ; it  follows from
 what  has been said before that those who
 have four or more perfect  cicatrices on the
 arm are free from danger for the rest of their
 lives  ; those,  on  the other hand, who have
 one or two marks, and these perhaps not very
 perfect ones, should certainly be revaccinated
 when they attain the age of puberty, and the
 operation should be done with as  much  care
 as  in  the  case of an  infant.  The  matter
 should be taken from an infant's arm, and in
 no case  whatever from  the arm of  a person
 who  has been successfully revaccinated,  as
 the lymph  then is not.  sufficiently  protective.
 A popular  notion exists that the human con-
 stitution changes every seven years ; there  is,
 however,  no proof whatever of the  truth of
 this assertion, and it seems pretty clear that
a second vaccination about the age of puberty
is all  that is  required.  If,  at  the second
operation,  the  arm rises, and all the usual
phenomena appear,  it  is probable  that the
               VALERIAN           467

 effect of the first operation had worn off, and
 the patient was liable to a modified attack of
 small-pox ;  if,  on the  other hand, no effects
 follow the second time, it is a sign  that the
 original vaccination remains efficacious, and
 that no danger  need  be feared even when
 small-pox is prevalent.   It is the custom at
 the London Small-pox Hospital to vaccinate
 every  attendant  and nurse when they first
 enter,  and after an experience of  thirty years
 it is important  to note the fact that not a sin-
 gle case of small-pox has arisen among  them.
 Although a certain small  proportion of those
 who have been thoroughly  vaccinated  in  in-
 fancy do take small-pox in a modified  form
 after they are  grown up, yet afier effectual
 revaccination such a case hardly ever recurs.
 In Wt'irtemberg, out of  14,384 soldiers who
 have been  revaccinated, only one  case  of
 small-pox broke  out during a period of five
 years.   There  can be no doubt that, on the
 outbreak of an  epidemic of small-pox, all the
 persons in the house should be carefully ex-
 amined, and those who have no cicatrices, or
 at least but imperfect ones, should at once be
 vaccinated, and not only those in the house,
 but others who  live close to and have recently
 mixed  with them, as is the case in a crowded
 court or alley.  If this were sufficiently done,
 there would be no occasion for a panic, ana an
 epidemic of  small-pox would probably  be at
 once stamped out.
   VACCINIA.  (See Vaccination.)
   VAGINA is the anatomical name for the
 female  passage,  and  necessary to be  ex-
 plained because it sometimes  occurs that in
 states of disease applications or injections are
 ordered to be applied to this part of the body,
 which is mentioned only by this term.  Some-
 times a slight membrane exists at the entrance
 to this passage, which  prevents  the proper
 and natural monthly discharge. When this is
 discovered it should be at once removed, and
 it is well if such  an  accident should be per-
 ceived  and remedied in  infancy, before any
 evil consequences can result from it.
  VALERIAN is the root of a well-known
 plant,  the  Valeriana  officinalis.  The  best
 plants grow in  dry soils.  The  root  consists
 of a kind of stock or head, whence numerous
 rootlets are given off.  The  color  is  light
 brown,  the odor  peculiar and characteristic.
 The roots contain valerianic acid and an oil.
 This oil contains two substances, valerole and
 valerianin, neither of very great importance.
 Valerole,  by exposure,  is slowly converted
 into valerianic  acid.  The preparations  of
 valerian are an infusion, a tincture, and  an
ammoniated tincture, in which aromatic spirit
of ammonia  replaces the ordinary spirit.
  Valerian acts as a powerful stimulant.  It is
mostly given in  nervous diseases, especially in
those of hysterical subjects,  as  well  as in
chorea and  such like affections, as an  anti-
spasmodic.  The  value  of valerian is  not 
4G8              VALVES                                   VARIX
quite clear;  some esteem  it highly,  others
rather scout  its efficacy   The  ammoniated
tincture is the best form of the remedy.   The
dose is a drachm.
   Valerianic acid, though contained  in vale-
rian, is prepared from a  totally different sub-
stance.   Fusel oil, .which is a waste product
in the distillation  of most forms of alcohol,
tends, when kept, to pass by oxidation into
valerianic acid.   This  may be done at once
by chemical means, sulphuric acid and bichro-
mate of potass  being  employed.  The  acid
is then neutralized by carbonate of soda, and
valerianate of soda is produced.
   Valerianate of soda is hardly ever used itself
in medicine, but is employed in the manufac-
ture of another salt, valerianate of zinc.  This
salt  occurs in fine scales, with the odor of
valerianic acid.   It is not  readily soluble in
water.  Valerianate  of  zinc is  commonly
esteemed  a valuable nervine tonic, though
some prefer to give sulphate  or oxide of zinc
along with the ordinary  tincture of  valerian.
It has been given  in nervous affections, as
chorea,  epilepsy, and hysteria.  It  has  also
been given with advantage along with quinine
in neuralgia.  A valerianate of quinine is
now made.  The dose of valerianate of  zinc
in from 3 to 5 grains or more.
  VALVES  are  usually folds of membrane
which guard  certain orifices ; they  are  met
with in  the course of  the veins, and play an
important part in the  proper action of the
heart.  (See Heart.)
  VANILLA, a delicious and  fragrant or-
chidaceous plant growing in the West Indies,
whose fruit, in the form of  a  long pod, is
highly prized, on account of its delicate flavor,
by confectioners, cooks, and chemists.
  VARICELLA.  (See Chicken-Pox.)
  VARICOSE  VEINS.  (See Varix  and
Veins.)
  VARIOLA, a technical name for small-pox.
(See Small-Pox.)
  VARIOLOUS  is  the name given to the
mild form which  small-pox takes in persons
who have been  vaccinated  or who  have al-
ready once had  the disease.  It is always
less  virulent  than  small-pox itself, and is
very rarely attended by serious results.  (See
Vaccination.)
  VARIX consists in dilatation and a con-
voluted  state  of  the veins, due in   most in-
stances  to  an obstruction  of the current of
blood toward the  heart.   It  occurs  very
often in the lower  part of the rectum, where
it constitutes haemorrhoids ; and in the afflic-
tion  known as varicocele the veins of the
testicle are thus affected.  The most frequent
seats of varix, however, are the lower extrem
ities,  a  condition  being there  established
which is commonly termed that of "  varicose
veins."
  In a well marked case of  varicose veins the
inner surface  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 prom-
inent  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 stiff-
ness 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 gen-
erally 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
standing, large ulcers may form on the lower
third  of  the  leg, constituting 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 applying  slight pressure with a pad
of lint and  a  bandage over  the bleeding
point.
  The predisposing causes of varix are an in-
herited tendency and debility,  due  to old age,
overwork, or long illness.   It is believed by
some that the distension of  the veins is occa-
sionally  preceded by a  gouty  condition  of
the  blood.  The chief  exciting cause is ob-
struction  to  the venous circulation  applied
either  directly  to the lower limb, as  in the
case of wearing tight garters, or  indirectly,
as in disease  of the heart,  congestion  of the
liver, or  constipation 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  stand-
ing 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.
  Treatment.—The subjects  of varix in the
lower  extremities,  when old  or debilitated,
should be invigorated by good diet and me-
dicinal tonics, such as quinine  and  prepara-
tions  of  iron.   In  cases where the patients
are of middle age, and are full-blooded, it will
be necessary  to advise temperance and restric-
tion of diet, and occasional  free purgation,
in order  to relieve a congested liver and a dis-
tended rectum.  In early stages of the affection
much may be done to prevent the further devel-
opment of the varix, and all  its troublesome 
VEINS
VEINS
4G9
 results of eczema, ulceration, etc., by remov-
 ing  all likely causes  of obstruction  to the
 venous  circulation.   The   patient  should
 avoid, as far as may be possible, standing or
 walking ; the limb for a period of six weeks
 or two months should  be kept elevated ; the
 skin  should be well rubbed with  the  hand
 night  and  morning,  and during the 'day an
 elastic stocking should be worn, or the limb
 should be bandaged from toe to groin. Many
 operations have been devised for the purpose
 of producing permanent obliteration  of the
 distended veins.   Of these, the safest and the
 one  most commonly practised consists in the
 application of needles and  twisted  sutures—
 tying  the  veins.   These  operations  rarely
 produce a permanent cure, but are often of
 great  service in cases where severe varix has
 resulted in painful eczema, or extensive and
 obstinate  ulceration.   In cases of old  and
 severe varix, very  little can be done to pro-
 duce any abiding relief.
   VEINS are vessels distributed through all
 parts of the body, and through which the blood
 returns to  the right side  of  the heart after it
 has  supplied the  different  organs and tis-
 sues.  In  addition to this widely distributed
 or systemic venous set, there are two special
 sets of veins,  the pulmonary and the he-
 patic.   The  first serves to carry blood  from
 the heart to the lungs, the second collects the
 blood from  the minute or  capillary  vessels
 ramifying in the walls of the stomach  and in-
 testines, and carries it to the liver.  The veins
 of the systemic  set  commence  by  minute
 branches, which, as they  travel  toward the
 heart, are found to increase in size and dimin-
 ish in number until  at last the blood is con-
 veyed to the right  auricular chamber of the
 heart by two large veins, the superior and in-
 ferior venae cavae.  The veins  of  the heart
 open directly into  the right auricular chamber
 of the systemic veins.  There are two kinds,
 the deep and the superficial veins.  The first
 accompany the arteries  of  the  limbs and
 trunk, and are deeply situated ; the latter are
 placed immediately under  the skin, and are
 prominent  and readily visible, especially in
 old and  thin persons.  On tightlv binding a
 handkerchief or bandage around the arm be-
 tween the elbow and shoulder, the  return of
 the venous blood to the  heart from the parts
 below the  constriction  may be prevented.
 The  superficial veins of the upper extremity
 become  distended  with  blood,  and  their
 branches and large trunks may be seen ex-
 tending from the fingers upward.  From the
 results of this  experiment, Harvey was led
 to the  conclusion  that the blood in  the veins
passes toward the heart, and that  the veins
commence in small branches, which gradually
pass into large and less numerous vessels as
they  pass  upward toward the heart.   Most
veins are provided with valves or small folds
of the  internal membrane which project into
 the  interior of the vessels.  The usual ar-
 rangement of these valves is thus : two folds
 are placed at directly  opposite points of the
 interior of a vein, their free margins are con-
 cave, and  their attached  margins  convex ;
 where there is a free current of blood toward
 the heart, each fold is driven outward and is
 applied closely  to the inner surface  of  the
 walls of the vein, so that the channel remains
 free.   If, however, the current of blood is
 obstructed, or has a  tendency to  flow back-
 ward from the  heart, these folds  are driven
 inward and  come  together in the  centre  of
 the calibre of the vein, and thus prevent any
 further regurgitation.   These valves are most
 numerous in the veins of the lower extremi-
 ties ; in  the largest and smallest veins they
 are absent.
   An incised wound of a vein is  much less
 serious, even when the vessel is large, than a
 similar injury of an artery.  In the former
 injury there is an even  stream of dark-colored
 blood, the flow of which can be readily arrest-
 ed by pressure below  the wound.  From a
 wounded artery, on the other hand, there is a
 profuse flow in jets of bright red blood, which,
 when the vessel is large, cannot be arrested
 save by completely closing the  vessel above
 and below the wound.   Even where  a large
 vein has been completely divided,  as in am-
 putation  of a limb, the flow of blood usually
 soon ceases, although the vessel does not con-
 tract.  Arteries,  both  large and  small,   to
 contract when cut through,  but still not suffi-
 ciently to obstruct the  bleeding.   An artery
 never becomes permeable  again after it has
 been wounded, and the blood is carried along
 the enlarged collateral vessels.  A wound  in
 the walls  of  a vein, when properly treated,
 closes by adhesion, and the calibre  of the ves-
 sel remains free.   In former times, when the
 operation of bleeding  was  often  performed,
 and  persons were bled habitually at certain
 seasons of the year, the incision at the front
 of the elbow was repeatedly made at the same
 spot and into the same veins.
  Inflammation of one or more veins, or phle-
 bitis,  may be acute or chronic.   The most
 frequent causes of acute inflammation are in-
 cised or punctured wounds of veins, irritation
 of the surrounding tissues, or the application
 of a ligature.  In  some rare cases inflamma-
 tion  attacks  veins  without  any appreciable
 cause.  Acute phlebitis occurring in a healthy
 individual, who  is submitted to suitable and
 careful treatment  under good hygienic con-
 ditions, usually runs a  favorable course, and
 terminates in complete and speedy recovery ;
 but when it attacks a " bad patient," and one
 who has been debilitated by previous disease
 or insufficient nourishment, it constitutes a
 very serious affection,  in consequence of a
tendency  to  the  formation of diffused ab-
scesses in  the  affected part,  of the  intense
constitutional reaction, and of the very prob- 
470
VEINS
VENESECTION
able occurrence of pyaemia.   The following
are the symptoms of ordinary acute phlebitis
attacking the superficial veins of a limb.  In-
tense pain  over the starting  point of the in-
flammation, and  tenderness  and redness of
the skin along the course of the inflamed ves-
sels ; the limb is swollen and cedematous,
and its surface is marked by  a pale  diffused
blush ; the patient suffers from more or  less
inflammatory fever, and complains of general
uneasiness, headache, and nausea ; the pulse
is high  and  strong, the skin hot, and  the
tongue dry at its  centre and of a bright red
color at its tip and edges. As the acute symp-
toms  subside  the  course  of  the inflamed
veins is marked  by hard cords, which remain
for a long time after convalescence.   In  bad
cases of phlebitis, abscesses  form about the
affected veins, and the  whole limb becomes
red  and much swollen ; the constitutional
symptoms take on a typhoid character,  and
there is  much prostration ; finally,  pyaemic
symptoms come on, as  pain and swelling of
one or more joints, jaundice,  a cough,  and
shortness of breath,  to which the patient suc-
cumbs.   In  chronic  phlebitis  the  symptoms
both local and  constitutional  are much  less
severe, although they last for a long time  arid
give rise to much trouble and anxiety.  The
affected  limb is  stiff  and painful,  and  its
movements  are interfered with.  There is
much cedema of the parts from which the in-
flamed vein proceeds, and considerable indu-
ration along  the branches  and trunk of  the
affected vessel.
  The treatment of acute phlebitis  should
consist in the administration  of tonics, and
occasionally  sedatives in order  to   relieve
pain.  The part affected  must  be kept at per-
fect rest, and if the veins of the lower limb be
inflamed the  patient should be kept in bed.
Warm fomentations should be applied over
the inflamed region,  and care  be taken to
guard the  patient  from draught.  Cooling
lotions or cold applications of any kind ought
to be avoided. The patient should be allowed
a generous  diet.  When suppuration takes
place the surgeon generally considers it neces-
sary to  make early  and free  incisions,  not
only to relieve suffering but  also to  prevent
diffusion of   the   suppurative  process.   In
chronic  inflammation, with much thickening
of veins, the affected limb  should be  kept at
rest as much as possible,  and be supported by
a firmly applied flannel bandage.
  Air, entrance of into Veins.—In the records
of practical surgery have been reported sev-
eral instances of sudden death or of alarming
prostration  during  the  course  of  cutting
operations  on  the neck and armpit.  The
history of these cases may be briefly summed
up : during the removal of a tumor in either
of the above regions, a  distinct gurgling or
hissing  sound  is  suddenly heard, and  the
blood at the bottom of  the wound becomes
frothy from admixture  with bubbles of air.
The patient either dies at once, or falls into a
deadly faint, complaining of  great  oppres-
sion over the heart and of  a sensation of im-
pending sudden death.   There are some few
instances of tardy  recovery from this  con-
dition, but death either  immediate or de-
layed for two or three  hours is the usual re-
sult.  The phenomena observed before death
in these cases, and the post-mortem examina-
tion, together with  the  results  of  physiologi-
cal experiments on animals,  indicate  very
clearly that the alarming symptoms  just de-
scribed are due  to  the entrance of  air into
veins, and its  transmission to the right side
of the heart along the vessels  whose proper
function it  is to return  back venous blood to
this central organ.   It  is easy to  account for
this introduction of  air into a wounded vein.
When the chest is expanded in the movement
of  inspiration,  a vacuum is formed within
this large  cavity,  which  is filled up  by a
downward rush of air through the windpipe,
and by a rush of blood  in a similar direction,
through the jugulars and other veins of the
neck.  If during an  operation,  as for instance
the removal of a tumor, one of these veins  be
wounded, and  the gap  thus formed  be  kept
stretched for a short time, a deep  inspiration,
as it suddenly withdraws  the blood from the
lower part of the opened vessel, might cause
a sucking in of  external air in considerate
quantity  through the wound.   The immediate
cause of death  is a failure in the supply of
arterial blood to the  brain, from the arrest of
the circulation,  but whether this arrest be due
to distension of the heart with air, to inaction
of the valves of  the heart in consequence of the
presence of air, or to a stoppage of the  flow
of blood through the lungs in consequence of
the admixture of air-bubbles, is still a matter
of speculation.
  VENESECTION, the operation of bleed-
ing from a vein, is one nowadays of com-
parative rarity, although in some cases it is of
undoubted value.  The veins  selected are
generally those at the bend of the  elbow, and
of these  the median cephalic is to be prefer-
red, as there is less  danger of wounding ihe
brachial  artery  than   in  operating  on the
median  basilic,  which lies immediately  over
that vessel, although most blood can be drawn
from it.   The  operation is thus performed :
The patient lying down or sitting, a tape  or
narrow bandage is fastened firmly round the
arm above the bend of the elbow, sufficiently
tight to arrest the flow of blood in the veins,
but not  to stop the pulse at  the wrist.   The
surgeon next takes the  patient's arm and ex-
tends it, and fixes the hand under his left arm-
pit, if he is operating on the right arm, and,
vice versd,  if on the left; next  by  gently rub-
bing the part, he causes as great an afflux of
blood as possible to the vein, which he keeps
up with his left thumb, at the same time that 
VENEREAL  DISEASES
VENEREAL DISEASES     471
 the four other fingers seize  the limb, and by
 being placed behind it  make  tense the skin.
 Then the surgeon takes the  heel of the lancet
 between his thumb and  forefinger, and stead-
 ies his hand by making  a point d'appui on the
 surface of  the  limb with his other  fingers.
 The opening of the vein is to be made  by a
 simple puncture,  and  obliquely to the direc-
 tion of the vein.  Immediately after the punc-
 ture the blood spirts out with greater or less
 rapidity, and its flow is  facilitated  by making
 the patient grasp a stick or a roller bandage.
 When  the  necessary  quantity of blood has
 been withdrawn,  the bleeding at  the point is
 arrested by placing the left thumb  upon it,
 and at the  same time removing  the  bandage
 from  the arm.  Afler cleaning the  part, a
 compress of lint, maintained in place by the
 application  of  a figure of 8  bandage  (see
 Bandages), and fixed by a pin, complete the
 proceeding.
   If the external jugular vein  in  the  neck is
 selected as the  point  to   bleed  from, the
 operation  is as iollows :  The patient lying
 down,  the vessel  (which is directed obliquely
 from before backward,  across the middle of
 the sterno-cleido-mastoid muscle),is compress-
 ed a little above the clavicle.  The puncture
 is made in the middle of the neck, ought to be
 large enough, and made in a direction across
 the  fibres of the  superficial skin-muscle, the
 platysma, else the wound would  close imme-
 diately the puncture was made, and the blood
 would  escape  into  the  sub-muscular tissue.
 The bleeding  is  arrested by a well-adapted
 compress.
   VENEREAL DISEASES  are   divided
 into gonorrhaa,  chancres,  and syphilis.  By
 some  writers it is  maintained that all three
 forms of this disease are produced  by  one
 poison,  while  others  maintain that  syphilis
 alone is due to a specific poison.
   Gonorrhoea is an acute inflammatory pro-
 cess going on in the lining membrane of the
 urethra.  This is at first  attended with pain in
 making water,  and  the passing  of  a clear
 watery mucus from the  urethra.   This heals
 up at first, but the discharge returns, having
 a  turbid and puriform  character.  The at-
 tack is atcended  with more or less feverish-
 ness ;  other symptoms may follow—excoria-
 tions, swellings, or even abscess may  occur.
   Treatment.—Gonorrhoea may  get  well of
 itself.   The  discharge subsides, the  inflam-
 matory symptoms disappear,  and the dis-
 charge becomes of a mucous character, and is
 then called a gleet.  It is usual, however, to
 have recourse  to remedies.  It   is   recom-
 mended in the early stages to try and arrest
 the disease  by what is called  the ectrotic or
 abortive treatment.  This consists in applying
 nitrate  of silver  in solution by means of a
syringe to the inflamed urethra.  This should
not,  however,  be attempted  by the   patient
himself.  If no opportunity  exists of apply- I
 ing  this  treatment,  the  patient  must  be
 treated according to general principles.   Rest
 must be enjoined, the diet must be low, the
 parts should be supported, antimony in small
 doses should be given, as also mild aperients ;
 leeches may sometimes  be necessary, and a
 hip-bath   administered.   The  inflammatory
 stage being over,  less  stringent  measures
 may be adopted,  and   various stimulating
 agents—such as  copaiba and cubebs, may be
 given.  As the patient  recovers, should the
 discharge  continue, injections of sulphate of
 zinc should be employed.
   Sometimes the gonorrhceal virus affects the
 eyes.  The treatment must be  the  same as
 for an  ordinary  case of ophthalmia.   (Sec
 Ophthalmia.)  Warts sometimes accompany
 gonorrhoea.  The best method  of  removing
 them is by knife or scissors, and touching the
 exposed parts with nitrate of  silver  or  some
 other escharotic.
   One of the evil consequences of gonorrhoea
 is stricture of the urethra.  This disease may
 come on  independent of gonorrhoea  in the
 form of what is called spasm of the urethra.
 In this condition the muscular coats  of the
 urethra contract, and, rendering the passage
 narrower, the urine either flows  slowly or not
 at all.  It  is brought on  by exposure to cold,
 the effects of a debauch,  the presence of irri-
 tation about the anus or the action of canthar-
 ides.  The  symptoms often retire as quickly
 as they  come on, by the  use of chloroform, a
 hip-bath, fomentation, some form of sedative
 by the mouth, or a gentle purgative.  Tinc-
 ture of muriate of iron may be  subsequently
 given with advantage.  (See Stricture.)
  The inflammatory action of gonorrhoea may
 produce stricture.   The same symptoms  may
 occur, and there may  be difficulty of making
 water, or  suppression  altogether.  In  such
 cases the symptoms are alleviated by the ordi-
 nary treatment.  Should an abscess outside the
 urethra  cause the stricture, the abscess should
 be opened.  In all cases where the urine is not
 passed the  catheter must be  employed, and
 for this purpose medical aid should be sought.
 The third and  most  difficult  form of stric-
 ture is  that  when the canal is  narrowed by
 chronic  structural change.  This constitutes
 true or organic stricture.  The  symptoms of
 this  form  of stricture  may for some time
 escape notice.  The urine is passed in an at-
 tenuated stream, sometimes twisted, or scat-
 tered, or dribbly.   Sometimes there is pain
 and uneasiness in  the bladder when it is  full.
 There is an increased tendency to micturition,
 and the  water passes away  frequently invol-
untarily  after  micturition.  There  is   also
 often a gleety discharge.
  The treatment of such cases is simple, but
 must  always be conducted under  surgical
superintendence.   It consists  mainly in  in-
ducing the absorption of  the enlarged  tissue
by the  introduction of  instruments called 
472      VENEREAL DISEASES
VENTILATION
 bougies.  At first a small-sized bougie is in-
 troduced, and subsequently larger ones, till
 at last the urethra acquires its natural size,
 and allows the urine to flow naturally.
   Chancre3,  the second  form  of  venereal
 diseases, are those sores which form on  the
 organs of generation, either after impure in-
 tercourse, or  independent of it.  They never
 assume the  appearance of  the true chancre
 with indurated edges, and are easily cured by
 external applications.   Oxide of zinc oint-
 ment,  the black wash, and other simple dress-
 ings may  be applied  externally, while cool-
 ing  medicine may be given, and  rest en-
 joined.
   Syphilis, the third form of venereal disease,
 is produced by a specific virus whereby a sore
 is formed which is called  a chancre.  Such
 sores exhibit  various characters, but they are
 reduced to two heads :  first, those which are
 not  followed by subsequent effects, and those
 which  are. The treatment of the first class of
 sores should always consist  of an attempt to
 cure them at once by the ectrotic treatment.
 This should  be effected by  means of  fusing
 nitric acid, the acid penitrate of mercury, po-
 tassa fusa, or chloride of zinc.  The  surface
 may be then dressed with lint.  Water dress-
 ings may be afterward applied.
  The second form of sore, which is really the
 symptom  of  a formidable disease, is  charac-
 terized as " a superficial erosion situated upon
 an indurated base.''  The sore has a regularly
 oval or elongated form, sometimes not big-
 ger than a millet-seed, and rarely attaining the
 size  of a  shilling.  The surface presents a
 pearly gray aspect without granulations. The
 general surface is usually cup shaped, as if
 scooped out by means of a gouge.  The in-
 duration of the base and margins of the sore
 are its  great characteristics.   The time of the
 incubation of this sore has been put down at
 from ten to forty days.  No  treatment of this
 sore can prevent the development of constitu-
 tional  symptoms.  The treatment consists in
 the same methods as those recommended for
 the simple sore.  The great mass of medical
 men, however,  recommend  some  form  of
 mercurial treatment.   Mercury is given inter-
 nally, and the sore itself is treated with mer-
 curial  ointment.  These sores may  proceed
 in their course  and produce  sloughing and
 phagedenic sores demanding in their treat-
 ment the most special care.  Such sores are
 frequently attended with bubo, the result of
 irritation of the absorbents.   The treatment
 of a  syphilitic bubo requires the same general
 treatment   as  an  ordinary  abscess.  (See
 Abscess.)
  Although  the primary sore may be healed,
 the true specific chancre is  followed  by cer-
 tain  general symptoms which are  called  sec-
ondary  and tertiary.  The syphilitic poison in
these cases pervades  the whole system, and
certain well-known symptoms follow.  In the
 course of a few days or weeks  a state of the
 system comes on in which there issallowness
 of the countenance, more or less emaciation,
 a sense  of  lassitude and  muscular debility.
 headache, with  palpitation, and other signs
 of disturbance of the heart's action, cedema of
 the lower extremities, and a tendency to bleed-
 ing at the nose.  Following these  symptoms
 are a variety of affections of the skin  known
 as  syphilitic  eruptions.   These  eruptions
 have  a copper color, a rounded  form,  a tend-
 ency  to  desquamate, and have no irritative
 quality.
  The treatment of such cases should  consist
 of an attempt  to relieve the system of  the ac-
 cumulated  syphilitic virus.  For many years
 the only general remedy  for this state was
 considered to be some of the preparations of
 mercury  to  the extent  of  salivation. Al-
 though it has been shown that the constitu-
 tional symptoms may be cured without mer-
 cury,  a large number of physicians still rec-
 ommend this  treatment.   Others have rec-
 ommended  chlorate of potass,  iodide  of po-
 tassium,  sarsaparilla, and a hygienic or tonic
 treatment.   No one, however,  should pre-
 sume, when  suffering  under  the various
 phases of these diseases, to attempt to treat
 themselves, but apply to the nearest  intelli-
 gent  practitioner who does not  advertise  his
 powers of curing these diseases  by some  se-
 cret treatment or vaunted remedy.
  VENTILATION is a subject of much im-
 portance to public  health, but one which  is
 often  much neglected.   By  ventilation one
 must  understand a due supply of fresh air in
 the twenty-four hours, so  as to allow  plenty
 of oxygen  to  enter the  lungs  and  properly
 aerate the blood.   But  it  is a  bad thing  if
 there  is too much  draught with the ventila-
 tion, as in this way the patient is often cold,
 and this  may do harm.   For this reason the
 poor,  who  huddle  together  in  winter in a
 small  room, prefer a stifling atmosphere with
a warm temperature to a ventilation which in
 their  case  is  generally  accompanied   by  a
draught.   Again, in the wards of a hospital it
 is usual to have the  windows open to let fresh
 air in. but this is sometimes bad for cases of
 bronchitis and Bright's disease, as  the cold
 air blowing  upon the patients increases their
 malady.  To obviate this,  there should be a
 corridor running parallel with each ward, and
 supplied  with  plenty of  windows on each
side ;  the one set,  communicating with the
open air, should be  opened, while those com-
municating with the ward are closed, and vice
versd ; in this way, by repeating the process
several times a day, enough fresh air will be
brought  in  the  room  without too  much
draught being felt.   In workshops,  factories,
etc., this entry of fresh air  is very important,
as a room soon becomes contaminated when
 many are working  in it.   An ordinary fire
and the usual crevices of a window or door 
VENTRICLE
VERTIGO
47d-
are  agents in  promoting  a current of air
through a room ; the smaller a room the of-
tener has the air to pass through it to sustain
a  proper amount  of  purity.   Each  person
should  have at least 800 cubic feet of space,
with a due current of air.  A bedroom should
have  the  windows open for the  greater part
of the day, so as to thoroughly aerate it.  (See
Air,  Respiration, and Lungs.)
   VENTRICLE is the  name applied to  a
cavity ; thus there are ventricles in the brain
and in the heart.  (See Brain and Heart.)
   VERATRIA is a powerful alkaloid which
exists in several vegetable  substances, but is
itself mainly obtained from sabadilla seeds.
The  process for obtaining  it is complicated,
but consists in  the separation of the alkaloid
by means of alcohol, and  afterward purifying
the product thus obtained.  The pure veratria
is crystalline and almost insoluble in water,
but freely so in alcohol.   Its taste is power-
fully  acrid, and it is excessively irritating to
mucous  membranes, especially   the  nose.
From this cause it gives rise to violent sneez-
ing when applied  to the nostrils.  There is
an officinal  preparation of veratria not much
used, viz., the  ointment of veratria.
   Veratria acts very powerfully on the skin,
and still more so on mucous membranes, pro-
ducing irritation on these, but afterward sed-
ative effects.  The true use of veratria is not
yet quite clear.
   VERATRUM   ALBUM,   or  White
Hellebore, contains veratria,  and  owes its
influence  to that substance.  The root-stock of
the plant is employed, but it  is  no longer
officinal.  It is generally seen in sections an
inch or two long, with the rootlets projecting
from  it.   The color is yellowish brown, light-
er within, and  it  has  an  exceedingly acrid
and bitter taste.  Y/hite hellebore used to be
employed mainly in the form of vinum vera-
triae—white hellebore wine.  This substance
when swallowed gives rise  to much vomiting
and  purging, and was  at one  time  used, as
was black hellebore, largely in the treatment
of mania.  It  gave rise to  much disturbance
of the alimentary canal, and greatly  reduced
the patient's strength, but did no good.  It
has fallen completely into disuse, as  has the
black  hellebore ;  but   another   vcratrum,
which, however, is  said  to  contain no vera-
tria, has come  into general  use, especially in
America, where it is a native. (See Verratrum
Viride.)
  VERATRUM VIRIDE, or Green Hel-
lebore, is known as Indian poke, and is said
to have  been long in use among the  aborigi-
nes of North America.  The root-stock, which
is thick and fleshy, is the part used.  It gives
rise to tingling,  and has a peculiar acrid taste
like others of the class.   Its only preparation
is the tincture.   This is an excessively power-
ful preparation, given  even in small doses ;
repeated at moderate  intervals it produces
much  sickness   and  great  prostration of
strength.   Even doses of a few drops of the
tincture will in a short time give rise to these
sensations.  It acts apparently  specially on
the heart, which it controls ; not long after it
has begun to take effect,  the pulse gets small
and  the  strength  is greatly  diminished.  It
does not purge  when  given  as  tincture, but
produces vomiting.  Its effects  have  been
compared to those of  colchicum, but though
analogous they do not  coincide.   In America
the drug has been largely given in inflamma
tions, especially of the  lungs.  It seems to do
good in rheumatism, but does not cut short
the attack.
  In pneumonia, green  hellebore has  been
employed with benefit.  It lowers  the temper-
ature, and seems to favor the local changes
necessary to recovery.   The remedy requires
careful handling.
  VERDIGRIS is  an acetate of copper, a
product which results from the action of some
fermenting substance on copper.   It is more
dangerous as a poison than valuable as a rem-
edy.  Not unfrequently its presence in badly-
cleaned copper cooking utensils has given rise
to somewhat serious results.   Sometimes,but
very rarely, it  is applied  externally ; inter-
nally it  is  never  used.  It  has  been mixed
with  honey and applied, by means  of  a
camel's-hair pencil, to  some half-vitalized
body, as warts, for the purpose of destroying
them, and so getting rid of them.
  VERMILION.  (See Mercury.)
  VERTEBRA.   (See Spine.)
  VERTIGO, or Giddiness,  is that peculiar
sensation wherein  we seem  to be standing
quite still, and objects running round us.  This
commonly causes loss of balance, and the
individual may fall  down.  In a good many
cases he is able to recover himself without
falling,  especially if he can lay hold of any-
thing to steady himself with for a moment. In
most  cases giddiness depends on an insuffi-
cient  or improper supply of blood to the
brain.  Thus, in  giddiness after a severe ill-
ness, in attempting to  stand  upright, we see
imperfect blood supply.   In other instances
the blood supply is  impure from containing
too much alcohol, or the products of imper-
fect  food-metamorphosis.   In  old people,
when the vessels become hardened and un-
yielding, as well as incapable of due resil-
ience, we often find giddiness a permanent
symptom.
  Thus it  is seen that vertigo is rather a
symptom  than  a malady, and  a symptom,
too, of very varying significance, for some-
times apparently over-fulness of the vessels
gives rise to a kind of giddiness.  If, for in-
stance, the face is flushed and the head  hot,
it may be desirable to  give some  purgative
medicine, whereas the kind referred  to first
of all as occurring in  convalescence, is best
remedied  by a glass of  wine.   The subse- 
474
VESICA
VISION
quent management depends on the same prin-
ciple.  Where there is weakness, good food
and  exercise are the best  remedies ; in the
other, saline purgatives, with some diuretic.
  Not unfrequently vertigo depends upon or
foreruns brain disease, and such brain disease
may be very intractable in character.  Head-
ache is commonly associated with such ver-
tigo.  Thus the symptom of giddiness, taken
by itself, may teach us nothing beyond di-
recting  attention to the case which, if care-
fully studied, will gradually reveal  itself to
the skilful practitioner.
  VESICA, an  anatomical  name  for  the
Bladder.
  VESICAL CALCULUS.  (See Stone.)
  VESICANT  is  anv remedy,  as Spanish
fly, acetic acid, etc., which can raise a blister
on the skin.  (See Blisters.)
  VESICLE is a small blister on  the skin
containing  a little clear  fluid within.   It is
seen in cases of eczema, herpes, and erysipe-
las ;  also when a blister is applied.
  VE3ICES  are  patches  of   hemorrhage
which occur in the skin in cases of purpura ;
they are  also known as ecchymoses ; when
very small  they are  called petechia;.  (See
Petechia.)
  VILLI are small prominences on the inner
or mucous lining of the intestinal canal, which
take  an active part in the absorption of the
food.  (See Intestines.)
  VINEGAR, as employed in medicine, is
only a dilute form of acetic acid.   It is used
as a refrigerant and as a  solvent  for some
medicinal substances yielding their properties
more readily to vinegar than to alcohol. The
officinal vinegar is made from  malt ; that in
most common use  is  made from wine.  It
really matters little which is  used.   Vinegar
and water  is a favorite local application for
cooling, but it is not nearly so efficacious as
spirit and water.
  VIOLETS, the plant of the viola odorata, is
no longer officinal.  The root was atone time
used, but recently only the petals  have been.
These  were used to prepare a syrup, which
was  a  beautiful  preparation, but  rather use-
less.  The  root  had more active properties,
especially emetic.
  VIRGINIA SNAKE-ROOT.   (See Ser-
pentary.)
  VISCERA is a name applied generally to
any of the  internal  organs ; thus the liver,
kidneys, spleen,  etc..  are  spoken of as the
abdominal  viscera.
  VISION.—The eye is the organ  of vision,
and by it we perceive those phenomena which
reveal  to us objects in the world around us.
The  eye is  a nearly circular body, placed safe-
ly in a bony cavity called the orbit, and acted
upon by certain  muscles,  so that  we  can
direct our  gaze  in  any direction we please.
In front of  the eye is a circular window called
the cornea, which enables light to enter ; be-
hind this is a circular ring of muscular fibres,
called the iris, which is variously colored in
different people ; in the centre of this ring is
an opening called the pupil, and  this corre-
sponds to the centre of the eye. and allows of
the transmission of  light.   Now the  iris, be-
ing muscular, can contract or dilate, and thus
the size  of  the pupil will  necessarily vary.
When the light is very strong  the pupil con-
tracts,  so as  to  let in less light, and con-
versely in the dark,  the pupii expands, so as
to allow as much as  possible to enter.  Placed
behind the iris,  but close to it, is a transparent
double convex lens,  and further behind is the
retina, a delicate membrane made up chiefly
of nerve-fibres, and when  the rays  of  light
fall on this membrane they excite in the brain
the sensation of vision.  The  retina  is con-
cave, and at  the  back of  the eyeball ; the
greater part of the eye is filled up in the centre
with  a  transparent  gelatinous   substance
known as the  vitreous body, while between
the cornea and iris is a similar clear substance
known as the aqueous humor.   Thus  it will
be seen  that in health there is a clear, trans-
parent passage for  the rays of light to pass
into  the eyeball, so  as to  fall upon the sensi-
tive  surface of the  retina ; and  further, this
passage is guarded by the iris, which,  by con-
tracting or dilating,  may diminish or  increase
the quantity of light entering.   Now the use
of the double convex lens is to bring  the rays
of light  to a focus  on the retina.   Parallel
rays, or those proceeding from a distant ob-
ject, are in this way brought to  focus, while
non-parallel rays are more or less deflected
from their previous  direction.  The  position
of the lens can  be slightly altered at will, and
this is of much use in determining  the size
and  clearness of an object ; the eye,  in fact,
accommodates  itself lo various distances, as
otherwise anything  afar off will  appear dull
and  blurred.  This  is the case in some dis-
eases.   If, for example, vve look at  two ob-
jects, one of which is at the distance of a yard
from the eye, and the other at two yards when
we fix the first the other be.comes dim ; while
if we fix the  second,  the other in turn becomes
indistinct.  Errors in the apparatus for this
accommodation of vision give rise to the affec-
tions known as myopia  and presbyopia, or
short-sight and long-sight.  The  usual cause
of short-sight is too great a convexity of the
lens, so  that the focus is formed in front ol
the retina, and not upon it.  It may be rem-
edied by slightly concave glasses, which, by
their diverging power, correct the  want of
accommodation and throwing the focus further
back cause the image to be formed on the
retina.   Working at a  microscope, and con-
stantly  looking at  small objects, as  reading
and writing, tend to produce  myopia.   It is
common in the case  of  young people, but
diminishes  with  age'.   Presbyopia, or  long-
sight, is the opposite condition.   The eye can 
VISION,  DOUBLE
VOMITING           475
see distant objects very well, but those which
are very near badly.   This is because the lens
is not convex enough, and does not  allow a
proper convergence of the rays of light upon
the retina.  It is corrected  by using  convex
glasses according to the degree to which the
patient is  affected.   It generally occurs  in
old people.
  People are color-blind when their retina will
not perceive some of the rays of light.   (See
Color-Blindness.)   The bluish  tinge seen
in solutions of quinine and  horse-chestnut is
called fluorescence, and is due to the fact that
extra rays of the spectrum are then made vis-
ible to the human eye.  The special sense of
sight is carried on by the optic  nerve, and if
this is diseased, more or less blindness will
ensue.  A cataract, or disease of the lens and
opacities in the cornea, cause  blindness by
preventing the light entering the  eye.   The
mischief may in some of these  cases be  re-
moved.  We may see flashes of light without
any  rays of  light  entering from the  outer
world.  Any sensation which  will stimulate
the retina in a way similar  to what ordinary
light does will cause a flash to appear before
the  eyes.  A  gentle  current of electricity
passed through the  temples  will give  the ap-
pearance of summer lightning.   In dreams,
and in some diseases of the brain, flashes of
light may also appear.  When an eye is  ex-
hausted by looking too long at a bright color,
another color.called the complementary color,
will  appear on removing the gaze.   This is
due to the retina being tired for a short  time,
and a false impression is  therefore conveyed
to the brain.  Thus, on looking at a scarlet
object with a fixed gaze, a green one will ap-
pear  on  looking  away, and every one  who
has gazed at the sun a short time will have ob-
served a black disk on the pavement when he
looks down again.  There  are  an  immense
number of optical delusions  which in sensible
people are corrected by the  experience of the
other senses, but which in foolish and  emo-
tional people may lead to extravagances and
erroneous impressions.   (See Eye.)
  VISION, DOCJBLE, may be produced at
will in perfectly healthy eyes :  "If a  person
hold the  two forefingers  in a line from  his
eyes, so that one may be more distant than
the other, by then looking at the nearest, the
more distant  will appear double" (Dr.  Ar-
nott,  " Elements of  Physics," vol.  ii.).   It
occurs,  moreover, as a frequent disorder of
vision, either dependent upon changes in the
nervous, transparent, or muscular structures
of the eye, or arising without any intrinsic
morbid changes, and in sympathy, as  it were,
with some disease affecting  a near or remote
organ of the body.   Thus  affections of  the
stomach, worms,  toothache,  headache, and
chronic affections of the brain are often asso-
ciated with double vision, which ceases after
the subsidence of the primary malady.  There
are two kinds of double vision :  In the first.
the patient sees double, treble, etc., with one
eye alone.  This is  called polyopia.   In the
second kind the patient sees double with both
eyes open—diplopia,  or double vision.
  Double vision may  be produced  through
long-continued exercise of the eye in reading
or writing by a bad light, and by  straining
the sight in reading small type.   In cases of
this kind  the disorder  is  usually transitory,
and may be speedily relieved by resting the
eyes or closing them for a short time.
  In recent squinting, due to  irritation in the
stomach  or intestines, or  to some severe
affection of the brain, the patient sees double.
In  ordinary  congenital or long-acquired
squinting of one eye, double  vision does not
generally occur, as the patient, by habit, has
learned to use only the  sound eye, and to
give all his attention to this.
  VITILIGO is a technical name for white
patches on  the skin, caused  by  loss of pig-
ment, or the usual coloring  matter,  at that
spot.
  VITILIGOIDEA is a name given to cer-
tain yellow  patches  which now and then are
met with round the eyelids and elsewhere on
the skin.  (See Xanthelasma.)
  VITREOUS BODY is the name given to
a gelatinous semi-fluid substance which fills
up the central  portion of  the eye.  It is quite
transparent, and  allows  of the transmission
of light.   (See Eye and  Vision.)
  VITRIOL.   (See  Sulphuric Acid.)
  VOICE is the product of  the vocal cords,
situated in the larynx, at the upper portion of
the windpipe.  The structure is fully  ex-
plained in the article on Larynx.  Voice
may be lost  from various causes.   The con-
dition is termed aphonia.  Thus voice is of-
ten lost in hysterical  people,  in whom a smart
electric shock will  generally bring it  back
speedily enough.   It may be  lost in disease,
as in  ulceration of the larynx, or in malig-
nant disease of the same.  In these cases the
nature of the malady is decided by  examina-
tion with  the laryngoscope, and  the remedy
will of course depend on the nature of the
malady.   (See Aphonia.)
  VOMITING means the  ejection  of the
contents  of  the stomach  upward, instead of
into the  bowel.  The  act is a complex one,
and seems due to two factors, viz., contrac-
tion of the  walls of the stomach itself, and
contraction of the  abdominal walls, the con-
tents  of the abdomen  thereby in their turn
pressing  on the stomach  itself.  The causes
of vomiting are very  various—irritation of the
stomach  itself, whatever  be  its  cause,  will
give rise  to ejection  of  its  contents ;  but
vomiting  occurs in  many  other maladies.
When gall-stones or  small urinary calculi are
passing there is usually sickness  and vomit-
ing ; in Bright's disease  there  is  vomiting
too, and  in  the maladies of  the brain among 
476        VOMITING BLOOD                              WARTS
children vomiting is an invariable symptom.
To arrest vomiting, ice swallowed  in  small
lumps is a capital remedy.  Bismuth is  good,
especially with small doses of opium.   In all
cases the quantity of the remedy used should
be small. Bulky  preparations will most prob-
ably be rejected.
  VOMITING  BLOOD.  (See Haematem-
esis.)
  VOYAGES are frequently undertaken as
a means of health, especially by persons with
delicate chests, and often are  attended with
most beneficial results.   We shall  only lay
  WAKEFULNESS.  (See Sleeplessness.)
  WALKING as a means of exercise is in-
valuable to people in sufficiently robust health
to undertake it. ' It should never be allowed
to be carried so far, however, as to produce
more than a sufficient  degree of fatigue to
make it pleasant, and  should never be in-
dulged  in to the foolish extent it is by some
young men.  The great thing in walking is
the  boot.  That  should not be  too  heavy,
strong,  with good thick  broad soles and  low
heels.   Walking boots should always be made
to lace ; what are called side-springs are  an
abomination.  A few nails are a decided  im-
provement.
  WARD'S PASTE was a patent medicine
long used for piles.  The confection of black
pepper was intended to  take its place, and is
a good  deal used in that troublesome affec-
tion.  (See Pepper.)
  WARMING  in  most  large  institutions
and churches, etc., is accomplished by means
of hot water, which circulates  in pipes through
the building and radiates heat.  A furnace in
the basement heats the water,  which  then
rises in the pipes, while  the cooler water de-
scends  back to the boiler  to  be  in turn re-
heated,  and so a continual current is  set up.
An ordinary room may  be heated by  a stove
or fire ; the latter is much to be preferred.  A
room should not be more than 650 Fahr., for
beyond this  point the heat is relaxing.
  WARTS  are papillary tumors, the varie-
ties of which depend upon their locality.  The
most common  are  those situated  about  tne
hands or fingers, or sometimes on the face,
and more rarely on other parts of the body  ;
thev chiefly  affect young persons, and their
structure is hypertrophied  papillae,  closely
adherent to each other, and covered with thick
cuticle.  A  somewhat scarce variety  occurs
upon the  scalp  occasionally, and  almost in-
variably in women after  adult age, although it
has been met with in  males, and from its
presence and form gives  great pain and incon-
venience in  brushing the hair.  A third va-
riety is occasionally met with  beneath or at
the side of the finger or toe  nails. These orig-
down one or two rules as to their selection, but
these are important : Voyages should never
be undertaken by any too delicate to stand a
little knocking about.   Sometimes people are
sent away this way who die on their voyage,
and  whom  it was  positive cruelty to send
abroad.  A short voyage is  useless.  One to
Australia and back  is good.  The time for
sailing  should  be  late  autumn,  after the
equinoxes.   Some few  private stores should
be taken, but these will suggest  themselves.
The first rule  is  the  guide  to  everything
else.
inate beneath the skin and  protrude beyond
the free margin of the nail.  They are gener-
ally very painful and troublesome.  Warts of
a  peculiar  nature,  arising  from   venereal
causes, are  met with  under the foreskin and
between  the labia, and are liable  to  rapid
propagation  from  their  close  contact with
neighboring parts.  Such warts  are undoubt-
edly contagious.
  In some persons warts appear to be hered-
itary, and the period of life up  to the time of
puberty  seems to  be that in  which  these
growths  flourish.   They  sometimes  appear
curiously, suddenly, and as suddenly disap-
pear.  It is very  probable that the poison of
decomposing animal matter is,  under certain
conditions, capable of exciting  these warts.
This is partly inferred from the fact that  those
engaged  in  the  manipulation  of  dead and
morbid tissues are- frequently  affected  by
them.  As a rule, warts do not materially in-
crease in size, supposing that they do not en-
tirely disappear, although occasionally, owing
to some permanent source of Icoal irritation,
they may " take on" a semi-maiicnant (see
Tumors)  character, especially  those occur-
ring about the face.
  Treatment. — The   treatment of  simple
warts,  such as occur on the fingers or scalp, is
very simple.  The  best method consists  of
their destruction  by the glacial acetic  acid,
which  may be either  dropped upon them  or
painted thickly over them with a brush, care
being taken to apply a little oil or glycerine
to the tissue contiguous to the wart, so as to
avoid blistering it.  Lunar-caustic, tincture of
the perchloride  of iron, a drop of pure  nitric
acid, or the acid nitrate of mercury, are all
good and  frequently efficient remedies.   The
scalp warts are often most effectually treated
by ligaturing their bases with a loop of silk or
thin silver wire, and allowing  them  to drop
off.  Venereal  warts  of  a not very  general
character  are best treated  by snipping  them
off  with  scissors, or  by  the  application  of
powdered oxide of zinc, or equal  parts  of
powdered savine and diacetate of copper.   In
the case of rapidly growing warts, and  those
W. 
          WASTING DISEASES

which are evidently degenerating in their ap-
pearance, excision of the growth and of the
integument from which it grows is the advisa-
ble treatment.
  The variety noticed as growing from under
the nails of the fingers or  toes is best treated
by pulling out the papillae constituting its bulk
by forceps, separately.
  WASTING DISEASES.—Wasting  is a
very common symptom in many disorders.
In the adult it is observed in all severe cases
of fever, but  then they recover their weight
during convalescence.  In  cancer and  con-
sumption it is a most marked symptom, also
in many  cases  of disease of any internal
organ ;  it is chiefly noticed also in those who
are liable to degeneration  of their  tissues.
(See Degeneration.)  It. is clearly impossi-
ble to enumerate all the causes of wasting, or
to give any account of the symptoms associ-
ated with it, as it is common to  so many va-
rieties of disease.  In children, in whom very
few symptoms can be observed, wasting is a
valuable indication of mischief.  It may arise
from insufficient nourishment, or over-feed-
ing, or  from unsuitable foods (see Diet), or
from chronic  diarrhcea. which more or less
exhausts the child (see Diarrhcea) ; or from
chronic vomiting,  generally  depending on
some gastric disturbance ; or from the child
having  rickets (see  Rickets), or from  the
presence of worms in the intestinal canal (see
Entozoa).  Inherited syphilis, consumption,
and tuberculosis will also cause much wasting.
A part may waste from want of use, and so it
is common to see a wasting of an arm or leg
in cases of  paralysis.  (See  Tabes  Mesen-
terica).
  WASTING PALSY.  (See Progressive
Muscular Atrophy.)
  WATER is a compound of hydrogen and
oxygen, in the  proportion by weight of two
parls of the lormer and sixteen of the latter.
Ordinary water is too well known to require
a full description.   It should be  clear, color-
less, and deposit no  sediment on  standing,
nor on  evaporating a drop  on a glass slide.
Covering a  large portion of the earth's sur-
face, it is invaluable  to  man  in many re-
spects ; in the form of ice in the Arctic re-
gions it forms a bridge of communication be-
tween distant places ; in its liquid state it sup-
plies animal  and vegetable matter  with the
means of sustenance ;  it supplies man also,
by means of  the seas and rivers, with means
for communication with foreign lands ; in the
ocean and in lakes and  rivers are also con-
tained  myriads  of fish and other  products
which are useful as food ; as steam it is use-
ful as a motor power in  economizing labor-
advancing civilization, and improving the con-
dition of man.  It occurs in various forms—
ice, hail, dew, hoar-frost, rain ; snow and hail
are but various kinds of water.  On evapora-
                 WATER             477

tion from the surface of  the earth, it  forms
clouds,  which, when  they  condense,  give
back the water to the thirsty earth.
  Pure water  is  only known to the chemist,
for  all the ordinary kinds of water contain
either gaseous, saline, or organic matters.  It
freezes at 320 F., or at zero on the Centigrade
scale, into a number of crystalline forms.  It
evaporates at  all temperatures and boils at
212" F. or 100° C, under the ordinary atmos-
pheric pressure at the sea level.  Above 39°
F. water expands by heat ;  below this point
it expands gradually,  thus differing  from
most fluids, which contract by cold ; it is due
to this fact that pipes burst  in a house in the
winter, and that a  jug  may become broken
when ice  forms.  Sea water, however,  con-
tracts regularly on lowering  the temperature.
The density of water  at  6o° F. is  taken as
unity (1.000), and it is the standard by which
the  specific gravities of  all solids and liquids
are  compared in  this country ; the barometric
pressure at the time should be noted to insure
accuracy ; the mercury should stand  at  30
inches or 760 millimetres. A cubic inch of pure
water weighs at 60° F. in air 252.456 grains.
Nearly all ordinary compounds contain water,
and therefore shrink on exposure to heat, for
then the water is driven off.  Nearly all crys-
tallizable  bodies  contain water, and when
heated become powdery.  There  are various
kinds of  natural waters, viz., rain  water,
spring, mineral,  river, and sea water.
  Rain water is never really  absolutely water,
as it contains gases which it absorbs in pass-
ing through the air ; melted ice and  melted
snow are perhaps the  purest forms of water
which can be obtained naturally.  The water
of our lakes contains various inorganic and
organic impurities from the rivers which flow
into them or the springs which supply them.
The beautiful color of  the Swiss lakes seems
due to the floating about of  innumerable fine
particles brought down by  the swift moun-
tain torrents.
  River water contains less saline matter than
spring water, but it also contains various or-
ganic impurities  according  to the  district
through which it passes.  Near large towns
it may  contain  a good deal of  sewage,  or
refuse from manufactories ; it  contains also
fish-spawn, leaves, silt or mud, according to
the rapidity of the current.  Before,  there-
fore, it  can be used for drinking purposes, it
must be filtered through beds of sand, gravel,
etc.,  so as to remove  the  impurities ;  any
running stream  has a self-purifying  power,
because it continually exposes fresh portions
of the water  to the air, and so  the organic
matters get oxidized.   It is  thus very impor-
tant that for  the due supply of a large  town
there should be a rapid current, absence of
sewage  matter from the  towns  above, and
proper filtration, so as to separate inorganic 
473
WATER
WATER-CLOSETS
impurities.  The presence of organic matter
may be roughly estimated by putting two or
three drops of permanganate  of potash into
half a gallon of water ;  if pure, there will be
a pink tinge ; if impure, it will be colorless, or
a  faintly  brown precipitate  is  produced.
River and rain water are ordinarily known as
soft waters, because they contain little  or no
lime ; hence they are more useful for washing
and other domestic purposes.
   Spring water, although it may look trans-
parent,  always contains saline matters, and
chiefly the lime salts ; hence  such water, al-
though  very agreeable to  drink  and  quite
wholesome, is known as hard water, and soap
curdles  in it and does not produce  a  good
lather.  Carbonate of lime, common salt, sul-
phate of lime, and carbonate and sulphate of
magnesia, are the salts most usually  present
in spring water.  They are held in solution
partly  by the carbonic acid which all  such
waters  contain ;  this is seen on boiling  the
water, when the  carbonic acid is driven off,
and on cooling  the water looks turbid and
deposits a small amount of  sediment  consist-
ing of the above salts ;  to this cause is due the
fur or incrustation on the inside of kettles and
boilers.   Pure water is very insipid, and it is
to the gases and saline impurities of ordinary
spring water that its refreshing properties are
mostiy due.  The danger from impure water
is due to the organic  matters  and those de-
rived from drains, sewers, etc.  An excess of
iime in  spring water is said to cause the Der-
byshire  neck, known  also  as  bronchocele or
goitre.
   Mineral waters contain iron, sulphur, and
various  salts, according to  the nature of  the
soil through which the water has percolated.
Those which contain iron are called  chalyb-
eate waters ;  those which contain carbonic
acid are pungent and effervescent ; artificially
prepared they are known as soda and seltzer
waters.   Some have sulphur or sulphuretted
hydrogen in solution, and are very nauseous
Others contain saline matters,  as the  springs
at Epsom, and hence the well-known medi-
cine commonly  called  Epsom salts.  (See
Mineral Waters.)
   Sea water is largely impregnated with com-
mon salt and with chloride of magnesium, to
which it owes its  bitter taste.   From the vast
surface  of the seas pure water is  constantly
evaporating to form the clouds ; into it run
the contents of myriads of rivers, while  the
sea itself constantly returns to the earth ma-
rine plants,  fish, guano, kelp, etc., which  are
useful to man.  The mean specific gravity of
sea water is 1.027, and  the quantity of salt it
contains varies  from  3.5 to 4 per  cent.
Hence it is easier to keep  afloat in salt than
in fresh water.   The following table shows
the composition of the sea water of the Brit-
ish Channel :
Water........................  o6V74372
Chloride of sodium.............  28-05948
Chloride of potassium...........   0-76552
Chloride of magnesium..........   3-66658
Bromide of magnesium..........   0-02929
Sulphate of magnesia...........   2 • 29578
Sulphate of lime ..............   1-40662
Carbonate of lime..............   0-03301
Iodine .........................    traces
Ammonia.....................    traces
                              1000-00000

  For chemical purposes water is  obtained
by distillation ; this may be done on a small
scale by heating water in a glass retort, and
allowing the vapor to pass over into  a re-
ceiver which  is kept cool ;  the vapor con-
denses and pure water is obtained ; however,
the first and the last portions distilled should
be thrown away, as the first may contain vol-
atile waters, and  the last saline impurities,
when the contents of the retort get too low.
The specific gravity of steam is 0.662,  of ice
0.94 ; hence ice is  lighter, and therefore floats
in water.   Water  may be produced when an
electric spark is passed through a vessel con-
taining a mixture of hydrogen and oxygen, in
the proportion of  two volumes of the former
and  one of the latter ; a slight explosion oc-
curs and a few drops  of moisture are  pro-
duced.  Water dissolves many substances,
and  therefore cisterns are best made of slate
and not of  lead, as that metal is acted on by
the water, and may give rise to colic and lead
poisoning if swallowed.  Iron pipes, and not
lead pipes, should  be used for the conveyance
of water for the same reason.  (See Filters.)
  WATER  BEDS,  or  Water-Cushions,
are very useful in many cases of fever, paral-
ysis, and long-standing disease ; they aid in
preventing any undue pressure on a part, and
so prevent the formation of  bed-sores ; they
are also of  great  comfort to a  patient, and
enable one to rest  much better than on an or-
dinary bed.
  WATER-BRASH is a common symptom
in indigestion.   It is caused  by the rising up
in the oesophagus,  or gullet, of a watery fluid
secreted by the glands of the stomach.  (See
Indigestion and  Pyrosis.)
  WATER-CLOSETS  are inventions  of
which no one has  any particular reason to be
proud.  With a show of cleanliness they com-
bine essential nastiness and a  good deal  of
real  danger.  In  large towns their use can
hardly be dispensed with ;  in  the  country,
with imperfect drainage  and water supply,
they  are  an intolerable nuisance.   Earth
should always be used instead of  water  in
country places ; it is preferable in every way.
To  keep water-closels moderately  safe, the
first thing is ventilation of the sewers ; if not,
they ventilate themselves into the house by
means of the water-closets.   A  pipe should
therefore lead from  the house  sewer to the
highest point of the building.  From time to 
WATER-CURE
WEIGHT  AND  HEIGHT    470
time the  pipes  and  traps  ought to be  ex-
amined, to see that the former are entire and
not leaking, and that the traps are in working
order.   A portion  of  disinfectant,  fluid  or
solid, should be used at least once every day.
The best is carbolic acid, in powder or in  so-
lution.  With these precautions  the water-
closet system  may be  worked  with  no very
great risk, but the best thing is to get rid of
them wherever possible.
  WATER-CURE.   (See  Hydropathy.)
  WATER IN THE CHEST.   (See Hy-
drothorax.)
  WATER ON  THE BRAIN.  (See Hy-
drocephalus.)
  WAX is  the  Cera  of  the Roman phy-
sicians, and is a peculiar substance occurring
in the  textures of plants, and sometimes  on
their surface.  It is also formed by animal  or-
ganisms, and in  the largest quantity  by  the
common bee.  It is obtained for use after  the
honey  which  the  waxen  cell  incloses  has
been expressed, and is fused in boiling water
and  strained.  This is the  yellow  wax  of
commerce.  The  white wax of the shops is
made by  bleaching the common  yellow wax
and exposing it to the air.   It is largely used
in the  preparation of plasters, ointments, and
cerates, and also  by dentists and mechanical
surgeons in taking  moulds or models of  any
part of the bodv.
  WAXY DEGENERATION  of the liver,
or kidney, or spleen.  (See Degeneration.)
  WEAK ANKLES.  (See Ankles.)
  WEAKNESS.   (See Debility.)
  WEANING.  (See Lactation.)
  WEIGHT.—The average weight of   the
human body may be taken at 154 lbs.  Such
a body would be  made up  of muscles  and
their  appurtenances, 68  lbs.,  skeleton,  24
lbs. ;  skin,  io£ lbs. ; fat, 28 lbs. ; brain, 3
lbs. ;  thoracic viscera, i\  lbs. ;  abdominal
viscera, 11  lbs.  ;  blood.  7  lbs.  About  five
pounds more blood will remain in the tissues
and will not drain away,  and therefore it is
reckoned with them.  The female weighs less
than the male.  The following is the weight
of the chief internal organs :
                   Male.
Drain................ 48"53 c
Heart............... 10
I.ungs............... 18-20
I.iver................. 50-60 '
Kidney..............  5_ !i
Spleen.................  4-6
 Female.
40 -45 oz.
 9
15 -18 "
4S -5° "
 Ai- 5 "
 4-6 "
  These are but averages ; a great variation
in the weight of people is met  with, depend-
ing on  their age, stoutness, sex, height, and
mode of living.
  WEIGHT AND HEIGHT.—Within  the
last  few years  public attention  has  been
drawn to the fact that weight is as important
an indication of the general condition of  the
human body as any other evidence, and many
 physicians make a practice of weighing their
 patients periodically  at  each  consultation.
 The habit of being weighed has almost be-
 come an amusement,  and in railway stations,
 shops, and  many places of recreation, weigh-
 ing-machines are to be  seen in  constant  re-
 quest.  It will  easily be seen, however,  that
 to know the correct weight of  an individual
 without reference to height is of little advan-
 tage, but if a standard be ascertained as to the
 proper proportion  which weight should bear
 to height, then we know how much a person
 ought to weigh, and can treat him accordingly.
.One of the earliest efforts made to obtain any-
 thing like a fixed relation between weight and
 height was that of Dr. Boyd, who weighed a
 certain number of inmates of the Marylebone
 workhouse.   He took the weight and height
 of 108 persons suffering from  consumption,
 and  found they measured 5 ft. 7 in.,  and
 weighed  90 lbs.  He  then measured  and
 weighed 141 paupers  not in ill-health,  and
 found their average height was 5 ft. 3 in., and
 they weighed 134 lbs.  This subject attracted
 the attention of the late  Dr. John  Hutchin-
 son, and he determined to take the height and
 weight  of persons of all classes of the com-
 munity.   In this way he collected the height
 and weight of upward of 5000 persons.  This
 list, however, included persons who exhibited
 themselves  as giants and dwarfs, and other
 exceptional  cases.   He therefore reduced his
 instances to 2650 persons, all of whom were
 men in  the  prime and vigor of life, and in-
 cluded sailors,  soldiers, firemen, policemen,
 draymen, gentlemen, paupers, and  pugilists.
 This group of cases was intended to make one
 class  as a set-off against another, so as to get
 a fair average.   The following is the result of
 Dr. Hutchinson's osbervations :
     Height.                     Weight.
     Ft.   In.                       lbs.
      5   1............................. 120
      5   2............................. 126
      S   3 ............................ '33
      5   4............................ 139
      S   5...........................  M2
      5   6......................•....... I4t
      5   7........................... 148
      5   8 ............................ J55
      5   9.  ........................... It2
      5   IO........................--- 169
      5   "............................ ]74
      6   0............................. 178
   Of course the result of  these  observations
 can  only be considered as  approximate, but
 they are sufficient to show that among a set
 of healthy men there is a healthy standard of
 height and weight.   In examining this table,
 Dr. Lankester found  that for every inch in-
 creased in height we have  five pounds more
 in weight, and  this  rule  holds  good for all
 practical purposes.  Starting  with  a person
 5 ft. in height, who, according to the assumed
 law, should  weigh 115 lbs., we obtain the fol-
 lowing results : 
480    WEIGHT AND  HEIGHT
WENS
     Height.                      Weight.
     Ft.  In.                        lbs.
     5   o..............................  115
     5   1..............................  120
     5   2.............................  125
     5   3   ...........................  '3°
     5   4.............................  J35
     5   5.............................  140
     S   6.............................  145
     5   7..............................  150
     S   »■  • --.......................  '55
     5   9..............................  160
     5   10 ............................  165
     5   11 .............................  '7°
     6   o..............................  175
     6   1............................  180
     6   2..............................  185
     6   3............................  IQJ
     6   4..............................  J95

  Although this law is approximately good
for a certain number of cases, even above and
below this table, it is  practically found,  and
especially in the case of children and growing
persons, that  there is  a  wide difference of
weight at heights below 5 ft.  Attention may
also be drawn to the fact,  that there will con-
stantly occur in the community instances of
persons  where either the  muscular or bony
systems  are excessively developed, and who,
consequently, weigh more or  less than their
height.
  The  conclusion we  come to with regard to
all these weighings and measurings is,  that
all ordinary  departures  from  the  average
height and  weight of the body deduced from
Dr. Hutchinson's tables  are due to an in-
crease or decrease of the fat or adipose tissue
of the  body.  Thus, taking the composition
of a human body weighing 154 lbs. and meas-
uring 5 ft. 8 in., it will be found to contain 12
lbs. of fat.   It is then mainly due to  the dim-
inution  or  increase  of this  substance  that
human beings vary in  weight, and  it is im-
portant  to  find out whether this fat be of any
use or value in the system, and whether the
indications afforded  by the weighing-scales
should not afford some suggestions for cau-
tion in diet and regimen.   Besides exerting a
primary influence on the growth of the body,
fat subserves  many  other purposes and is
essential to animal life.   When there is too
little deposited for the purposes of life, then
serious  disease has already commenced, or
may  set  in ; while, on the other hand, a re-
dundancy of this deposit may seriously inter-
fere with the functions  necessary to life.  It
is from this point of view that the value prac-
tically  of  a  knowledge  of the  height  and
weight  of   individuals  becomes apparent.
When the weight of a person is much below
his height, then  it may be suspected  that
some disease has set in, which may go on to
the destruction  of life.   One of the earliest
symptoms  of  consumption is a tendency to
loss of weight.   Long  before any symptoms
are present of  tuberculous deposits  in the
lungs, this  loss of weight is observable in per-
sons afflicted with  consumption.  At  this
stage of the disease, a large amount of evi-
dence renders  it probable that  the  fatal ad-
vance of this disease may be prevented.  This
fact has been admitted by the practice intro-
duced during the last thirty years of adminis-
tering cod-liver oil  and fatty substances  to
those who are threatened with consumption.
In fact,  it may be stated generally that, wher-
ever the weight is much below the height, sus-
picion should be aroused and the indication
regarded.  The other  side  of  the  question
should not be forgotten  ; in certain  lamilies
and  individuals there  is  a tendency to de-
velop adipose tissue  unduly.  However  free
from fat may be the  food, what  little it  con-
tains is  arrested in the tissues of these indi-
viduals  and they become " fat"—that is,  they
weigh more  than their  height.   Sometimes
this is deposited all over  the system so as not
to be an obvious obstruction to  the functions
of life ;  but it  can be well understood that,
when two  men of equal stature, say 5  ft.  8
in., one having  to carry  154 pounds  and the
other 168 pounds, the latter will be at a disad-
vantage.  This arises from two causes.   The
heavier  man, carries, in the first place, greater
weight,  and in the second place his heart has
to project into the tissues of the  body a larger
amount  of  blood in  order to keep him alive.
For  every  pound a  man weighs above  his
height his system is at a disadvantage, and he
suffers in various ways.   When fat is equally
distributed about the body, then no immediate
disadvantage is felt ; but when fat is accumu-
lated in  particular parts of the body, interfer-
ing with the functions of particular  organs,
then its evil influences become speedily ap-
parent.   When  persons  weigh  much above
their height it  is obviously a matter of im-
portance that they should, as much as possi-
ble, relieve the tax on their muscular and cir-
culating system by diminishing their  weight ;
but this must be done with caution. The  sud-
den withdrawal of accustomed articles of  food
is unwise, and it is better gradually to lessen
the fatty portions of diet than to go to ex-
tremes.   When looked at carefully, there can
be no doubt that the relation of height and
weight  are very important as legards health
and the  chances of life. Whenever the weight
is below the height there is a fair suspicion of
scrofulous or tuberculous disease, and when
the weight  is greatly in  excess  of the height
there is a tendency  to those sudden impair-
ments of muscular  and  circulating powers
which may lead to premature and sudden
death.   (See Bantingism.)
  WENS are   encysted tumors, most  fre-
quently met  with on the scalp or eyebrows.
The origin of these  tumors is in obstruction
or imperfect congenital development of the
sebaceous follicles dilated by the  accumulation
of their contents.   If existing  on  the scalp
they are generally multiple, and the cyst wall
strong and tough, and at first but loosely ad- 
WET-NURSING
WHITLOW            481
herent to the surrounding  tissues.  If irrita-
tion be set up by continuous pressure or fric-
tion,  the  cyst wall becomes intimately ad-
herent to these tissues.  The contents vary
from  being  merely  an accumulation  of the
natural sebaceous secretion to several  forms
of its  perversion.   Sometimes they are semi-
fluid or honey-like,  sometimes atheromatous,
sometimes steatomatous or  fibrinous, occa-
sionally  purulent.   Hairs  or eyelashes are
frequently met with in their cavity,  and  in
encysted tumors,  which  exist  in  the ova-
ries,  hair,  skin,  teeth, or bones  are  met
with.
  Treatment.—The treatment of such tumors
consists in their removal :  if very small, evac-
uation by pressure  is sufficient ; but if large
and unattached, a  simple  incision  through
the  integument  and  down upon  the  cyst
wall,  with the subsequent enucleation of  the
entire cyst and its contents.   Supposing the
tumor to be very large, and its cyst wall thin
and adherent, removal must  be effected by
regular dissection.  It  must be borne in mind
that, unless the entire cyst or bag is removed,
there  is every probability of the tumor return-
ing.   These  tumors may occur in the neck,
and a somewhat favorite locale is just under
the angle of the lower jaw.  Those  occurring
on the eyelids (tarsal tumors) have extremely
thin walls, arid it  is rarely necessary to dis-
sect them out, as by eversion of the  eyelid
and rupture of the sac from the under surface
all deformity from cicatrix is avoided, and the
result is all that is required.  (See Eyelids.)
It is well to remark that these wens should be
removed by  a surgeon as soon as they are
noticed, as the scars increase in size, and are
horribly unsightly if situated in any prominent
place, and their removal is  safe and generally
unattended with any great  pain.
  WET-NURSING  may be  required  in
those cases where on  the death  of the
mother, or because  she is  incapable of suck-
ling her infant, another woman who has been
recently confined is employed for the purpose
of giving the child sustenance.  It is better to
have  a wet-nurse  than to bring the  child up
by hand or by bottle.  Precautions should be
taken to see that the wet-nurse is in good
health at the time.
  WETTING THE  BED, so frequent  in
children and  so well known to nurses, requires
careful attention, and  should not always be
treated as an avoidable habit and punished
accordingly—though it is often  necessary
when a child is of sufficient age to  under-
stand  to  create  habits of  self-control  by
severe measures,   In   the first place, how-
ever,   pains  should  be  taken to  ascertain
whether the irritable condition of the bladder
be not produced by the too alkaline condition
of the water, or by the presence of worms  in
the  rectum, which cause great irritation in the
surrounding nerves, and so involuntarily lead
to the discharge of  the water.  If after all
precautions  have been used to discover  a
local cause for the habit, and none seems to
exist, the occurrence of it must be treated as a
fault, especially  if it  occur in the  daytime,
when indolence and  indifference alone can
accOunt for such an uncleanly practice.  Fre-
quently, however, in  young children, it will
be found to cease altogether after a few doses
of suitable medicine to allay one or other of
the causes of irritation.
  WHEALS are red  and white marks on the
skin,  which are  seen  in cases of nettle-rash,
and  in  some  forms  of  indigestion ;  tepid
water will generally relieve the tingling, brt
the treatment must be directed to the cause.
  WHEY is  the  watery part of  milk,  the
part which separates  when curds are made.
It is a wholesome and pleasant drink, and in
cases of cholera or fever is very often bene-
ficial.
  WHISKEY.  (See Distilled Spirits.)
  WHITE  BLOOD  CORPUSCLES  are
rounded, often granular cells, which are seen
in the blood with the aid  of a good micro-
scope.  (See Blood.)  They  are in excess in
cases of leucocythasmia and lymphoma.
  WHITE  LEG.  (See  Phlegmasia  Do-
lens.)
  WHITE PRECIPITATE.  (See  Mer-
cury).
  WHITE  HELLEBORE.   (See  Vera
trum Album.)
  WHITE     SOFTENING  OP  THE
BRAIN.  (See Cerebral  Softening.)
  WHITE    SWELLING. (See   Knee-
Joint.)
  WHITES.  (See Leucorrhcea.)
  WHITLOW, called also paronychia, is  a
very common  and, if neglected, serious affec-
tion.  It signifies an  abscess of the fingers,
and it may arise from various causes, and
has  various localities and intensities.  The
simplest form is one which is limited to the
surface.  The  finger is swollen,   inflamed,
and intensely  painful,  and  the integument
generally  vesicates.  This form frequently
begins by inflammation of  the matrix of the
nail,  which nail  may be  eventually shed.
The treatment consists of poultices, fomenta-
tion, and attention to the state of the bowels.
A more serious form of  the disease is one
which affects  the deeper  structures,  and
attacks the subcutaneous areolar tissue, and
this much resembles a boil, and the swelling,
tension,  and  pain  are very considerable.
The affected parts should be freely incised to
evacuate pus, and this proceeding must  be
followed by fomentations and poultices.   In
the case of a painful tip to a  finger, which is
very painful and does not seem inclined to
suppurate, it should be well rubbed with lunar
caustic.
  The worst form of whitlow is the tendinous
whitlow or bone-felon ; and the disease origi- 
482       WHOOPING-COUGH
WHOOPING-COUGH
nates in the deep fibrous tissue of the finger,
or in the  periosteum or bone.  It is charac-
terized by the most excruciating pain  from
the very outset of the disease.  Pus forms
early, and the constitution is affected  with
frequently severe  inflammatory fever.   If
this state  of things be permitted to continue,
there is   no relief  for the  symptoms  until
nature has  evacuated  the pus herself ; but
then the joints are disorganized, the  tendons
have sloughed, the bones become carious or
necrosed,   and if recovery takes place, it  is
with stiff,  useless digits,  requiring  amputa-
tion.  The treatment of such cases consists in
the early and  free evacuation of the pent-up
matter by a deep,vigorous incision down  to the
bone.  The pain at the time is most acute, but
the relief is instantaneous, and in all probabil-
ity a useful finger is retained.  These bone-
felons not unfrequently spread into the  palm
of the hand,  forming  palmar  abscesses, or
may extend underneath the annular ligament,
and the matter burrow up into the tendinous
sheaths of the muscles of the forearm.  In
opening such  abscesses  in  the  palm, the
incision should be  made over  and  down
upon  the  metacarpal  bone,  taking  care to
avoid wounding the digital artery or palmar
arch.
  The subsequent treatment of bone-felons
consists in poulticing, fomentation,  and the
administration of  tonics,  and in  taking care
that stiffness of the fingers  be avoided  after
the free incisions, and when the tissues  have
become healthy,  by early passive  motion,
and inunction  of ointment, such as creosote
or resin.   All  dead skin is to be carefully re-
moved.   Their most frequent causes are the
inoculation of  decaying animal or vegetable
matter, and the effect of such on a somewhat
low state  of health.  It must be borne in
mind that the  discharge from them is conta-
gious-
  WHOOPING-COUGH  is  a disease of
great  frequency in childhood,  and  a  large
proportion of  infant mortality is  due to this
cause.  It belongs to that class of disorders
which is called 2ymotic. It is contagious, but
differs in  this  respect from other contagious
diseases, that whereas  they are  communica-
ble by a third  person who may  all the  time
be unaffected, this  is not so with whooping-
cough, and this fact has some practical im-
portance in a children's hospital.  A ward for
measles and scarlet fever should be kept  quite
separate from the  main building, and all the
nurses, etc., should also be distinct ; but for
cases of whooping-cough it is enough if other
children are kept from  going into the ward,
while the  nurses, etc., may go about without
spreading the  disease.  Whooping-cough  is
known in different parts  as  hooping-cough,
chin-cough, kink-cough,  and pertussis.   It
may  be defined as a disorder in which a con-
vulsive  cough consists of a long series of
short and  forcible  expirations,  and then a
deep and loud inspiration, and repeated more
or less frequently during each paroxysm ; it
lasts several weeks, occurs  once in a lifetime,
and is most common in childhood.  Whoop-
ing-cough  has  been known since the mid-
dle of the seventh century, and has always
of late years been prevalent in this country ;
it seems to be  most fatal  in  those  years in
which measles  are also prevalent.  No dis-
ease kills more children under one year of
age  than   whooping-cough ;  nearly 70  per
cent of all the cases occur under two  years
of age, and not more than 5 per cent  of  the
deaths are recorded as above five  years of
age.
  Symptoms. —The earliest is a common cold
or catarrh,  accompanied by a cough ; there is
also  a slight amount  of fever, restlessness,
and sometimes  rnnning at  the eyes and nose.
The cough  in a few days becomes more trou-
blesome,  and  some  glairy  fluid  may  be
brought up from  the chest  ; in a week or ten
days, but oftener later,  the child w 11  begin to
have the characteristic  whoop ;  the  cough
comes on in paroxysms, and is more irequent
by night than by day ;  each paroxysm begins
with a deep and loud inspiration, followed by
a succession of short  and sharp expirations,
again followed by a deep inspiration, and the
repeated expiration ; this may go on several
times, and  last one or two minutes, accord-
ing 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 parox-
ysms a day, and  several fits of coughing be-
sides, without  the  whoop  being heard.  In
ordinary  cases  there  are from four to  ten
spasmodic  attacks in  the twentv-four hours.
These symptoms last for three or four weeks,
and then the cough abates in severity and
frequency, and finally ceases altogether ; even
when there is  no whooping, the child may
continue  to have a troublesome cough for
some lime.  In  most cases  there  is  some
bronchitis 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 bad import.
and  this  is generally the way in which such
cases die.   Whooping-cough cannot be  made
out until the characteristic whoop appears,
and then there  can  be  no difficulty in recog-
nizing  the disease.
  Treatment—In all  cases it  is best for the 
WILLOW
WINE
483
 child to keep in the house as soon as the mal-
 ady has declared itself ; in a very mild case it
 need not be kept in bed, but it should be in a
 room of a warm and even temperature, and
 protected from  draught ; it  can  then  be
 allowed to play about as it likes.   If there is
 any lung affection  it must be  put to bed, and
 hot linseed-meal poultices placed round the
 chest.   Other children  must not be allowed
 to come  near it unless they have had an at-
 tack previously, for in this way its spreading
 may be prevented.  The child must be fed in
 the usual way, but solid food should be given
 sparingly.  Where the  infant is emaciated,
 and  has some other  disease, as rickets, etc.,
 the treatment proper for that disease may be
 continued.  Steel  wine is very  valuable in
 cases of whooping-cough, and more especially
 when  there  is no fever, and  during con-
 valescence ;  it may also stop the diarrhcea,
 which  is  now  and then  present.  If there
 is any prolapse of the bowel, the part should
 be sponged  lightly with  a solution of  sul-
 phate of iron, and  at once returned.  This is
 often due  to the excessive diarrhcea, and steel
 wine must be given internally.   Numberless
 remedies have been  tried to cure whooping-
 cough,   but  none   have  succeeded.   Iron,
 alum,  zinc,   sulphuric  acid,  etc.,  have  all
 failed to do much.  The most hopeful remedy
 is belladonna if given in large doses, and the
 symptoms watched ;  children can bear more
 of this  drug the younger they are, but it is a
 dangerous remedy, and can  only be  given
 with the greatest care.   Warm clothing must
 be worn, and during convalescence a nourish-
 ing diet, moderate exercise in  the air when
 fine, a tepid bath in the morning, and a tonic,
 as steel wine or  cod-liver oil, must be en-
 joined.
   WILLOW.—The  bark of the  willow is
 sometimes used in  medicine, but only to pro-
 duce its active principle, salicine.  (See  Sal-
 icine.)
   WIND IN  THE  STOMACH.   (See
 Flatulence,  Indigestion,   and  Inward
 Fits).
   WINDPIPE is the main tube, or trachea,
 which allows  of the passage of air from the
 mouth and nostrils  into tlje lungs.  It can be
 felt in the throat, and when pressed gives an
 uncomfortable feeling of impending suffoca-
 tion.  (See Lungs  and Foreign Bodies.)
   WINDS enter most  essentially into  the
 climate  of any region, the prevalent wind giv-
 ing it a  character of its own.  This has been
 alluded  to  in dealing with house-building and
 climate, and  need  not be further alluded to
 here.  Extreme cold, if dry and still,  may be
 borne much more easily than a higher temper-
ature if  windy.  The continual renewal of the
air next the body abstracts the heat more rap-
idly in  the one case  than the  other.   (See
Climate and House.)
   WINE is the name generally given to fer-
 mented liquors when no foreign ingredient is
 added to flavor them.   Thus the fermented
 wort of  malt is called malt wine when hops
 are not added.  Some wines are made from
 the juice of various fruits fermented, as cur-
 rants, gooseberries, elderberries, and others.
 The  term wine, however, is more especially
 applied  to the fermented juice of the grape.
 Of all fruits the grape  is  best adapted  for
 making wine.  The reason is that the juice of
 the grape contains tartaric acid, and this acid
 forms an insoluble salt with potash.  Thus
 the acid  of  the wine is  thrown down in  the
 form of  an insoluble supertartrate of potash,
 which is called tartar, and when purified is
 sold under the name of cream of tartar, and
 when burned is  converted into carbonate of
 potash or salt of tartar.  The acids contained
 in other fruits, as the citric acid in the orange,
 the malic acid in the apple and pear, form
 soluble supersalts with potash, are retained in
 the fermented juice, and render the wine so
 sour  that sugar  has to  be added to  cover
 their  acidity.   This is the case with all the
 fruits from which home-made wines are pre-
 pared, and, in fact, the source of the objection
 to them as ordinary beverages.
  Wines generally contain more alcohol than
 beers (see Beer) and less than distilled spirits.
 (See Distilled Spirits  and Alcohol.) The
 quantity  of alcohol varies very much in differ-
 ent kinds of wines  ; and, in fact, the quantity
 of alcohol is the first element  which deter-
 mines the price of wines.   An import duty is
 levied on all wines  coming into  this  country,
 and those containing below a certain percent-
 age of alcohol pay  less than those above the
 same point.  Wines, however,  are  not con-
 sumed for their alcohol alone.   They contain
 other ingredients which they derive from the
 grape-juice, which give them taste and flavor.
 Thus, when the fermentation of the grape-
 juice  is  not  complete, a certain quantity of
 sugar is left, and according to the quantity of
 sugar wines are said to  be " sweet" or dry.
 While hocks, clarets, and  other light wines
 contain little or  no sugar, port, sherry, and
 champagne  always  contain a large  amount.
 In the case of  port  and sherry this  sugar  is
 added during the manufacture, in order to en-
 able them to keep and bear exportation.  At
 the same time that a large quantity of the tar-
 taric acid contained in the juice of the grape
 is  thrown down while the " must"  is being
 fermented and the wine is in  the cask, the
 whole of the tartaric acid is not got rid of,
 and a certain quantity is retained.   In order
 to get rid of this, the wines of Spain are ex-
 posed to a process called '* plastering," which
 consists in mixing with  the grapes a certain
quantity of gypsum, or plaster of Paris.  The
quantities of  alcohol, sugar, and acid found
in  one imperial pint of  certain of the wines 
484
WINE
WINE
commonly consumed will be found in the fol-
lowing table :
Wine.
Port....................
Brown Sherry..........
Pale Sherry.........
Claret .................
Burgundy..............
Hock.................
Moselle................
Champagne............
Madeira...............
St. El ie (Greek)........
Santorin (Greek red)...
16

16
18
171A
17%

17
16
16
i6!/3
4
4/s
2%
360
 80
3	1 133 j
4	0 400 |
4	0 22
Z%	0 40
 80
 90
170
161
160
127
140
 go
100
  From  this table  it will  be seen that it is
erroneous to suppose that ports, sherries, and
madeiras are free from acidity.   They do not
contain so  much tartaric  acid as the lighter
French and German wines, but  the  taste of
the acid is covered by the sugar they contain.
 The sugar in wine  is often a very prejudicial
agent.  As  it exists in most wines, it is in a
state in which it  more readily  ferments than
when in the form of common sugar.  Hence
patients  are recommended to take  " dry"
wines.  The fact is,  with regard  to  ports,
sherries, and madeiras,  they can hardly be
said to be wines at all. They are  all made on
the same principle—that of adding to the gen-
uine  wine certain  quantities of sugar and
brandy.  In short, it may be stated  that all
these wines are manufactured  by the taking
the wine of  one brewing and adding to  it the
" must" or  unfermented juice  of  a  second
quantity, and adding the pure brandy distilled
from  a third portion.  It has been a  great
misfortune that these wines have been thrust
into circulation in  our country,  and  a  taste
has been acquired for them which it seems
now impossible to annihilate.
  When the stimulus of alcohol is required in
disease,  it  is no  doubt better to  secure it
through pure wines, such as those of France,
Germany, or our own country,  than in the
saccharine compounds presented to us from
Spain and Portugal.  If  larger quantities of
alcohol are required  in  disease, it is better
presented in the form of  brandy or whiskey.
The latter  spirit is now sold so  pure that it
may without hesitation be used  in the  sick-
room  as a substitute for strong wine.  A the-
oretical objection has been urged against the
use of spirits and water.    It is said that the
stomach, through the action of endosmosis,
absorbs the water, and leaves the  spirit to act
as an  irritant on the stomach and surrounding
organs.  This is said not to be the case with
the  alcohol and water in wines,  when the two
are  held in a much closer chemical union.
  There are  three  other qualities in wines
which demand some consideration. The first
is what is called  the bouquet and flavor of
wines.   These  things are  sometimes  con
founded, but  they are  really different.  The
vinous flavor is common to all wines, but the
bouquet  is peculiar to certain  wines.  The
substance which gives  flavor to all wines is
cenanthic ether, and is formed during the fer-
mentation of  the grape-juice.  When separat-
ed from the wine, this substance is anything
but pleasant  to the taste and  smell.  It is
composed of an acid—cenanthic acid—which
forms an  ether with the alcohol.  The  bou-
quets of wines are formed in the same way
by some of the acids found in the grape-juice
after fermentation,  combining with the ethyl
of the alcohol, and  forming ethers.   Many of
the bouquets  thus formed are well known, and
they consist of  ethers  formed by ethyl  with
acetic, proprionic,   pelargonic,  butyric,  ca-
prioc, and caprylic acids.  As far as we know
at present, these ethers do not in any way ex-
ert  medicinal effects on  the  system.   All we
know  is,  they  are, many  of   them, most
agreeable to the taste and act upon the tongue
as delicious odors of flowers upon the nose.
These  are  the  things which  make  one wine
more pleasant to drink  than the other, and
which  give the highest price to the best of
wines.  They are not  detectable by chemical
agency, and it is the taste  of these  bouquets,
and nothing else, which gives to one wine the
value of 25j. a  bottle, and another  is.  bd.,
when  all other qualities  are  precisely  the
same.
  Another point in the  nature of  wines is
their coloring matter.  Some wines are what
are called  " red,"  and others are  "white."
Ports,  clarets, burgundies, are all red ; while
some of the wines of Greece, Germany, Hun-
gary, and other parts of  the world  are red
also.   The red  colors of  these wines have
been analyzed  with some care,  but they do
not seem to exert any influence upon  the sys-
tem.  The most important agent in  them is
tannic acid, or  tannin, which exists in some
wines to a very large extent.   It is especially
present in ports and clarets,  and less in  bur-
gundy.   It gives an astringency to red wines
which  is  not  found  in white.  The large
quantity of tannin in port gives  it a tendency
to deposit a sediment, which is known by the
name of " crust," and which is  found on the
lower side of  the bottle after keeping.  This
crust consists of oxidized tannic acid, which
becomes insoluble,  and carries  down with it
a blue coloring matter, and the  saline matter
contained in  the wine.  The longer port is
kept the more of the  crust it throws down.
By  this process port wine  loses its color and
density, and  acquires a  purer flavor, and its
price  is  proportionately  enhanced.   Port
wines kept twenty, or thirty, or forty years
command, when originally good wines, almost 
WINE
WORMWOOD          485
 fabulous  prices  in  the  market.   This, how-
 ever,  is a  mere matter of  taste,  and  such
 wines have no dietetical  or medicinal qualities
 to recommend them. Even the assertion that
 they may  be  taken with  more   impunity
 than new wines is  problematical.   They do
 not seem to contain so much alcohol as wines
 not kept, and may  be taken  in larger quanti-
 ties on that account.
   The other  coloring matters described by
 chemists  are a blue and brown coloring  mat-
 ter.  The latter is  found in dark white wines
 as well as in red wines.   The brown coloring
 matter is found in port wine, when  all the
 tannic acid and blue coloring  matters  are
 thrown down.  The blue coloring  matter is
 derived from the skins of the red grapes from
 which red wines are made.   These skins are
 also the  source of the  tannin.  The  brown
 coloring matter is more  or less present in the
 skins of red and white grapes.
   The other matters which give  a character
 to wines are the saline  compounds.  These
 substances, which constitute the " ashes" of
 all burned  vegetable tissues,  exist in  very
 varying quantity in all  fruits, and are found
 dissolved in the juices of fruits ; hence we find
 them remaining in the wine after fermentation
 of  the juice.   The  most abundant of these
 salts is the  bitartrate of  potash (cream of tar-
 tar), of which we have  already spoken.  In
 addition to this, wines contain tartrate of
 lime,  tartrate of alumina,  tartrate of iron,
 chloride of  sodium,  chloride of potassium,
 sulphate of potash,  phosphate of  alumina.
 These salts  occur in the proportion of from
 one to four  parts in the one thousand of wine.
 They  do  not make much difference  in  the
 flavor  or action of wines ; but their presence
 or absence is one of the surest indications of
 the genuineness of a wine.  Those who man-
 ufacture wines with  alcohol and water, and
 add a certain quantity of good wine to give a
 flavor, do not usually add these mineral con-
 stituents,  which are always the best test cf a
 genuine wine.
  In conclusion, we may say, with regard to
 the medicinal arid dietetical use of wines—
  I. That, where they are employed for the
 sake of the stimulating effects of alcohol, it is
 a matter of indifference which may be  ad-
 ministered, remembering that some wines are
 twice the strength of others.
  2. The bouquet and flavor of wines  render
 them more  agreeable than to drink any form
 of mixed spirits or beer.
  3. Wines  are less likely,  especially when
 administered on an  empty  stomach,  to do
 harm to the coats of the stomach  than any
 mixture of brandy.
  4. All sugared wines, as port  and sherry,
shoud  be interdicted in gouty states  of the
system, and in  diabetes, and in dyspepsia
attended with wind  in the stomach.
  5.  For all dietetical purposes.clarets,  hocks,
and  the  dry wines of Greece, especially the
latter, are to be preferred before all others.
  6.  Where it is desirable to secure an astrin-
gent effect, the red light wines are to be pre-
fered to the white.
  7.  The tartaric  acid of wines is  not injuri-
ous,  and does not increase acidity in the stom-
ach or the  bleed.   It is an error to suppose,
on this account,  that unsugared wines may
not  be  given where there  is a  tendency to
form lactic acid in the stomach or  lithic acid
in the blood.
  8.  Where powerful stimulants  are required,
it is better to give brandy, gin,  whiskey, or
robur, than even the stronger wines.
  9.  Pure  spirits with water are better than
wines manufactured from impurely distilled
alcohol, which contains fusel oil, and acts in-
juriously on the nervous system.
  WINTER-COUGH is  a very common
symptom in cases of emphysema and chronic
bronchitis.   It is generally worse every win-
ter,  and may go  away in  the summer alto-
gether.   Those who are exposed to the wea-
ther  are very liable to it ; also those who are
intemperate,  and  those who have  heart and
kidney disease. The best thing for those who
can afford  it is to keep in the house in  bad
weather, or  seek some milder  climate,  but
this can seldom be done.  Wearing a respira-
tor, not talking in the open air, and avoiding
fogs  and night air, are useful measures.  (See
Bronchitis and Emphysema.)
  WINTER-GREEN.  (See Chimaphila.)
  WISDOM-TEETH are generally cut be-
tween twenty and twenty-five years of age  ;
they are four in  number, two  in  each jaw,
and are placed at  the back part of the mouth.
Sometimes a little discomfort  attends their
coming through the gum.
  WOMB.  (See ' Uterus, Inversion  of
Womb, Involution, Pregnancy,  and Pro-
lapsus.)
  WOOL may either be bought  at the chem-
ist's, under the name of cotton-wool, when it
is  very  fine  and  white and soft,  or at the
draper's, under the name of wadding, when
it has a sort of glaze or thin skin  over it,
which enables it  to be cut into  lengths, and
when opened so  that the skin  is outside it
forms a valuable dressing and protection from
the air  for burns  and scalds,  and is also
largely used as a warm covering  for rheumat-
ic limbs and joints, and in  cases where flan-
nel appears to be too  harsh and  unyielding a
material.
  WORMS include all those parasites which
infest the  intestinal  canal ;  they are com-
monly  divided into three classes—the tape-
worms,  the round worms,  and the thread-
worms.   (See Anthelmintics,  Ascarides,
Entozoa, and Parasites.)
  WORMWOOD is the  flowering herb of
the Artemisia Absinthium, and is the flavor-
ing ingredient in  the  liqueur absinthe.  The 
486
WOUNDS
XANTHELASMA
X.
  The most frequent cause of non-congenital
forms of wry-neck is rigidity of the muscles
on one  side of the neck in consequence of
rheumatic or inflammatory affections.   The
distortion  in some few  instances  is due to
paralysis of one sterno-mastoid muscle, the
head being drawn to the opposite shoulder by
the unopposed contraction of the fellow mus-
cle.  A  condition resembling  genuine wry-
neck  may  be  produced by   the  following
causes :  disease of  the bones or joints of the
cervical  portion of the spine, the retractile ac-
tion of an  extensive scar on one side of the
neck, extensive scrofulous  ulceration along
the neck, swelling and induration of cervical
glands.
  A variety of  wry-neck is occasionally met
with in which there are  incessant spasmodic
contractions of one sterno-mastoid muscle,
approximating  the head  to the shoulder by
violent,  jerking movements.    This trouble-
some affection is always acquired, and seldom
comes on  before  the  age of twenty-five or
thirty years.  It occurs  more  frequently in
females than in  males.   After it  has lasted
for a long time great pain is  left by the pa-
tient, in consequence of  the violent and re-
peated  movement of the head  and the verte-
bral bones in the neck, and much debility re-
sults  from  want of sleep.   The  convulsive
movements in most cases persist during the
life of the patient, although they may be re-
lieved from time to time by galvanism and by
a  change  of air  and  scene.   Subcutaneous
section of  the lower part of the affected sterno-
mastoid muscle arrests the spasmodic  move-
ments, but these in the course  of a month or
six weeks usually return  again  with the same
activity.  Occasionally  spasmodic wry-neck
is  a temporary affection excited  by gastric
and intestinal irritation or congestion of the
liver.
  Treatment.—In  cases of  genuine  wry-
neck, whether  congenital  or  acquired,  cure
may  sometimes  be effected by the use of a
collar or machine contrived in order to keep
up prolonged and gradually increasing exten-
sion of the contracted sterno-mastoid muscle.
This kind of treatment is usually  associated
with frequently repeated shampooing of the
affected  side of the neck.  In old and ad-
vanced  cases,  however,  this treatment will
prove ineffectual, and  then  the last resource
of  the surgeon will  be subcutaneous division
of  the contracted  muscle.  This  operation,
followed by gradual elevation of the head by
means of  a collar, generally results in per-
manent  cure.
odor is disagreeable and the taste very bitter.
The substance contains a bitter principle ab-
stracted  by alcohol, called absinthine.  The
plant itself, or an infusion of it, is a powerful
bitter tonic, and it  is said also anthelmintic.
The liqueur is said  to give rise to peculiar
affections of the nervous  system, different
from those of ordinary alcoholism.
  WOUNDS.  (See Accidents,  Dissection
Wounds, Gun-shot Wounds.)
  WRIST-DROP is a symptom occasionally
met with  in cases of lead-poisoning ;  the
patient is  then more or less unable to  raise
the wrist, as the  extensor  muscles  of  the
arms are wasted and paralyzed.  (See Lead
Poisoning).
  WRITER'S CRAMP is  a wasting of the
muscles of the ball of the thumb, caused, as
the name  implies, by too  much  using of
them ; rest and electricity are the best reme-
dies.   (See Paralysis.)
  WRY-NECK consists in a remarkable but
not  very  uncommon distortion of the head
and  neck, which  in the majority of  cases is
congenital.   In a well-marked  instance  of
this  affection the  following  appearances are
presented : the  entire head  is  bent forward
and downward, and is approximated to the tip
of the  shoulder, usually on  the  right side ;
the  face is  directed  forward,  slightly up-
ward, and  to the opposite or left side ; the
right side of the neck is traversed in  a direc-
tion from above  downward  and  forward by
a tense and hard subcutaneous band which is
formed by the persistent and unnatural con-
traction of  the sterno-mastoid  muscle—the
muscle which in the healthy stale  may be dis-
tinctly seen passing from  the back of the ear
on each side  downward along the side of the
neck to the upper margin of the breast-bone ;
the side of the face which  corresponds to the
contracted  sterno-mastoid muscle is  usually
smaller than  the opposite half ; any attempt
made to restore  the head to its normal  erect
position will always cause  severe pain.  This
distortion,  when congenital,  may be  due to
some disorder or deficiency in development of
the fcetal nervous system,  to  uterine pressure
associated with an irregular  position of the
child in  the womb, or to  violence produced
during delivery, as  forcible  twisting of the
neck by the rough "usage of forceps.  The
congenital  wry-neck is usually slight  and al-
most inappreciable  for some months  after
birth, but as the child grows up and begins to
take active exercise, the distortion rapidly in-
creases, and soon gives rise to uneasiness and
even suffering.
  XANTHELASMA  is a  disease  of the
skin in which yellow, slightly raised patches
occur on  various parts  of the body.   It is
most common around the eyelids, but is seen
also on the elbows, knuckles, and other parts
of the body.   It is sometimes associated with 
XANTHIC OXIDE                          YELLOW  GUM         487
jaundice, but it  is a condition of no practical
importance  and requires no treatment.  It is
of very rare occurrence, and gives rise to  no
troublesome symptoms.
  XANTHIC OXIDE, or XANTHINE, is
sometimes met with in the form of a calculus,
or stone in the bladder :  such stones are usu-
ally small, but are of such  rare occurrence as
to be looked upon more as curiosities than as
possessing any practical interest.
  XANTHINE.  (See Xanthic  Oxide.)
  XERODERMA,  or ICHTHYOSIS, is a
form of dry skin sometimes met with in chil-
dren and adults.  It is usually congenital, and
may occur in many members of the same fam-
ily. The skin is1 dry, harsh, and rough.  On the
face the epidermis  is usually comparatively
smooth ; on the neck  it is rough and has a
branny appearance ; on the rest of the body,
cracks are seen  on the  skin.  Such patients
do  not  generally enjoy good health, and are
liable to palpitation of the heart.
  Treatment.—This is  usually of but.  little
avail.  Olive oil will remove the scales and
improve the general appearance, while cod-
liver oil and steel may be taken internally for
the benefit of the health.
Y.
   YEAST as  used in medicine   is chiefly
 employed in  making poultices.   These  are
 applied to old sores, but are not so useful as
 charcoal  poultices  or those  of chlorinated
 soda.
   YELLOW FEVER is an infectious, con-
 tinued fever, beginning with languor, chilli-
 ness,  headache,  and pain in the  back ;  the
 countenance is flushed and the eyes moist and
 suffused ; the skin gradually acquires a lemon
 or greenish-yellow color ;  there  is  generally
 a wandering of the mind, and often delirium  ;
 the patient is  restless and watchful, or he may
 pass  into  a state of  drowsiness  and  then
 coma ; there is an uneasy feeling at the pit of
 the stomach, and vomiting, at first  of a clear,
 glairy fluid, and afterward of a coffee-ground
 appearance ; there may also be  irrepressible
 hiccough, and shrieking or melancholy  wail-
 ing.  Sometimes the disease progresses with
 fearful rapidity, running through all the stages
 and putting an end to the  patient's  life with-
 in twenty-four hours.  The vomiting of the
 dark-colored fluid is indicative of a fatal ter-
 mination.
   Yellow fever was first recorded in the West
 Indies in 1647, and  since  then  it  has  been
 more or less present up to the present time.
 In St. Thomas and San Domingo the  disease
 seems to be permanently located.   It appears
 to affect  those who live in the  low country
 more than  those  on the  hills ;  it  does  not
 spread, as  a rule,  to parts more  than  3000
 feet above  the sea.  A certain amount  of
 heat is essential to the development of  this
 fever ; few cases are observed where the tem-
 perature is less than 720 Fahr. ; and the first
 frost puts an end to its spread.   Dr. Maclean,
 who has had much experience  of  disease in
 the tropics, thus lays down the differences be-
 tween  yellow  and remittent  fevers :  Yellow
 fever  is  specifically  distinct  from  remittent
 fever.  Yellow fever is unknown   in India,
where true malarial  fevers abound.  There is
in yellow fever an absence, for the  most part,
of that periodicity  which  is so characteristic
of true malarial fevers—i.e., the remissions
 and exacerbations.   Men  do not pass from
 recovery  to  health, as is the case in such a
 marked  degree in yellow fever, after which
 there is no, orrery little, evidence of the ex-
 istence of any cachexy.  Malarial fevers exist
 and are destructive at a temperature at which
 yellow fever is at once destroyed.  Albumi-
 nous urine is almost invariable in yellow fever,
 only  occasional in remittent.   There is  in
 yellow fever a great  deal of bleeding from
 various parts of the body ; in remittent fever,
 this is   generally  absent.   Quinine  has a
 power over the malarial fevers, but not over
 yellow  fever.   Men  suffer  from  malarial
 fevers again and again ; second attacks of yel-
 low fever are very rare.
  Treatment.—The  patient  should   have a
hot bath in the first stage, and then, going to
bed, he should  have warm drinks so  as to en-
 courage sweating ; this may be followed by a
 purgative so  as to  have  the bowels  well
 open.  Mercury need not be  given ; nor is
 quinine of any use.   The sickness is very dis-
 tressing,  but may be relieved  by lime-water
 or by a few drops of chlorodyne  or chloro-
 form ;  creosote and  hydrocyanic acid do not
 seem to be  of any use  for  this  purpose.
 Stimulants must be given according to  the
 needs  of  each  case.  The great objects in
 treatment  are  to  sustain  the vital  powers,
 to moderate the febrile excitement, and to
 check  any  distressing symptoms that may
 arise.  Of course, competent medical advice
 should be obtained at the earliest  possible
 moment.
  YELLOW GUM, or the jaundice of new-
 born  children,  comes on two or  three days
 after birth, and then the child's skin is of a
 yellow color, the urine very dark, and stain-
 ing  the  cloths a  deep yellow, while  the
 motions  are.  light.   It is a simple  disorder,
 which will soon pass away.   It is due to the
 liver, being engorged from the lungs, not act-
 ing properly at first.   The child should  be
 put to the breast, and the mother's milk is
 generally sufficiently aperient at first to open
 the bowels ; if  not, a little grey powder may 
488         YELLOW-WASH
ZYMOSIS
be given at bed-time.   It may be some days
before the  yellow tinge has quite gone from
the ski
  ZINC is introduced into  the Pharmaco-
poeia in the metallic form for the preparation
of its chloride.
  The  oxide of zinc  is made by heating the
carbonate.  It  is a white  powder,  without
taste or smell, and turns  yellow by heating.
Its only preparation  is an ointment, which is
very useful.  If given internally  in  large
doses  it  causes vomiting, but is never  used
with that intention.   It is chiefly given  as  a
nervine tonic and astringent.  It is used, as
are all the other preparations of zinc given
internally,  in chorea, epilepsy, hysteria, and
neuralgia.   Externally, the ointment is  very
useful as an application to raw, weeping sur-
faces.  The dose is 5 or 10 grains.
  Calamine is a form of oxide  no longer offi-
cinal.  Its  ointment, known  as  Turner's
cerate, long had a reputation where now the
oxide is used.
  Chloride of zinc is  made by dissolving zinc
in hydrochloric acid.  A solution of it is offi-
cinal.  When made into a paste with  llour or
any  similar substance the chloride acts as  a
powerful escharotic.    In  weaker solutions it
is a useful astringent.  Chloride of zinc paste
is sometimes used to destroy cancerous mass-
es and malignant ulcers, so as to obtain  a
healthy fresh surface.  A solution of this was
long used for disinfectant purposes, under the
title  of Sir W.  Burnett's solution.
  Sulphate of zinc is the most  important salt
of the metal.   It is got by  dissolving  the
metal in sulphuric acid, as when  hydrogen is
prepared.  The salt  occurs  in crystals,  very
much alike to those of Epsom salts, but gives
off water instead of abstracting it from the
atmosphere.  Sulphate of  zinc  given inter-
nally in  fair doses, gives rise  to  vomiting,
speedily  and surely.  It  is  thus one of our
best  emetics in  suitable cases, but must not
be administered where there  is already irrita-
tion.   It  is given in smaller  doses like the
oxide,  as  a tonic,  in nervous  complaints,
chorea, epilepsy, hysteria, and the like.  It
is well combined with valerian.  Externally,
sulphate of zinc is very largely used in vari-
  YELLOW-WASH is  a lotion made  by
dissolving   corrosive   sublimate  in  lime-
water.
ous forms of discharge, and is a most valua-
ble astringent.  The  dose as  an emetic is
from 15 to 20 grains, as a tonic 3 to 5.   As a
lotion 3 grains may be dissolved in an ounce
of water.
   Carbonate of zinc and acetate of zinc are as
yet little employed ;  their effects are interme-
diate  between  those of the oxide and of the
sulphate.
  ZYMOSIS  is a technical term, applied to
actions of a peculiar and  not much-under-
stood  nature,  and  allied  to  fermentation.
There are various  fevers which seem to have
their origin in some poison which enters the
system, and there for a time  the poisonous
germs  seem to multiply and  increase ; thus
if a person be inoculated with a most minute
quantity of small-pox matter he will catch the
disease, if unprotected, and in the course  of
a few days hundreds of pustules will appear,
and from  each of these pustules a little fluid
may be taken, and  thousands of  persons
might  in  this way have  the disorder.   Now
although we are ignorant as to the exact na-
ture of the poisons  in the different fevers,
there are fair grounds for assuming that, when
a small dose of any poison of this class enters
the blood, it there  goes through a process of
multiplication  just  as yeast does during fer-
mentation.  All these poisons are contagious.
There  are  seven  principal diseases of  the
zymotic class,  according to the nomenclature
of the  Registrar-General,  and eleven others
less common :  1, small-pox ;  2,  measles ; 3,
scarlet-fever ;  4,  diphtheria ;  5,  croup ;  6,
whooping-cough ; 7, continued fevers, includ-
ing typhus, typhoid, and simple  continued
fever ; 8,  quinsy ; 9,  erysipelas ;  10,  puer-
peral fever ; 11, carbuncle  ; 12, influenza ; 13,
dysentery ; 14, diarrhcea ; 15, cholera ; 16,
ague ;  17,  remittent fever ; 18, rheumatism.
It is most important to remember that all zy-
motic diseases are in a great measure prevent-
ible, and if proper precautions were observed
and sanitary measures regularly carried out,
an immense number of lives might  be  annu-
ally saved to the country.
Z.
the end. 
INDEX.
Abdomen, 7.        ...
    Gunshot wounds in the, 19C.
Ablution, 7.
Abnormal, 8.
Abortion, 8.
Abrasion, 8.
Abscess, 8.
    Lumbar, 292.
    Psoas, 392.
Absinthe, 9.
Absorbents, 9.
Absorption, 10.
Abstinence, 10.
Acacia, 10.
Accidents:
    Bites or Stings,  11.
    Bleeding, 10.
    Bruises,  11, 47.
    Burns and Scalds, 11, 48.
    Choking, 65.
    Cut-Throat, 91.
    Dislocations. 116.
    Fractures, 173.
    Gunshot Wounds, 195.
    Railway Injuries, 399.
    Sprains, 11, 437.
Acetic Acid, 12.
    Glacial,  187.
Acholia, 12.
Acidity of the Stomach, 12.
Acne, 12.
Aconite, 12.
Acrid, 13.
Actea, 13.
Acupressure, 13.
Acupuncture, 13
Acute Hydrocephalus, 13, 224.
Addison's Disease,  13.
Adhesion, 13.
Adipose, 13.
Aeration, 13.
Affusion, 14.
After-birth.  See Placenta.
After-pains,  14.     .               ,
Ague.  See  Intermittent Fever and
     Malaria.
Air, 14.
Air-passages, 15.
Albino, 15.
Albumen, 15.
Albuminuria, 15.
Alcohol,  16.
Alcoholism, 16.
Ale.  See Beer.
Aliment.  See Diet and  Food.
 Alkalies, 17.
 Alkaloid, 17.
 Allopathy, 17.
 Allspice, 17.
 Almonds, 17.
 Aloes, 17.
 Alopecia.  See Baldness.
 Alteratives, 17.
 Alum, 17.
 Amaurosis, 17.

 aSS&U.   See Vision, Double.
Ambulances, 18.
Amenorrhcea, 19.
Ammonia, 19.
Ammoniacum, 20.
Amnesia, 20.
Anaemia. 20.
Anaesthetics, 20.
Anasarca, 21.
Anchylosis, 21.
Aneurism, 21.
Angelica, 22.
Angina Pectoris, 22.
Angostura Bark, 22.
Angular Curvature, 22.
Animal Heat.  See Heat, Animal.
Anise-seed, 22.
Ankles:
    Dislocated, 120.
    Sprained, 11, 437.
    Weak, 22.
Anodynes.   See  Narcotics.
Anorexia.  See Appetite.
Antacids, 23.
Anthelmintics, 23.
Anthrax.  See Carbuncle.
Antidote, 23
Antimony, 23.
Antiphlogistics,  23.
Antiscorbutics, 23.
Antiseptics, 23.
Antispasmodics, 23.
Anus, Artificial, 23.
Anus, fissure of the, 163.
Aorta, 24.
Aperients, 24.
Aphasia, 25.
Aphonia, 25.
Aphthae, 25.
 Apncea, 26.
 Apoplexy, 26.
 Appendix Vermiformis, 27.
 Appetite, 27.
 Apples, 27.
 Aqua Fortis, 27.
 Arachnitis,  27.
 Arcus Senilis, 28.
 Ardent Spirits.  See Alcohol.
 Aristolochia, 28.
 Arm:
     Broken, 177.
     Dislocated,  118.
 Arnica. 28.
 Aromatics, 28.
 Arrack, 28.
 Arrowroot, 28.
 Arsenic, 28.
 Arteries, 29.
 Arthritis, 29.
 Artificial Anus, 23.
   -----  Mineral  Waters, 320.
   .-----  Respiration, 29.
 Ascarides, 29.
 Ascites, 29.
 Asiatic Cholera.  See Cholera.
 Asphyxia, 29.
 Assafoetida, 30.
 Asses' Milk, 313.
Asthenia, 30.
Asthma, 30.
Astigmatism, 30, 155.
Astringents, 30.
Ataxy, 31, 389.
Atheroma, 31.
Atmosphere.  See Air.
Atomized Fluids, 166.
Atrophy, 31.
    Of the Heart, 212.
    Of the Liver, 289.
    Of the Muscles, 390.
Atropia, 31.
Aura, 31.
Auricle, 31,  209.
Auscultation, 31.
Axilla, 31.
Azote, 31.

Baker's Itch, 31.
Baldness, 31.
Balm of Gilead, 32.
Balsam, Canada, 52.
Balsam, Friar's.   See Benzoin.
Balsam of Copaiba,  85.
Balsam of Peru, 32.
Balsam of Tolu, 451.
Bandages, 32.
Bantingism, 33.               .  .
Barbadoes Leg.  See Elephantiasis.
Barbadoes Tar, 33.
Barberry, 33.
Bark.
     Angostura, 22.
     Cascarilla, 56.
     Cinchona, 68.
     Cinnamon, 6g.
     Mezereon, 312.
     Oak, 342.
     Peruvian, 368.
     Pomegranate, 383.
 Barley, 33.
 Baryta, 33.
 Basilicon, 33.
 Bathing, Sea, 33.
 Baths :
     Cold, 34.
     Hot, 34.
     Medicated, 34.
     Roman, 34.
     Sitz, 427.
     Turkish, 34.
 Bay, 34.
 Bay Cherry, 34.
 Bay Salt, 34.
 Bed-sores, 34.
 Beef-tea, 35.
 Beer, 35.
 Beeswax.  See Wax.
 Belching.   See Eructation.
 Belladonna, 33.
 Belly.  See Abdomen.
 Belly-ache.  See Colic.
 Benzoin, 36.
 Berberry.   See Barberry.
  Berries, poisonous, 36.
 Betel, 36. 
490                                           INDEX.
Bile, 36.
Bilious Headache.  See Headache.
Bilious Fever.  See Remittent Fever.
Birds as Food, 36.
Birth. See Labor.
Birth-mark.  See Naevus.
Bismuth, 37.
Bistoury, 37.
Bites :
    Insects, 257.
    Snakes, 431.
Bitter Almonds.  See Almonds.
Bitter-sweet.   See Dulcamara.
Black Draught, 37.
Black Snake Root.  See Actea.
Black Vomit, 37.
Black Wash, 37.
Bladder, 37.
    Stone in the, 440.
Blebs, 37.
Bleeding,  10, 37.
    From the Bowels (Melasna), 303.
    From the Nose (Epistaxis), 144.
Blindness.  See Amaurosis,  Color-
    blindness, and Eye.
Blister, 37.
Blood, 38.
Blue Disease.   See Cyanosis.
Blue Ointment, 39.
Blue Pill, 39.
Blue Stone.  See Copper.
Boils, 39.
    In the ear, 130.
Bone, 39.
    Exfoliation of, 150.
Bone-Felon.  See Whitlow.
Borax, 40.
Bougie, 40.
Bowels.   See  Abdomen,  Enteritis,
    and Melaena.
Brain, 40.
Brain-Fever.   See Meningitis.
Bran, 41.
Brandy, 42.
Bread, 42.
Breast, 42.
Breast-Bone, 42.
Breast-Pang.  See Angina Pectoris.
Breath, Shortness of.  See Dyspnoea.
Bright's Disease, 42.
Brimstone.  See Sulphur.
Bromide of Potassium.   See Potass.
Broken Bones.  See Fractures.
Bromine, 44.
Bronchi, 44.
Bronchitis, 44.
Bronchocele.   See Derbyshire Neck.
Bronzed Skin, 47.
Broom, 47.
Brow Ague, 47.
Bruises, 11, 47.
Bryony, 47.
Bubo, 47.
Buchu, 48.
Bullae, 48.
Bunion, 48.
Burgundy.  See Wines.
Burns and Scalds, 11, 48.
Bursae, 50.
Butter, 51.

Caecum, 51.
Caesarean Section, 51.
Cachexia, 51.
Caffeine.  See Coffee.
Cajeput Oil, 51.
Calabar Bean, 51.
Calcareous Degeneration.  See  De-
    generation.
Calcification.  See Degeneration.
Calculus, 51.
Calomel.   See Mercury.
Calves-Foot Jelly.  See Gelatine.
Calumba.   See Columba.
Camomile.  See Chamomile.
 Camphor, 52.
 Canada Balsam, 52.
 Cancer, 52.
 Cancrum Oris, 53.
 Canella, 54.
 Canker.  See Cancrum Oris.
 Cantharides, 54.
 Caoutchouc.  See India-Rubber.
 Capsicum, 54.
 Caramel, 54.
 Caraway, 54.
 Carbolic Acid, 54, 100. 115, 116.
 Carbon.  See Charcoal.
 Carbonic Acid Poisoning, .54.
 Carbuncle, 55.
 Cardamoms, 55.
 Cardialgia,  55.
 Caries, 55.
 Carminatives, 55.
    Dalby'sj 92.
 Carotid Artery, 55.
 Carpus, 55.
 Carrageen Moss, 55.
 Carron Oil, 55.
 Cartilage, 55.
 Cascarilla Bark, 56.
 Caseine, 56.
 Cassia, 56.
 Cassia Pulp, 56.
 Castor Oil, 56.
 Catalepsy, 56.
 Catamenia.  See Menstruation.
 Cataplasm.   See Poultices.
 Cataract, 56.
 Catarrh, 57.
 Catechu, 57.
 Cathartics, 57.
 Catheter, 57.
 Catnip, 57.
 Caul, 58.
 Caustics, 58.
 Cautery, 58.
 Cayenne Pepper.  See Capsicum.
 Cells, 58.
 Cellulitis.  See Pelvic Cellulitis.
 Cellulose, 58.
 Centipedes.  See  Insects, poisonous.
 Cephalalgia.  See Headache.
 Cerate, 58.            %r
 Cerebellum.   See Brain.
 Cerebral Softening, 58.
 Cerebro-Spinal Fever, 59.
 Cerebro-Spinal Meningitis.  See Me-
    ningitis.
 Cerebrum.  See Brain.
 Cervix, 60.
 Cevadilla.  See Sabadilla.
 Chafing.  See Intertrigo.
 Chalk, 60.
 Chalk-Stones, 60.
 Chalybeate, 60.
 Chamomile, 60.
 Champagne.  See Wines.
 Chancre.  See Venereal Diseases.
 Change of Life.  See Menstruation.
 Chaps, 60.
 Charcoal, 60, 115.
 Charpie, 60.
 Cheese, 60.
 Chest, 61.
    Gunshot Wounds in the,  196.
 Cherry-Laurel, 62.
 Chicken-Pox, 62.
 Chicory.  See Coffee.
 Chilblains, 63.
 Children.  See  Diet, Dysentery.
 Child-Crowing.   See  Laryngismus
    Stridulus.
 Chills, 63.
 Chills and  Fever.  See Intermittent
    Fever.
 Chimaphila, 64.
 Chin-cough.  See Whooping Cough.
 Chiretta, 64.
' Chloral, 64.
Chloric Ether, 64.
Chloride of Lime, 64, 115.
Chlorine, 64, 100, 115.
Chlorodyne, 64.
Chloroform, 64.
Chlorosis, 65.
Chocolate.  See Cocoa.
Choke Damp, 65
Choking, 65.
Cholera, 66.
Cholera Infantum, 67.
Cholera Morbus, 67.
Cholagogues, 67.
Chorea, 67.
Chronic Hydrocephalus.   See Hy-
    drocephalus.
Chyle, 68.
Chyme, 68.
Cicatrix, 68.
Cider, 68.
Cinchona, 68.
Cinnabar, 69.
Cinnamon Bark.  69.
Circulation of Blood.  See Heart.
Circumcision, 69.
Cirrhosis of the Liver, 69.
Citrate of Magnesia, 298.
Citrates, 70.
Citric Acid, 70.
Citron, 70.
Claret.  See Wines.
Clavicle.   See Collar-Bone.
Clavus, 70.
Clergyman's Sore Throat.   See Sore
    Throat.
Climacteric, 71
Climate, 71.
Clothing, 72.
Clove-Hitch,  72.
Cloves, 72.
Club-Foot, 72.
Clyster.  See Enema.
Cocculus Indicus, 73.
Cochineal, 73.
Cocoa, 73.
Cocoa-nuts, 73.
Codeia, 73.
Cod-Liver Oil, 73.
Coffee, 74.
Colchicum, 74.
Cold, 74.
Colic, 75.
Collapse.  See Shock.
Collar-Bone, 75.
    Fractured, 176.
Collodion, 75.
Collyrium, 75,
Colocynth,  75.
Cologne,  131.
Colon.   See Abdomen.
Color-Blindness, 76.
Colostum.  See Milk.
Colotomy, 76.
Columba, 76.
Coma, 77.
Combustion, Spontaneous,  77.
Composition of the Human Body, 77.
Compression, 79.
Concretions, 79.
Concussion, 7Q.
Condiments,  80.
Confections, 80.
Confinement.  See  Labor.
Confluent  Small-Pox.   See  Small-
    Pox.
Congestion, 80.
Conia, 8r.
Conjunctiva, 81.
    Diseases  of the,  153.
Conserves, 81.
Constipation, 81.
Consumption, 82.
Contagion, 84.
Continued Fevers, 84.
' Contusions, 84. 
INDEX.
491
Convalescence, 85.
Convulsions, 85.
    Infantile, 243.
    Puerperal, 393.
Cooling  Medicines.  See Refriger-
    ants.
Copaiba, 85.
Copper, 86.
Copperas.  See Disinfectants.
Coriander, 86.
Cornea.   See Eye.
Corn-Flour, 86.
Corns, 86.
Coroner's Court, 86.
Corpulence.    See Bantingism  and
    Diet.
Corrosive Sublimate, 87.
Coryza.   See Nose.
Costiveness.  See Constipation.
Cotton-Wool, 87.
Couching.  See Cataract.
Cough, 88.
Coughing Blood.  See Haemoptysis.
Counter-Irritation, 88.
Coup-de-Soleil (Sunstroke).    See
    Heat-Stroke.
Cowhage, 83.
Cow-Pox, 88.
Crabs, 88.
Crab-Lice, 153.
Cramp, 88.
Craziness.  See Insanity.
Cream, 88.
Cream of Tartar, 83.
Creasote, 89.
Creatine, 89.
Crocus.   See Saffron.
Croton Oil, 89.
Croup, 90.
Cubebs, 90.
Cumin, 90.
Cupping, 90.
Curcuma.  See Turmeric.
Curry-Powder, 90.
Curvature of the Spine.   See Lateral
    Curvature.
Cusso,  91.
Cut-Throat, 91.
Cuts.   See  Accidents.
Cyanides, 91.
Cyanogen, 91.
Cyanosis, 91.
Cystitis, 91.
Cysts, 92.

Dalby's Carminative, 92.
Daltonism,  92.
Dandelion,  92.
Dandruff, 92.
Datura.  See Stramonium.
Deadly   Nightshade.    See  Bella-
    donna.
Deafness, 92.
Death-Rattle.  See  Rattle.
Death, Sudden.  See Sudden Death.
Debility, 93.
Decline,  bee Consumption.
Decoctions, 93.
Defecation, 94.
Defervescence, 94.
Deformities:
    Anchylosis, 21.
    Club-Foot, 72.
    Fiat-Foot, 164.
    Hare-Lip, 203.
    Knock-Knee, 273.
    Malformation, 298.
    Spina Bifida, 435.
    Wry Neck, 486.
Degeneration, 94.
Deglutition, 96.
Deliquescence, -96.
Delirium, 96.
Delirium Tremens, 96.
Delitescence, 97.
Delivery.  See Labor.
Delusion.  See Insanity.
Dementia. 97.
Demodex Folliculorum, 97.
Demulcents, 98.
Dentifrice.  See Teeth.
Dentition, 98.
Deobstruents, 100.
Deodorants, 100.
Depilatories, 101.
Derbyshire Neck, 101.
Determination of Blood, 102.
Dew-Point, 102.
Dextrine, 102.
Diabetes, 102.
Diachylon, 103.
Diaphoretics, 103.
Diaphragm, 103.
Diarrhoea, 103.
Diastole, 107.
Diathesis, 107.
Diet, 107.
    of Infants, 108.
    of Children, 109.
    of Adults, no.
Digestion, in.
Digitalis, 112.
Dilatation, 112.
Dill, 112.
Diluents, 112.
Dioresis, 112.
Diphtheria, 112.
Diphtheritic Paralysis, 359.
Dipsomania, 113.
Disinfectants,  115.
Dislocation, 116.
    of Ankle-joint, 120.
    of Elbow, 118.
    of Hip-joint, 119.
    of Knee-cap, 120.
    of Knee-joint, 120.
    of Lower-jaw, 118.
     of Shoulder, 118.
     of Thumb, 119.
Dispensaries, 121.
Dissection Wounds, 121.
Distilled Spirits, 121.
Distilled Water.  See Water.
Diuretics, 122.
Dizziness.  See Vertigo.
Donovan's Solution,  122.
Douche, 122.
Dover's Powder, 122.
Dragon's Blood, 122.
Drainage.  See House.
Drain Fever.  See Typhoid Fever.
Drastics, 123.
Dress.  See Clothing.
Dropped Wrist, 123.
Dropsy, 123.
Drowning, 123.
     Treatment of  the  apparently
       drowned, 124.
 Drowsiness, 125.
 Drunkenness, 12s.
 Dry Cupping.  See Cupping.
 Dulcamara, 127.
 Dulcamarine, 127.
 Dumb Ague.  See Intermittent Fe-
     ver.
 Dumbness, 127.
 Dura Mater, 127.
 Dysentery, 127.
 Dysmenorrhcea, 128.
 Dyspepsia.  See Indigestion.
 Dyspnoea, 129.
 Dysuria, 129.

 Ear, 129.
     Foreign Bodies in the, 172.
 Earache,  131.
 Earth-closets, 131.
 Eau de Cologne, 131.
 Ecchymosis.  See Bruises,
 Echinococcus, 131.
Eclampsia.  See  Puerperal Convul
    sions.
Ecraseur, 131.
Ecstasy, 131.
Ecthyma, 131.
Ectozoa, 132.
Ectropion.  See Eye.
Eczema, 132.
Effervescing Draughts, 134.
Effusion, 134.
Eggs, 134.
Elaterium, 134.
Elaterine, 135.
Elbow, Dislocation of, 118.
Elder Flowers, 135.
Electricity, 135.
Electro-Biology.   See Mesmerism.
Electuaries, 136.
Elemi,  136.
Elephantiasis, 136.
Elixir,  136.
Elm Bark, 136.
Emaciation, 136.
Embalming, 136.
Embolism, 136.
Embrocations, 136.
Embryo, 136.
Emetics, 137.
Emmenagogues, 137.
Emollients, 137.
Emphysema, 137.
Empyema, 139.
Emulsions, 140.
Encephalitis, 140.
Encephaloid Cancer.  See Cancer.
Endemic Diseases, 140.
Endocarditis, 140.
Enema, 140.
Enervation, 141.
Enteric Fever.  See Typhoid Fever-
Enteritis, 141.
Entomania.  See Insanity.
Entophyta, 141.
Entozoa, 141.
Entropion.  See Eye.
Enuresis, 143.
 Ephemera.  See Milk Fever.
 Epidemic Diseases, 143.
 Epidermis.  See Scarf-skin.
 Epiglottis, 143.
 Epilepsy,  143.
 Epiphora, 144, 153.
 Epiphyta, 144.
 Epispastics, 144,
 Epistaxis, 144.
 Epithelium, 14;.
 Epsom Salts, 145.
 Epulis, 145, 194.
 Ergot, 145.
 Eructation, 146.
 Eryngo, 146.
 Erysipelas, 146.
 Erythema, 148.
 Escharotics, 148.
 Essences, 148.
 Ether, 148.
 Ether  Spray, 149.
 Eustachian Tube.  See Ear
 Evaporation, 149.
 Evolution, 149.
 Exanthemata, 149, 158
 Excision, 149.
 Excretions,  149.
 Exercise, 149.
 Exfoliation of Bone, 150.
 Exophthalmos, 150.
 Exostosis, 150.
 Expectorants, 150.               j
 Expectoration, 150.
 Extracts, 150.
 Extravasation of Urine, 151.
 Eye, 151.
     Foreign Bodies in the, 172.

 Face-ache, 135.' 
492
INDEX.
 Facial Palsy.  See Paralysis.
 Faecal Accumulation, 155.
 Fxcal Vomiting, 155.
 Faeces, 155.
 Fainting.  See Syncope.
 Faintness, 156.
 Falling Sickness.  See Epilepsy.
 Fallopian Tubes, 157.
 False Joints, 157.
 Famine Fever.  See Relapsing  Fe-
    ver.
 Farcy.   See Glanders.
 Farns,  158.
 Fat.  See Adipose and Bantingism.
 Fatty Degeneration. See Degenera-
    tion.
 Fatty Heart.  See Degeneration.
 Fauces,  158.
 Febrifuge, 158.
 Febrile Disorders, 158.
 Feeding Bottle, 158.
 Fennel,  1-8.
 Fern, 158.
 Fever, 158.
    Bilious, 36.
    Cerebro.-spinal, 59.
    Hectic, 214.
    Milk, 314.
    Puerperal, 394.
    Purpuric, 395.
    Putrid, 396.
    Relapsing, 402.
    Remittent, 403.
    Rheumatic, 404.
    Scarlet, 419.
    Typhoid, 456.
    Typhus, 457.
    Yellow, 487.
 Fibrin,  i6r.
 Fibrous  Degeneration.  See Degen-
    eration.
 Figs, 161.
 Filters, 161.
 Fingers, 162.
    Fractured, 178.
 Fish, as food, 163.
 Fish, poisonous, 163.
 Fissure of the Anus, 163.
 Fistula,  164.
 Fits, 164.
 Flanks, 164.
 Flannel, 164.
 Fiat-Foot, 164.
 Flatulence, 164.
 Floating Tumors, 165.
 Flooding.  See Labor and Ergot.
 Flowers of Sulphur,  165.
 Fluctuation,  166.
 Fluids, Atomized, 166.
 Flux, 166.
 Foeticide, 167.
 Foetus, 167.
 Fomentations, 167.
 Food, 167.
 Forceps, 171.
 Foreign Bodies:
    in the Ear, 172.
    in the Eye, 172.
    in the Nose, 172.
    in the Rectum,  172.
    in the Throat, 172.
    in the Vagina, 172.
    in the Windpipe, 171.
Formication, 173.
Fousel Oil, 173.
Foxglove.  See Digitalis.
Fractures, 173.
    Arm-bone, 177.
    Collar-bone, 176.
    Fingers, 178.
    Forearm, 178.
    Taw, 175.
    Knee-cap, 177.
    Leg, 177-
    Nasal Bones, 175.
    Ribs, 179.
    Thigh, 176.
Frankincense, 179.
Freckles, 179.
Friar's Balsam.   See Benzoin.
Frost-bite, 179.
Frozen Limbs, 180.  -
Fumigation, 180. _
Fungus Hoematoides, 180.
Fusel Oil.  See  Fousel Oil.

Galbanum, 181.
Gall.   See Bile.
Gall-Bladder, 181.
Galls,  181.
Gallic  Acid,  181.
Gall Stones, 181.
Galvanism, 183.
Gamboge, 183.
Ganglion, 183.
Gangrene, 183.
Gargles, 183.
Gastric Catarrh.  See Indigestion.
Gastric Fever.   See Typhoid  Fever.
Gastric Juice, 184.
Gastric Ulcer, 184.
Gastrodynia, 186.
Gelatine,  186.
Gentian, 187.
Giddiness.  See Vertigo.
Gin.  See Distilled Spirits.
Gin-Drinker's Liver, 187.
Ginger, 187.
Glacial Acetic Acid, 187.
Glanders, 187.
Glands, 188.
Glass-Pock.  See Chicken-Pox.
Glauber's Salts,  188.
Glaucoma.  See Eye.
Gleet.  See Venereal Diseases.
Globulin,  188.
Glossitis.   See Tongue.
Glottis, 188.
Glucose,  188.
Glycerine, 188.
Glycogen, 189.
Goitre. See Derbyshire Neck.
Golden Ointment, 189.
Gonorrhoea.  See Venereal Diseases.
Goose-skin, 189.
Goulard Water.   See Lead.
Gout, 189.
    Plumber's, 376.
    Rheumatic,  406.
Granular Degeneration, 191.
Granulations, 191.
Grape-sugar, 191.
Gravel. lot.
Graves's  Disease, 192.
Green Sickness.   See Chlorosis.
Gregory's Powder, 193.
Grey Powder, 193.
Griffith's Mixture, 193.
Gripings,  193.
Gristle.  See Cartilage.
Grocer's Itch, 193.
Guaiacum Wood, 193.
Gullet, Obstruction of, 193.
Gum Acacia.  See Acacia.
Gum Arabic.  See Mucilage.
Gum Benjamin.   See Benzoin.
Gumboil,  194.
Gums,  Diseases  of the, 194.
Gunshot Wounds, 195.
Gymnastics,  196.
Gypsum.   See Plaster of Paris.

Haemoptysis, 198.
Haemorrhage, 198.
    Cerebral, 199.
Haematemesis, 199.
Haematuria, 200.
Haemorrhoids, 201.
Hair, Diseases of the, 202.
Hallucination.   See Insanity.
Hanging, 203.
Hare-Lip, 203.
Hartshorn.   See Ammonia.
Hay-Fever, 204.
Head.  See Scalp.
Head-ache, 204.
Health.  See Hygiene.
Health Resorts of America and  Eu-
  rope, 206.
Hearing, 209.
Heart, 209.
    Diseases of the, 212.
Heartburn, 213.
Heat, 213.
Heat, Animal, 214.
Heat-spot, 214.
Heat-Stroke, 214.
Hectic Fever, 214.
Hellebore,  215, 473.
Hemiplegia, 215.
Hemlock, 216.
Hemorrhage.  See  Haemorrhage.
Hemp, Indian, 216.
Henbane, 216.
Hepatic Disorders.   See Liver.
Hepatitis, 216.
Hermaphrodite, 217.  •
Hernia, 217.
Herpes, 218.
Hiccough,  219.
Hickory-Pickory.   See Hiera Picra.
Hiera Picra, 219.
Hip-joint Disease, 219.
    Dislocation of Hip-joint, 119.
Hoarseness, 219.
Hob-nailed Liver, 219.
Hock.  See Wines.
Home-sickness. See Mal-de-Pays.
Homoeopathy,  219.
Honey, 220.
Hooping -  cough.    See  Whooping-
  cough.
Hops, 220.
Hordeolum, 220.
Horehound, 220.
Horse-radish, 220.
Hospital Gangrene, 220.
Housemaid's Knee, 221.
Houses, 221.
Human  Body.  See Composition of
  the Human Body.
Humidity,  223.
Hydatids, 224,  290.
Hydragogues, 224.
Hydrate of Chloral.  See Chloral.
Hydrocephalus, 224.
Hydrochloric Acid, 223.
Hydrocyanic  Acid.    See  Prussic
  Acid.
Hydrogen, 225.
    Sulphuretted, 225.
Hydropathy, 225.
Hydro-Pericardium, 225.
Hydrophobia, 226.
Hydrothorax, 227.
Hydruria,  227.
Hygiene, 227.
Hygrometer, 227.
Hyoscyamus.  See Henbane.
Hyperaemia, 228.
Hypermetropia, 155.
Hyperpyrexia, 228.
Hypertrophy, 22S.
Hypochondria, 228.
Hypodermic Injection, 229.
Hysteria, 229.
Hysterical  Paralysis, 358.

Ice, 231.
Ice-bags, 231.
Iceland Moss, 231.
Ichor.  See Pus.
Icterus.^ See Jaundice.
Icthyosis, 231, 487.
Idiocy, 231. 
INDEX.
493
Idiopathic, 231.
Idiosyncracy, 232.
Illusions, 232, 252.
Impetigo, 232.
Impotence, 232.
Inanition, 232.
Incisions, 232.
Incompatibles, 233.
Incontinence of Urine, 233.
India Rubber, 233.
Indian Hemp, bee Hemp.
Indian Poke.   See Veratrum Viride.
Indigestion, 233.
Indigo, 242.
Induration, 242.
Infanticide, 242.
Infantile Convulsions, 243.
Infantile Paralysis, 359.
Infants, 243.
Infection, 243.
Inflammation, 243.
Influenza, 247.
Infusions, 249.
Infusoria, 249.
Ingrowing Nails.  See Nails.
Inhalation, 250.
Injections, 250.
Inoculation, 250.
Insanity, 250.
Insects, Poisonous, 257.
    Centipedes, 258.
    Scorpions, 257.
    Spiders, 258.
Insolation.  See Heat-stroke.
Insomnia. See Sleeplessness.
Inspissation, 258.
Intermittent Fever, 258.
Internal Bleeding, 261.
Intertrigo, 261.
Intestinal Worms, 261.
Intestines, 261.
Intoxication.   See Drunkenness.
Intussusception, 262,
Inunction, 263.
Inversion of the Womb,  263.
Involution, 263.
Inward Fits, 263.
Iodine, 263.
Ipecacuanha, 264.
1 rrigation, 265.
Iris. 265.
Iritis, 265.
Iron, 266.
Irritants, 267.
Irritation, 267.
Ischuria, 267.
Isinglass.  See Gelatine.
Issues,  267.
Itch, 268.

Jactitation, 268.
Jalap, 268.
James's Powder,  268.
Jaundice, 269.
Jaw:
    Dislocation of, 118.
    Fractured, 175.
Joints :
    Diseases of, 269.
    False, 157.
    Gunshot Wounds of, 196.
Juniper, 270.

Kamela, 270.
Keloid, 270.
Kernels.  See Glands.
Kidneys, the, 271.
King's Evil.  See Scrofula.
Kink-Cough. See Whooping Cough.
Kino, 272.
Kirschwasser, 272.
Kleptomania, 272.
Knee-cap.   See  Dislocations  and
    Fractures.
Knee-joint, 272.
    Diseases of, 272.
    Dislocation of, 120.
    Fracture of, 177.
    Sprains of, 437.
Knock-knee, 273.
Kousso,  274.

Labor, 274.
Laburnum, 274.
Lacmus.  See Litmus.
Lactation, 275.
Lacteals, 275.
Lard, 276.
Lardaceous Degeneration, 276.
Laryngeal Phthisis, 276.
Laryngismus Stridulus, 276.
Laryngitis, 276.
Laryngoscope, 277.
Laryngotomy, 277.
Larynx, the, 277.
Lateral Curvature, 278.
Lateritious Urine, 279.
Laudanum.  See Opium.
Laughing Gas.  See Nitrous Oxide.
Laurel-Cherry.  See Cherry-Laurel.
Lavender, 279.
Laxatives, 279.
Lead, 279.
Lead Colic, 280.
Lead Poisoning, 280.
Leeches, 281.
Leeching,  281.
Leg:
    Eczema  of,  133.
    Fractured, 177.
Lemon, 281.
Lens, 281.
Lentigo, 282.
Lepoid, 282.
Lepra, 282.
Leprosy, 282.
Lettuce, 283.
Leucorrhcea, 283.
Lice.  See Ectozoa.
Lichen, 283.
Liebig's  Extract.  See Meat, Ex-
    tract of.
Life, Change of.  See Menstruation.
Ligature, 283.
Light, 284.
Lightning-stroke, 284.
Lime, 284.
Liniments, 285.
Linseed, 285.
Lipoma.  See Nose.
Lips, wounds of the, 285.
    Cracked, 286.
    Ulcerated, 286.
Liqueurs.  See  Distilled Spirits.
Liquor Sanguinis, 286.
Litharge.  See  Lead.
Lithates, 286.
Lithia, 286.
Litholysis, 286.
Lithotomy, 286.
Lithotrity, 286.
Litmus, 287.
Liver, the, 287.
    Inflammation of. See Hepatitis.
Lobelia  Inflata, 291.
Lock-jaw.  See Tetanus.
Locomotor Ataxy.  See Progressive
    Locomotor Ataxy.
Loins.   See  Lumbar Abscess.
Long-sightedness.  See Eye and Vis-
    ion.
Lotions, 291.
Louse.   See Ectozoa.
Low Fever.  See Typhoid Fever.
Lucifer Match-Maker's Disease, 291.
Lumbago, 292.
Lumbar Abscess, 292.
Lunacy.  See Insanity.
Lunar Caustic, 293.
Lungs, the, 293.
    Wounds of the, 29s.
Lupus, 296.
Lymph, 297.
Lymphatics, 297.
Lymphoma, 297.

Macaroni, 297.
Mace, 297.
Madeira.   See Wines.
Madness.  See  Insanity.
Magnesia,  297.
Mal-de-Pays, 298.
Malaria, 208.
Malformation, 298.
Malignant  Diseases, 299.
Mallow, 299.
Malnutrition, 299.
Malt Liquor.  See Beer.
Mandrake, 299.
Manganese, 300
Mania, 300.
Manna, 300.
Marasmus, 300.
Marjoram, 300
Marriage, 300.
Marsh-mallow, 300.
Mastication, 300.
Mastich, 300.
Match-Maker's Disease.  See Luci-
    fer Match-Maker's Disease.
Matico, 300.
Matter, 301.
Mead.  See Distilled Spirits.
Measles, 301.
Meat, Extract of, 304.
Meconium, 305.
Medulla Oblongata, 305.
Medullary Cancer. See Cancer.
Megrims, 305.
Melaena, 305.
Melancholia, 305.
Melanosis, 305.
Meningitis, 306.
Menorrhagia, 307.
Menstruation, 308.
Mentagra, 308.
Mercury, 308.
Mesentery, the, 310.
Mesmerism, 311.
Metacarpus,  312.
Metastasis, 312.
Metatarsus, 312.
Mezereon Bark, 312.
Miasm.  See Malaria.
Midriff, 312.
Migraine,  312.
Miliaria, 312.
Milk, 312.
Milk Fever, 314.
Milk Leg.   See Phlegmasia Dolens.
Mineral Springs of America and Eu-
    rope, 314.
Mineral Waters, Artificial, 320.
Miscarriage.  See Abortion.
Mixtures,  321.
Moles, 321.
Molluscum, 321.
Monkshood.   See Aconite.
Monomania.  See Insanity.
Morphine.  See Opium.
Mortification, 321.
Moss, Corrageen.  See  Corrageen
    Moss.
Mother's Marks.  See Naevus.
Motes in the Eye.  See Muscae Voli-
    tantes.
Mouth,  Cancer of the.   See Can-
    crum Oris.
Mouth, diseases of the, 323.
Mouth-Washes.  See Gargles.
Moxa, 323.
Mucilage,  324.
Mucous Membrane, 324.
Mucus, 324. 
494
INDEX.
 Mulberry Calculus, 324.
 Mummification.  See Mortification.
 Mumps, 324.
 Muriatic  Acid.  See Hydrochloric
     Acid.
 Muscae Volitantes,  324.
 Muscle, 325.
 Mushrooms, 325.
 Musk, 325.
 Mustard, 325.
 Myalgia.  See Rheumatism.
 Myopia, 326.
 Myrrh, 326.

 Naevus, 326.
 Nails, diseases of the, 327.
 Narcotics, 328.
 Nasal Hemorrhage.  See  Epistaxis.
 Nausea, 328.
 Navel.  See Umbilicus.
 Neck, Stiff, 328.
 Necrosis, 329.
 Nephralgia, 330.
 Nerves, 330.
 Nettle-rash, 331.
 Neuralgia, 331.
 Neuritis, 333.
 Neurosis, 334.
 Nicotine.  See  Tobacco.
 Nightshade,  Deadly.   See Bella-
    donna.
 Nipples, Affections  of the, 334.
 Nitre, 335.
 Nitric Acid, 335.
 Nitrous Ether, 335.
 Nitrous Oxide, 335.
 Nodes, 335.
 Noli me tangere.  See Lupus.
 Nomenclature of Diseases, 336
 Nose :
    Diseases of the, 337.
    Fracture of the, 175.
    Foreign bodies in the, 172.
 Nose-bleed.  See Epistaxis.
 Nosology, 339.
 Nostalgia, 339.
 Numbness, 339.
 Nursing the Sick, 339.
 Nutmeg, 340.
 Nutmeggy Liver, 341.
 Nux Vomica, 341.

 Oak Bark, 342.
 Obesity. See Bantingism, and Weight
    and Height.
 Obstructions:
    Circulation, 343.
    Hepatic, 343.
    Intestinal, 342.
    Renal, 343.
 OZdema, 344.
 Oesophagus, 344.
 Oiled Silk.  See Silk, Oiled.
 Olfactor  Nerves, 344.
 Olibanum, 343.
 Olive Oil, 345.
 Ointments, 345.
    Golden, 189.
    Royal, 410.
 Onychia. _ See Nails, diseases of.
 Ophthalmia, 345.
 Ophthalmoscope, 348.
 Opisthotonos, 348.
 Opium,  348.
 Opodeldoc, 350.
 Opoponax, 350.
 Optic Nerves, 350.
 Oranges, 350.
 Orthopnoea, 350.
 Ossification, 351.
 Otitis, 351.
Otorrhoea, 351,
Ovarian Dropsy, 351.
Ovarian Irritation, 351.
Ovaries, 351.
 Ovariotomy, 351.
 Ovum, 352.
 Oxalic Acid, 352.
 Ox-Gall, 352.
 Oxygen, 352.
 Oxymel, 352.
 Oxyurides, 352.
 Ozoena.  See Nose, diseases of.
 Ozone, 352.

 Packing, 332.
 Pain, 353.
 Painter's Colic, 354.
 Palate, the, 354.
 Palma Chrisli, 355.
 Palpitation of the Heart, 356.
 Palsy.  See Paralysis.
 Pancreas, 356.
 Pandemic, 357.
 Papules, 357.
 Paracentesis, 357.
 Paradise, Grains of, 357.
 Paralysis, 357.
 Paraplegia, 361.
 Parasites, 362.
 Paregoric Elixir, 363.
 Pareira, 363.
 Paronychia.  See Whitlow.
Parotid Glands, 364.
Parotitis.   See Mumps. •
Parsley, 364.
 Parsnip, 364.
 Parturition, 364.
 Patella, 364.
 Peas, 364.
 Pectoriloquy.   See Stethoscope.
 Pellitory, 364.
 Pelvic Cellulitis, 364.
 Pelvis,  365.
 Pemphigus, 365.
 Pennyroyal, 365.
 Pepper, 365.
 Peppermint, 365.
 Pepsin, 365.
 Pericarditis, 366.
 Pericardium, 367.
 Percussion, 367.
 Pericranium, 367.
 Perinxum,  367.
 Periosteum, 367.
 Peritoneum, 367.
 Peritonitis,  368.
 Perityphlitis, 368.
 Perry.  See Cider.
 Perspiration, 368.
 Pertussis.  See Whooping Cough.
 Peru,  Balsam  of.   See  Balsam  of
    Peru.
 Peruvian Bark.  See Cinchona.
 Pessaries, 368.
 Pestilence.  See Fever, and Plague.
 Petechiae, 369.
 Phagedena, 369.
 Phalanx, 369.
 Pharynx, 369.
 Phenic Acid.   See Carbolic Acid.
 Phlebitis, 369.
 Phlebolithes, 369.
 Phlebotomy, 370.
 Phlegm, 370.
 Phlegmasia Dolens, 370.
 Phosphoric Acid, 370.
 Phosphorus, 170.
 Phosphorus Disease, 371.
 Photophobia, 371.
 Phrenology, 371.
 Phthisis.   See Consumption.
 Physiology, 371.
 Physostygma, 371.
 Pia Mater,  371.
 Picrotoxine, 371.
 Pigeon-breast, 372.
 Pigment, 372.
 Piles.   See Haemorrhoids.
 Pimento, 372.
Pins and Needles, 372.
Pitch, 372.
Pityriasis, 372.
Placenta, 372.
Plague, 372.
Plasma, 372.
Plasters, 374.
Plaster of Paris, 374.
Plethora, 374.
Pleura, 374.
Pleurisy, 374.
Pleurodynia, 375.
Pleurosthotonos, 376.
Plumber's Gout, 376.
Plumbism, 376.
Plummer's Pill.  See Mercury.
Pneumonia, 376.
Pneumothorax, 376.
Podophyllin, 377.
Poisoning, 377.
    Antimony, 381.
    Arsenic, 381.
    Belladonna,  381.
    Berries, 36.
    Carbonic Acid, 54.
    Corrosive Sublimate, 87, 380.
    Fish, 163.
    Hydrochloric Acid, 380.
    Lead, 280, 381.
    Mercury, 381.
    Nitric Acid, 380.
    Nux  Vomica, 382.
    Opium, 381.
    Oxalic Acid, 380.
    Phosphorus, 381.
    PrUssic Acid, 382.
    Sulphuric Acid, 380.
    Strychnine,  382.
Polyuria, 383.
Pomades.   See Hair.
Pomegranate-root Bark, 383.
Pompholyx.  See Pemphigus.
Poppy Capsules, 383.
Porrigo, 383.
Port.   See Wines.
Portal Vein, 383.
Porter. See Beer.
Potass, 383.
Potato, 386.
Poultices :
    Bread, 386.
    Bran, 386.
    Linseed-meal, 386.
    Mustard, 326.
    Yeast, 386.
Precipitate, White.   See Mercury.
Precordium, 386.
Pregnancy, 386.
    Diseases of, 388.
    Signs of, 387.
Prepared Chalk.  See Chalk.
Presbyopia, 388.
Preserved Meat, 388.
Probang. 389.
Probe, 389.
Procidentia, 389.
Progressive Locomotor Ataxy, 389.
Progressive Muscular Atrophy, 390.
Prolapse of the Womb, 391.
Prolapsus, 391, 401.
Proof Spirit, 391.
Proptosis, 391.
Prostration.  See Shock.
Proud Flesh, 391.
Prunes, 391.
Prurigo, 391.
Pruritus, 39r.
Prussic Acid, 392.
Psoas Abscess, 392.
Psoriasis, 393.
Ptosis, 393, 152.
Ptyalin, 393.
Ptyalism,  393.
Puerperal Convulsions, 393.
Puerperal Fever, 394. 
INDEX.
495
Puerperal Mania, 394.^
Pulmonary Consumption.  See Con-
    sumption.
Pulse, 395.
Pupil. 395-
Purgatives, 395.
Purpura, 395.
Purpuric Fever, 395.
Pus, 395.
Pustules, 396.
Putrid Fever, 396.
Pyaemia, 396.
Pyelitis, 397.
Pylorus, 397.
Pyvethrum.  See Pellitory.
Pyrexia, 397.
Pyroligneous Acid. See Acetic Acid.
Pyromania.  See Insanity.
Pyrosis, 397.
Pythogenic Fever, 397.

Quartan Ague, 397.
Quassia, 397.
Quicklime, 115.
Quicksilver.   See Mercury.
Quinine, 397.
Quinsy, 398.
Quotidian  Ague, 399.

Rabies.  See Hydrophobia.
Radius, 399.
Railway Injuries, 399.
Rain, 400.
Ramollissement, 400.
Ranula, 400.
Rattle, 400. _
Rectified Spirit,  400.
Rectum, 400.
Recurrent Tumors, 401.
Red Gum, 401.
Red Poppy. 401.
Red Precipitate.  See Mercury.
Refrigerants, 402.
Relapsing  Fever, 402.
Remittent Fever, 403.
Renal Disease.   See Kidneys.
Re^in.   See Rosin.
Respiration, 404.
Respiration, Artificial.   See Drown-
    ing.
Respirator, 404._
Retention  of Urine, 404.
Retina, 154, 404.
Retro- Pharyngeal Abscess, 404.
Rhatany,  404.
Rheumatic Paralysis, 359.
Rheumatism, 404.
Rhinoplastic Operation, 407.
Rhinoscope, 407.
Rhubarb,  407.
Rhus Toxicodendron,  407.
Ribs, 408.
    Fractured, 179.
Rice, 408.
Rickets, 408.
Rigidity of the Body, 409.
Rigors, 409.
Ringworm, 409.
Rochelle Salts, 409.
Rodent Ulcer, 410.
Roman Bath.  See Baths.
Rose Cold.  See Hay Fever.
Rosemary, 410.
Roseola, 410.
Rose Petals and  Rose Hips, 41°-
Rosin, 410.                        .
Round Worms.   See  Entozoa and

Rbval Ointment.  See Basilicon.
Rubbing.  See Inunction.
Rubefacients, 410.
Rubeola, 410.
Rue, 410.
Rum, 411.
Rumination  411.
Rupia, 411,
Rupture.  See Hernia.
Rye, 411.

Sahadilla, 411.
Saffron, 411.
Sage, 412.
Sago, 412.
Salad, 412.
Salad Oil.  See  Olive Oil.
Sal Ammoniac, 412.
Salicine, 412.
Saliva, 413.
Salivation, 413.
Salt, 412.
Saltpetre.  See Potass,  Nitrate of.
Sal Volatile,  412.
Sambricus, 414.
Sandal-wood, 414.
Sanitary Regulations, 4'i4.
Santonin, 417.
Sarsaparilla, 417.
Sassafras, 418.
Savin, 418.
Scabies.  See Itch.
Scald Head.  See Porrigo.
Scalds.   See  Burns and Scalds.
Scalp, 418.
Scammony, 418.
Scar.  See Cicatrix.
Scarf-skin, 419.
Scarification, 419.
Scarlet  Fever, 419, 415.
Sciatica, 420.
Scirrhus. 421.
Sclerotic, diseases of the, 154.
Scorbutus.  See Scurvy.
Scorpion-bites.   See Insects.
Scrivener's Palsy.  See  Paralysis.
Scrofula, 421.
Scurf, 422.
Scurvy, 422.
Scybala, 423.
Sea-bathing, 33.
Sea-Holly.  See  Eryngo.
Sea-Sickness, 423.
Sebaceous Glands. See Skin.
Sedatives, 424.
Senega, 424.
Seidlitz Powders, 424.
Senna, 424.
Septicaemia, 424.
Serous Apoplexy, 425.
Serpentary, 425.
Serpents, Bites of.  See Snakes.
Serum.  See Blood.
Seton, 425.
Shaking Palsy, 425.
Sherry.  See Wines.
Shingles.  See Herpes.
Shivering.  See Rigors.
Shock, 425.
Short-sightedness.   See  Eye  and
    Vision.
Shortness of Breath, 427.
Shoulder, Dislocation of,  118.
Sialogogues, 427,
Sick-Headache.   See Headache.
Sick-Room, 427.
Sight, 427.
Silk, Oiled, 427.
Sitz-bath, 427.
Skeleton, the Human, 427.
Skin, 428.
    Graftin?, 428.
Sleeplessness, 429.
Slough, 430.
Small-Pox, 430.
Smell. 431.
Smelling-Salts.  See Ammon.a.
Smokina.   See Tobacco.
Snakes, Bites of, 431.
Snake-Root.  See Actea and Serpen-
    tary.
Sneezing,  431.
Snuff, 431.
Soap, 431.
Soda, 432.
Soda-Water,  433.
Softening of the Brain.  See Cerebral
    Softening.
Solutions, 433.
Sore Eyes.   See Ophthalmia.
Sore Throat,  433.
Space, 433.
Spanish Fly.   See Cantharides.
Spasmodic Croup. See Laryngismus
    Stridulus.
Spasm, 433.
Spearmint, 434.
Speculum, 434.
Speech, 434.
Spermaceti, 435.
Spider-bites.  See Insects, Poisonous.
Spigelia, 435.
Spina Bifida, 435.
Spinal Cord,  435.
Spine, 436.
    Lateral Curvature of, 278.
    Railway  Injuries to, 399.
Spirits.   See Alcohol.
Spitting Blood.   See Haemoptysis.
Splints, 436.
Sponge, 437.
Spongiopiline, 437.
Spontaneous  Combustion.   See Com-
    bustion.
Sprains, 437.
Spray-producer.  See  Fluids,  Ato-
    mized.
Springs.  See Mineral Waters. _
Spurious Croup.  See Laryngismus
    Stridulus.
Squill, 438.
Squint.  See Eye.
Staphyloma,  438.
Starch, 439.
Stavesacre, 439.
Sternum.  See Breast-Bone.
Stethoscope,  439.
Stiff-Neck.   See Neck,  Stiff.
Stimulants, 439.
Stings.  See  Accidents and Insects.
Stinks.  See  Deodorizers.
Stomach, 439.
    Acidity of the, 12.
Stomach-ache.   See Gastrodynia.
Stomach-Pump, 439.
Stone, 440.
    in the Kidney, 441.
Storax, 441.
Stout.  See  Beer.
Strabismus.   See Eye.
Stramonium, 441.
Strangling.   See Choking.
Strangulated Hernia.  See Hernia.
Stricture, 441.
Stroke.   Se   Apoplexy  and Hemi-
    plegia.
Strophulus.   See Red Gum.
Struma.  See Scrofula.
Strychnine, 442.
Stumps, 442.
Stupor, 443.
St.  Vitus's Dance.  See Chorea.
Stye.  See Hordeolum.
Styptics, 443.
Stvrax.  See Storax.
Subcutaneous Injection.  See Hypo-
    dermic Injection.
Subinvolution, 443.
Suckling.  See Lactation.
Sudamina, 443.
Sudden Death, 443.
Sudorifics, 443.
Suffocation, 443.
Sugar of Lead.  See Lead.
Sulphate of Iron, 116, 266.
    of Magnesia, 145.
    of Zinc, 116. 
490
INDEX.
Sulphur, 444.
    Flowers of, 165.
Sulphuric Acid, 444.
Sulphurous Acid, 444.   _
Sumach.  See Rhus Toxicodendron.
Sumbul, 444.
Sun-stroke.   See Heat-stroke.
Suppositories, 444.
Suppression of the Urine, 444.
Surgical Erysipelas, 147.
Suspended Animation.  See Drown-
    ing.
Sutures, 444.
Sweat.   See Perspiration.
Swellings.   See Anasarca.
Sympathy, 445.
Syncope, 445.
Syphilis.  See Nodes, and Venereal
    Diseases.

Tabes Mesenterica, 445.
Taenia Mediocannellata, 446.
Taenia Solium, 446.
Taliacotian Operation, 446.
Tamarinds, 446.
Tannic Acid,  446.
Tannin, 446.
Tansy, 446.
Tape-Worm. 446.
Tapioca, 446.
Tapping, 446.
Tar, 446.
Taraxacum, 447.
Tartar,  447.
Tartar Emetic, 447.
Tartaric Acid, 447.
Taxis, 447.
 Tea, 447.
     Beef, 35.
 Teeth.  See Toothache.
 Teething.  See Dentition.
 Temperament, 448.
 Temperature. 448.
 Tendo Achillis, 448.
 Testicles, 448.
 Tetanus, 448.
 Tetter, 450.
 Theine. See Tea.
 Thermometer, 450.
 Thigh, Fractured,  76.
 Thoracic Duct, 450.
 Thorax, 450.
 Thorn-apple. See Stramonium.
 Thread-worms.   See Ascarides.
 Throat:
      Foreign Bodies in, 172.
      Sore, 433.
 Thrush, 450.
 Thumb, Dislocation of, 119.
 Tic Douloureux, 450.
 Tin, 450.
 Tinctures, 451.
 Tobacco, 451.
 Toe-Nail, Ingrowing.  See Nails.
 Tolu Balsam, 451.
  Tongue,  451.
  Tonics, 452.
  Tonsils, 452.
  Toothache,  453.
  Tormentella, 453.
  Tourniquets, 453.
  Tracheotomy, 453.
  Tragacanth, 454.
  Training, 454.
  Trance, 454.
  Trichinae, 454.
  Trocar, 454.
  Trusses, 454.
  Tubercular Meningitis.  See Menin
      gitis.
Tuberculosis, 455.
Tumors, 455.
    in the Ear, 130;
    Floating, 165.
    on the Palate, 355.
Turkish Bath.  See Baths.
Turmeric, 455.
Turpentine, 455.
Tympanites, 456.
Tympanum.  See  Ear.
Typhoid Fever, 456, 415.
Typhus Fever, 457.

Ulcers, 459.
    Gastric, 184.
    Lip, 286.
    Scrofulous, 461.
    Varicose, 461.
Umbilicus, 462.
Unguents.   See Ointments.
Urates,  462.
Urea.  See Urine.
Ureter,  462.
Urethra, 462.
Uric Acid. 462.
Urinals, 462.
Urine, 462.
    Extravasation of, 151.
    Incontinence of, 233.
    Retention of, 404.
    Suppression of, 444.
Urticaria.   See Nettlerash.
Uterus, 463.
Uvula,  464.

Vaccination, 464.
Vaccinia.  See Vaccination.
Vagina, 467.
     Foreign Bodies in, 172.
Valerian, 467.
Valves, 468.
Vanilla, 468.
 Varicella.   See Chicken-Pox.
 Varicose Veins.    See Varix  and
     Veins.
 Varicose Ulcers, 461.
 Variola.  See Small-Pox.
 Varioloid, 468.
 Varix,  468.
 Veins,  469.
 Venereal Diseases, 471.
     Chancres, 472.
     Gonorrhoea, 471.
     Syphilis, 472.
 Venesection, 470.
 Ventilation, 472.
 Ventricle, 473.
 Veratria, 473.
 Veratrum Album, 473.
 Veratrum Viride, 473.
 Verdigris, 473.
 Vermilion.  See Mercury.
 Vertebra.  See Spine.
 Vertigo, 473-
 Vesica, 474.
 Vesical Calculus.   See Stone.
 Vesicant, 474.  ■
 Vibices, 474.
 Villi, 474.
 Vinegar, 474.
 Violets, 474.
 Virginia Snake-Root.  See Serpen
     tary.
 Viscera, 474.
  Vision, 474.
     Double, 475.
  Vitiligo, 475.
  Vitiligoidea, 475.
  Vitreous Body, 471;.
  Vitiiol.  See Sulphuric Acid.
Voice, 475.

Votnnf'fe.  SeeHxmatemesi,
Voyages, 476.

Wakefulness.   See  Sleeplessness.
Walking,  476.
Ward's  Paste, 476.
Warming, 476.
Warts, 476.
Wasting Diseases,  477-  „
Wasting  Palsy.    See  Progressive
    Muscular Atrophy.
Water,  477-
Water-Beds, 478.
Water-Brash, 478.
Water-Closets, 478.
Water-Cure.  See  Hydropathy.
Water-Filters,  161.
Water  in  the  Chest.  See  Hydro-
    thorax.         .
Water on  the  Brain.   See Hydro-
    cephalus.
Wax, 479-      .     _   -r.
Waxy Degeneration.  See Degener-
    ation.
Weak Ankles.   See Ankles.
Weakness.   See Debility.
Weaning.   See Lactation.
Weight, 479.
Weight and Height, 479.
Wens, 480.
Wet-Nursing, 481.
Wetting the Bed,  481.
Wheals, 481.
Whey, 481.
Whiskey.   See Distilled Spirits.
White Blood Corpuscles, 481.
White Leg. See Phlegmasia Dolens.
White Precipitate. See Mercury.
 White  Softening of the Brain.   See
     Cerebral Softening.
 White  Swelling.   See Knee-joint.
 Whites.  See Leucorrhcea.
 Whitlow, 481.
 Whooping-Cough, 482.
 Willow, 483.
 Wind in the Stomach, 483.
 Windpipe,  483.          •
     Foreign Bodies in the, 171.
 Winds, 483.
 Wine,  483.
 Winter-Cough, 483.
 Winter-Green.  See Chimaphila.
 Wisdom Teeth, 485.
 Womb, 483.
 Wool,  485.
 Worms, 485.
 Wormwood. 485.
 Wounds, 486.
 Wrist-Drop, 486.
 Writer's Cramp, 486.
 Wry Neck, 486.


 Xanthelasma, 486.
 Xanthic Oxide, 487.
 Xanthine, 487.
 Xeroderma, 487.


 Yeast, 487.
 Yellow Fever, 487.
 Yellow Gum, 487.
  Yellow Wash, 488.


  Zinc, 488.
 I Zymosis, 488.
  Zymotic  Diseases.  See Nomencla-
      ture. 
 
 
 
WBA L289h 1881




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