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THE
IQIETY NOTIES
OF
MEDICAL PRACTICE
CH. GATCHELL, M.D.
FoEMERLY PROFESSOR OF THE THEORY AND PRACTICE of MEDICINE,
UNIVERSITY OF MICHIGAN, AND PHYSICIAN TO UNIVERSITY
HOSPITAL ; ATTENDING PHYSICIAN AN ID CL.INICAL LEC-
TURER. To cook county HospitaL, cHICAGo;
AUTHoR of “How To FEED THE sick”;
**TREATMENT OF CHOLERA.”
SEC O N D E DITION
CHICAGO
G R O SS & DE L BRIDGE
1885
TO
RIC EIA R D H U G H E S,
WHO
HAS DONE
SO MUCH TO LEND
WALUE AND CIIARACTER,
TO THE SCIENCE OF MEDICINE,
IN GRATEFUI, ACKNOWLEDGMENT OF MANY FAVORS,
AND IN MEMORY OF A PLEASANT DAY
AT BRIGHTON BY THE SEA,
THIS BOOK IS INSCRIBED
BY IIIS SINCERE
ADMIR.ER, AND
FRIEND,
T H E A UT LI O R.
Copyright, Gross dé Delbridge, 1883.
y
:
PREFACE.
This book is intended to be a pocket companion for those
who need it. The effort has been to include in its pages
that part of medicine which makes up the bulk of the phy-
sician's daily practice. And, in addition, I have endeav-
ored to introduce much which forms part of a practical
medical education, and yet is not taught in the college
lecture-room; what older physicians have gradually accu-
mulated only after years of experience. - -
Directions for the management of the most pressing
emergencies, medical, surgical, and obstetric, are carefully
given, while chronic diseases and rare căses, in the treat-
ment of which there is always time and necessity for con-
sulting larger works, receive no attention. A hand-book
must treat of rules, not of exceptions. - jº
An effort has been made to give additional weight to
many recommendations by attaching to them the names
of those who are widely and favorably known in our pro-
fession. Thus I have made frequent reference to our most
eminent systematic writer, Richard Hughes, of England,
who enriches and illuminates every subject which he
touches. Baehr, Jousset, Lilienthal, Dunham, Jahr, Bayes,
and numerous others, have been called upon for the re-
sults of their experience.
I am much indebted to Dr. Chas. Adams, Attending
Surgeon to Cook County Hospital, for very many contri-
butions to the Part on Surgery, and the accuracy of the
206337
4 PREFACE.
entire subject may be relied upon, since it has all under-
gone at his hands a careful and thorough revision.
Dr. F. R. Day, formerly Resident Physician, Cook
County Hospital, has prepared the sections on Fractures,
Dislocations, and Amputations, for the revised edition, and
also favored me with the drawings from which the illus-
trations have been prepared.
Dr. J. H. Buffum, author of “Diseases and Injuries of
the Eye,” has very kindly prepared for me the article on
that subject, thus rendering it worthy of entire confidence.
If those who have been many years in practice should
seek in vain between these covers for remedies which they
have at times found to be of signal service, let them reflect
that if one thousand physicians should each set about pre-
paring a work of this character there would be produced a
thousand different books, with as great a variety of details
as there were authors, and yet there would undoubtedly
be a general agreement upon the leading remedies for each
and every disease. It is this common ground that I have
attempted to occupy.
CH. GATCHELL.
CHICAGO, MARCH, 1885. *
PART I. e 2°
MEDICAL PRACTICE.
FEWERS.
FEVER AND CHILL TEMPERATURES.
122° Fahr.—Highest ever recorded.
107° or Over — Death.
106° to 107*— Almost always fatal ; except in intermittent.
105° to 106°– Intense fever; recovery doubtful.
104° to 105°– High fever; dangerous if long continued.
102° to 104°– Active fever; recovery the rule.
101° to 102°– Moderate fever. ?
100° to 101°–Slight fever.
99° to 100°– Feverishness.
98.6° — Normal.
97° to 98°–Subnormal; not grave.
95° to 97°– Collapse; in itself without danger.
93° to 95°– Algid collapse; great danger—recovery possible.
92° to 93°—Fatal collapse.
CONTINUED FEVERS.
A Continued Fever is one which is marked by a con-
stantly elevated temperature, without sufficient remission
or exacerbation to alter the course from that of a continuous
action. -
TYPHOID FEVER.
SYNONYMS : Enteric Fever; Abdominal Typhus.
PROGNOSIS.–Favorable: Pulse of 110 to 115, with
distinct first sound of the heart; temperature not higher
than 104° to 105° F. on the eighth day; abdominal symp-
toms mild, and ceasing early. Unfavorable: The continu-
ance of abdominal symptoms—so long as these last, the
patient is not out of danger; pulse 120 to 130, with feeble
apea beat, and indistinct first sound; capillary bronchitis;
hamorrhage from bowels; severe cystitis; bed-sores; per-
foration of intestine (almost invariably fatal). Prognosis
6 REY NOTES OF MEDICAL PRACTICE.
also bad in fat persons, gouly subjects, and alcoholists; also
if complicated by disease of the kidneys, organic disease
or degeneration of the heart, Oedema of the lungs, pya-mia,
or gastric catarrh. -
CoMPLICATIONS.— Preumonitis; pleuritis; perforation of
bowel and peritonitis; intestinal haemorrhage; parotitis.
CAUSES OF DEATH.— Excessive hamorrhage; perforation
and peritonitis; pneumonitis; asthenia.
LEADING REMEDIES.
Baptisia.--To be given as soon as typhoid fever is sus-
pected. Face dark-red, with a besotted expression; dull,
stupefying headache, with confusion of ideas; tongue brown
and dry; pulse full and soft; dull, aching pains. Also,
throughout the course of the disease, to reduce the high
temperature. -
Give in the period antecedent to the full development of the intes.
tinal affection.—Hughes. . . . - -
Bryonia.-Violent, stupefying headache; restless sleep,
with moaning and groaning; face red and swollen; delirium
day and night, with strange fancies; desire to escape;
tongue, coated with a yellowish fur, with parched lips,
great thirst, vomiting, tenderness at pit of the stomach, and
constipation. Of no use after the diarrhoea has set in.
Belongs to the treatment of mild cases, and “those in which the
brain is not altogether deprived of its functional power.”—Baehr.
Mercurius.--Tongue loaded with thick, moist, creamy
coating; painful sensibility of whole abdomen; diarrhoea;
stools copious, liquid, flocculent, sometimes a little bloody;
clammy, fetid perspiration. -
Indicated by predominance of abdominal symptoms.—Jousset.
Must be suspended as soon as tongue becomes dry and delirium
manifests itself.-Lilienthal. - * -
Rhus tox. — Mind dull and clouded; incoherent mutter-
ing, or active delirium; headache; epistaxis, tongue brown
and dry, with red tip; lips, teeth, and tongue covered with
sordes; skin clammy; general trembling; debility, and pros-
tration; pulse weak, and slow; abdomen bloated; frequent
involuntary, copious, yellowish evacuations. This remedy
belongs to the treatment of the intestinal stage of the dis-
ease, after diarrhoea has set in. Also in pneumo-typhus,
with epistaxis, severe bronchial affections, dirty-looking,
sanguinolent expectoration.
Rhus, corresponds to typhus of intense character, beginning with
chill, followed by burning heat, and a copious diarrhoea, which sets in
early.—Baehr. -
Arsenicum.— Extreme prostration, and great emacia-
tion; face pale and shrunken; falling of lower jaw; tongue
dry and cracked, black, with inability to protrude it; mouth
covered with Sordes; great thirst; decubitus; sopor; picking
at bed clothes; distended abdomen; pulse small, almost im.
* ,
TYPHOID FEVER. * - 7
perceptible; irregular action of the heart, with indistinctness
of first sound; violent, almost continuous relaxation of
bowels; discharge very fetid; breathing short and anxious;
rattling cough; fetid breath. Symptoms of decomposition
of the blood set in early, such as nose bleed, bloody, diar-
rhoea, bloody sputa, petechiae on the skin.
This remedy should be given early, without waiting for
the disease to develop its pernicious character.
A remedy of priceless value. —Ruddock.
Sometimes restoring the patient when almost beyond hope.—Lawrie.
Muriatic ac.— Extreme prostration; patient stupid and
unconscious; sliding down in the bed; low, muttering delir-
ium; picking at flocks; inability to protrude the tongue:
depression of lower jaw; turning up of the eyes; involuntary
stools and urine.
SPECIAL REMEDIES.
Opium.—Coma, stertorous breathing.
Hyoscyamus.- Coma-vigil, or loquacious delirium.
Terebinthina. – Tympanites, and hamorrhage of the
bowels.
Well nigh specific for tympanites.—Hughes. &
Belladonna.—Great cerebral congestion and furious
delirium.
Arnica.-Low condition, with involuntary discharges.
Antimonium tart.— Preumo-typhus, with great rat- .
tling in the chest, and dyspnoea. - -
Phosphorus.-Pneumo-typhus, with violent bronchitis,
hepatization, hypostasis, and laryngitis. -
Unsurpassed by any other medicine.—Baehr.
GENERAL MEASURES.
Sick-room.— Let it be a large, well ventilated, upper
room with open fireplace, if possible. Make free use of
disinfectants, and look well to sewer pipes, or other sources
of impure air. Immediately remove all soiled clothing, and
immerse in chlorine water, and boil within twenty-four
hours; all other articles should be burned. Receive all dis-
charges into a porcelain bed pan, and cover immediately with
a solution of sulphate of iron or chloride of zinc. As soon
as the vessel is removed from the patient, cover it with an
old cloth, to prevent exhalations from escaping into the
room, and immediately g
Dispose of Discharges, in the country, by emptying
bed pan into a freshly dug hole, far removed from a privy
or well, and cover with dry earth. If in the city, empty
it into a water-closet, which must be used for no other pur-
pose. At frequent intervals flush this closet with large
quantities of solution of sulphate of iron or chloride of
zinc.; or still better, let all discharges be burned.
*
8 KEY NOTES OF MEDICAL PRACTICE.
Bed.—If possible have two beds, and night and morn-
ing change the patient, airing one while using the other.
Avoid the use of feather beds—too soft a mattress favors bed-
sores; hair mattress best. Cover the mattress with rubber
cloth, place over this the sheet, and a small “draw sheet”
under the hips. Let the pillows be small, rather hard, and
so arranged as to support shoulders and expand the chest.
Nursing.—See to it that the nurse gives the patient
sufficient drink to slake thirst. Often when the patient is
delirious or comatose this is neglected. Have the sordes
washed from the lips, teeth, and tongue with a soft cloth,
moistened in. lemon-water, as often as it accumulates. Ex-
amine the back and hips daily for redness. If it occur, have
the spot washed four times daily in alcohol and water, dry
thoroughly, dust with powder, and use air cushions. Do
: permit the patient to stand up, or in any way exert him-
self.
Bathing.—Sponge the entire body several times daily
with tepid water. If the temperature rise to 103° F. in
axilla, put the patient into a warm bath, 80° to 90° F.,
gradually lower the temperature of the bath by cold water
till the desired effect is produced. May have to go to 60°
F., but not lower. If the temperature fall rapidly, remove
the patient; if slowly, wait till the temperature in axilla
reaches 101° F. Do not use the bath later than the second
week. Cold pack answers same purpose. Spread a comfort
on the bed, over this blankets, over these a sheet wrung out
of cold water. Lay the patient on the sheet, wrap him in -
it, then fold over him the free 3dges of the blankets and
comfort, making all snug. Leavé"Him till the sheet becomes
warm. This is a very efficient method of reducing tempera-
ture, and for many reasons it is to be preferred to the cold
bath.
Diet.— Bighly important. Eacclusive milk diet best.
Regularly every two hours give the patient a glass of milk,
or its equivalent at convenient intervals. If milk disagree,
try it with lime-water, scalded, iced, or otherwise vary the
method of administration until a form is found which the
patient can take and digest. Let the patient draw the milk
through a bent glass tube. If for any reason the patient
cannot take milk, give other food, being careful to have it
fluid in form, easy of digestion, and highly mºutritious. In
early days give beef broth, mutton broth, chicken broth;
later, food which is stimulating as well as nourishing —
beef tea, wine whey, café au lait, or egg and coffee; again
come back to broths and gruels after the period of depres-
sion has passed. Vary the diet to suit the caprice of the
patient. But remember that the milk diet is superior to all
others, and need not be departed from if it agree with the
patient. Af
TYPHUS FEVER. 9
Examining Patient.—Notice particularly at each
visit — pulse; nature of heart-beat; state of abdomen;
temperature; number and character of discharges; respira-
tion, and the state of the lungs. * .
Convalescence.— Especial care is demanded during
this period. Avoid use of vegetables. No solid food must
be taken until the stools are consistent and fecal. The
slightest error in diet may eaccite a relapse.
TYPHUS FEVER.
SYNoNYMs: Ship Fever; Jail Fever.
PROGNOSIS.—Always grave. Unfavorable: High
temperature; frequent pulse; early, furious delirium, or early
stupor; previous debility; in alcoholists usually fatal. Fa-
vorable : Youth; moderate temperature and pulse, and
mild nervous symptoms.
CoMPLICATIONS.— Preumonia and swollen parotid glands
most common. -
CAUSEs of DEATH.— May result from meningitis; pneu-
monitis; capillary bronchitis; gangrene; asthenia and par-
alysis of the heart; nephritis.
iFADING REMEDIES.
Baptisia.— Early stage, with high fever and intense
character of the onset. . .
Phosphoric ac.— Great nervous depression, with but
slight febrile excitement or signs of blood poisoning;
complete apathy and indifference; quiet delirium, with
stupefaction, deafness, dull, staring look, epistaxis; disten-
sion of abdomen, with rumbling and gurgling; watery,
grayish diarrhoea; thick, cloudy urine; profuse perspiration;
pulse weak, small, frequent, intermitting.
Phosphorus.-For a still lower grade of nervous de-
pression. Eyes hollow and sunken; frequent and copious
epistaxis; dryness of mouth, gums stand off from teeth, and
bleed easily; vomiting of watery, bilious, or slimy masses;
loud rumbling and meteorism of abdomen; grayish or black
discharges, from decomposed blood; roseola spots, or ecchy-
moses. Also in pneumonic complication, the chief remedy.
May save life at the utmost extremity.—Hughes.
Arsenicum.—Intense febrile toxaemia. Great restless-
ness and anxiety; tongue black, dry, and hard; speech unin-
s telligible; excessive thirst; meteorism; involuntary stools
and urine; discharges brown, watery, foul; haemorrhage
from bowels; cold, clammy perspiration and decubitus.
Also for kidney complications, with suppression of urine.
10 KEY NOTES OF MEDICAL PRACTICE.
SPECIAL REMEDIES.
Opium.—Stupor or coma.
Mercurius bin., Rhus.-- Parotitis.
Rhus, Muriatic ac.— For milder forms of febrile
toxaemia. - &
. . Belladonna. — Headache, cerebral congestion, and ac-
tive delirium. .
Stramonium.—Delirium So furious as to threaten the
patient's exhaustion. *
GENERAL MEASURES.
Typhus being highly contagious, strictly quarantine the
patient, and observe all antiseptic, precautions. Give an
abundance of fresh air; remove all windows, regardless of
cold, and keep the patient well protected with blankets.
Guard against bed-sores. In noisy streets, stuff the pa-
tient’s ears with cotton. If the temperature rise to over
104° F., put the patient in a bath ten degrees below the
temperature of the body, and gradually reduce the tempera-
ture of the water to 70° F., till the bodily temperature falls
to 101° or 102° F. If the heart’s action is weak, with much
prostration and feeble circulation, give an occasional dose
of brandy—not more than one ounce, altogether, in the
twenty-four hours. -
Diet.—Of greatest importance to aid nutrition. Begin
early, and give small quantities of very nutritious food regu-
larly and persistently. Milk is the best. Also use beef tea
and broths. If necessary, support by nutrient enemata.
DIFFERENTIAL DIAGNOSIS.
TYPHOID.
FNDEMIC.
Advent insidious, with general
malaise; headache; chill, rare;
several days before patient takes
to bed. - -
Temperature.— Little rise at
onset; maximum about 7th day;
exacerbates.
Eruption.— Lenticular spots,
bright rose color;
crops; abdomen.
Delirium appears late; low
muttering. -
Countenance pale, olive, lead-
611.
Emaciation great.
Bowels.--Tympani tes, and
“pea-soup” diarrhoea.
Duration, 21 to 40 days.
Terminates by lysis.
successive
TYPHUS.
EPIDEMIC.
Advent 8wdden, with intense
chill; steadily increasing head-
ache, with great prostration.
Temperature.—2d day
105° to 1070 ori the 3d
mains high to end.
Eruption.— Small, slightly ele-
vated, called “mulberry rash";
remains throughout disease;
sides of chest and extremities.
Delirium active from the first.
104°;
ay; re-
Countenance dull, heavy; late,
7mahogany color.
JEmaciation slight.
Bowels.—Constipated; no tym-
panites.
Duration, 14 days.
Terminates by crisis.
CEREBRO-SPINAL FEVER. . . . 11
a CEREBRO-SPINAL FEVER.
syn oNYMs: Spotted Fever; Cerebro-Spinal Menin-
gifts. . - -
PROGNOSIS.–Grave. Unfavorable: Extensive ham-
orrhage into the cutis, with marked signs of vital prostra-
tion. More fatal among infants and young children than
youths and adults. Continued rapidity of the pulse un-
favorable. Favorable: Cessation of headache; free per-
spiration. - • . . .
CoMPLICATIONs.— Preumonitis; nephritis; oºdema, and
congestion of the lungs.
CAUSEs of DEATH...--Asphyxia, from lesion in respira-
tory nerve-center; asthenia; oºdema of luſngs; necraemia.
LEADING REMEDIES.
Gelsemium.— Early in the attack. Fever; great lan-
guor and drowsiness; obscuration of sight; vertigo; respira-
tion slow and sighing; pulse soft and feeble; complete loss
of muscular power. - . . .
In my hands this has been one of the most efficient remedies.
Veratrum vir.—Severe frontal headache; violent vom-
iting; pain in stomach: convulsions; retraction of head;
opisthotonos; rolling of eyes, dilated pupils; pulse labored,
slow, and irregular.
Used with great success in many undoubted cases.—Hale.
Belladonna. –Violent headache; drowsiness; delirium;
cutaneous hyperaºsthesia; face red and bloated; boring of
head into pillow; spasmodic distortion of face; grinding of
teeth; . extremities. - .
Cicuta. — Dilated pupils; staring look; jerking of eye-
balls, and muscles of face, arms, and hands; deafness; pale
face; head retracted; rigid spine; dysphagia; insensibility.
Is considered by many to be nearly a specific in this disease.—
Lilienthal. - - - -
Hydrocyanic ac.— Fulminant cases. Patient stricken
down suddenly; loss of consciousness; dyspnoea; gasping;
Small pulse; purple face; tonic spasms; low moaning; flut-
tering pulse.
Hyoscyamus.-Delirium and convulsions.
Opium.—Face bloated; eyes fixed; half-closed lids;
deep, slow breathing. *
Actaea.—Spasms continue after acute symptoms have
subsided.
Arsenicum.— Septic symptoms; foul discharges from
the bowels; signs of decomposition of the blood; petechiae.
Rhus, Bryonia.—Typhoid-like state; low fever, etc.
*
y
.k.
12 KEY NOTES OF MEDICAL PRACTICE.
GENERAL MEASURES.
Most important to get up free diaphoresis early. Put
the patient into a hot bath—104°-106° F.—for a short
time, then wrap him in warm blamkets until free perspiration
is induced. Repeat if the skin again becomes dry and hot.
Ice-bag to the head.
Diet.—Give concentrated liquid food freely,– milk,
beef tea, broths. Nourish by enemata if the patient cannot
take food by the mouth.
Look to the state of sewage and drainage, and provide
for good ventilation of the dwelling. Observe great care
during convalescence; relapses are generally fatal.
SIMPLE CONTINUED FEVER.
SYNTONYMI: Gastric Fever.
PROGNOSIS.–In absence of complications, always
favorable.
LEADING REMEDIES.
Baptisia.-Chilliness; fever; violent headache; great
languor; loss of appetite; great thirst; thick, white coating
on tongue; nausea; vomiting; epigastrium and abdomen
sensitive; constipation, with later diarrhoea.
Baptisia is a true specific. Defervescence and crisis will follow its
use in a very short time.—Hºtghes.
Arsenicum.— Later in disease. The tongue dry and
brownish; abdomen distended; great thirst; prostration;
restlessness; diarrhoea; burning pains in stomach; pale
face; cold extremities.
Bryonia.-Vertigo; nausea and faintness on sitting up;
fullness in forehead, as if everything would be pressed out;
splitting headache; lips parched, dry, and cracked; tongue
coated; constipation; great irritability. - .
Mercurius.—Pale, yellow, earthy color of face; tongue
thick, yellow coating; fetid breath; gums swollen; profuse
secretion of saliva; region of stomach Sore to touch; dark-
red urine; diarrhoea. - -
Antimonium tart.—Empty or putrid eructations;
constant nausea and inclination to vomit; loss of appetite;
loathing of food; great secretion of mucus; apathetic
state, excessive debility and prostration; alternate mucous
diarrhoea and constipation.
CoNSULT —Nua, v., Puls., Iris, Ipec.
GENERAL MEASURES.
Plain and simple food must be given, as every error in
diet is apt to cause a relapse.
-
SCARLET FEVER. - 13
ERUPTIVE FEVERs.
The Eruptive Fevers are distinguished by a high
degree of contagion; a period of incubation; intense fever;
a characteristic eruption, and immunity after one attack.
SCARLET FEVER.
SYNONYMI: Scarlatina.
PROGNOSIS.— Depends upon character of the pre-
vailing epidemic. In severe cases always uncertain. #.
favorable: Temperature of 105°,+; dyspnoea; cold surface;
livid hue of the eruption; suppurative pharyngitis; persis-
tent vomiting; complete suppression of the urine. Also
bad in the very young, in organic disease, and if compli-
cated.
ILEADING REMEDIES.
ScARLATINA SIMPLEX. —Acom., Bell., Rhºds.
SCARLATINA ANGINOSA.—Apis., Merc. 70d., Amm. cqrb.,
Mwr. ac., Lach.
SCARLATINA MALIGNA.—Atlanth., Merc. cyan., Ars.,
Mwr. a.c., Cupr. ac., Rhus. -
Aconite.—Has a limited use early, to subdue arterial
excitement.
Belladonna. – In the sthenic form the eruption Smooth
and shining, with great vascular and nervous excitement;
congestion of brain, and delirium; throbbing of carotids;
eyes injected; face fiery red; tongue white, with red edges,
or red, with raised papillae; fauces and tonsils inflamed and
swollen; external swelling of neck. Of no benefit in
adynamic cases. -
Rhus.-Scarlatina simplex, when the eruption is mili-
ary, the rash being interspersed with fine red points, and
sometimes fine vesicles. Also, in the adynamic form, erup-
tion dark; eyes swimming; tongue dark-brown and dry; lips
and teeth covered with sordes; drowsiness; low, muttering
delirium; epistaxis; swollen parotids, and thin, offensive
discharges from bowels.
I have used Rhus in these cases with great success.
- Apis.—Fever of low type. Tongue deep red, and cov-
ered with blisters; tonsils oadematous, swollen, and ulcer-
ated; abdomen sore to touch; slimy and bloody discharges
from bowels; urine scanty and dark-red; micturition fre-
A." and painful; loss of consciousness; delirium; Sopor.
so for oºdema and dropsy. -
14 KEY NOTES OF MEDICAL PRACTICE.
-v
Ammonium carb.-Swelling of parotid, and lym-
phatic glands of neck; throat dark-red, with tendency to
gangrenous ulceration. - -
Mercurius iod.— Much glandular swelling, with stiff-
ness and pain; salivation; fetor of breath; rapid and great
prostration; commencing ulceration of throat.
Ailanthus.-Malignant cases, the patient being sud-
denly taken with violent vomiting; severe headache; intol-
erance of light; hot, dark-red face? rapid, small pulse; high
temperature; drowsiness; muttering delirium; dark, livid,
miliary rash in patches. -
Directly specific, and of eminent value.—Dr. Madden.
Arsenicum.—The eruption grows suddenly pale; skin
cold; small pulse; rapid prostration; putrid Sore-throat;
great restlessness; dyspnoea; fetid, involuntary discharges
from the bowels. -
Cuprum ac.—Sudden retrocession of eruption, followed
by vomiting, convulsions, rolling of eyes, distortion of face,
Sopor, and delirium; signs of metastasis to brain.
Employed with gratifying success.--Dr. Drummond.
Muriatic ac.— Malignant cases. Severe ulceration of
throat; fetid breath; acrid discharges from nose; soreness
and vesicles about nose and mouth; eruption faint and
livid; flushed, cheeks; eyes dull-red. • -
Lachesis.—Throat swollen, ulcerated, livid; great fetor
of breath, the system seeming to be re-inoculated from the
ulcerated sore throat, with general prostration; quick, fee-
ble pulse; low, muttering delirium, and jactitation.
It has never disappointed me.—Hughes. &
Cuprum ac.—Retrocession of eruption; quick, small,
irregular pulse; low temperature; Sopor; foil; of eyes;
facial distortion; Spasm of various muscles; cold face; blue
lips; convulsions. -

SPECIAL REMEDIES.
Retrocession of eruption.—Ars., Cupr. ac., Camph.
When the fever degenerates into a low, typhoid-like con-
dition.—Rhus, Ars., Lach. - -
Stage of desquamation.—Ars., Sulph.
Nephritis and dropsy.—Ars., Apis, Terebin. -
Discharges from ears.-Mur. ac., Hep. Sulph., Sil.,
Graph., %. dulc. - -
ischarge from nose.— Mur. ac., Aur., Ars.
Inflammation of eyes.—A com., Sulph.
Glandular swellings.—Rhus, Lach., Merc.
GENERAL MEASURES.
Quarantine the patient, and remove other children. Put
the patient in an upper room, large, well ventilated, and
free from upholstered furniture and drapings. Use all anti-
MEASI, IES. 15
septic precautions with clothing, utensils, und discharges.
Sponging the body frequently with tepid water moderules
the ſever, allays restlessness, and favors sleep. Promote
free action of the skin. Watch the state of the urine, and
anticipate kidney complication. Use caution until recovery
is ſully ostablished.
Diet.— Light and nutritious. Milk, brollis, gruels,
toast, etc. I) rinking large quantities of witter ſavors action
of the kidneys. In low cases feed as in typhoid.
MEASLES.
synonyms: Morbilli; Rubeola.
PROGNOSIS.–If uncomplicated, ſavorable. Unfav-
orable: In tuberculous subjects, and cachectic constitutions;
black measles; complicated by epistaxis, diphtheria, capil-
lary bronchitis, or broncho-pneumonia.
LEADING REMEDIES.
Acomite.— IIigh temperature, and other febrile symp-
tons—hot skin, red eyes, intolerance of light; general
malaise. In simple cases the only remedy required.
Pulsatilla.-lèyes red and watery, sensitive to light;
thick, yellow discharge from nose; dry inouth, no thirst;
loose cough; rumbling in bowels, and diarrhoea.
of high repute for the diarrhoea.—Hughes.
Euphrasia.—Streaming of hot, burning tears from the
eyes, with great photophobia; proſuse running from the
nose, without burning. -
Invaluable for the nasal and conjunctival calarrh.—IIughes.
Bryonia.— Bruption retarded, or retrocession of erup-
tion, with oppression of chest, and laborious breathing; dry
cough, with shooting pains in cliest.
IRemarkably successful in bronchitis.—Jousset.
Ipecac.— Bruption, retarded or suppressed, with nausen
or vomiting, and rattling of mucus in the chest. Will
generally stop the epistaxis.
Weratrum vir.—Convulsions before the eruption; con-
gestion of lungs during febrile stage.
Arsenicum.—Adynamic and malignant cases. Burning
heat of skin; quick, small pulse; great anxiety; restless-
ness; sudden retrocession of rash; pale, bkoaled ſuce; great.
sinking of strength.
Camphor.- Rubeola fulminans. Face grows suddenly
ale; skin cold and purple; stiffness of body, utter prostra-
#. and collapse. Give drop doses, ſrequently repeated.
16 KEY NOTES OF MEDICAL PRACTICE.
SPECIAL REMEDIES.
Phosphorus.--Bronchitis or pneumonia.
Rhus.-Low fever; dry, brown tongue.
Rali bi...—The hoarse, laryngeal cough.
Cuprum ac.— Retrocedent, aſſecting brain.
Belladonna. – Cerebral congestion, or sore throat.
Sulphur.—To promote recovery; strumous subjects.
ºustºdi. swelling; ulcerations; dysen-
tory.
y GENERAL MEASURES.
Quarantine the patient. ltoom well ventilated, with even
temperature. Darken the room while the eyes are sensitive.
To relieve itching and burning of skin, cool water spong-
ings. Warm bath to bring out delayed cruptions. }; the
temperature rise to 103°-104° F., reduce it by cool sponge
baths. Protect the patient against, cold air and sudden
changes of temperature, and keep the chest well protected.
Diet of milk and broths. sº
SMALL POX.
SYNONYMS: Variola ; Varioloid.
PROGNOSIS.— Depends on the type of the disease.
In variola discreta, uncomplicated, favorable. In variola
confluentes, grave. Unfavorable : In the intemperate;
syphilitic; extremes of life (recovery rare after sixty); lung
complications; inflammation of skin between the pustules;
epistaxis and other haemorrhages; scanty urine early; in-
tense secondary fever between ninth and twelfth days. In
variolat hapmorrhagicat, recovery rare.
Causes or DEAT II.- (lºdemn glottidis; general bronchi-
tis; pneumonitis; acute fatty degeneration of the kidneys;
asthenia.
LEADING REMEDIES.
VARioLA DiscreTA.—Bell., Amt. tart., Sulph.
VARioLA ConFLUENTES.–Sulph., Ars., Phos.
VARIOLA HAEMORRIIAGICA.— Phos., Ars., Lach.
Antimonium tart.— One of the most useful remedies;
it reduces the ſever, the pustules run their normal course.
It is also especially useful in pulmonary complications, and
for gastric disturbances. Given early, it mitigates the
severity of the disease.
Belladonna.-- High ſever; severo, local symptons;
throbbing carotids; injected eyes; photophobia; sore-
throat; severe pain in back; starting and jumping in sleep;
delirium.
SMALL POX. 1%;
Mercurius.- Maturation impending, and suppurative
fever rising. Moist, swollén tongue; ulcerated throat;
fetid breath; profuse flow of Saliva; dysenteric discharges
from bowels. --
Arsenicum.— Haemorrhagic variola; eruption dark;
skin blue, or livid; great sinking of strength; small, fre-
quent pulse; extreme thirst, anguish, and restlessness.
Actaea.— Early stage; Severe pain in back and eyes;
headache; sore, bruised pain all over; exhaustion; nausea.
Hydrastis.— Great redness, swelling and aching of the
skin, with very sore throat; intense aching in small of back
and legs. Especially useful when ulcers occur on mucous
membrane of Imouth and fauces.
Sulphur.— Disease pursues an irregular course; pus-
tules become purple or black. Also for period of desi-
cation.
SPECIAL REMEDIES.
PNEUMONIA.—Amt. tart., Phos.
GLANDULAR SWELLINGs.—Merc. iod.
Low, TYPHOID STATE.—Bapt., Ars.
BOILS.–Hep. sulph., Sulph., Phos.
OPHTHALMIA.—Merc. cor., Sulph.
DELIRIUM.–Bell., Stram., Verat. vir.
DROPSICAL SWELLINGs.—Apis., Ars.
CoNGESTION OF LUNgs.-Verat. vir., Acom., Bry.
REPERCUSSION OF ERUPTION.—Camph., Ars., Sulph.
GFIENERAL MEASURES.
Complete Isolation. Vaccinate the patient, if this
has never been done. Free ventilation of the apartment
highly important. Should be attended by one who has
already suffered from the disease. Cleanliness and disinfec-
tion of the strictest kind. In cold weather keep the patient
well covered, a fire in the room, but, the windows wide
open. Guard against bed-sores. Give the patient frequent
sponge-baths. Do not injure pustules. Let adults wear
loose gloves, and bind the hands of children, to prevent
Scratching. To prevent pitting, keep the patient in a dark
room, protect the pustules from injury, and keep each one
well anointed with Vaseline and flour, made into a paste.
Cold water compresses to the face and hands often allay the
burning pain. If there are ulcers in the mouth and throat, let
the patient take bits of ice, and use a mild Hydrastis gargle.
Clothing.—After the attack, destroy all clothing, and
funnigate the room.
Diet. — From the beginning, give a sustaining diet of
milk, eggs, meat broths, oysters, and beef tea every three
hours. Fresh, ripe fruits allowable if the bowels are not
affected. For drink, give iced milk, or if this does not
agree, lemonade, or raspberry-vinegar water.
2
DIFFERENTIAL DIAGNOSIS.
Invasion.—Headache, vomiting, mal-
Fever.—Temperature may reach 105°-
107°, with great heat of skin and frequent
pulse; fever higher during eruption.
SCARLET FEVER.
Incubation 1 day to 7 weeks—average,
4–7 days.
jººn,
tion, desquamation.
aise, Sore throat.
invasion, erup-
Cerebral symptoms frequent and grave.
Eruption.— Appears first on neck and
chest. 24 hours after invasion; spreads
rapidly. Color, bright-rose or deep-red.
Finger nail drawn over makes white
streak, lasting several minutes.
Desquamation.—Large patches, espe-
cially from hands and feet; itching.
Tongue.—“Strawberry.”
Pace flushed, dry, red.
Emaciation slight.
Duration 21–28 days.
Crisis about 14th day.
Sequelae.—Nephritis; dropsy; otitis;
ophthalmia; glandular enlargements.
MEASLES.
Incubation 7–14 days.
Stages.— Premonitory, eruption, desgua-
mation. - -
Invasion.— Chill, coryza, headache, lassi-
tude, cough, fever.
Fever.—Temperature may reach 105°–3.
falls after eruption.
Cerebral symptoms usually absent.
Eruption.—On 4th day appears first on
face; spreads gradually; color, rose-red or
7mahogany; is rough; may be confluent,
crescentic, and papular. Line made by
finger nail disappears quickly.
IJe&quamation.—Bran-like, mealy odor.
Tongue coated, with red edges.
Face.—Suffused and watery eyes.
Emaciation not marked.
Duration 14–21 days.
Crisis — None.
Sequelae.—Chronic bronchitis; otorrhoea;
ophthalmia; phthisis.
SMALL POX.
Incubation 5–20 days— average 10 days.
Stages.—Incubation, eruption, suppura-
tion, desiccation.
Invasion.—Chilliness; 8evere pain in back
and head.
Fever.—Temperature of 106°, with
bounding pulse, pain in head and back —
relief from eruption. Secondary fever —
very high on 8th day — and falls slowly.
Cerebral 89/mptom8 frequent — delirium
about 3rd day. Convulsions in children.
Eruption.—On 3d or 4th day appears first
at edge of hair, lips, palate, or fauces.
First macule, then vesicle, pustule, which
; slough, and leave cicatrix, or form
SCQ0.
Desquamation.— Scabs, crusts, and thick
scales; violent itching. -
Tongue coated, swollen, with red edges.
Face flushed, anxious; photophobia.
Emaciation great.
Duration 4–5 weeks.
Crisis about 21st day.
Sequela.— Chronic diarrhoea; abscesses;
glandular enlargements; various diseases
of eyeball and eyelids.
&
i
WACCINATION — INTERMITTENT FEVER. 19
VACCINATION.
Caution.— Be sure to use only a pure article of bovine
virus. Keep it in a cool place in a tightly corked vial.
Scrape the skin in three places till the true skin is
reached and ready to bleed, but without any flow of blood.
Moisten the virus, and rub it well over the raw surfaces.
Or, make several slight horizontal and transverse cuts,
crossing each other, and rub the virus over these. Let it
thoroughly dry, or put a piece of plaster over. If the vac-
cination “takes” — w
3rd day.— Papule appears. 10th day.—Areola begins to fade.
6th day.—Vesicle, with central 11th day.—A brown, mahogany
depression. crust has formed.
8th day.—Vesicle distended with 33rd day.-Crust becomes de-
lymph, and has wide, tached.
red areola.
The fever which sometimes accompanies may be met by
Bell.
Vaccination should be performed at least twice — in
infancy and at the age of puberty. Also, whenever expos-
ure is liable to occur.
DENGUE.
SYNONYM : Breakbone Fever.
PROGNOSIS.—Favorable, except in the aged, and in
feeble infants.
LEADING REMEDIES.
Gelsemium, Bryonia, Eupatorium, Rhus, Actaea, Arsent-
C7.7%. -
PERIODICAL FEWERS.
Periodical Fevers are marked by intervals in the
course of the disease, during which the patient is almost or
quite free from fever.
INTERMITTENT FEVER.
SYNoNYMs: Ague; Chills and Fever.
LEADING REMEDIES. -
Cinchona. – Recent cases. Paroxysm preceded by head-
ache, hunger, ºpiº, Each stage well marked—first
the chill, which is severe, and the principal feature of the
20 EEY NOTES OF MEDICAL PRACTICE.
attack, with violent shivering, and aching pains; then the
fever, followed by violent thirst, and sweat, which is some-
times profuse and exhausting, Apyreacia : — Patient suffers
but little—feels almost in ordinary health.
DOSE.-First decimal, or centesimal, trituration, two or
three grains every three or four hours in apyrexia.—Hughes,
Paehr, Pamellū, Jousset.
Undoubtedly the most important remedy.—Baehr.
Arsenicum.—Attack preceded by weariness, approach-
ing prostration; paroacysm imperfectly developed; before
chill, vertigo, headache, yawning, stretching, and general
sense of discomfort; chill and heat intermingled; op-
pressed breathing; nausea, sometimes vomiting; small,
feeble pulse, even during hot stage. One of the stages
often absent—sometimes the sweat, but usually the chill.
Tendency to increase in the severity of the paroxysms, and
rapid and excessive prostration. Urgent thirst throughout.
Apyreacia : — Prostration; nausea; pains in stomach and
bowels; dropsical swellings. -
Ipecac.—Backache; short chill, long fever; nausea,
vomiting, and other gastric disturbances, occurring before
and during chill and heat; tongue thickly coated with
yellowish, moist fur; great oppression of chest; mausea and
vomiting predominate. Apyreacia : — More or less gastric
disturbance.
Useful in mild forms of tertian.—Baehr. f .
Nux v.–Chill long-lasting and hard; fever severe;
sweat profuse; both chill and fever accompanied by much
gastric and bilious disturbance; distressing pains in head,
back, and legs. During chill, external warmth aggravates,
and causes shivering.
Nua, in alternation with Ipec., for impure intermittents in non-
aguish districts.--Hughes.
Natrum mur.”— Chill beginning in feet or small of
back; blue nails; thirst; bursting headache, relieved by
sweating; bilious chill; bilious vomiting before and during
chill. For severe cases. DoSE.—“I am compelled to declare
myself for the higher dilutions.”—Dr. Watzke.
Eupatorium perf.-Thirst several hours before chill,
continuing during chill and heat. Chill short, hot stage
protracted, and sweat slight. Vomiting of bile at end of
chill. During chill and heat back aches violently, as if it
would break. -
Veratrum alb.-Predominance of external coldness;
cold, clammy perspiration; great thirst, especially during
chill and sweating; great exhaustion and sinking of
strength; vomiting and diarrhoea, with griping, and pain in
back and loins.
Indicated in the most pernicious kinds.—Rau6.
Phosphoric ac.—Profuse Sweat.
INTERMITTENT FEVER—REMITTENT FEVER. 21
Gelsemium.—Severe nervous symptoms.
Aconite. — Recent cases in plethoric subjects.
Cedron.—Chills recur with marked regularity. -
Ignatia.—Chill relieved by external warmth; thirst
only after paroxysm. - -
Capsicum.—The sweat coincides with the heat, instead
of following it. -
Pulsatilla.-Gastric symptoms, and resulting chlorosis
and hydraemia.
Hydrastis.--Cachectic subjects, with hepatic and gas-
tric symptoms.
Arsenicum, Ipecac., Cedron, Sulphur, for dumb
ague. -
Chinoidine will often cure when Quin. Sulph. fails.
GFIENERAL MEASURES.
During the Pº give Acom. to mitigate its severity.
Apply artificial heat during the chill, cooling drinks during
the hot stage, and warm, dry clothing after the sweat.
In malarial districts, avoid out-door air after sundown;
‘sleep in an upper room.
REMITTENT FEVER.
SYNONYMS : Bilious Fever; Typho-malarial Fever.
PROGNOSIS.–Favorable. -
LEADING REMEDIES.
• Belladonna.- For initiatory fever. Severe chill, with
vomiting and retching; violent fever, which is especially
high at night.
Gelsemium.—Congestion of head; flushed face; chilli-
ness; languor; great muscular weakness; pulse full, quick,
and soft; dull pain in head, back, and limbs. .
China. – Great prostration; fluctuating pulse; humming
in the ears; marked remission.
Ipecac.—Gastric disturbance; headache; yellow or
white-coated tongue; bitter taste, vomiting, and contin-
ued nausea.
Mercurius.--Thick, yellow, pasty coating on tongue;
earthy color of face; bitter taste; soreness in liver.
Applicable during greater part of disease.—Baehr. A
Bryonia.-Pressive or tearing pains in chest; better
when at rest. Thin coating on tongue; bitter taste; consti-
pation. Distinctly marked febrile motion. -
Pulsatilla. —Whitish coating on tongue; bitter eructa-
tions; bitter vomiting; chilliness; thirstlessness.
22 KEY NOTES OF MEDICAL PRACTICE.
Rhus.— Fever degenerates into a low, typhoid state,
with adynamia, diarrhoea, tongue brown and dry, Sordes on
lips, teeth, and tongue. -
Arsenicum.— Great emaciation, prostration, and rest-
lessness, with intense thirst; dark, fetid discharges from the
bowels. -
GEENERAL MEASURES.
Sometimes degenerates into low, typhoid-like condition,
when nursing and diet should be similar to that recom-
mended for Enteric Fever. -
PERNICIOUS AGUE.
SYNONYM : Congestive Chill.
1 | Comatose, Algid,
VARIETIES.–Cerebral{}. Icteric.
PROGNOSIS.— Grave. Recovery rare if more than
two paroxysms occur.
I have never lost a patient except where there has been an evident
heart affection — a fatty condition or dilatation — or where an organic
brain lesion has occurred during the first chill.—J. P. Dake. -
TREATMENT.— Must be prompt and vigorous. Bring
about reaction as soon as possible. In the cold stage, apply
heat to the surface, with stimulants. When there is cere-
bral congestion, cold affusions to the head.
Gastro-enteric {
ILEADING REMEDIES.
Arsenicum.—Cold, clammy sweat; breath cold; eyes
sunk in sockets; Hippocratic countenance; great prostra-
tion, with great anguish, thirst, and restlessness.
Veratrum vir. — Intense cerebral congestion; delirium;
face purple; violent throbbing of carotids; pulse full, hard,
and bounding.
Especially when the congestion involves the brain, and the chill
has been severe and profound.—J. P. Dake.
Gelsemium.— Burning heat of the surface; great sensi-
tiveness to light and sound; delirium; predominance of
nervous symptoms, with great muscular weakness.
When brain and spinal cord are both pressed, and heart's action
irregular.—J. P. Dake.
Quinia sulph. — Must be freely given to bring about
reaction. Give five grains every two hours, or three grains
every hour, till signs of reaction appear; then two grains
every three hours till the time for another paroxysm is past.
Caps. am., one-fourth part, may be advantageously combined
with the Quim. . -
If the dose cannot be given by the stomach, administer
subcutaneously
PERNICrous AGUE –YELLow FEvKR. 23
- - LENTE's soluTION.
B. Bi-Sulphate of quinine. . . . . . . . . . . 50 grains,
Dilute sulphuric acid. . . . . . . . . . . . 1 drachm, . .
Carbolic acid, liq. . . . . . . tº a 6 tº tº g º e & 5 minims,
Water, to make . . . . . . . . . . . . . . . . 1 ounce.
Dissolve the bi-sulphate in the sulphuric acid and water,
by the aid of heat; filter, and add the carbolic acid. Ten
drops contain one grain of the bi-sulphate.
Subcutaneous injection is the quickest and most powerful means
of bringing the patient under the influence of Quinine.—Bartholow.
SOLUTION OF SULPHATE OF QUININE.
B. Sulphate of quinine.............. 30 grains,
Sulphuric acid, dilute. . . . . . . . . . . . sufficient,
Water . . . . . . . . . . . . . . . . . . . . . . . . .... 2 ounces. Mix.
Quinine is called for in some cases—perhaps at some stage in all
cases —and no other remedy can take its place.—J. P. Dake.
The prompt, and energetic administration of Quinine is impera-
tively demanded.—L. A. Falligant.
My treatment is Quinine, Quinine, Quinine.-W. H. Holcombe.
Quinine is the remedy par eaccellence.—A. Chargé.
GENERAL MEASURES.
During the congestive chill use free, hot foot baths and
mustard draughts to the extremities, to divert the circula-
tion. If intense congestion of the head, use cold affusions;
but do not use them if the face be pale. If there be great
prostration, profuse, cold perspiration, cold breath, give
Stimulants — feed the patient with brandy or whiskey; put in
Some finely pounded ice if there be great thirst.
Remissions greatly promoted by free and frequent use of hot mus-
tard foot bath. Prostration and exhausting sweat demand stimulants.
—Falligant. -
YELLOW FEVER.
SYNONYM : Febº's Icterodes.
PROGNOSIS.–Favorable : Free, copious urine, how-
ever dark or bilious it may be, most favorable of any single
sign. Unfavorable: Blood in the early vomit; black vomit;
faltering articulation; suppression of wrine.
LEADING REMEDIES.
FIRST STAGE.
Camphor.—Initiatory chill, severe and long-lasting, with
great coldness of skin, and prostration. DoSE.— Drop doses
of tincture every ten minutes.
24 KEY NOTES OF MEDICAL PRACTICE.
Aconite.—First stage, after reaction from chill; fever;
burning heat; dry skin; full, hard, and rapid pulse; violent
thirst; red face; headache; restlessness; prostration and
vomiting.
Belladonna. – Cerebral congestion; headache; throb-
bing of carotids; face scarlet-red, shining, and swollen; eyes
red and sparkling; active delirium; pain in stomach, with
nausea and vomiting. -
Acon, and Bell. are complements of each other in the stage of fever
and cerebro-spinal irritation, and I therefore use them in alternation
every half hour at first.—Holcombe. - .
SECOND STAGE.
Bryonia.-After cerebro-spinal symptoms have sub-
sided, and the gastric symptoms are prominent. Splitting
headache; eyes red and sparkling; tongue yellow-coated;
lips parched, dry, and ... great irritability, and vom-
iting. -
& Argentum nit.—Womiting of brownish mass, mixed
with coffee-ground-like flakes. -
If the patient sinks, if the vomiting becomes worse, or with any of
those various signs which indicate haemorrhage from the gastric mu-
cous membrane, Arg. nit. is the remedy.—Holcombe.
THIRD STAGE.
Arsenicum.— Face yellowish and livid; eyes dull and
sunken; .ngse, pointed; lips and tongue brown or black;
burning or stitching pain in epigastrium and region of liver;
suppression of urine; oppression of chest; short, anxious
breathing; pulse small and tremulous; skin cold; cold,
clammy perspiration; rapid prostration, and vomiting of a
brown, turbid matter, mixed with mucus, and sometimes
stained with blood.
Lachesis.- Delirium; slow, difficult speech; red face;
tongue heavy, trembling, dry, and brown, nausea; vomit-
ing; irregular, weak pulse; urine almost black. t
When Bell. and Alcon. produce no further amelioration, a change
to Arsen, and Lach. brings about the desired amendment.— Holcombe.
Crotalus.— Hamorrhage from eyes, nose, mouth, stom-
ach, and intestines—from all the orifices of the body, even
to bloody sweat.
Has proved of excellent service.—Neidhard.
SPECIAL IREMEDIES.
Sabina, Secale.—Threatened abortion.
Hyoscyamus, Coffea.—Nervous sleeplessness at night.
Antimonium tart.— Prolonged and incessant nausea.
Veratrum alb.-Vomiting and abdominal pains.
Phosphorus, Mercurius.-Resulting diarrhoea or dys-
entery. f
Ipecac.—Continued nausea; vomiting of glairy mucus.
CORYZA — OZAENA. - 25
Cantharis.— Cramps in abdominal muscles and legs,
with º urging to urinate, or suppression of urine.
Scarcely ever fails to remove strangury, and restore the renal secre-
tion.—Holcombe.
GENERAL MEASUREs.
Quarantine the patient; use disinfectants; keep the pa:
tient quiet, in horizontal posture; keep the air fresh and
pure; cool sponging of the body when the fever is high.
Diet.— Requires strict attention. First stage, milk and
water, with lime-water added; black tea, with cream ; ice
cream; bits of ice, to slake the thirst, and allay vomiting.
Later, give rice, milk, and arrowroot. During the stage of
prostration, beef tea, wine whey, café au lait. Great cau-
tion is necessary, lest an error in diet excite a relapse.
DISEASES OF RESPIRATORY ORGANS.
CORYZ.A.
SYNoNYM : NasalCatarrh.
LEADING REMEDIES.
Camphor.— Incipient stage, chill, Drop doses, fre-
quently repeated, often cut it short. %.º.~~~~~,
Aconite.— Chilliness, followed by feverishness, as pre-
cursor of catarrhal fever. -
Euphrasia.-Acrid, fluent coryza, with Scalding tears
and aversion to light.
Arsenicum iod. —Abundant discharge of thin, hot, eac-
corating mucus from nose, with burning sensation; lassi-
tude and prostration.
Mercurius iod.— Frequent Smeezing; Soreness of nose;
discharge of thick mucus, great accumulation in posterior
nares; salivation; sore throat; profuse perspiration.
Hydrastis.--Thick, tenacious Secretion from posterior
nares, constantly dropping into the throat. Also, a spray,
locally, of Muriate of Hydrastis.
Rali bi.-Chronic coryza, with tough, stringy mucus;
hoarseness; cough; yellow-coated tongue, and gastric dis-
turbance.
OZAENA.
LEADING REMEDIES.
Aurum. — Discharge offensive; bones of nose sore; mel-
ancholia; mercurialization; syphilitic subjects.
Nitric ac.—Syphilitic ozaena; also after drugging with
large doses of Mercury.
26 REY NOTES OF MEDICAL PRACTICE.
-
Kali bi.—Thick, tenacious, sometimes bloody discharge,
and “plugs” of thick mucus.
Pulsatilla.-Soreness of nostrils, with greenish dis-
charge.
GENERAL MEASURES.
Local applications, administered by means of atomizer,
should be made to affected part. If discharge is very offen-
sive, use solution Kali perman., five grains to one ounce
warm water; or Carbol. ac. five drops, Iod. six drops,
to one ounce water. In severe cases of ozaena, ointment of
red precipitate (Hydr. praecip. rub.) may be applied directly
to the Sores, whenever they can be reached, in the nasal
cavity. - -
OEDEMA GLOTTIDIS.
Apis mel.—Sudden oedema of glottis.
Trust to Apis — it has cured it in its most fatal form.—Hughes.
CoNSULT—Ars., Sang., Stram.
GENERAL MEASURES.
Scarify the glottis with the point of a guarded bistoury;
or, with finger nail sharpened to a point. Inhalations of
steam. Tracheotomy, if suffocation is imminent.
EPISTAXIS.
LEADING REMEDIES.
Aconite.— Prolonged or violent bleeding in plethoric
subjects, with fullness of cerebral vessels.
Belladonna — Congestion of head, blood bright and
flowing freely. From being over-heated. -
Arnica.- From injury. Nose feels hot; blood red and
liquid; haemorrhage preceded by itching or tingling of nose.
Nitric ac.— Disposition to nose bleed; severe and fre-
quent attacks. Often succeeds. -
China. –Weakly persons who have lost much blood;
ringing in ears; pale face.
Bryonia.- Bleeding of nose when menses should
appeal'.
Hamamelis.-Passive flow, blood dark and liquid;
haemophilia.
Ferrum phos. – Epistaxis in old people.
GENERAL MEASURES.
Raise the arms above the head. Apply cold water or ice
to the root of the nose, or back of the neck. Insert into
the nostril a plug of lint saturated with Hamam. Inject
into the nostril a solution of Alum. (See Part III.)
w
HAY FEVER—INFLUENZA. 27
HAY FEVER.
SYNONYMS : Hay Asthma; Rose Cold. - “A
LEADING REMEDIES.
Arsenicum.—The leading remedy. Its persistent use
has cured some cases. -
Sticta pulm.— I have used it considerably, and with
the very best results. – Dr. B. F. Bailey.
Ipecac. — In conjunction with Ars., especially when
asthmatic symptoms prevail.
Sabadilla.-Hay fever, with violent Sneezing and run-
ning of eyes and nose. -
I have cured a number of severe cases.—Bayes.
Quinine. — Use solution locally.
With Binz's solution of Quinine as a local application I have had
very good results.—Hughes. -
GENERAL MEASUREs.
Change of climate assures immunity. Mackinac and the
shores of Lake Superior, the White Mountains, favorite
resorts. Sea voyage also effectual. To stop violent par-
oxysms of sneezing, plug the nostrils with cotton — not
tight, but so that the air, in breathing, will filter through.
INFLUENZA.
LEADING REMEDIES.
Arsenicum iod.— Chills, with flushes of heat; severe,
fluent coryza, discharge irritating and corrosive; Sneezing;
puffiness of face; prostration. -
The specific remedy.—Hughes. -
Aconite.—High fever; hot, dry skin; restlessness;
dry, violent, racking cough, with stitches in chest.
TMercurius.-Rheumatic pains in head, face, ears,
teeth, and extremities; fluent coryza, with catarrh of throat
and lungs, with violent, racking, unceasing cough; chill
and heat, with profuse, non-alleviating sweat. - * .
Eupatorium perf.- Distressing backache and “bone
ains.” -
p Kali bi.—Troublesome cough, with coated tongue, and
loss of appetite. -
GENERAL MEASURES.
In severe cases confinement to bed with warm drinks
and a hot-bottle sweat will greatly aid. If the cough is
severe keep the atmosphere of the room moist. -
28 KEY NOTES OF MEDICAL PRACTICE.
CROUP – CATARRHAL.
SYNONYMI: Acute Laryngitis.
LEADING IREMEDIES.
Aconite.— Early in attack, short, dry, hard, metallic
cough; hurried, labored breathing; hot, dry skin; thirst;
restlessness. - -
This is the principal remedy for catarrhal croup.
Spongia.— Rough, crowing, barking cough; loud,
wheezing, sawing respiration; suffocative fits; inability to
breathe except with head thrown back. -
With Acon., sufficient in most cases. '•
Hepar sulph.-Loose, rattling, choking cough; air pass-
ages seem to be clogged with mucus. After resolution has
been initiated by Acon. and Spong., so that the breathing has
a rattling rather than a sawing sound. -
Rali bi.— The throat becomes filled with tough, tena-
cious mucus.
Phosphorus.-Hoarseness after croup, with tendency
to relapses. -
Antimonium tart.—Loose cough, much mucus on the
lungs, with difficult expectoration.
GENERAL MEASURES.
º Hot fomentations to the throat, and hot foot bath, up to
the knees, often benefit. Give the patient plenty of fresh
air. Give frequent doses of the indicated remedy.
CROUP – PSEUDO-MEMBRANOUS.
PROGNOSIS.–Grave. Unfavorable: Signs of car-
bonization of the blood; face becomes blue, hands cold, and
fingers blue under the nails, with drowsiness and stupor;
pulse weak, Small, irregular, and frequent; cold extremities.
LEADING REMEDIES.
Iodine. — Dry, short, barking cough, with wheezing,
sawing respiration, imminent suffocation, and extreme dysp-
noea. DOSE.-Teste uses a one-per-cent solution, three drops
every fifteen minutes.
As soon, as I am satisfied of the existence of true croup, I give
Iod., second dilution.— Dr. Elb. - -
Bromine. — Child gasping for air; rattling of mucus in
the windpipe when coughing; false membrane, eactending to
the lungs; great prostration. -
Constitutional prostration is the characteristic indication for the
preference of Brom. Iod. suits the more sthenic form.—Hughes.
Kalibi...— Gradual onset; hoarse, dry, barking cough;
tonsils and larynx red and swollen, with patches of pseudo- . .
CROUP, PSEUDO-MEMBRANOUs—cough. 29
membrane; violent wheezing and rattling in trachea; mem-
brane thick and tenacious.
Has frequently cured membranous croup.—Hughes.
SPECIAL REMEDIES.
Belladonna. – Early, as anti-pyretic, and to reduce
the local capillary congestion. . . .
Arsenicum.—Great puffy swelling of throat and neck;
putrid breath; rapid and extreme prostration. g
Phosphorus.- Increased dyspnoea, agony, and restless-
ness; hollow cough; the croupous process extended to
bronchi; the lungs hyperamic.
Antimonium tart.— Danger of asphyxia occasioned
by movable patches of membrane; cough feeble and without
resonance; mucous ràle in trachea.
Hepar sulph.-After the attack, a rattling cough
Ten) 8,111S.
Phosphorus. - Dry cough remaining after recovery.
GHENERAL MEASURES.
Give the patient an abundance of pure air. Keep the
temperature of the room at 75° F., and the atmosphere
inoist. Early in the attack bits of ice are grateful to the
patient. Give inhalations of the indicated remedy, Iod.,
Brom., Kali bi., by means of the steam atomizer, in addi-
tion to its internal administration. The fumes of slacking
lime inhaled by the patient, has proved useful in many cases.
Tracheotomy.— The percentage of recoveries following
tracheotomy is such as to demand its trial in every critical.
case. The operation is called for when there is considerable
false membrane in the laryma, when respiration is so difficult
that you see falling in of the sternum each time the patient
breathes, and each supra-clavicular space deepens with every
inspiration. (For method of operating see Part III.)
Diet.— Give nourishing food, liquid in form — broths,
beef tea, milk, eggs stirred in milk, wine whey, egg coffee;
Or, nutrient enemata. -
COUGH. .
LEADING REMEDIES. y
Nitric ac.— Chronic, laryngeal cough, without expecto-
ration, with stinging and smarting as of small ulcer in
larynx — generally on left side.
I , have long used it with benefit in dry and violent laryngeal
coughs.—Hughes.
Hepar sulph.- Irritating cough, with hoarseness,
excited by exposure to cold; rattling of mucus in throat;
sensation as of a clot of mucus, or internal swelling,
when swallowing.
30 REY NOTES OF MEDICAL PRACTICE.
Phosphorus.— Dry cough, excited by tickling in the
throat, with hoarseness; phthisical cough, in those with
weak lungs. . .
Spongia.— Dry, hoarse cough, with pain in larynx;
worse at night. - -
Sulphur.— Dry cough, with hoarseness and dryness in
throat, and tightness of chest. Or, loose cough, with ex-
pectoration of whitish or yellowish mucus. .
Kali bi...—Cough with tough, stringy expectoration, pre-
ceded by much wheezing, accompanied by difficult breathing,
and followed by dizziness. -
Mercurius.-Chronic, moist cough, worse at night.
Hyoseyamus.—Nervous, dry, spasmodic cough, worse
at night, especially on lying down.
Belladonna.--Short, dry, hollow, convulsive cough,
worse at night, with tickling in throat, flushed face, head-
ache, and cerebral congestion. -
Bryonia.—Hard, dry, shaking cough, with pain in side,
chest, and head. • .
GFF NERAL INTEASURES.
Cough is a symptom, and the cause must be ascertained
and removed. In simple cough, a cold compress about the
throat at night often relieves. Drink small quantities of
cold water at frequent intervals. Give gum water, and
demulcent drinks, when from simple irritation.
WHOOPING COUGH.
SYNoNYM: Pertussis. -
LEADING REMEDIES.
Aconite.-Initiatory fever, with dry, hard, wheezing
cough, burning pains, or dry itching in the larynx.
Indispensable for the fever.—Boenninghausen.
Ipecac.—Violent, Suffocative cough, the child becoming
stiff and blue in the face; gagging and vomiting of mucus.
One of our best remedies.- Baehr. *
Drosera.--Spasmodic stage, with frequent and exces-
sively severe paroxysms of hoarse, loud cough, sometimes
with bleeding from nose and mouth. Fever may be absent,
or, fever intermixed with chills, accompanied by perspira-
tion, and after the cough, vomiting of food or mucus.
DoSE.—1x or tincture.—Bayes. .
Holds a prominent place among whooping-cough remedies.—
Boenninghausen. . - -
Hydrocyanic ac.–Spasmodic stage, convulsions and
Suffocative attacks. -
Exerts almost magical influence.—West.
y WHOOPING COUGH — BRONCHITIS. 31
Belladonna. – Sudden, violent paroxysms of cough, with-
out expectoration, worse at night, with sore throat, cerebral
congestion, redness of eyes, epistaxis.
Very useful remedy. Suitable only at the beginning, or, later,
when there is cerebral congestion or fever.—Boºn?vinghausen.
Carbolic ac.— Second stage. Cough dry, hard, spas-
modic.
I have used the 2x with excellent effect.
Corallium rub.-“A remedy of exceeding value in
violent cases.”—Carroll Dunham.
Cuprum.—Convulsions. “Has always succeeded with
me.”—Jousset. -
Phosphorus.--Supervening broncho-pneumonia. ,
Hepar ºh- Croup prevailing at time of epidemic of
whooping cough. .
GENERAL MEASURES.
In the case of infants watch them closely and take them
up if a paroxysm of cough sets in. Wear warm clothing,
and guard against chill. If the attack be severe give plenty
of nourishing food to keep up the strength. e
BRONCHITIS.
PROGNOSIS.— Generally favorable. It is grave in the
capillary bronchitis of young children, and the Suffocative
catarrh of the aged. Unfavorable : Breathing oppressed
and very rapid—60 and over per minute; pulse 150 or over,
small, thread-like, and irregular; bluish countenance and
other signs of carbonization of the blood. Favorable:
Respirations become easier and less frequent; subsidence of
sub-crepitant rôles, and return of respiratory murmur, and
diminished frequency of pulse-beats.
LEADING REMEDIES.
Aconite.—Early in attack; chill and fever; dry, hot
skin; restlessness and thirst; short, hard, tickling cough, with
constant laryngeal irritation. To be of service Acon.
must be given early; later it is of no use except as inter-
current if there be continuous fever.
Should the inflammation have thoroughly established itself, we
cannot expect AC0n. alone to cure it"; -
Antimonium tart.— Great oppression and Suffocative
breathing; extensive mucous ráles; great rattling of mucus
with the cough, but nothing is raised; also, symptoms of
incipient carbonic-acid poisoning — Sopor, delirium, pallor,
bloated countenance; also, profuse sweat without relief;
disposition to vomiting and diarrhoea; paroxysms of rat-
tling cough, ending in vomiting. For capillary bronchºtis
of children, and pneumonia motha of the aged. * .
Enjoys the largest sphere of action, and is prečminently character-
32 KEY NOTES OF MEDICAL PRACTICE.
ized by a profuse eaccretion of mucus which it is difficult to raise, with
or without fever.—Baehr.
The grand remedy for this dangerous disorder (suffocative catarrh
of the aged). I have almost invariably relied }; it alone, and have
seen desperate cascs recover under its use.—Hughes.
Belladonna.--Dry, distressing, spasmodic cough, in
short paroxysms, but very violent, especially toward even-
ing; no expectoration, or yellowish, tenacious, scanty,
blood-streaked; respiration oppressed, irregular, and hur-
ried; sensation of fullness in chest, with determination of
blood to lungs. Useful º in first three or four days.
Bronchitis setting in with violent fever; moderates the latter much
more certainly than Acon.— Baehr.
Mercurius.--Violent fever, temperature high; great
perspiration, without relief; alternation of chills and heat,
with great sensitiveness to changes of temperature;
tongue with thick, yellowish coating; diarrhoea; feeling
of dryness, roughness, and Soreness down middle of chest;
violent, wearing cough, especially in evening and until
midnight, with tenacious, yellowish, sometimes blood-tinged
expectoration, every paroxysm of . preceded by anxious
oppression and dyspnoea; unquenchable longing for ice-
cold drinks. Particularly adapted to children and robust
adults — not so much for old people. Mucous membranes
extensively involved — lungs, stomach, bowels.
Bryonia.-Trachea and large bronchi affected; dry
cough, with stitches in the chest, short, labored respiration;
with cough, determination of blood to head, turgescence of
face. Ordinary “cold on the lungs.”
Too extensive claims are made for Bry. - Good where the
catarrh invades the trachea and large bronchi– it is of little use
beyond.—Hughes.
Kalibi...— Burning pain in trachea, cough with expecto-
ration of tough mucus, which can be drawn out in strings;
tongue thickly coated, with loathing of food.
ronchorrhaea, with copious, purulent expectoration, give Kali bi.,
by inhalation, two grains to four ounces of water.—Meyhoffer.
Ipecac.—Asthmatic breathing; much nausea and vomit-
ing of mucus, rattling of mucus in bronchial tubes, face
livid during cough; loud, mucous ráles, with wheezing
º severe gastric ailments and intestinal catarrh,
pallid or bluish or bloated countenance. Principally adapted
to bronchial catarrh of children.
Hepar sulph.-Cough, with wheezing over whole
chest, in severe paroxysms, with danger of suffocation;
expectoration of a yellowish, tenacious mucus. Croupous
bronchitis.
SPECIAL REMEDIES.
Veratrum alb.-Fáiling strength; increased frequency
and irregularity of pulse; coarse rāles; secretion of copious
quantities of mucus, which cannot be coughed up; skin
cold, with cold sweat.
CAPILLARY BRONCHITIS — ASTHMA. 33
Arsènicum.— For aged people, with great debility;
oºdena of lungs. - -
s.— Complications — occlema of lungs, or
Rhus.--Typhoid symptoms and violent fever.
CAPILLARY BRONCHITIS.
IREMEDIES.
Antimonium tart., Calcarea carb., Phosphorus, Ipecac.,
Arsenicum. -
CHRONIC BRONCHITIS.
With mucus expectoration.—Amt. tart., Kali bi.
With purulent expectoration.—Merc., Sil., Lyc., Calc.,
Sulph., Iod.
No bronchial disease of long standing can be successfully treated
without Sulph. or Lyc.—Meyhoffer.
Sulphur. — Rheumatic or gouty subjects, or those of
scrofulous diathesis. Bronchorrhoea, with putrid expecto-
ration. -
Curative in the most inveterate forms.-Meyhoffer.
GENERAL MEASUIRES.
If the patient is suffering from extreme dyspnoea, hot
fomentations to the chest afford prompt relief. Do not
leave fomentations on to become cold — renew at frequent
intervals. In capillary bronchitis, keep the patient in a
well ventilated room, but with an equable temperature, and
a warm, moist atmosphere. *
Diet.— In acute, with fever, diet as in other fevers.
When profuse expectoration, nourishing, albuminous food.
Demulcent drinks good — milk, gruel, barley water.
ASTHMA.
LEADING REMEDIES.
Arsenicum.—Asthma, with burning heat in chest, cold
sweats, complicating heart disease, or following bronchitis.
The more the patient seems on the point of suffocating, the
more painful and distressing his restlessness, the more
wheezing and louder the respiration, the more Ars. will
be found appropriate. This is accompanied by livid coun-
tenance; cold sweat; frequent, . pulse; palpitation; :
distended abdomen. .
ArS. sometimes exerts a magical effect.—Baehr.

3
34 REY NOTES OF MEDICAL PRACTICE.
Nux wom.—Tongue coated with thick, yellow fur; slight
nausea; flatulence; constipation; disorders of digestion.
The best curative medicine we have for simple spasmodic asthma,
where there is no bronchial lesion.—Hughes.
Ipecac.—Attacks of suffocation; feeling of constriction
in throat and chest; coldness; paleness; anxiety and sick-
ness; rattling of mucus in bronchial tubes. Bronchitic
asthma. Give frequent doses during paroxysm. *
Lobelia.- Purely nervous asthma; constrictive, Suffo-
cative sensation; vertigo; nausea; vomiting; sense of great
emptiness in stomach.
Aconite.— Dyspnoea; labored breathing; great fear and
anxiety of mind; Suffocative cough at night. Often relieves
during paroxysm of spasmodic asthma, and bronchitic asth-
ma from cold.
Sambucus.-Violent dyspnoea; nightly suffocative at-
tacks, with profuse perspiration. Especially useful in asthma
of children.
Grindelia.-- Mucous asthma; tenacious sputa; nervous
and cardiac asthma.
Sulphur.—Gouty subjects, or those subject to skin dis-
€8;S6S. -
GENERAL MEASURES.
Let the patient seek the most comfortable position for
himself, to favor respiratory effort. Keep the atmosphere
of the room moist. To relieve paroxysm : A cup of very
strong coffee, drop doses tincture ſpec.; inhalation of Nitriie
of Amyl, of Chloroform, or Ether; inhalations of the smoke
of burning Stram, leaves, made up into a cigarette, or in a
pipe-twenty grains of the leaves, or ten grains of the dried
root. Soak blotting paper in a strong solution of Potassic
Nitrate (saltpeter), and dry it thoroughly. Burn this, and
let the patient inhale the fumes. -
Diet.- Important. Asthmatics are generally dyspeptic,
and much can be accomplished by attention to the stomach.
Never overload the stomach. Do not eat a hearty meal late
in the day. Let the diet be nourishing, but plain, whole-
Some, and easy of digestion. Use no coffee.
PNEUMONITIS.
SYNONYM : Lung Fever.
PROGNOSIS.–Favorable : Acute; uncomplicated:
previously healthy subjects; one lung. Unfavorable: Ex-
tremes of life; complication with Bright's, heart, pregnancy,
etc.; pulse over 150; delirium after first week; collateral
gedema; gangrene; both lungs: . . - * * - .
TCAUSEs of DEATH.-Collateral odema; heart failure and
heart clot; asphyxia; asthenia. . . . .
PNEUMONITIS. : 35
LEADING REMEDIES.
4. * * - g
* Veratrum vir.—Stage of congestion; full, hard,
bounding pulse; rusty expectoration; great oppression of,
chest; delirium. Dose.—Several drops of tincture.
I have seen the happiest effects when the attack came with a sévere,
long-lasting chill —J. P. Dake. º .
T have aborted threatened attacks with this remedy.
Aconite.— Initiatory chill and fever; stage of conges-
tion; of no use after hepatization has occurred, and Verat.
vir. is often superior to it in the first stage.
Bryonia. — Moderate fever; severe, shooting, cutting
pains in chest; painful cough, with scanty expectoration of
tough, rust-colored mucus; stage of restlessness has passed;
patient quiet and exhausted; tongue covered with thick,
white fur; stomach inactive; liver engorged; rheumatic
pains in chest muscles. -
The most essential remedy in second stage.—Baehr.
Phosphorus. – Stage of hepatization; pain not very
Severe — vaguely localized s stitches; great weight and
oppression of chest; marked embarrassment of respiration;
cough, with bloody, muco-Sanguinolent, or sanguineo-
purulent, difficult expectoration. Very useful in severe
cases, asthenic pneumonia, and “typhoid pneumonia.”
Collateral oadema. -
Our sheet anchor in pneumonia.—Hirschel.
Antimonium tart.— Commencing resolution; increased
frequency of pulse; great anxiety and restlessness; copious,
cool perspiration; pallid countenance; suffocative spells; ,
great dyspnoea; loose, rattling cough, as if much would be
expectorated, but nothing comes; impending paralysis of
lungs; collateral cºdema. -
One of the most important remedies when pneumonia deviates
from its normal course.—Baeh?". - .
Sulphur.—After defervescence, to promote resolution.
A deficiency of reaction, and a simultaneous absence of such
symptoms as point to a destruction of the organic powers, constitute
the best indications for this remedy.—Baehr.
SPECIAL REMEDIES.
Chelidonium.— Liver complication.
Sanguinaria.--Suppuration; hectic fever,
Lycopodium.— Chronic pneumonia, with hectic.
Nitric ac.— In aged, or of feeble constitution.
Mercurius.- Broncho-pneumonia; profuse sweats.
Rhus.—Typhoid character; ‘‘prune-juice ’sputum.
Hepar sulph., Silica. – Purulent infiltration; abscess.
Belladonna.-Cerebral congestion; delirium; convul-
S1OllS. - - - * ,
GENERAL MEASURES.
Keep the patient in a large, well ventilated room. Abun-
dance of pure air important. Patient should be propped
36 KIEY NOTES OF MEDICAL PRACTICE.
- up in bed, in a raised posture. Large, thin poultice to the
chest. Give mucilaginous drinks and nourishing food.
CONGESTION OF THE LUNGS.
LEADING REMEDIES.
Aconite.— In plethoric subjects, with short, anxious
breathing; pulse quick and hard; burning, pressing pains
in chest.
The main remedy.—Baehr.
All-sufficient when case taken early.—Hughes.
Veratrum vir.—Great arterial excitement; faint feel-
ing in stomach; nausea; heart's beat loud and strong; pulse
full and hard.
Has often cured.—Hempel.
Cactus.- Congestion of lungs dependent on cardiac
affection, with oppression of respiration; acute pains; feeble
voice; feeling of constriction.
I have used this remedy with excellent effect.
Phosphorus.-Feeling of great weight on chest.
When turgescence so great as to allow oºdema to occur.—Hughes.
OEDEMA OF THE LUNGS.
LEADING REMEDIES.
Phosphorus.-Acute pulmonary oedema in connection
with pneumonia, or other diseases of the teºry Organs.
This remedy sometimes has a brilliant effect.—Rafka.
It is possessed of extraordinary powers against Oedema.-Baehr.
Antimonium tart. — Cyanosis; audible rattling; great
dyspnoea; coarse rôles; the bronchial tubes containing a
great quantity of mucus; the patient in constant danger of
ºtion. CEdema of lungs occurring in course of general
rOpSW.
#. more than once seen the oedema subside entirely under the
use of this medicine.—Hughes.
Arsenicum.—Supervening on anasarca; great debility
and prostration.
Ammonium carb.-Give on first signs of drowsiness,
and carbonic-acid poisoning.
HAEMORTYSIS.
IDIFFERENTIAL DIAGENOSIS.
HAEM OPTYSIS, HAEMATEMESIS.
Blood - - - - Bright-red - - - Dark.
Blood - - - - Coughed up - - Vomited.
Blood - - - - Frothy - - - - Fluid.
Mixed with - - Sputum - - - Food.
Preceded by - - Dyspnoea - - - Stomach distress.
Stools contain - - No blood - - - Blood.
Respiration - - Râles in lungs - Lungs clear.
HAEMOPTYSIS — PLEURITIS. 37
LEADING REMEDIES.
Aconite.—Blood red, frothy; incessant cough; hot
chest; anguish; red face. DoSE.—“Ilow dilutions, repeated
very often.”—Jousset. -
Indispensable in sthenic cases.—Hughes. -
Hamamelis. – Profuse haemorrhage of venous blood,
coming into mouth without effort, like a warm current.
When blood is black, a precious remedy.—Jousset.
When flow is passive, from venous hamorrhage, a reliable remedy.
— Hughes. -
Arnica. –Abundant, blackish blood, with clots, after
injury or bodily exertion.
Especially useful when with heart disease or traumatism.—Jou88et.
Ipecac.— Copious bleeding, preceded by sensation of
bubbling in chest; cough, with spitting of blood occasioned
by least effort; with cough, tickling behind sternum.
Holds high rank.—Hughes.
Millefolium.— Blood red, frothy; ejected without
much coughing.
Almost always justifies the indications.—Hughes. -
Veratrum vir.—From congestion of lungs, with full,
hard, bounding pulse.
Cactus.- Marked arterial excitement; haemorrhages
from over action of the heart.
Haemoptysis with heart disease.—Raue.
Digitalis.--From obstruction of pulmonary circulation
in consequence of heart disease and tuberculosis.
Phosphorus.--Tight feeling in chest, with dry, tight
cough, followed by hamorrhage.
Inflammatory symptoms supervening on an attack of haemoptysis.
—Hughes.
The principal remedy when there is haemoptysis in dangerous cases
of fever.—Jous&et.
G.ENERAL MEASURES.
Recumbent posture; head and shoulders elevated–airy
room. Bits of ice in the mouth; a little salt on the tongue.
PLEURITIS.
PROGNOSIS.—Favorable : In the young, and healthy
subjects; effusion scanty; early absorption. Unfavorable :
In cachectic, double-sided, persistent high fever; rapid in-
crease of effusion, or return after having once subsided;
complication with phthisis. -
CAUSES OF DEATH.-Collateral oedema of the lungs;
perforation of the diaphragm, and peritomitis; perforation
of the lung, with pneumo-thorax; hectic; pneumonia; syn-
cope from dislocation of the heart. - -
38 KEY NotEs of MEDICAL PRACTICE.
LEADING REMEDIES.
Aconite. — Chill and initiatory fever. Great thirst;
quick and rapid pulse; hot, dry skin: red face; shortness of
breath; great nervous excitability; piercing, stitching pains
in chest, with dry cough.
In simple, acute pleurisy, the sufficient medicine.—Hughes.
Bryonia.-Acute, stitching pains in side, greatly aggra-
wated by breathing or movement; labored, short, anxious,
and rapid breathing, performed almost altogether by
abdominal muscles.
The sovereign remedy when the inflammation has advanced to the
stage of serous effusion.— Trinks.
Arsenicum.— Great dyspnoea, with but little pain.
Second stage, patient much prostrated, weak, and cachectic.
It Will ;}sh more than any other remedy in the stage of
effusion.—Mitchell.
SPECIAL REMEDIES.
Apis.—Resorption of effusion.
Arnica.--From over-exertion or a blow.
Iodium.— In scrofulous subjects, replaces Bry.
Sulphur. — Plastic exudation, slow to disappear.
Mercurius.-Exudation inclines to become purulent.
Antimonium tart., Phosphorus.-Pleuro-pneumo-
Ill&.
GENERAL IMEASURES.
Absolute rest important. Poultices, large, hot, and fre-
quently renewed. Thoracemtesis is called for if the amount
of effusion is great, with great dyspnoea, and imminent
danger from suffocation; effusion liable to return if done
before fever subsides. Use aspirator, needle anointed with
oil—no preliminary incision; introduce near the axillary
line, fifth intercostal space on the left side, fourth on the
Tight, near the upper edge of the rib; patient recumbent;
evacuate slowly; admit no air.
Diet.—As in fevers generally. Give a sustaining diet if
there is much suppuration.
EFFUSION IN PLEURAL CAVITY.
LEADING REMEDIES.
Apis.-Oppression very great; inability to lie down;
absence of thirst; dark and scanty urine. From recent
inflammation, and after Scarlet fever.
Absence of thirst and suddenness of oedema reliable indications.—
Hempel. -
Sulphur.—“Unabsorbed pleuritic effusion, and that
which comes on insidiously, I have frequently cured with
the continued use of the tincture of Sulph., three or four
Y-Z s.4-r co-. *
HYDROTHORAx–PULMONARY PHTHISIS. 39
doses a day at first, but, as improvement continues, one or
two doses a day.”—Dr. Cate.
IHYDROTHORAX.
LEADING REMEDIES.
Arsenicum.— Severe dyspnoea; Suffocative attacks,
especially at night; patient cachectic; face bloated; small
pulse; idiopathic cases.
Digitalis.-Secondary to cardiac affection; face pale
or bluish; pulse slow and intermittent; urine Scanty.
Digit. the remedy in cardiac dropsy.—Hale.
Apocynum.—When amount of effusion very great.
Main treatment to be directed to primary disease, on which
the dropsy depends.
PLEURODYNIA.
LEADING IREMEDIES.
Aconite.— Rheumatic pleurodynia, recént attack, with
fever.
Bryonia.—Sharp, stitching pains, with rheumatic ten-
dency. •.
Arnica. — Myalgic pleurodynia, with stitching pains;
“spurious pleurisy.”—Hughes. *
Actaea rac.—Neuralgic pleurodynia, with deranged
uterine function.
Is specific.—Hughes.
Ranunculus.— Idiopathic intercostal neuralgia in
anaemic or debilitated subjects.
Nux v.—Haemorrhoidal subjects; patient cannot lie on
affected side.—Jousset.
PULMONARY PHTHISIS.
SYNONYM : Consumption.
VARIETIES:— I. Catarrhal Phthºsis, or Lobular Pneu-
monia. This disease is a continuation of pneumonia
(catarrhal type). -
II. Fibrous Phthisis, or Cirrhosis, or Induration of
the Lung, or Interstitial Pneumonia. In this form the con-
nective tissue growth is a prominent feature.
III. Chronic Tubercular Phthisis. Miliary tubercle is
deposited in the lymphatic structure of the lung.
LEADING REMEDIES.
Iodium. – Emaciation; loss of appetite; night sweats;
profuse, yellowish expectoration, sometimes blood-streaked.
More particularly indicated if tuberculosis is the result of
Scrofulosis. Does not act favorably if diarrhoea present.
40 KEY NOTES OF MEDICAL PRACTICE.
DoSE.—Sia:th sometimes has good effect, but first often
indispensable.
Our best hope of future success in phthisis lies in knowing how to
use Iod. for it.—Hughes.
One of our most important remedies in confirmed phthisis.—Baehr.
Phosphorus. – Continued hoarseness, with distressing,
dry cough and sore feeling in the larynx and trachea; pain
in the stomach after meals; retching and vomiting of
mucus; continual diarrhoea, especially after meals. It
keeps down the hyperiemia of the lungs, quiets the cough,
and often moderates the diarrhoea. DOSE.— Medium dilu-
tions.
It is curative in pneumonic phthisis.—Hughes.
In earlier stages it effects absorption and restores the normal
respiratory murmur more certainly than any other remedy.—Mitchell.
Baptisia.--Disposition to well marked chills, or only
chilly "feelings, particularly mornings, followed by fever
and perspiration; general debility; profuse expectoration;
marked anorexia; bowels regular; laryngeal phthisis, with
severe, constant cough and great emaciation.
One of our most serviceable remedies in pºtniss with profuse expec-
toration, morning chill and hectic.—Mitchell.
Stannum.— Hectic and emaciation; cough loose and
rattling, with profuse, greenish, or muco-purulent expectora-
tion of a disagreeable, sweetish taste; much rattling of
mucus in the lungs; cough and expectoration worse morn-
ings; soreness in chest after coughing; a sense of great weak-
ness and emptiness in chest, so that slight exertion of the
voice causes great fatigue. Useful in bronchial dilatation.
Even when it cannot cure, it will do much to moderate the exhaust-
ing sweats and expectoration.—Hughes. *
Calcarea phos. – Delicate skin; flushed cheeks; con-
gestive headaches; appetite irregular; dyspepsia with acid
eructations; at times, diarrhoea; lassitude and weakness
except when under excitement. In females, menses early
and profuse. Calc. 70d., Calc. carb., and Calc, ars. also
used.
Kali carb. — In pneumonic phthisis, when there is
moist cough, with profuse, purulent expectoration, and
sharp, stitching pains in the walls of the chest.
It is rarely that ulcerative pulmonary phthisis can be cured with-
out Kali carb.-Hahnemann.
#yonia– Pleuritic complications and bronchial ca-
tarrh.
No remedy equals it in allaying the accompanying fever.—Mitchell.
Cod-liver oil.— Useful in many cases when there is
emaciation. If it disturb digestion, or cause derangement of
the stomach, it will do more harm than good. Do not take
it on an empty stomach — a half hour after a meal is the
best time. Large doses are not necessary — a teaspoonful
after breakfast and dinner is sufficient. The use of the
oil must be persisted in for months and years.
Before taking the oil chew a clove or bit of cinnamon; deposit the
PULMONARY PHTHISIS. 41
oil well back on the tongue and take it down at one swallow, then eat
a piece of cracker or drink some sweetened coffee, and it will leave
scarcely any taste in the mouth. -
Hypophosphites of lime and soda.- This is of
benefit in many cases. It will not do as a substitute for the
oil, but some patients, after taking the latter for a time,
cease to make further improvement; in such cases the hypo-
phosphites may be added to the treatment, and the improve-
ment will continue. -
SPECIAL REMEDIES.
Sulphur.— Fetid expectoration.
Hepar sulph. — Laryngeal phthisis.
Hyoscyamus. – Dry, nocturnal cough.
Aconite.—Acts promptly in haemoptysis.
Kali iod.— Corrects the tubercular diathesis.
Digitalis. –Violent headache, preventing sleep.
Belladonna. –Teasing, dry cough, with dyspnoea.
Arsenic iod.— For the hectic fever, in late stages.
GENERAL MEASURES.
Hygiene.— Live as much as possible in the open air;
let sleeping rooms be large and well ventilated ; take
systematic exercise calculated to develop the chest, particu-
larly by deep breathing. Wear flannels, and avoid sudden
changes of temperature. Cool sponge-baths, judiciously
employed, have a tonic effect. But nothing can take the
place of fresh air and sunshine.
Diet.—This should be simple but mutritious. Let it
consist in great part of animal food; fresh beef, mutton,
chicken, eggs, oysters, and particularly milk. Good vege-
tables, of course, should also be included. Avoid the use of
Salt meats, fish, pork, rich gravies, pastry, and everything
that will disturb the digestion. Above all, avoid anything
that will disturb the bowels. Use mo alcoholic stimulants
whatever.
As to the use of alcohol in incipient cases, I have no hesitation in
pronouncing an opinion adverse to it.—Dr. T. K. Chambers.
Climate.—Change of climate is imperative in almost all
cases. Altitude is an important feature; cases do best at an
elevation of 2,000 feet or over. There should be a large
proportion of clear, Sunshiny days; a dry, well drained soil;
a dry air, with little rainfall; an equable temperature, with
no sudden changes. Warmth is not a necessity — a cool air
is more stimulating and invigorating.
My best results, when evidences of consolidation were present,
have been obtained in mountain regions, 1,500 to 2,000 feet above the
sea. My most decidedly beneficial and permanent results have
been obtained in Asheville, North Carolina (altitude 2,250 feet), in
New Mexico and the Adirondack regions of New York.-A. L.
L00mis, M.D.
42 KEY NOTES OF MEDICAL PRACTICE.
DISEASES OF CIRCULATORY SYSTEM.
HEART.
PERICARDITIS – ENDOCARDITIS — MYOCARDITIS.
DIAGNOSIS.—Pericarditis.-Friction sound synchro-
mous with heart beat, until effusion, when there is increased
area of cardiac dullness and displacement of the apex beat.
Rarely idiopathic; generally occurs as complication of
rheumatic fever, pleurisy, pneumonia, albuminuria, or sep-
tica?mia. - -
Endocarditis.-Systolic, ventricular, valvular murmur,
of recent origin, associated with a condition which would
be apt to excite this affection. Seldom idiopathic—gen-
erally associated with acute rheumatism.
Myocarditis.- No characteristic signs— always accom-
panied by peri- or endo-carditis.
CAUSE OF DEATH.—Cardiac palsy — the pulse becomes
small and irregular, pulmonary veins engorged, and death
from asphyxia consequent upon Cedema of the lungs.
LEADING REMEDIES.
Aconite.—Acute, stitching pain in praecordium; diffi-
cult breathing, with suffocative feeling; feeling of tightness
about heart; intermission of beats, or tumultuous palpita-
tion felt over large area, with irregular action and volume
of pulse. Great anxiety and tossing about.
Aconite finds its true sphere in cardiac inflammation, whether or
not there be high fever. Useful not only at beginning, but sometimes
throughout entire course of the disease.
Spigelia.-Severe shooting or stabbing pains; distress-
ing oppression of chest, the least motion almost producing
suffocation; violent palpitation, so severe that the walls of
the chest are raised.
An important remedy in rheumatic endocarditis. Pain and violent
action of heart highly characteristic.
Digitalis. – Pericarditis coming on insidiously; friction
sound of short duration; serous effusion; distressed breath-
ing: syncope; palpitation; intermittent, feeble pulse, not
synchronous with heart beats; livid, turgescent face, with
blue lips. Hyperamia of liver; great anxiety, without any
continual restlessness.
An excellent remedy in acute affections of the heart, more particu-
larly pericarditis. If more §". used in acute heart affections,
would be less frequently called upon to use it in chronic heart dis.
ease.—Baehr.
HEART — ANGINA PECTORIs. 43
Bryonia.-Pericarditis as complication of rheumatism,
pleurisy, or pneumonia. Commencing effusion, sharp,
Stitching pains in praecordium.
For idiopathic pericarditis we have much better remedies.—Baehr.
Arsenicum.— Pericardial effusion; violent palpitation;
rapid pulse; intense thirst; burning pain; anxiety; faint-
ness; extreme restlessness; suffocative attacks; coldness of
surface; great anguish, and apprehension of death.
Cactus.-Sharp, pricking pain in heart, or sense of
constriction; oppressed breathing; dry cough; pulse quick,
throbbing, tense and hard; great palpitation.
Lachesis.- Cramp-like pain; anxiety about the heart;
Suffocation on lying down; oppression on lying down; hands
and feet cold; pulse intermittent. .
A good remedy in endocarditis.—Baehr. . -
Veratrum vir.—Strong, loud beat of heart, with quick
pulse and difficult breathing. .
Veratrum alb.-Cold sweat; Hippocratic countenance;
signs of collapse. - - .
Naja, Aconite, Iodine.—After an attack of endocar-
ditis, to complete a cure and prevent valvular disease.
VALVULAR DISEASE.-Ars., Plumb.
DILATATION.—Digit., Physos., Tabac.
CARDIAC DROPSY.—Digit., Spig., Ars.
FATTY DEGENERATION.—Phos., Ars., Arm. (to relieve
dyspnoea in fatty heart). -
HYPERTROPHY.—A com., Cact., Naja, Spig., Arm. (after
training, rowing, and violent muscular exercise).
PALPITATION.
Cactus.--When due to plethora.
Coffea, Nux.— Nervous palpitation.
China. – Due to excessive tea drinking. -
Tabacum.— Palpitation, with fainting attacks.
Moschus. – To be given at the time of an acute attack.
GENERAL MEASURES.
In acute inflammatory, rest, and hot poultices over the
region of the heart. In chronic organic disease, avoid run-
ning, climbing, all over exertion and mental excitement,
and hearty meals. . -
ANGINA PECTORIS.
LEADING REMEDIES.
Arsenicum.— Extreme dyspnoea, increased by slightest
motion; debility; pale and haggard face; feeble and irreg-
ular pulse; fear of immediate death. -
This remedy is chiefly useful given in the intervals of the
44 KEY NOTES OF MEDICAL PRACTICE.
attacks, as a curative, or preventive, if the case is one of
pure neurosis. Dos E.-Higher attenuations recommended.
No remedy can be more certainly relied upon than Ars.—Hart.
7720,7072. -
Spigelia. — Severe stabbing stitches in heart at every
beat; violent palpitation; tendency to syncope. DoSE.—
Begin with third; give higher or lower according to sus-
ceptibility of patient.
This is the principal medicine for angina pectoris. It corresponds
to the anguishing, sub-sternal pain, radiating to the neck and arms;
irregularity of pulse; tendency to syncope; palpitation; aggravation
by the least movement.—Joussel.
Digitalis. – Cases in an advanced stage; recurring fre-
quently and suddenly. Dos E. – Baehr recommends Digi-
tallm, Second and third triturations. 4’
Hydrocyanic ac.—Violent palpitation ; long fainting
spells; feeling of suffocation, with torturing pains in chest;
irregular, feeble beating of heart. Recent cases.
SPECIAL REMEDIES.
Glonoine. — Pale face in paroxysm.
Cuprum.— Muscular, of long standing.
Cactus. – Constrictive pain; rheumatism.
Nux v.– Gouty or haemorrhoidal subjects.
Aconite. — Recent cases; plethoric subjects.
Veratrum alb. — Cold extremities; cramps; cold sweat.
GENERAL MEASURES.
At the time of an attack, place the patient in a comfort-
able position, with plenty of fresh air; loosen the clothing;
apply large, hot fomentations over the region of the heart, and
warmth to the extremities. Give inhalations of Nitrite of
Amyl. Put ten drops on a bit of cotton in a drachm vial —
keep corked when not in use. Give frequent teaspoonful
doses of brandy.
Those who are subject to attacks of angina pectoris
should observe a regular, quiet mode of life, avoiding all
eaccitement or over exertion, errors of diet, overloading the
stomach, or anything which may excite the heart’s action.
The use of tobacco must be strictly prohibited.
DISEASES OF THE DIGESTIVE TRACT.
STOMATITIS.
LEADING REMEDIES.
Mercurius.-Swollen glands and abundant salivation.
Hydrastis.—Yellow-coated tongue; viscid secretions.
Nitric ac.—When accompanied by derangement of
liver and portal congestion; also, when of mercurial origin.
PAROTITIS — CANCRUM ORIS —TONSILITIS. 45
Kali chlor.—Mercurial'stomatitis. Breath fetid, with
ulcers on mucous surfaces.
GFIENERAL MEASURES.
Use gargle of eight grains of Kali chlor. to one ounce
of water.
PAROTITIS.
SYNoNYM: Mumps.
LEADING REMEDIES.
Aconite.— Fever; hot, dry skin; furred tongue.
Mercurius iod.—The gland swollen, red, and painful;
jaws stiff.
Rhus.-Swelling becomes dark-red and erysipelatous.
Pulsatilla.-Metastasis to breasts, or to testicles.
Belladonna. – Sudden disappearance of swelling, with
loss of consciousness or delirium.
GENERAL MEASURES.
Keep the child in a warm room. In metastasis to mam-
maº or testicles, use Bell. ointment, one grain to the ounce.
CANORUM ORIS.
SYNONYMI : Noma.
* Arsenicum.—Extensive disorganization, and great pros-
tration.
Has no rival.—Hughes.
CoNSULT —llerc., Lach.
GEENERAL MEASURES.
Apply locally Sub-nitrate of Bismuth, sufficient to cover
well the diseased parts. This has been used with great suc-
CeSS.
TONSILITIS.
SYNONYM: Quinsy.
LEADING REMEDIES.
Aconite. — High fever; headache; restlessness; sting-
ing, pricking fullness, or feeling of choking; throat looks
as if scorched.
Belladonna. – Bright redness and rawness of throat;
flushed face; glistening eyes; headache; pain on swallow-
Ing.
Mercurius bin. —Throat swollen; copious secretion of
saliva; swelling of gums and tongue; fetid breath; ulcers
in mouth; profuse perspiration, and nightly exacerbation,
Will often avert suppuration.
46 KEY NOTES OF MEDICAL PRACTICE.
Gelsemium.—Initiatory fever; aching in all the limbs;
great muscular weakness.
ECali bi. — Secretion of much viscid mucus. -
I have cured several cases of recurrent quinsy with Kalibi. and Gels.
Baryta carb.-Sensation as of a plug in the throat;
raw, scraping, or shooting pain on Swallowing.
If you begin the treatment early with this remedy, suppuration
need hardly ever occur.—-Hughes.
Hepar sulph. —Tonsils much swollen, with throbbing
pain. This remedy should be given as soon as there are
signs of commencing Suppuration.
Apis. - Dryness of mouth and throat; much Cedematous
swelling. •
Ammonium mur.— Putrid discharge and tendency to
gangrenous ulceration.
Silica.—Abscess slow to heal; scrofulous subjects.
Lachesis.- Left side, with hyperasthesia of throat.
Arsenicum.— Great prostration; throat putrid and
gangrenous.
GENERAL MEASURES.
Early, bits of ice in the mouth. Later, inhalations of
steam give great relief. Lance with a guarded bistoury as
soon as pus has formed.
Co- 4–2, 7 a---~ * Z4_2 <
GASTRIC CATARRH – ACUTE AND SUB-
ACUTE.
LEADING REMEDIES.
Arsenicum.—Burning distress in stomach; intense
thirst; violent vomiting, with excessive pain, anguish, and
restlessness; vomiting immediately after drinking; great
prostration; quick, small pulse. Also in late stage, extremi-
ties cold; pulse small; features sunken; hiccough ; extreme
debility. Dose.— Do not give too low — 6th to 12th.
The principal remedy — hardly any other needed.—Hughes.
Cantharis.-Violent pains in stomach, the patient toss-
ing about in agony; severe burning in stomach; vomiting,
with violent retching and burning thirst; urine scanty,
burning — constant desire, passing few drops at a time.
Phosphorus.-Vomiting of blood, mingled with bile
or mucus; great fullness of stomach, with painfulness to
pressure and cutting pains; vomiting of water as soon. as it
becomes warm in the stomach.
Mercurius.- Pasty coating on tongue; extremely vio-
lent thirst; much saliva collects in mouth ; bitter, sour
vomiting.
Iris.-Great burning and distress in epigastrium; vom-
iting, with great prostration; burning in mouth, fauces,
and Oesophagus; headache.
, * Eminently adapted to many forms of mucous gastritis.-Hughes.
-A

' ' ' ' ºs.
GASTRIC CATAR.R.H. - 47
Aconite.—Simple gastritis, from cold; distention, with
burning, throbbing pains; attack preceded by chill when
muscular coat of stomach involved. DOSE. —“Tincture.”—
Hempel. - -
Veratrum alb.-Hippocratic countenance; eyes sunken
and glazed; lips blue; extremities cold and covered with
clammy sweat; almost imperceptible pulse ; intense thirst
for cold drinks. -
Antimonium crud.— Great nausea; paroxysms of claw-
ing, pressing pain; loathing of food; tormenting thirst ;
tongue with thick, white coating.
º of the chief remedies for gastric catarrh without fever.—
Baehr. p
Ipecac.— Feeling of emptiness, with pinching pains and
bloating; insipid, bitter, rancid taste; vomiting of ingesta,
bile, and mucus, and persistent nausea. Brought on by eat-
ing sour or fat food.
Bryonia.--Stomach bloated; exceedingly sensitive;
nausea, with feeling of coldness and chills, and faintness on
sitting up. 1
Pulsatilla.-Brought on by eating fats, fruits, ices, or
acid food; chilly creepings; sensation as of a mass of undi-
gested food in stomach; greasy, rancid, bitter taste; tongue
thickly coated; absence of thirst. -
Nux v.–After abuse of drugs, stimulants or condi-
ments; bitter or sour taste; sour belching; fullness and
pressure in stomach; continued frontal headache, especially
in morning; not much pain.
GASTRIC CATARRH — CHRONIC.
IRIEMEDIES.
Sulphur, Lycopodium, Nua. v., China, Bismuth, Pulsatilla.
VoMITING.—Ipec., Kreas.
HEARTBURN.—Puls., Caps.
WATERBRASH.-Lyc., Nua, v.
ACIDITY..—Calc. carb., Phos., Sulph. ac.
FLATULENCE.-Carbo veg., Lyc., Arg. nit.
GASTRALGIA.—Nua, v., Bism., Cocc., Hydroc. ac., Ars.
GENERAL IMEASURES.
Acute.—During the height of attack, no food whatever.
Give bits of ice to slake thirst. If the attack is protracted,
and it becomes necessary to nourish the patient, use nutrient
enemata. As improvement progresses, feed cautiously.
First, ice cream, iced milk with lime water. Then, starchy
foods only—arrowroot, rice, barley water, gruels. Later,
broths. No Solid food until recovery is complete. Chronic.
Care in diet, as in dyspepsia. Avoid tea and coffee, pud-
dings, Sauges, stimulants, fresh bread. Eat slowly and
48 KEY NOTES OF MEDICAL PRACTICE.
masticate thoroughly. Buttermilk is excellent. A milk
diet often curative.
Wear warm clothing, and take salt-water sponge-baths
to excite activity of the skin.
Drinking water as hot as can be taken often relieves dis-
tress, and stops nausea and vomiting.
GASTRIC ULCER.
I)ANGERS.— Perforation of the wall of the stomach,
Haemorrhage from rupture of a vessel.
LEADING REMEDIES.
Arsenicum.— Constant thirst ; distention, pressure, or
cutting in epigastrium ; nausea; fainting; Waterbrash;
vomiting thick, glairy mucus, or a brownish, blackish fluid;
burning in stomach, with great pain on pressure.
When ulcer at pyloric end.—Hughes,
Deserves to be classed in foremost rank. —Baehr.
Argentum mit.—Violent gnawing, griping, and burn-
ing; painful swelling of stomach, with violent belchings.
Kreasote.— Womiting, with heat and burning in
stomach and bowels; foul and sanious matter vomited,
indicative of disorganization of mucous membrane.
Cantharis.-Severe burning pains in stomach, burning
thirst, vomiting, with violent retching.
Eali bi...—Yellow-coated tongue, nausea, foul taste, and
faintness; giddiness, followed by violent vomiting of a
white, mucous, acid fluid, with pressure and burning in
stomach; vomiting of Sour, undigested food, of glairy fluid,
of blood.
|Ulceration near cardiac end.—Hughes.
Hydrastis.-Sour eructations; dull aching, causing a
weak, faint, gone feeling; cutting pains, with oppression
and sense of weight; acute, distressing pain, with nausea,
acidity, and loss of appetite.
SPECIAL REMEDIES.
Ipecac., Hamamelis, Kreasote. — For haemorrhage.
Atropine.—No medicine better to subdue the frightful
cardialgic pain of ulcer of the stomach.-Baehr.
Opium.— Perforation. “The only favorable recorded
terminations to this event are those in which the opiate
treatment was pursued.”—Dr. Wilson Foz.
GENERAL MEASURES.
Complete cure possible in all recent cases. During the
severity of the disease, absolute rest, confinement to bed;
maintain warmth of the body.
Diet.— In severe cases, give the Stomach absolute rest —
nourish by nutrient enemata — beef tea and milk, or nutrient
HAEMATEMESIS. - 49
suppositories. This treatment continued thirty days will
cure the most obstinate case. Return to a solid diet
gradually — milk only at first – then broths and gruels, and
soft food. No sugar allowed. -
In other cases, milk diet will accomplish the desired
result. Add lime water, and a little boiled arrowroot to the
milk. During the course of treatment let the patient drink
occasionally a teacup of weak dilution of Calendula.
Perforation.— Usually follows a hearty meal. Order
absolute repose. Give Opium, to prevent movements of the
stomach. Continue the opium treatment many days.
Haemorrhage.— Rest, ice, and the indicated medicine,
HAEMATEMESIS.
DIFFERENTIAL DIAGNOSIS.
HAEMATEMES IS. ‘HAEMOPTYSIS,
Blood - - - - Dark - - - - - Bright-red.
Blood - - - - Vomited - - - - Coughed up.
Blood - - - - Fluid - - - - - Frothy.
Blood mixed with Food - - - - - Sputum.
Preceded by - - Nausea - - - - Chest pain.
Preceded by - - Stomach distress - Dyspnoea.
Stools contain - - Blood - - - - - No blood.
Respiration - - Clear - - - - - Râles in lungs.
LEADING REMEDIES.
Ipecac.— Sudden attack, with great paleness of face and
nausea; vomiting of blood, or pitch-like substance; inde-
scribable sick feeling in stomach; pulse scarcely perceptible;
fainting.
Has long-established reputation and deserves the preference.—
Hughes. w
There is no more efficacious remedy.—Baehr.
Hamamelis. –Thin, dark blood; fullness and gurgling
in abdomen; blood in vomit and stools. • .
A number of excellent cures have been reported.—Hempel.
Arnica.--From mechanical injury or over exertion;
vomiting of dark coagula; Soreness as if from a bruise.
Aconite.--Excruciating, pains in stomach; gagging,
retching, gasping for breath; distressed face, anguish, cold
sweat on forehead. With great vascular excitement, pulse
full, bounding, and rapid.
Arsenicum.— Extreme palpitation; anguish; violent
thirst; small, quick pulse; chilliness. -
Belladonna. – Congestion of head and stomach; sing-
ing in ears; flickering before eyes; red cheeks; foeling of
fullness and warmth in stomach.
China. – For secondary symptoms, after all bleeding
has ceased. . . . . - º -
4.
50 REY NOTES OF MEDICAL PRACTICE.
GENERAL MEASURES.
Command absolute rest in a horizontal posture; loosen
the clothing and keep the patient quiet and free from
excitement. Room cool and airy. Let the patient swallow
small bits of ice, or, in its absence, take frequent sips of
cold water. Drinking hot water will sometimes succeed
better than cold. Cold applications over the stomach are
harmful; mustard plaster better. Following the attack, keep
- the stomach at rest; nourish by enemata. The first food
must be cool, and liquid. No solid food until every trace of
pulsation in the epigastrium has ceased. Fainting need not
alarm — bleeding stops if the patient faint. Give the medi-
cine at frequent intervals.
SICK HEAD ACHE.
SYNONYMS : Gastric Headache; Bilious Headache.
LEADING REMEDIES.
Iris.-Sick headache, beginning with blur before the
eyes, followed by nausea and vomiting; dull, heavy, frontal
headache, with continuous nausea, and vomiting of mucus
and bile.
In “sick headache” this is a most reliable remedy. Give the
mother-tincture, ten drops in a half-glass of water, a teaspoonful at
Jrequent intervals—every ten minutes. Your patient should expe-
rience relief in twenty or thirty minutes.
Ipecac.—Headache as if the brain and skull were bruised,
even to root of the tongue; intense and constant nausea.
Nux v.–Sick headache brought on by wine, coffee,
close mental application, sedentary habits; begins in morn-
ing, increases through the day, with dimness of vision, sour,
bitter vomiting, constipation; worse from noise, and after
eating. - * >
Podophyllin.— Bilious headache, beginning with blur
before the eyes, darting pains in forehead; or, stunning
headache through temples, giddiness, flushed face, heart-
burn, nausea, bilious vomiting, and diarrhoea.
Chelidonium. – In bilious temperaments, darting, tear-
ing, throbbing pains in forehead and temples, with heaviness
and coldness in occiput, accompanied by vertigo, anxiety,
melancholia, nausea, and bilious vomiting.
When clearly of hepatic origin. — Hughes.
Bryonia.— Head aches as if it would split, made worse
by stooping or motion; gets sick and faint on sitting up;
sour, bitter vomiting. tº :
Veratrum alb.-Severe bilious vomiting, distressing
headache, faintness from violence of attack.
Hepar sulph.- “A valuable remedy in chronic cases.”
—Lawrie. *
Naja.-Temporo-frontal; dull pain.
A very valuable remedy.—Holcombe.
HEADACHES OF FEMALES.–DIARRHCEA. 51
HEADACHES OF FEMALES.
LEADING REMEDIES.
Sepia.--Disorders of the sexual functions; irregular,
scanty menses; leucorrhoea; dark rings under the eyes.
Platina. – Plethoric, animated, and sensitive subjects;
dark hair; rigid fiber; menses profuse, accompanied by
colicky pains. - -
Ignatia.— Hysterical subjects, with disposition to gon-
vulsions; headache periodical—passes off with flow of pale,
limpid urine; feeling as if nail were being driven into head.
Cocculus.— Reflex uterine headache; menstrual colic;
dull headache, with vertigo and nausea.
Actaea.— Hysterical and menstrual headache; pain ex-
tends to eyeballs, attended by faintness, and “sinking” at
pit of stomach. .
DIARRHOEA – A CUTE.
LEADING REMEDIES. . . "
Aconite.—After checked perspiration, after cold or
damp; frequent, scanty, loose, green stools, with tenesmus,
fever, and restlessness.
Aloes. – Pain and rumbling in the bowels before stool;
escape of great quantities of flatus with stool; constant
urging to stool; stool involuntary, with escape of flatus;
stool seems to pass without exertion; after stool sensation
as if more in rectum. .
Antimonium.— Stools watery and profuse, with disor-
dered stomach and white-coated tongue; alternate consti-
pation and diarrhoea. -
The gastric symptoms predominate.—Bell.
Arsenicum.—Watery, mucous, or bloody discharge;
great weakness, faintness, and rapid exhaustion; thirst and
restlessness; burning in rectum: emaciation; pallor; sunken
cheeks; stools, watery, fetid, painless. - -
Note especially the great restlessness and the exhaustion after the
stool, and the sticky perspiration.— P. P. Wells.
Apis mel.--Stools greenish, yellowish, slimy mucus, or
yellow watery; tongue dry and slimy; little or no thirst;
hands blue and cold.
The absence of thirst, existing with a dry tongue, and dry, hot
skin, are characteristic.—Bell.
Bryonia. — Diarrhoea, in hot weather; stools brown,
thin, fecal, or containing undigested matter; aggravation
in morning as soon as he moves.
Calcarea carb.-Scrofulous subjects; distended abdo-
men, with emaciation; whitish or watery stools; chronic
diarrhoea, with chalk-like stools.
The stools are of less importance than the person.-Bell. . . . .
52 KEY NOTES OF MEDICAL PRACTICE.
Chamomilla.-Green, watery passages, often mixed
with feces and mucus.
The cases for Cham, are those of early childhood, during the pro-
cess of teething and from taking cold.—P. P. Wells. -
China.-Frequent, watery stools, containing undigested
matter, with pinching colic, occurring especially at night.
Croton.—Yellow, watery, or greenish-yellow stools,
expelled with great force.
The three highly characteristic symptoms of yellow, watery stool,
sudden expulsion and aggravation from food and drink, form a trio
whose presence will make success certain and brilliant.—Bell.
Dulcamara.—Stools yellowish, greenish, watery, with
colic. From “taking cold’” in cold, damp weather.
Gummi gutt.—Yellow or green stools, mired with mucus,
preceded by excessive cutting about umbilicus.
One of the most important remedies in the treatment of diarrhoea,
acute and chronic.—Bell.
Ipecac.—Stools as if fermented, green, with nausea
and colic; frequent stools of greenish mucus. -
The continuous nausea is the most constant distinctive symptom of
Ipec.—Bell.
Iris.- Bilious stools and bilious vomiting, in hot
weather, with much exhaustion and debility. -
Mercurius.--Stools slimy, brownish, whitish-gray,
acrid, and burning; cutting, pinching pain in abdomen,
with chilliness; bilious stool, preceded by colic, followed
by tenesmus.
Phosphoric ac.—Diarrhoea not debilitating, though of
long continuance; involuntary, with emission of flatus;
stool thin, whitish-gray. • -
One of the most prominent remedies for white, watery diarrhoea,
acute or chronic.—Bell.

Podophyllin.— Early morning diarrhoea; stool fre-
quent; painless, yellow liquid, with meal-like sediment.
Sulphur.— Diarrhoea. Some hours after midnight, or
driving patient out of bed early in the morning. Stools
pappy, greenish-yellow, fetid, slimy.
Very wide range of action. Early morning diarrhoea very charac-
teristic.—Bell. -
Veratrum alb.- Diarrhoea, violent, painful, copious,
with profuse perspiration; stools watery, sudden, involuntary.
A remedy of great value, and very often required. It is useless in
painless cases.—Bell. - -
CHRONIC DIARRHOEA.
Arsenicum, Calcarea carb., China, Ferrum, Gummi gutt,
Hepar, sulph., Lycopodium, Phosphorus, Phosphoric ac.,
Podophyllin, Sulphur.
GENERAL MEASURES.
Those who are subject to diarrhoea should wear a flannel
binder about the abdomen; wear warm clothing; avoid ex-
DYSENTERY. 53
posure to wet and cold; keep the feet dry; look to drainage,
and see that there is no sewer gas in dwelling, during acute
attacks, absolute rest in bed.
Diet.— In acute attack, the less food the better. A void
the use of solid food, liquors, coffee, strong tea, fruits, or
vegetables; no potatoes; let diet consist of milk and lime
water, broths, gruel, rice (well cooked), barley water, whey,
panada, beef tea, with a teaspoonful of isinglass to the half
pint. In chronic diarrhoea, nourishing but simple and easily
digested food — fresh meat, mutton, beef, Soft eggs; milk
diet good. Avoid Salt and cured meat, pork, veal, and
fresh vegetables.
DYSENTERY.
LEADING REMEDIES.
Mercurius cor.— Distressing, persistent tenesmus, and
cutting, colicky pains. After stool, burning and tenesmus
of rectum and bladder. Urine scanty, hot, bloody, or sup-
pressed. Stools frequent; mucus mixed with blood, or
almost pure blood. - -
naº safely be regarded as specific remedy for whole process.—
º when occurring in great intensity, and accompanied by
the characteristic urinary symptoms.-Bell. . -
Nux v.–Frequent, small evacuations, with violent ten-
esmus; pressing pains in the loins and upper part of the
Sacral region, with sensation as if broken; great heat and
thirst, with redness of the face. The pains and tenesmus
cease with the evacuation. -
The importance of this drug in the treatment of dysentery is hard-
ly second to that of any other.-P. P. Wells.
Aconite.— Early in attack, with fever, dry heat, great
restlessness. Stool bloody, slimy, scanty, frequent, with
tenesmus. DOSE.-The lower attenuations are to be pre-
ferred.—Hempel. -
In very beginning, often able to cut short dysentery.—Bell.
Belladonna. –Violent fever; retention of urine; severe
gastric derangement; nausea and vomiting; violent urging;
scanty discharge of slimy, bloody stool, with tenesmus;
abdomen distended, hot, and painful; Spasmodic, clutching
pains. -
terº"; #e only remedy required for severe cases of infantile dysen-
Se: to Merc, the most important remedy in dysentery.—Baehr.
More . to be appropriate in the early stage, when the inflam-
mation extends to the serous tissues.— P. P. Wells.
Aloes.— Loud gurgling in abdomen. Before stool, sen-
sation of fullness and weight in pelvis; after stool, faintness.
Stool bloody, jelly-like mucus. Temesmus very severe.
One of our most valuable remedies in dysentery.—Bell.
54 KEY NOTES OF MEDICAL PRACTICE.
Cantharis.--Stool of blood and mucus, like scrapings
from intestines; with stool, cutting in abdomen; after
stool, shiverings; scanty urine, and tenesmus of bladder.
Appearance like scrapings of the intestines is the most character-
istic symptom of Canth.—Bell. -
Capsicum.—Stools of mucus, streaked with black
blood; cutting colic; tenesmus; drawing pains in back;
drinking causes shuddering; tenesmus of bladder; stram-
gully. -
This is one of the most important remedies in dysentery, and is
nearly allied to Nua, v. and Merc.— P. P. Wells.
One of the royal remedies for dysentery.—Bell. -
Arsenicum. — Stools dark, bloody, acrid and excoriat-
ing, with tenesmus and burning in anus and rectum, and
great prostration. Called for when case is far advanced;
discharges dark and fetid; prostration extreme.
SPECIAL REMEDIES.
China. – Intermits; returns periodically.
Colocynthis.-Very severe colicky pains.
Dulcamara.-Autumnal, from cold and wet.
Sulphur.—After violence of attack has passed.
Rhus.- Low fever; involuntary, thin, at night.
Colchicum.—Jelly-like, skinny stools; autumnal.
Arnica. —Tormina; tenesmus; much ha-morrhage.
Podophyllin. — Prolapse of bowel with every stool.
Ipecac.— Much nausea and vomiting; bloody stools.
CHRONIC DYSENTERY.
- EEMEDIES.
Nitric ac., Phosphoric ac., Sulphur, China, Calcarea carb.
GENERAL MEASURES.
Absolute rest in bed; keep disinfectants, sulphate of iron
and carbolic acid, in bed-pan; dispose of discharges with
antiseptic precautions; preserve free ventilation; change
sheets and clothing daily. If distressing tenesmus, enema,
consisting of two ounces boiled starch, containing thirty
drops Laud., or five grains Chlo. hyd. Suppository, con-
taining one-half grain alcoholic extract Bell., also excellent.
Hot fomentations to abdomen often relieve the pain. Free
tnjections of hot water will relieve the distress accompany-
ing a severe attack of dysentery, and help cut short the
disease. Chronic.— Keep the abdomen warm by a flannel
binder. Avoid cold and wet. Warm clothing. Remove
from malarial district.
Diet. — Cold drinks often aggravate the colic. Simple
diet — scraped meat, milk, gruel, barley water, rice-flour
gruel. Avoid solid foods, fruits, vegetables, and stimulants.
PERITONITIs. 55
PERITONITIS.
ACUTE IDIOPATHIC.
LEADING REMEDIES.
Aconite. —From cold, with predominance of febrile
symptoms. Burning, cutting, darting pain in bowels.
Indispensable.—Hughes.
The principal remedy.—Jousset.
Belladonna. –Severe congestions of head and chest,
with anguish, dyspnoea, restlessness, dark-red, and bloated
face; continual distressing vomiting of bile, alternating
with retching; intestines distended, so that convolutions
can be felt. Also, for the vomiting, in later stages.
Suitable only at the commencement.—Baehr.
Bryonia. —Stage of exudation; stitching, lancinating
pains in bowels, worse from slightest motion; tongue white
and dry; great thirst; bowels constipated.
When primary fever relaxes, and effusion threatens.—Hughes.
Mercurius cor.—Frequently exacerbating fever, with
creeping chills, and copious º after the heat;
peritonitis secondary to wounds and operations in abdomen;
tendency to purulent effusion; abscesses.
Has high curative power.—Hughes. . -
Veratrum alb.-Copious and frequent vomiting; face
pale and sunken; skin cold; pulse small; anguish, restless-
ness, and distressing thirst. -
Colocynthis.- Diarrhoea, with rectal and vesical tenes-
mus, with or without colicky pains. -
Circumscribed peritonitis, from extension from abdominal organs.
—Jousset. -
Opium.— Great distention of abdomen; retention of
stool and urine; complete inactivity of bowels; paralytic
weakness of intestinal canal, remaining after disappearance
of the exudation.
Arsenicum.—Sudden sinking of strength; cold, clam-
my perspiration; restlessness; thirst ; constant vomiting;
burning in abdomen. Also, later, when copious and per-
sistent exudation.
Sulphur.—To excite and promote absorption of the
exudation.
GENERAL MEASURES.
Warm fomentations; or, in some cases, cold compresses
do more good than hot. Keep the patient at perfect rest,
and avoid all mental or emotional excitement. Keep the
room well ventilated, and at an even temperature. Some-
times necessary to remove even the weight of the bed clothes
from the abdomen, by barrel hoops, or suitable contrivance.
Turpentine stupes over the abdomen.
56 KEY NOTES OF MEDICAL PRACTICE.
Diet.— For intense thirst of the early stage, give bits of
ice. Ice swallowed sometimes relieves vomiting. As the
appetite returns, give food which will leave but little fecal
residue. If much exhaustion, broths and mourishing food.
Return to diet of solid food very gradually and cautiously.
COLIC.
LEADING IREMEDIES.
Colocynthis.-- Extremely severe, cutting, griping, in-
termittent, abdominal cramps, causing patient to bend
double, with much moaning and complaining.
Chamomilla.-Flatulent colic; the abdomen much
distended; flatulence passes in small quantities, without
much relief; pinching, twisting pain; great impatience;
children want to be carried.
Nux v.–Flatulent colic from indigestion; cramps in
stomach, with upward pressure; cutting, pinching pains;
frequent urgings to stool without effect.
Iris v. — Severe, flatulent colic, with sickness of stom-
ach, and headache. This remedy will often help when
others fail. -
Plumbum.—Violent, constrictive, pinching pain in re-
gion of navel; retraction and hardness of abdomen; flatulence
and obstimate constipation ; face and skin pale, bluish, or
yellow; chronic enteralgia.
Opium.— Great accumulation of gas in intestines, with
great distention of abdomen, and cutting, pressive, and
twisting pains; complete inactivity of intestines.
• Dioscorea.—Sudden attacks, with vomiting of food;
pain changes from one part of abdomen to another, with
much rumbling.
COLIC:-
INDIGESTION.—Nua, v., Puls., Ipec., Ars.
INFANTS.–Cham., Bell., Cina, Ipec., Iris.
BILIOUS.—Merc., Ipec., Podo., Dios., Iris.
NERVOUS..—Coloc., Bell., Igm., Opium, Plumb.
FLATULENT.—Nua, v., Cham., Lyc., Dios., Iris.
RHEUMATIC.—Verat. alb., Dulc., Bry., Puls., Rhus.
GENERAL MEASURES.
If the stomach contain a mass of indigestible food, give
warm water and salt; tickle the back of the throat, and
produce emesis. Drinking a large quantity of warm water
often relieves, Place the patient on his left side, with the
hips raised, and give a copious injection of warm water;
retain as long as possible; apply hot formentations to the
abdomen.
LEAD COLIC — CONSTIPATION. 57
LEAD COLIC.
IREMEDIES.
Opium, Platina, Alumina, Belladonna, Arsenicum,
Stramonium.
Opium.—Retraction of abdominal muscles; slow pulse;
obstinate constipation.
Soon gives relief.—Hughes.
A most valuable specific.—Baehr.
After-effects.- Stram.: Paralysis. JBell.: Amaurosis.
GENERAL MEASURES.
In acute attack, give free milk diet, and let the patient
drink large quantities of soft water. Use copious warm
injections; warm baths.
Workers in lead should bathe and wash carefully, and
change linen frequently; do not eat in the workshop; keep
up free ventilation. After one attack, change of occupation
only will exempt from repetition. -
CONSTIPATION.
LEADING REMEDIES.
Sulphur. - Hard, knotty stools, accompanied by ham-
orrhoids, followed by burning pain in anus and rectum;
flushes of heat; frequent weak, faint spells. Good with
which to begin treatment. The improvement begun under
Sulph. must be followed by some other remedy.
Nux v.– For those of sedentary habit, high livers, and
after abuse of drugs. Frequent, ineffectual urging to stool,
which is large, hard, and passed with great difficulty. Dys-
pepsia and haemorrhoids. Often acts well after Sulph.
Opium.— Complete torpor of bowels; stools hard and
lumpy; headache; drowsiness; dizziness; congested face;
abdomen much distended, with almost complete paresis of
intestines.
Plumbum.—Stools of small, hard balls; frequent
attacks of violent, colic, retraction of abdomen; sense of
constriction of sphincter ani.
The chief indication for the use of Plymb. in constipation is the
constant presence of a spasmodic or colic-like pain.—A. C. Pope.
Hydrastis.-Headache and hamorrhoids; Severe pain
in rectum after stool for hours. Especially useful after
abuse of purgative medicines. Dos E.- Drop of mother-
tincture, once daily, before breakfast, for a week.
Has been curative of constipation more frequently than any other
remedy.—Hughes. - -
Platina. – Difficult expulsion of soft stool; frequent
urging, great straining, passing but small quantities; putty-
like stool, Sticking to the anus; constipation while traveling.
58 KEY NOTES OF MEDICAL PRACTICE.
AEsculus.- Dryness of rectum, feeling as if full of
small sticks; painful haemorrhoids, with severe backache.
Lycopodium.—Stools hard, Scant, and passed with
great difficulty; ineffectual urging; acidity and heartburn;
loud rumbling and gurgling in bowels.
Graphites.—Stools large, hard, and knotty; tendency
to cutaneous disorders. -
Nitric ac.—Stools hard, dry, and Scant, and passed
without pain; headache; sour or bitter taste after eating;
sour eructations; excessive flatulence.
In the front rank of remedies for constipation.—Dyce Brown.
Ignatia.-Constipation, with prolapsus of rectum on
slight effort to evacuate; Creeping, itching sensation in
abdomen. -
Bryonia.-Hard, large, dry stools; chilliness; pain
about the liver; rheumatic tendency, accompanied by
symptoms of indigestion; frequent eructations after meals;
headache.
GENERAL MEASURES.
Drink a goblet of oatmeal water every morning on rising.
Avoid tea and coffee. Let the diet consist largely of coarse
meals, succulent vegetables, and juicy fruits. Eat brown
bread rather than white.
Diet. —Avoid—Tea, coffee, wine, beer, pork, veal, salt
meats, cheese, beans, cakes, pastry, pickles, biscuit, fresh
bread, muffins, griddle cakes. Eat—Mush, hominy, oat-
meal, wheaten grits, corn bread, greens, cresses, squash,
turnips, spinach, cabbage, tomatoes, asparagus, cauliflower,
figs, pears, prunes, peaches, apples, oranges, melons, grapes,
cherries, berries.
HAEMORRPHOIDS.
LEADING REMEDIES.
AEsculus hip.–Haemorrhoids like ground nuts, of a
purple color, very painful, with burning sensation; itching,
burning pains, with sensation of fullness and dryness of
rectum; slight ha-morrhage; severe aching pains in back;
constant and severe backache, extending to sacrum and
hips; stool hard and dry, passed with difficulty, followed by
sensations of constriction, fullness, dryness, and pricking .
pains in rectum.
Almost specific.—Hughes.
Hamamelis.-Profusely bleeding hapmorrhoids. Burn-
ing, itching, and rawness of anus; weakness of back—feels
i. º it would break; discharge of large quantities of dark
...OIOOCl. -
Never fails in true varicosis.—Hughes.
In excessive haemorrhage a certain remedy.—Jou88et.
IRAEMORRff OfDS. . . 59
Aloes.—Haºmorrhoids, with flow of hot, blackish blood;
haemorrhoids protrude, like bunch of grapes, with constant
bearing down in rectum; great heat and tenderness of the
tumors, relieved by cold water; heat in bowels, and heat
and painful pressure in liver; painful inflammation of the
tumors. -
Collinsonia.- Blind or bleeding piles, with sticking
pains in rectum; obstinate and habitual constipation;
stools lumpy and light-colored; uterine disorders; congest-
ive inertia of lower bowel. *
In constipation and haemorrhoids I prefer it to Aloes.—Hughes.
Nux v.–For blind or bleeding piles. From abuse of
spirituous liquors, or sedentary habits. Bleeding, burning,
and frequent protrusion of the piles; abdominal plethora;
tearing, pressing, bruised pain in small of back; habitual
constipation.
Sulphur.— Bleeding, burning, and frequent protrusion
of the piles; stinging, burning, and Soreness, in and about
anus; itching and tenesmus after a soft or bloody stool;
alternate constipation, and discharge of blood-streaked
I'll ll CllS. - -
SPECIAL REMEDIES.
Capsicum.— Burning and itching.
Ferrum.—Cachectic constitutions.
Aconite. — Inflammation of tumors.
Hepar sulph. - Chronic hepatic affection.
Arsenicum. – Emaciated subjects; burning pain.
Podophyllin.—Portal congestion; bilious subjects.
GHENERAL MEASURES.
Avoid soft cushions, and feather beds. Sedentary habits
are bad. Correct uterine disorders. Make a habit of going
to stool shortly before bedtime. Injections of cold water are
beneficial. If the piles are inflamed and tender, anoint
with Acom. cerate, and sit over steam of hot water.
Ointment of Boracic ac. and Vaseline has magic effect
in relieving itching piles. *
Make cerate, or suppository, containing mother-tincture
of AEsc., Hamam..., Aloes, ('ollims., or other indicated rem-
edy, and use locally. -
Diet.—Avoid coffee, peppers, spices, stimulating or
highly seasoned food, beer, wine, spirits; and do not over
eat. During attack, no meats; vegetables and fruits best.
60 KEY NOTES OF MEDICAL PRACTICE.
ENTOZOA.
TAENIA SOLIUM.
(TAPEWORM.)
Pepo semen.—Take one ounce of pumpkin seed, the
shells having been removed; mash it up, and make an
emulsion with milk. Take this dose at bedtime, after hav-
ing fasted from breakfast. In the morning, take a table-
spoonful of castor oil, abstaining from breakfast. Use one-
half this dose for children under twelve.
Filix mas.— B. Ol. Filic maris - - 3.j.
Mucilag. - - - -
Glycer. aa - - - 3ij.
Aqua. dest. - - - 3 j. Mix.
DOSE.- Give in four doses, fasting, and follow by castor
oil. Or, give drop doses Male Ferm, every four hours, and
a dose of Merc. cor. night and morning. Continue several
days.
Punica gran.-- Use the freshly prepared fluid extract
of the bark of Pomegramate root (Gram. rad. cort.). In
the morning before eating give the patient a dose of castor
oil, and in one hour follow this by a dose of one ownce of
the fluid extract of Pomegranate, taken in a wineglassful of
water. Repeat this dose at intervals of one hour, until
three ounces have been taken.
This will cause the prompt expulsion of the entire worm. Failure
will only follow the use of an inert preparation of the drug.
Rottlera tinct.— Give two or three teaspoonfuls of
tincture, after twelve hours' fasting. A dose of Castor oil
may be given if no purgative action follow the taking of the
medicine.
This is the pleasantest, safest, and surest remedy with which I am
acquainted.—Lewis Sherman. -
ASCARIS LUMBRICOIDES.
(ROUND WORM.)
Santonine.—Give two-grain doses of 2x trituration every
three hours. This is a genuine specific for the round worm.
For young children use Cima. -
The symptoms indicating the presence of worms, and
calling for this remedy, are — Boring at the nose; livid cir-
cles about the eyes; slight fever; fretfulness and ill temper;
short, hacking cough; coated tongue; bad breath; tossing
º
CONGESTION OF THE LIVER, 61
and uneasiness, or crying out in sleep; nausea and vomit-
ing; capricious appetite; itching of nose and anus; the
urine white and thick; sometimes convulsions.
Mercurius cor., Antimonium crud., Stannum.—
The existence of worms is usually accompanied by an un-
healthy state of the mucous membranes of the intestines,
which secrete a large quantity of tenacious, slimy mucus.
To correct this condition, Merc. cor., Amt. crud., or Strºm.,
the principal remedies, must be given, when the worm
symptoms will all disappear. -
OXYURIS WERMICULARIS.
(PIN WORMS.)
Teucrium.—Thread worms, with much itching and irri-
tation about the anus, especially troublesome in the evening;
depraved or capricious appetite; pains in the epigastrium;
picking at the nose; offensive breath; straining at stool;
disturbed sleep, and general restlessness.
Lard should be applied locally; it relieves the irritation,
destroys the worms, and stops their breeding.
DISEASES OF THE LIVER,
CONGESTION OF THE LIVER,
LEADING REMEDIES.
Podophyllin.-Feeling of fullness in right side, with
acute pain in one spot : active congestion, with pronounced
bilious symptoms; diarrhoea; prolapsus ani; bitter taste;
Sallow complexion.
When “bilious ” symptoms predominate, best remedy.—Hughes.
Leptandrin. — Aching pains in liver; yellow-coated
tongue; profuse, papescent, tar-like, very fetid stools; con-
stant dull pain in region of gall bladder; much Soreness in
head and eyeballs.
Iris. – Pain over liver; crampy pain in back; flatulence
in bowels; griping pains; headache; vomiting; lassitude;
prostration. Excites the biliary secretion.
A specific remedy.—Hughes. -
Sulphur. — Chronic cases, hepatic cases from portal
engorgement. Constipation, or early morning diarrhoea;
frequent weak faint spells, with flashes of heat.
A remedy of great value.—Hughes.
In chronic, holds the first rank. - Baehr.
Sepia-Replaces Sulph. in women at climacteric,
*.
62 KEY NOTES OF MEDICAL PRACTICE.
Chelidonium.—Chronic congestion. Constant pain
under inner angle of. right shoulder blade; Sallow skin;
yellow-coated tongue; dull headache; constipation; fullness
in region of liver. - .
Has high value as a hepatic remedy.—Hughes.
Nux v.–Enlargement and induration; shooting, pulsa-
tive pains; excessive tenderness in region of liver; pressure
in epigastrium and hypochondria, with shortness of breath
and constipation ; active congestion, from excess of stimu-
lating food or alcohol.
Lachesis.-Acute pain in liver, extending toward
stomach; cannot bear any pressure about hypochondria.
Suitable in obstinate cases of drunkards.
Cured a very severe case of chronic congestion, with jaundice and
pain.—Jousset.
. GENERAL MEASURES.
Often caused by a too abundant, highly seasoned, and
stimulating diet, and alcoholic drinks. Hence these must
be avoided. Observe regularity in the hours of meals; eat
light; avoid tea, coffee, and “hearty” food, and stimulants.
HEPATITIS.
PROGNOSIS.–Grave. Unfavorable: Abscess; ema-
ciation; hectic; hepatitis following dysentery. Most recov-
eries follow discharge of abscess through the lung; next,
intestine, intercostal space, cavity of pleura, abdominal
wall, in the order given, the latter being almost invariably
fatal. When air obtains free access to the cavity of a hepatic
abscess, a favorable result seldom follows. Multiple abscess
unfavorable.
LEADING IREMEDIES.
Aconite. — Beginning of attack — violent inflammatory
fever, with insupportable, shooting pains in region of liver;
tossing and great restlessness.
Belladonna. — Oppressive pain in region of liver, ex-
tending to chest and shoulders; distension of epigastrium,
with difficult and anxious breathing; congestion of head;
obscuration of sight; sensation of fainting, violent thirst;
sleepless tossing about; nausea; retching, distressing vom-
iting; continued fever, with high temperature. No use
after local pains abate. .
Better adapted to this disease than Acon.—Baehr.
Mercurius.--Fullness and Swelling in region of liver,
with pricking, burning, oppressive pain, preventing pa-
tient's lying on right side, worse on movement of the body;
pain in shoulders; anorexia; agonizing thirst; jaundice;
HEPATITIS — JAUNDICE. 63
shivering, sometimes followed by sweating, but without
relief; acute parenchymatous inflammation.
Most important remedy in worst forms of acute parenchymatous
hepatitis.-Baehr. -
Bryonia.-The pains in region of liver are sharp and
shooting. With tension and burning, increased by touch,
coughing, or respiration, especially during inspiration, and
much increased by motion; violent, spasmodic oppression
of chest; rapid and anxious breathing; bitter taste; yellow-
coated tongue; constipation; severe headache; sub-inflam-
matory cases. . r

Hepar sulph.-For threatened abscess, or, after suppu-
ration # Begum. - - -
GENERAL MEASURES.
When abscess has been made out, evacuate with aspirator.
JAUNDICE.
LEADING REMEDIES.
Aconite. — Fever; stitches in liver; yellow skin; scanty,
dark urine; clay-colored stools; local pain; inflammatory
symptoms; or, prostration; womiting; oppression of chest;
blue nails; cadaverous countenance; cold extremities; feeble
pulse; collapse. •
Has cured some malignant cases.—Jousset.
Mercurius. – Duodenal catarrh, with extension of the
inflammation to bile ducts; complete jaundice; skin very
yellow ; thickly coated, flabby tongue; nausea; womiting;
loathing of food; grayish-white feces; diarrhoea; tenesmus;
urine scanty and dark-red; pain in region of liver;f icterus
neonatorum. -
One of the most frequently indicated remedies, with or without
fever.—Ralue. -
- Chelidonium.—Yellowness of eyes and skin; pain in
liver and right shoulder; bitter taste; tongue clean, of deep-
red color; stool white; urine dark-red; region of liver dis-
tended and painful.
No better remedy.—Hale. -
China.-- Gastro-duodenal catarrh, particularly after
great loss of animal fluids, or in malarial jaundice; oppress-
ive headache; perverse appetite, with canine hunger; dingy-
yellow complexion; liver swollen, hard, and tender, with
spasmodic, Stitching pains, .
Recurrent form.–Lilienthal. . .
Hydrastis.-Gastro-duodenal catarrh; sense of sinking
and prostration at epigastrium, with violent and continued
palpitation of heart.
Podophyllin.-Enlargement of liver, with severe pain;
urine scanty, and dark-yellow; stools clay-colored; nausea
64 KEY NOTES OF MEDICAL PRACTICE.
and vertigo. In complication with gall-stones. Duodenal
catarrh.
Arsenicum.— Malignant jaundice; the bile decomposed,
poisoning the tissues; . or bluish patches on the skin.
Especially valuable when from disorganization of the liver.—Hem-
pet. -
Phosphorus. – Malignant cases; nausea; epigastric
tenderness; numbness of extremities; liver swollen and
very sensitive to pressure; chills; pulse weak and low;
drowsy, comatose condition; acute hepatic atrophy.
Nitric ac.— Chronic jaundice; enlargement and indu-
ration of liver; obstinate constipation; fetid, dark-colored
urine; sharp pain in pit of stomach.
Crotalus.-Malignant; typhus icterodes.
Iodine. — Chronic, and after abuse of Merc.
Chamomilla.-Acute, from fright or anger.
Sulphur.—Chronic, organic disease of liver.
Nux v. — Chronic constipation; sedentary and intem-
perate habits.
GENERAL IMEASURES.
Hot fomentations, to relieve pain; warm clothing; light
diet; broths; roast apples; vegetables; plenty of water.
CALCULI — BILIARY.
LEADING REMEDIES.
Berberis.- Pain; Soreness and burning in the biliary
tracts, with tendency to gall-stone. Also to be given at the
time of the attack, for pain attendant on the passage of
gall-stone.
Arsenicum.—Severe attacks; the patient pallid and
exhausted; covered with cold sweat; the syncope inter-
rupted only by efforts to vomit. Give this remedy to excite
reaction.
Calcarea carb.”— Give frequent doses every fifteen
minutes, during paroxysm, to relieve pain.
Dr. Drury's recommendation led me to try it. The effect of this
remedy in the next case I had was something marvelous, and it has
never failed me since. Drs. Bayes and Dudgeon have also borne tes-
timony to its efficacy.—Hughes.
China. –To correct tendency to formation. “I give
usually Chim. 6x, six pills twice a day, till ten doses are
taken; then six pills every other day, till ten doses are
taken; then every third day, till ten doses are taken; and
so on, till at length the dose is taken only once a month. I
have not failed to cure, in a single instance, permanently
and radically, every patient with gall-stone colic who has
taken the remedy as directed.”—Dr. David Thayer.
Chelidonium.—“Has cured numerous cases.”—Hale.
CALCULI, BILIARY — NEPHRITIS. 65
To PREVENT RETURN.—Chim., Berb., Chel., Nua, v.,
Podo., Merc., Sulph.
GENERAL MEASURES. o
At the time of the attack direct efforts to moderate the
pain and set free the impacted calculus. Apply hot fomen-
tutions, or chloroform liniment. . A full, warm bath helps.
Olive oil, taken in large quantities, sometimes promotes
easy passage of the stone. In severe cases, failure to relieve
excruciating pain may necessitate resort to inhalations of
chloroform, or morphine hypodermically.
Diet.—Eat sparingly of animal foods; abstain from use
of fatty and saccharine substances. Do not have meals at
too great intervals, as the gall bladder should be frequently
emptied. Carlsbad and Vichy waters have proved curative.
DISEASES OF THE KIDNEYS.
NEPHRITIS — ACUTE.
LEADING REMEDIES.
Aconite.—Acute idiopathic, from cold ; high fever;
restlessness; dark, scanty urine; Stitches in region of
kidney. -
Cantharis.- High fever; urine scanty, high-colored,
bloody, passed drop by drop, with Scalding, burning pain,
with tearing pains in loins. Very useful in post-Scarlatinal
and post-diphtheritic nephritis.
Apis.-- Renal pains; urine scanty, albuminous; sudden
occlema. Especially useful in post-Scarlatinal nephritis, and
the congestion of kidneys of pregnancy, with Gedema.
Terebinthina. – Passage of Scanty, dark, and bloody
urine. “Coffee-ground ’’ sediment in urine.
Almost infallible in renal congestion.—Hughes. - -
Belladonna. — Shooting pains from kidneys to bladder;
renal region very tender to pressure; urine orange-yellow,
or bright-red, depositing a thick Sediment. Important
remedy for congestion of kidneys.
Arsenicum.— Urine scanty, dark-brown, and albumin-
ous; great thirst and restlessness; pale, waxy skin; Oedema
of parts, or anasarca. -
The best remedy in most cases of post-Scarlatinal nephritis.--
Hughes.
Hepar sulph.-Threatened suppuration; cessation of
the acute pain; sensation of throbbing and feeling of weight
in renal region; alternate chills and flushes of heat, followed
by perspiration. . •
5
66 ECEY NOTES OF MEDICAL PRACTICE.
GENERAL MEASURES.
Absolute rest in bed; hot fomentations to the small of
the back; drink large quantities of soft water. -
Diet.— Milk and vegetables, avoiding meats and all
stimulants.
BRIGHT’S DISEASE.
VARIETIES:—I. Parenchymatous Nephritis; the inflam-
matory affection; affecting the tubules, or stroma, or both.
II. Red Granular Kidney; the cirrhotic, or gouty
affection, originating in the fibrous stroma,
III. Amyloid Kidney; the waxy, or amyloid affection,
originating in the vessels.
PARENCHYMATOUS NEPHRITES.
PROGNOSIS.— Acute, often followed by recovery; if
it reach the second stage (Degeneration) recovery is very
rare; the third stage (Atrophy) is invariably fatal.
CAUSEs of DEATH.- Uraemia; meningitis; peri- and
endo-carditis; pneumonia.
LEADING REMEDIES.
Cantharis.-- Early stage. Urine Scanty, albuminous,
high-colored, Scalding; aching pains across the loins. Urine
contains a large quantity of epithelial cells. Headache;
delirium; convulsions; coma. Most useful where desqua-
mation is considerable, and uraemia threatens.
Terebinthina. – Idiopathic parenchymatous nephritis;
urine scanty, dark, smoky, bloody; much albumin, and
many blood-casts; anasarca. Of no use in uraemia. There
must be blood in the urine in order for this remedy to be
indicated.
Arsenicum.— Large white kidney; skin pale and waxy;
partial or general dropsy; puffy appearance and debility;
urine Scanty, albuminous, containing fat globules, renal
epithelium, fibrine casts, and a few blood corpuscles. In-
flammation of serous membranes.
Cases of cure by this remedy are numerous and brilliant.—Hughes,
Phosphorus.— Chronic tubular nephritis; urine high-
colored, high specific gravity, containing albumin, oil glob-
ules, and exudation cells.
The best remedy in fatty degeneration.—Hughes.
RED GRANULAR KIDNEY.
PROGNOSIS.—A cure may be effected in the early
; later, the patient may live for years, but it is finally
atal.
BRIGHT’s DISEASE. - 67
CAUSEs of DEATH.— Generally uraemia; may be from
complications — pneumonia, etc. .
Plumbum.— Cirrhotic kidney. Headache; dyspepsia;
oedema of face and ankles. Urine–low specific gravity,
small percentage of albumin, hyaline, and granular casts,
and a few blood corpuscles.
In 1876 I made a cure in an undoubted case of incipient renal cir-
rhosis, using Plumbum met., 6x trituration alone. The former patient
is in good health at the present writing (1885), and has remained so all
these years. In numerous other cases, which, however, were already
chronic when coming under treatment, by the same remedy the disease
has invariably been arrested in its rapid course, with improvement of
all symptoms, although the final result has, of course, been that to
which the extensive, and far advanced degeneration must, inevitably
lead. In a case which occurred in my wards in Cook County Hospital
a year ago, a cure was effected. No dietetic or hygienic regulations
were adopted, but I'lumbum met., 6x, alone was relied upon.
SPECIAL REMEDIES.
Nux v.–Dyspeptic vomiting.
Cactus. – Over action of heart.
Apocynum.–For excessive dropsy.
Arsenicum.— Serous inflammations.
Mercurius cor.— Bronchitis in complication.
Phosphorus, Chelidonium.—Intercurrent pneumo-
Illèl.
GENERAL MEASURES.
Adopt measures to keep the skin active, and promote
free diaphoresis. Give vapor baths, or Turkish baths, being
careful not to carry it to the extent of weakening the patient.
Use, also, salt water and alcohol sponge baths. Let the
patient be warmly clad, and avoid cold air, or sudden low-
ering of the bodily temperature. Take plenty of open-air
exercise. - -
Diet.— Milk diet best. Let the patient gradually leave
off all his ordinary food, until he reaches an exclusive milk
diet. Begin by drinking a quart of milk a day, and grad-
ually increase the quantity from day to day, until finally
five or six quarts are taken daily. Divide the day into equal
periods, and take a half pint or pint at a time. Keep it up
for at least a month.
AMYIOID KIDNEY.
Amyloid degeneration of the kidneys belongs to a cachexia
depending on tertiary syphilis or prolonged suppuration,
and should be treated in accordance with the nature of the
primary affection. *
REMEDIES.
Phosphoric ac., Nitric ac., Mercurius, Kali iod., Sarsa-
parilla, Silica.
68 KEY NOTES OF MEDICAL PRACTICE.
CALCULI— RENAL. .
LITHIC ACID CALCULI.— Lyc., Nua, v., Puls., Sars.,
J'upat., Colch. * l
Lycopodium.— Disorders of digestion and derangement
of liver. Lithic acid crystals (red sand) in the urine.
Nux v.–Disorders of digestion from high living; con-
stipation.
Diet.— Must be carefully regulated. It must be simple,
digestible, and moderate in amount. Eat sparingly of
meats; let the diet consist chiefly of vegetable food. If
meats be eaten, take but a very small quantity at any one
meal. Avoid rich and highly seasoned dishes, and take no
champagne, Spirituous, or malt liquors.
Regimen.—An abundance of out-door evercise highly
important, to supply the system with oxygen. Keep up
healthy action of }. skin by Turkish baths, and daily fric-
tions with flesh gloves. Drink large quantities of pure soft
water. Filtered rain water is superior to all others.
PHOSPHATIC CALCULI.—Phos. ac., Aletris, Helon.; Ign.,
Chºn. -
Diet.—The diet should be nutritious and simple. Drink
freely of pure water.
Regimen.— Exercise, change of scene, and mental rest
important. Attention to the bladder important; do not let
the urine be long retained, and treat first indications of
vesical catarrh.
OxALATE of LIME CALCULI.—Nitro-mul’. ac., Uranium
Nitrate. -
Diet.—Avoid the use of Sugar, rhubarb, asparagus, oils
and fats, and spirituous, or malt liquors. Drink no “hard ”
water— i.e., water containing lime.
Regimen.—As in previous form.
Berberistinct.— Give during the attack of renal colic,
to promote passage of the stone.
GENERAL MEASURES.
During passage of a calculus, the intense suffering of the
patient must be relieved. Apply hot fomentations over the
loins and lower abdomen; put patient into a hot hip bath;
give enema of starch and Laudanum, thirty to forty drops,
and let the patient get the effects of the opiate; inhalations
of Chloroform, if urgency demands; subcutaneous injec-
tions of Morph. Sulph. ; drink large quantities of bland
liquids during the attack. If it be a uric-acid stone, give
#. potassii citratis, one-half fluid ounce, every three
OUIS,
UIR, AEMIA — CYSTITIS. 69
URAEMIA. -
PROGNOSIS.–Unfavorable: Setting in with great
violence; convulsions and coma; if the kidney degeneration
is far advanced. Favorable : Those cases in which the
impediment to the excretion of the urine can be speedily
removed.
Cantharis.— Uraemia secondary to congestion or inflam-
mation of the kidneys. Give frequent doses Tereb. if
Canth. fail.
Digitalis.- If heart's action weak.
Apocynum.— Uraemia following dropsy. Administer
remedies subcutaneously if patient unconscious.
GHENERAL MEASURES.
Resort to every possible means to restore the action of
the kidneys. Hot compresses, or hot poultices over loins;
hot pack, to promote diaphoresis. If there be any urine in .
bladder, use the catheter. If it occur in puerperal state,
terminate labor as soon as possible. For convulsions,
Morphine, one-eighth or one-quarter grain hypodermically,
or Potassii brom. per rectum. Free purgation may be pro-
cured by Oleum tiglii, one drop on the finger, touched to
the back of the tongue. -
Diet.—After the attack give mourishing diet, especially
a free milk diet.
DISEASES OF THE BLADDER.
CYSTITIS — ACUTE.
LEADING IFEMEDIES.
Aconite.— Only when there is much erethism or fever.
Dry, hot skin; thirst and restlessness; frequent and violent
urging to urinate, with burning in bladder; painfulness in
region of bladder.
Cantharis.-Violent pains and burning heat in bladder;
very frequent micturition, with tenesmus vesicſe; burning
and cutting pains, so severe patient screams aloud; constant
desire to urinate, with scanty emission of dark or bloody
urine. º
Belladonna. – Region of bladder very sensitive; urine
hot and red; involuntary dribbling of urine; great nervous
irritability.
Camphor.—The best remedy for strangury, especially
useful if the attack was brought on by toxic doses of Can-
tharides.
9-4-(2-y-tº- 2. - % -&-v -
70 REY NOTES OF MEDICAL PRACTICE.
Cannabis. – Especially gonorrhoeal cystitis. Its º:
toms are similar to those of Canth., but less intense. It
may be given in acute cystitis if improvement does not
follow the use of the former in twenty-four hours.
CYSTITIS – CHRONIC,
Chimaphilla.--Dysuria, with mucous sediment in
urine. 4. -
The best remedy in the chronic form.–Ruddock.
I have often used it with advantage. From one to five drops of the
mother-tincture seems to be the most suitable dose.—Hughes.
Mercurius.- Fever, with chilly creepings and great
sensitiveness in region of bladder; urine turbid, fetid, con-
taining pus. . Also in gonorrhoeal cystitis.
Sulphur.— Obstinate chronic cases; urine very fetid.
CONSULT— Dulc., Senecin, Apis, Puls.
GENERAL MEASURES.
Acute.— Hot hip-bath, or hot fomentations, with abso-
lute rest in horizontal position. CHRONIC.— Great benefit
often follows washing out the bladder. Use a small quan-
tity of water at blood heat, lightly colored with Hydras.
tinct. Force it gently and slowly. The best method is to
use a fountain syringe, with a fleasible soft rubber catheter.
This can be used for either male or female patients. Inject
into the urethra a 4 per cent. solution of Cocaine, and the
passage of the catheter will then be painless. This will
also relieve irritation and strangury.
Diet.-- Prescribe a diet which shall keep the urine as free
from solids as possible. In acute cases eat but little meat,
and avoid the use of all stimulants, wine, spirits, beer, tea,
coffee, spices. Drink large quantities of pure soft water,
such as Poland or Waukesha water. Filtered rain water is
best.
ENURESIS.
LEADING REMEDIES.
Sulphur.— Nocturnal enuresis, copious discharge.
Should begin the treatment of every case.—Jahr.
Belladonna. – Paresis of sphincter vesica, may be
necessary to give several drops of mother-tincture at a dose,
for children.
Causticum.— Involuntary passage of urine at night
when sleeping; passage of urine when coughing or sneezing.
Equisetum.—Haš-proved curative in many cases of
nocturnal enuresis.
Cina. –When traceable to worms.
HAEMATURIA. 71
GENERAL MEASUREs.
Child should sleep on a hard mattress, with light gover-
; Avoid hot drinks and highly seasoned food late in the
day.
HAEMATURIA.
LEADING REMEDIEs.
Terebinthina.—The blood intimately mixed with the
urine, which has a dirty, brown-red, or even blackish color;
burning and drawing pains in kidneys; spasmodic urging
and pressing in region of bladder.
Occupies the first place.—Hughes. -
Cantharis.-Violent, cutting, pressing, and crampy
pains in the bladder, extending into the urethra and kid-
. Strangury and burning; blood discharged drop by
Ci l'OI).
&e of the chief remedies.—Hartmann.
Millefolium.— Pain in renal region, chilliness; the
blood forms a sediment in bottom of vessel like a bloody
cake; pressive pain in urethra during flow of blood.
Has been used successfully.—Hering. -
Hamamelis.-Haºmorrhage from passive congestion of
kidneys, with dull pain in renal region.
Belladonna. – Renal hyperacmia from cold.
Nitric ac.—Active hamorrhage after Mercury; tenesmus
vesica, after micturition; dissolution of blood corpuscles.
Arsenic.—Urine scanty, very dark, mixed with pus and
blood, and rapid decomposition of it in the vessel; wide-
spread burning pains in urinary organs.
Efficient in both acute and chronic.—Baehr.
Camphor.—Haematuria after eaccessive use of can-
tharides.
GENERAL MEASURES.
Absolute rest; promote action of the skin by vapor baths;
let the patient drink large quantities of soft water; copious
injections of warm water often afford, great relief. When
the bladder is filled with thick clots of blood, which cannot
be passed or drawn through a catheter, force into the bladder
two ounces of warm water containing in solution five drops
of Muriatic ac, and sixteen grains of Pepsin; in a few hours
ºuts of the bladder will readily pass through the
Catheter. - -
</~~<- a--~~~ --&-e-ea –
72 KEY NOTES OF MEDICAL PRACTICE.
DISEASES OF THE NERWOUS SYSTEM.
EIYPERAEMIA OF THE BRAIN.
LEADING REMEDIES.
Belladonna. — Face red and congested; injection of
conjunctiva; photophobia; extreme sensitiveness to the
slightest noise; sudden starts and jerks; general hyper-
aesthesia. Tendency to delirium.
Veraturm vir.—Cerebral hyperamia accompanying fe-
brile conditions; headache; violent throbbing of the carot-
ids; sensitiveness to sound and light; flushed face; tingling
and prickling in the lower limbs; full, hard, bounding
pulse. -
One of the most powerful remedies for cerebral hyperamia.-
JBaehr. -
Aconite.—The result of cold or violent emotion, with
hot, dry skin, and great excitement of the circulation.
Gelsemium.— Passive hyperamia, and hyperaemia oc-
curring during dentition.
Glonoine.—Sudden and intense congestion, with vºo-
lent headache; absence of fever.
Arnica.--When from injury.
CEREBRAL MENINGITIS.
PROGNOSIS.— Grave. Unfavorable : Tonic spasms;
difficult deglutition; incontinence of feces and urine; ster-
torous respiration; stupor and coma.
LEADING REMEDIES.
Aconite.—In the im?tial stage; fever; dry, hot skin;
great arterial tension; face red and bloated; burning in
brain, with sensation as if it were moved by boiling water;
great restlessness and anxiety.
As soon as pulse becomes slower, and symptoms of exudation set
in, Acon. no longer indicated.— Baehr.
Belladonna. – Face red and bloated, with red, spark-
ling eyes; boring of head into the pillow; great sensitiveness
to light and noise, with general hyperiesthesia; violent
throbbing of the carotids; loss of consciousness; violent
delirium; convulsive movements of the limbs; vomiting;
involuntary stools and urine.
A disposition to perspire constitutes a valuable indication in favor
of Bell. as compared to Acon.— Baehr.
CEREIBRAIL MENINGITIS. 73
Bryonia.-After effusion has set in; mild delirium;
severe, shooting, and tearing pains in the head, with sharp
screams; livid face; chewing motion of the jaws; stupor.
When the stage of excitement is merging into that of depression
and stupor.— Hughes.
Helleborus.-Eyes rolled up; lids half closed; face
pale; breathing slow and deep; sighing; Soporous sleep,
with screaming and starting; automatic motions of one
arm and one leg; jerking, and convulsive movements. Fol-
lows Bell. -
The proper period for its application has arrived if reaction has
almost entirely ceased and the symptoms of paralysis are more or less
completely developed.— Baehr.
Apis mel.—Convulsions; sopor, interrupted by piercing
shrieks; bending back and rolling of the head; grating of
teeth. I'ollows well aſter J3ry. -
Sulphur.—“Appropriate as a means of assisting the
delaying resorption of the exuded fluid; hence, in the stage
of paralysis, after it has continued for a time without any
perceptible change.”—Baehr.
Arnica. – Especially when of traumatic origin; also to
promote resorption of serous effusion after inflammation.
Absence of all signs of reaction contra-indicates this agent decid-
edly.— Baehr.
Zincum. — Patient unconscious; eyes half closed; dilated,
insensible pupils; extremities, or whole body, cold; blue-
ness of hands and feet; impeded respiration; small, weak
pulse. Inflammation has ceased, and effusion, with cerebral
torpor, remains.
Even in advanced paralysis, with general coldness, it has been
l:nown to excite salutary reaction.—IIughes.
SPECIAL REMEDIES.
Opium.— Deep coma. -
Rhus.-Wiſh erysipelas and low fever.
Mercurius, Kali hyd. –Syphilitic cachexia.
Hyoscyamus.-Severe cerebral pains; delirium; aber-
ration of sight. -
GENERAL MEASURES.
Keep the sick-room darkened, well ventilated, and very
quiet. Raise the head on a thin pillow. In severe attacks,
cut the hair. Apply cold to the head. To be of service,
cold applications must be continuous — not warm at inter-
vals. Use a bladder, or small rubber bag, half full of
pounded ice; or, cover the head with a soft cloth, and con-
duct to it a constant small stream from a vessel of cold
water, by a siphon of small rubber tube or cotton wicking.
Great caution mecessary. Apply only in the stage of excite-
ment; never after the stage of depression has set in.
Throughout the attack, keep the extremities aparm. During
convalescence the patient must be kept free from all excite-
ment or disturbance; do not talk to children.
74 REY NOTES OF MEDICAL PRACTICE.
Diet.—During fever, give liberally of gold water to
slake the thirst. Barley water, milk and water, and broths
should be given as soon as depression sets in. In convales-
cence return to solid diet cautiously.
APOPLEXY.
LEADING REMEDIES.
Aconite.— Full, strong pulse; plethoric subjects; great
arterial excitement.
You will be astonished at the rapidity with which the beneficial
results will manifest themselves under this potent drug.—Hughes.
Belladonna. – Great cerebral congestion; red, swollen
face; throbbing of cerebral vessels; dilatation of pupils;
conjunctiva red and injected; convulsive movements of face
or limbs; involuntary discharge of urine. To be of service,
must be given early, when the effusion is still attended by
violent symptoms of congestion.
Sometimes has a magic effect.—Baehr.
Opium.— Profound stupor; bloated, dusky-red face;
stertor and irregular breathing; stupid, besotted counte-
nance; convulsive motion of extremities; patient moans
and groans; is hard to arouse; face covered with profuse,
cold sweat.
This drug is of great value.—Hartmann.
Arnica.- No arterial excitement or cerebral congestion;
sudden attack, with stupefaction, sighing, and muttering:
involuntary discharges. Also, to promote resorption of
effusion, to be given after the attack, with Bell., if signs of
cerebritis.
JB #: a remedy to promote resorption, Arm. occupies first rank.-
(162/07".
SPECIAL REMEDIES.
Nux v.–Congestive condition of brain favoring apo-
plexy. For those of sedentary habit, who have indulged in
rich diet and alcoholic stimulants.
Sulphur.—To promote resorption, “comes in where the
action of Arm. terminates.”
Phosphorus.-- Retards degeneration of arteries.
Faradization.—To restore paralyzed muscles.
For PREDIsPosition.—Nuw v., Phos., Baryt., Lach.,
Gels., Hyos.
FoR AFTER-EFFECTS.–Caust., Zinc., Cupr., Plumb., Cocc.
GENERAL MEASURES.
Loosen all tight clothing, especially about the neck; re-
move the patient to a quiet, cool place; let him lie with the
head and body raised, and give plenty of fresh air. Rub
the extremities with heated flannels, and apply hot bottles.
ALCOHOLISM. - 75
Apply warm cloths to the head; cold applications do harm,
especially if the face is pale and the surface cool. VeneSec-
tion worse than useless. - -
Diet.— Of great importance. Avoid over eating, rich
food, and stimulants of all kinds. At no time should a full
animal diet be indulged in. .
Avoid all excitement, fits of passion, over exertion, Sud-
den changes of temperature, exposure to hot sun, over-
heated rooms, hot baths, wet feet, and excesses of whatever
kind.
ALCOHOLISM — ACUTE.
SYNONY MI: Delà" wºm. Th’emens.
LEADING REMEDIES.
Hyoscyamus 1x. — Delirium mixed—loquacious, fu-
rious, muttering, and incoherent; pulse small and quick;
very compressible; skin cold and clammy. -
Hyos, most commonly useful; rare that the delirium is inflamma-
tory enough for Bell, or sufficiently maniacal for Stram.—Hughes.
Opium.—Comatose condition; loud, stertorous breath-
ing; loss of consciousness and sensation.
Antimonium tart.— Much mucous gastric disturbance
with the attack, and profuse cold sweat.
Arsenicum.— Great irritability of the stomach; great
prostration and muscular tremors.
Ammonia.—To “Sober up ’’ one who is “pretty tight,”
give a dose consisting of one drachm Spts. Ammon., diluted
in a little water.
GENERAL MEASUIRES.
A cup of strong coffee is often of great benefit. It is
highly important that the strength be maintained by a
avutritious diet, as the danger is from eachaustion. Give
soups, beef tea, warm milk, coffee, egg beaten up in coffee
or milk. A plentiful sprinkling of red pepper may be
used in seasoning the food.
Use as little violence as possible; employ only gentle
compulsion, trying to soothe and quiet the patient by kind
words, keeping him as quiet as possible, and, if you can
manage it, in a darkened room. Have the windows Securely
fastened, and help at hand to summon in case of necessity.
ALCOHOLISM – CHRONIC.
LEADING IFEMEDIES.
Nux v.– Often indicated. A few drops of the 1x in
frequently repeated doses for the bad effects following a
“spree.” Very good for morning vomiting, trembling
hands, and other nervo-muscular affections of drunkards.
76 KEY NOTES OF MEDICAL PRACTICE.
Zinc phosphate.—In chronic alcoholism, for nutrition
of mervous centers.
Capsicum.—Ten drops of the tincture in a little water
for atomic dyspepsia of drunkards. -
Arsenic.— For the morning vomiting, gastritis, pros-
tration, muscular tremors. -- - " .
Moschus.-The best remedy to allay the craving.
GENERAL MEASURES.
To correct the habit, the use of alcoholic stimulants must
first be entirely given up. As substitute, Th. Cinchoma.
rubra may be given, a teaspoonful dose, two or three times
daily; or, -
B. Ilupulinae, fl. ext.
Tr. Capsici, equal parts.
DoSE.— 1 or 2 tsp. p. r. m.
This, also, is an excellent substitute for the alcoholic
stimulant. - -
Diet.—A most important part of the treatment. Have
the patient eat freely of fruits and vegetables, and drink
milk, lemonade, fruit-flavored syrups, and water.
OPIUM HAIBIT.
Diminish the dose by insensible degrees, without the
knowledge of the patient. Get control of the patient and
deal out to him his daily allowance. If the patient has a
hypodermic syringe, its use and custody must be given up
to some one else. If the daily quantity is not more than
four grains, the use of the syringe must be given up at once,
and a proportionate quantity — i.e., three times as much —
given by the stomach. When the per diem quantity is from
one scruple to one drachm, considerable reduction must be
made before the syringe can be abandoned, but it must be
dropped at the earliest possible moment. The rate of reduc-
tion should not be greater than 1-16 grain hypodermically, or
1-5 grain by the stomach, each three to eight days. The
necessary time must be given, even though it take a year.
Never stop the opiate suddenly.—Bartholow.
Mix the dose of Morph. with a quantity of the 1a, or 2a:
trituration of Nua, v., or Quin. Sulph., gradually lessening
the proportion of the former and increasing that of the
latter, until the one comes to be substituted for the other.
If Laudamºm be taken, pursue the same plan, substituting
Tr. Coca, Erythoaxylon.
Diet.— Success is promoted by correcting the abnormal
condition of the digestive functions by appropriate reme-
dies. Important to keep the patient well nourished. If
digestion is good, and food can be taken and assimilated,
the diſticulties of treatment are reduced one half. Give
HEAD ACHE. . . 77
milk, eggs, animal broths, steaks, chops, and other substan-
tial food. It is important to have occupation for mind and
body. -
Absolute control of the patient is necessary by any method, and
easier to obtain by the one here given than by any other. .
HEAD ACHE — CONGESTIVE.
LEADING IFEEMEDIES.
Aconite.—Fullness and heavy feeling, as if everything
would push out of forehead; burning headache, as if brain
agitated by boiling water; vertigo, with nausea and vanish-
ing of sight; arterial tension and ea:Cited circulation
throughout the body.
Belladonna.— Intense headache, aggravated by noise,
motion, moving the eyes, contact, and even coughing; great
congestion of the head, with throbbing of carotids; jerking
headache, extremely violent on walking — pain increased at
every step; stabbing as if with a knife, from temple to tem-
ple; burning of eyes, and pain as if eyeballs would start
from their sockets. . -
Veratrum vir.—Intense cerebral congestion, feeling as
if head would burst open, accompanied by nausea and vom-
iting. Headache proceeding from nape of neck. Heart
beats loud and strong, with great arterial excitement.
Glomoine.—Active cerebral congestion; violent throb-
bing, pulsating headache, with fullness and pressure in
head; pain so severe as to drive to frenzy; patient grasps
his head, and rolls and cries with agony; headache from
exposure to heat of Sun. -
China. – Deafness; noises in ears.
Cactus.—Heavy pressing on Vertex.
Opium.— Passive congestion — sleepiness.
Gelsemium.— Passive congestion — giddiness.
IBryonia.- Frontal; dyspepsia — constipation.
Nux v.– Occipital, with dyspepsia and constipation.
HEAD ACHE – NERVOUS.
(HEMICRANIA.)
LEADING REMEDIES. - .
Belladonna. – Red face; great sensitiveness to noise
and light; right-sided, aggravated by slight jar.
The best medicine if of recent origin:—Hughes.
Sepia. — Chronic cases; skin yellowish under the eyes;
women with disordered sexual function; leucorrhoea; irregu-
lar menstruation, Scanty, preceded by pain; headache gener-
ally occurs about time of menses. - -
Sep. has largest and most unanimous testimony in its favor as a
radical remedy for this disease.—Hughes.
78 KEY NOTES OF MEDICAL PRACTICE.
Ignatia.--Headache as if a nail were driven in side of
head; periodical; pain usually semilateral; persons of highly
nervous temperament, or in those whose nervous system
has given way to anxiety, grief, or mental work.
Nux v.–Sedentary habits; habitual constipation; sen-
sation as if skull would split; worse in open air, during
motion and stooping; irritability of senses.
A leading remedy in hemicrania.—Baehr.
Coffea.— Great nervousness, exaltation of senses, and
insomnia; one-sided headache, as from a nail driven into
parietal bone; useless in case of coffee drinkers.
Arsenicum.— Neuralgic and periodical headache; mi-
graine and headache from abuse of Quinine and from mias-
matic influences; great weight in head, particularly in
forehead.
Gelsemium.—Appears suddenly, with dimness of sight,
or double vision; vertigo; great heaviness of head; bright-
red face; dull, heavy expression of countenance; full pulse;
general malaise. -
Neuralgic headache after cerebro-spinal meningitis.—King.
Amyl nit.— Pallor of face; headache, which increases
in severity, and then abates, again and again. .
GFIENERAL MEASURES.
All victims of hemicrania must give up the use of coffee.
.*
NEURALGIA.
LEADING REMEDIES.
Aconite.—Acute idiopathic, from cold; face red and
hot; pains very severe, lancinating, pulsating,- almost in-
tolerable at night, with great restlessness. Must be acute
congestion or active inflammation.
Invaluable in recent cases.—Hughes. -
Belladonna. —Violent, cutting pain; red, shining swell-
ing; congestion of face; eyes injected; lachrymation; great
nervousness and restlessness; palpitation of heart; motion
and contact exceedingly painful; pains appear in evening;
most violent toward midnight.
Colocynthis.-Tearing, tensive pain, greatly aggra-
vated by every motion of the facial muscles; better from
warmth; attended by inflammatory heat and swelling; acute
neuralgia, from cold.
Spigelia.- Neuralgia of trigeminus; pain jerking, tear-
ing, sometimes periodical, always attended by feeling of
anxiety at heart, and great restlessness; aggravated by
slightest contact, by motion, or stooping; face pale. Of no
use in chronic cases.
Deserves the first place.—Baehr.
NEURALGIA— SCIATICA. 79
Arsenicum.— Idiopathic neuralgia. Burning, agoniz-
ing pain, accompanied by great restlessness and anguish.
Intermittent, with tendency to periodical return. Worse
from cold; easier during exercise. As a consequence of
malaria, or in those of debilitated condition. DOSE.-
Acts best in high attenuations.
Quiets nervous pain better than any other medicine.—Baehr.
Iris v.–Neuralgia of head, temples, and eyes, begin-
ning in the morning, and lasting for hours, causing burning
distress in epigastrium, and vomiting. The entire scalp
and face are involved, with sharp, shooting, cutting pains.
Rhus.-After getting wet.
Cedron.— Marked periodicity.
Gelsemium.— Malarial origin.
Hepar sulph.-After abuse of Merc. **
Veratrum alb.-Icy coldness of part.
Bryonia.- Intercostal; worse on motion.
Ralibi...— Supra-orbital, with gastric disorder.
China. – Pain, aggravated by the slightest touch.
Pulsatilla.- In lymphatic subjects; jerking pain.
Kalmia.-Neuralgia affecting one-half of the face.
Phosphorus.--Tic-doloureux from nervous debility.
Chelidonium.— Right supra-orbital, with liver disorder.
GFIENERAL MEASURES.
Hot applications sometimes relieve. Paint the course of
the nerve with the mother-tincture of Acom. or Bell. Chlo-
roform liniment locally. Dip a needle in oil of peppermint,
or oil of cloves, draw it along the course of the affected
nerve; this sometimes has a magic effect. The local appli-
cation of a Menthol pencil relieves many cases very prompt-
ly. Protect the part from exposure to cold or damp; wear
warm clothing; rest important for those who are over
worked; galvanism often cures.
Diet.— In chronic cases, and debilitated subjects, an
abundance of nutritious food. Cod-liver oil, and other
animal fats, very important; butter, cream, etc., should
enter largely into the diet.
SCIATICA.
LEADING REMEDIES.
Chamomilla.-Pains intolerable; drawing and tearing
in character, with paralytic sensation.
Will often cure in young persons of nervous temperament.— Hughes.
Rhus:- Brought on by exposure to wet, straining, and
lifting. Pains worse when lying quietly; relieved by mo-
tion. Numbness, formication, and stiffness.
In chronic cases rarely fails.-Ruddock.
80 KEY NOTES OF MEDICAL PRACTICE.
Colocynthis.--Shooting, tearing pains; worse from
motion and pressure. Pain sets in suddenly; is constant,
becoming at times intolerable; felt most in daytime.
Has always enjoyed high repute.—Hughes. . -
Arsenicum.—Burning pains, attended by anguish and
restlessness; worse at night. Chronic cases. -
Actaea.— IIysterical subjects; ovarian or uterine com-
plications. - .* -
Lycopodium.— Coxalgia, with violent jerks of the
limbs, stiffness, weakness, and formication. Obstinate,
chronic cases. W
GIENERAL IMEASURES.
Apply heat; cover the part with flannel, and run over it
with a hot sad-iron. The battery should be tried in obsti-
nate cases. Acupuncture often relieves. Apply Menthol
locally. - T - ,
TETANUS.
PROGNOSIS.–If the access has been slow, the spasms.
mild, the paroxysms short, recurring at long intervals, and
patient can sleep, and the temperature is not over 101° F.,
the prognosis is favorable; temperature over 101° F., wºnfa-
vorable; 103° F., or over, dangerous. *
LEADING REMEDIES.
Strychnia.-Intermittent fits of spasm, with bending
body backward, and disturbed respiration; extreme stiff-
mess of limbs; hardness of muscles; full consciousness dur-
ing the spasm; the Spasm, eacited by the slightest touch.
DOSE.—1.x or 2x trituration. -
Aconite.— Idiopathic tetanus, excited by exposure to
cold or Wet. Frequent alternation of redness and paleness
of face; distortion of eyes; body bent backward; face cov-
ered with cold sweat; rigidity of muscles of jaws and neck.
Its spasms are more continuous than those of Strych., and less de-
pendent on reflex excitement.—Hughes.
Hydrocyanic ac.— Lockjaw; bloating of face and
neck; pretruded, glistening eyes; body bent forward or
backward; irregular pulse.
Belladonna. – Constriction of throat; tightness of chest;
grinding of teeth; clenching of jaws; distortion of face;
mouth foaming; obstructed Swallowing; renewal of spasm
on attempting to drink.
Cicuta. —Trismus from injuries to head.
Rhus.--Froſh wounds of joints or tendons.
Ignatia.-- Extreme opisthotonos; from fright.
We should give tolerably large doses of the remedy employed.
IRepeat frequently.—Hughes.
EPILEPSY — CHOREA — HYSTERIA. 81
GENERAL MEASURES. -
Reep the room at a comfortable temperature, the patient
very quiet, and allow no draft or cold air to strike him.
Diet.— Give abundant nourishment. Give four ounces
of milk every two hours; one egg, with milk, morning,
noon, and night; if the pulse indicates great exhaustion,
give nutrient enemata in addition. If the jaws are locked,
pour liquid food between the jaws and cheek. -
EPILEPsy.
LEADING REMEDIES. ,
Belladonna. — Recent cases. Cerebral congestion dur-
ing and between the paroxysms. Young and sanguine
subjects, and for pelºt mal. . . .
Will often be found efficient.—Baehr. -
In gases of some standing, Calc. Ineeded to complete the recovery.
—Hughes.
Cuprum.—Violent convulsions, occurring at night.
Occupies the first plage among our remedies.—Jousset.
CONSULT—Ign., Cicuta, Cocc., Strych., Opium, Arg.mit.,
IVuá; v. -
. GEENERAL MEASURES. -
Inhalations of Amyl mºt, to ward off a threatened attack.
During the attack loosen clothing, and keep the patient
from injuring himself. Pressure on both carotids, which
makes pressure on cervical sympathetic and par vagum
nerves, will often shorten an attack. In female patients,
pressure on ovarian regions sometimes has a like effect.
When the convulsions cease, draw the tongue forward, and
turn the head to one side, that the half-paralyzed tongue
may not fall on the larnyx. Let the patient rest.
CHOREA.
SYNONYM : St. Vºtus’ Damce. - -
LEADING REMEDIES. •
Igmatia, Actaea, Arsenicum, Ferrum, Cuprum, Agart-
cus, Acomºte. Tºfie SIt & AAA ! ”
Galvanism, ”the constant current, has cured many
C&l,SČS. -
HYSTERIA.
LEADING REMEDIES. -
Ignatia. —Attack preceded by sensation of lump in
throat, followed by sense of Suffocation, spasmodic eructa-
tion, convulsive movements of arms and legs, clenching of
hands; alternate flushing and pallor; yawning and sighing.
Its continued use modifies the morbid impressionability.—Hughes.
*
*
6
82 KEY NOTES OF MEDICAL PRACTICE.
Moschus.- Great anxiety; palpitation of the heart;
tendency to fainting; headache; feeling of constriction of
chest, and general chilliness, and copious flow of colorless
Ull’ll le. - -
In low dilutions, will sometimes arrest and always shorten par-
oxysms.-Hughes. -
Asafoetida.—Sensation as of a ball rising in the throat.
Nervous palpitation; the throat symptoms predominate.
Pulsatilla. — Patients of mild, sensitive, tearful dispo-
sition; frequent derangement of menstruation; the attacks
being characterized by tearfulness, or fits of crying, without
assignable cause.
Aurum.— Melancholia.
Sepia.- Chlorosis; leucorrhoea.
Actaea.— Depending on menstrual suppression.
Platina.— Uterine derangements; nymphomania.
GHENERAL MEASURES.
In the attack, loosen the clothing; give air; sprinkle
the face with cold water; give Moschus.
Regimen.—Avoid tight clothing, excitement, or emo-
tion; take open-air exercise; observe regular habits; early
hours; eat plain food; avoid stimulating diet; correct uterine
and sexual disorders.
CONVULSIONS.
LEADING REMEDIES.
Belladonna. – Great cerebral congestion; hot, flushed
face; violent throbbing of carotids; drowsy after the spasm;
starting and jerking in sleep; great vascular erethism.
- Seldom happens that a second attack will occur after administer-
ing Bell.—Baehr.
Ignatia.--Tomic spasms, very violent during dentition,
in those of highly nervous organization, from fright or
grief. Of spinal rather than cerebral origin.
Chamomilla. – Extreme sensitiveness, with great
irritability; one cheek red and hot; bloated bowels; rest-
lessness, with moaning and groaning.
Cuprum. — Andemic condition. , Shrill cries during
attack; drowsy and stupid in intervals; bloated abdomen;
involuntary, thin discharge from bowels.
CONVULSIONS FROM
PASSION.— Cham.
INJURY.—Ars., Cicuta, Bell.
WoRMS.— Cima., Merc., Cicuta.
FRIGHT. — Op., Hyos., Acom., Bell.
STOMACH DISTURBANCE.-Ipec., Nua, v.
INCIPIENT BRAIN AFFECTION.— Bell., Gels., Verat. vir.
LARYINGISM US STRIDULUS. 83
GENERAL MEASURES. •
Ilose no time; have the child stripped and put in a warm
bath (90° F.); apply to the head a large sponge wrung out
of cold water; remain in the bath ten or fifteen minutes. .
In an emergency, if no other remedy is at hand, give
Camphor, by inhalation, or a drop in a little sweetened gum
water. Lance the gums if they are swollem and inflamed.
During the spasm administer Amyl nit. by inhalation.
If the child is robust and apparently healthy, the attack
is probably reflex; if weakly, wasted, or cachectic, it is
probably from the brain. *
If the patient is an infant reduced by e.vhausting diarrhoea,
let it remain in the bath but two or three minutes, and do
\
not put cold water to head; give stimulants of brandy and
milk, freely.
LARYNGISMUS STRIDULUS.
SYNONYMIS: Spasmodic Croup; False Crowp.
LEADING REMEDIES.
Aconite.—Attack excited by cold, dry air. Spasm of
larynx; severe dyspnoea; febrile symptoms.
Eminently specific.—Hempel.
Of priceless value.—Ruddock.
Chlorine. — Spasm of glottis; a succession of crowing
inspirations, each followed by an ineffectual effort at expi-
ration; the chest inflated; with turgescenee of face; more
or less complete coma; followed by relaxation of the spasm.
DoSE.— Prepare weak solution in water, so that the odor of
the Chlor. can just be detected. Teaspoonful at a dose.
Prepare fresh frequently.
I have used it with great advantage.—JDunham. -
Iodine.— Child rachitic, with swelling of bronchial
glands.
To be preferred to all other remedies, as long as general organism
has not become too much reduced. Baehr.
Belladonna. – Red face; arterial excitement; cerebral
congestion. -
Sambucus.- Burning, red, hot face; hot body; cold
hands and feet; profuse perspiration on face and body.
Moschus.-Give by inhalation at time of attack, to cut
short paroxysm. -
- GENERAL MEASURES..
Quickly immerse the child in a warm bath; apply a hot
compress to the throat–renew frequently. Sponge the
chest with cold water; give Moschws. . Two or three times a
day give the neck and chest a cold sponging. As the spasm
ceases, if the breathing is not reëstablished, dash the chest
with cold water; give inhalations of Amm.; employ artificial
respiration, if Inecessary. . -
84 KEY NOTES OF MEDICAL PRACTICE.
HYDROCEPHALUs–ACUTE.
PROGNOSIS.—About’ seven-eighths of all cases are
fatal. Unfavorable : Deepening stupor; eyes dim, glazed,
and turned upward; convulsions. Patient may die in
coma or convulsion. Favorable : A copious outbreak of
perspiration; diminished oppression of breathing; increased
flow of urine.
LEADING REMEDIES.
Belladonna. – Heat of head; throbbing carotids; pain
in head; buries head in pillow; eactreme sensibility to light.
and noise; eyes red, sparkling, and protruding; violent
delirium; drowsiness; stupor; with occasional framtic
screams ; convulsions; vomiting, and occasional involun-
tary evacuations. The medicine until effusion sets in.
The sheet anchor, after vomiting sets in.-Hughes.
Bryonia.-Impending effusion. Face dark “crimson-
red”; dry lips; dry, brownish tongue; hasty, impetuous
drinking and Swallowing; constipation; suppression of
urine; dry heat, especially of head; drowsiness; chewing
motion of jaw. - -
Belleborus.-After exudation. Rolling the head; auto-
matic motions of one arm and one leg; Soporous sleep, with
screaming and starting; lower jaw sinks down; chewing
motion of mouth; Squinting; pupils dilated; forehead
wrinkled, and covered with cold sweat. . .
One of the most important remedies.—Laurie. - -
Digitalis.--Sometimes called for in second stage, after
effusion. Pulse slow, weak, and irregular; sopor; slow,
heavy breathing; sleep, with frequent startings; convul-
sions. -
Has high reputer-Hughes.
Cuprum.—Hydrocephalus following catarrhal fever, or,
metastasis during eacanthematic fever, Stage of effusion.
Hot head; deep Sopor, with twitching and jerking of the
limbs; coldness of the hands, and bluish appearance of
fingers.
Sulphur. — “If others fail.”—Hughes.
Iodine. — “Incipient stage.”—Jousset.
Calcarea carb.- “Scrofulous subjects.”—Jahr.
DoSE,-- Our best observers unite in affirming that frequently re-
}; doses of low attenuations are preferable in this disease.—
Q6/17°.
HYDROCEPHALUS – CHRONIC,
Calcarea carb.-Scrofulous diathesis.
Arsenicum iod.—Tubercular cachexia. -
Sulphur.- : With Calc. carb., accomplishes almost in-
credible results.”—Jousset, -
DISEASES OF THE SEKIN. 85.
DISEASES OF THE SRIN.
LEADING REMEDIES.
Arsenicum.—The cutaneous affections to the treat-
ment of which Ars. belongs are those which involve the
nore superficial structures of the skin; hence, in branny,
scurfy eruptions, and those marked by the presence of
papules, or minute vesicles, on inflamed bases. It should
be used for dry, Scăly eruptions, accompanied by intense
burning of the surface. . - Y.
VARIETIES.–Pityriasis; Psoriasis; Herpes zoster; Pru-
*igo; Eczema (chronic); Lichen; Pemphigus; Urticaria;
Impetigo; Ecthyma, Lupus. -
Antimonium tart.— In toxic doses this drug excites a
dermatitis, first papular, then vesicular, and lastly pustular,
and its therapeutic sphere lies in the treatment of pustular
eruptions, the pustules being large, round, full, with red
areolae.
VARIETIES.—Ecthyma; Impetigo erysipelatodes; Syco-
8ès; Acme. -
Apis mel. — Indicated in skin affections not going on
to destruction of tissue, but accompanied by excessive itch-
ing, especially of a burning, stinging character. Also, if
there be dedema of the part.
VARIETIES.–Urticaria; Lichen; Erythéma modositm;
Lupus. ** -
Croton tig.—Adapted to the treatment of eruptions
characterized by the appearance of minute, closely set, red
papules, which gradually become vesicles and pustules,
which break, become confluent, and form scabs, the process
being accompanied by intense burning and itching. In
relieving the itching of eczema, it often has a magic effect.
VARIETIES.—Eczema rubrum, facie et genitale.
Graphites.—Skin affections characterized by rhagades,
fissures, excoriations in folds of the skin, and the exudation
of a sticky, glutinous, transparent fluid from raw places or
Sores; itching eruptions, secreting a corrosive serum.
VARIETIES.—Eczema impetigimodes; Mentagra; Impet-
tgo; Psoriasis palmaris; Crusta lacted.
Lycopodium.— Eczematous, suppurating eruptions on
the head; eruptions which bleed easily, and form thick
crusts; unhealthy skin, with indolent, suppurating inflam-
mations, and swollen cervical glands. -
VARIETIES.—Impetigo; Porrigo capitis (dry); Intertrigo;
Plica Polonica; Eczema. - -
Hepar sulph. —Adapted to Scrofulous subjects, in
whom the slightest injury Suppurates; eruptions moist, in-
86 KEY NOTEs of MEDICAL PRACTICE.
clined to ulcerate, eacceedingly sensitive to the touch; bleed
easily; eruptions spreading by new pimples.beyond the main
excoriation; vesicular, or pustular eruptions in flexures of
joints, elbows, knees, and between scrotum and thighs;
abscesses, whitlows, boils. . - . . . .
VARIETIES.–Eczema impetigimodes; Crusta lacted; Inter-
trigo; Impetigo; Herpes labialis.
Mercurius.- Eruption of innumerable, minute, trans-
parent vesicles, on a light, rose-colored efflorescence, occu-
pying a large portion of the skin, with pricking and itching;
*tching eruptions, with eaccoriating discharges; excessive
perspiration, viscid, of strong odor, occurring chiefly at
night. - #
VARIETIES.—Intertrigo; Eczema; Rupia; Ecthyma;
Lepra; Impetigo; Psoriasis. - -
Mezereum.— Eruptions characterized by papulation,
vesiculation, pustulation, and the formation of thick crusts,
with intolerable itching; itching occurring in the evening
when in bed, aggravated or changed to burning by touch or
by scratching; sensitiveness to touch; ulcers, with red
areola, sensitive and easily bleeding; painful at night; the
secretions tend to form an adherent scab, under which pus
collects. -
VARIETIES.—Eczema; Impetigo; Herpes zoster, Pityria-
sis versicolor; Prwritus; Prurigo Semilis; Mentagra;
Brythema.
Rhus.—Vesicular eruptions on any part of the body;
burning and redness over large cutaneous surfaces, which
soon swell and become covered with vesicles, accompanied
by almost intolerable itching and burning; has a tendency
to invade large surfaces rather than penetrate deeply into
tissues.
VARIETIES.–Eczema; Herpes zoster et labialis, Pem-
phigus; Erythema modosum, Urticaria; Prurigo.
Sepia.-Vesiculo-pustular eruptions, with itching and
cracking of the skin, chiefly affecting the joints, with a
Ayellow, earthy color of the skin, and “liver spots” in vari-
ous parts; women with disease of the uterus.
VARIETIES.—Chloasma; Timea circinata; Psoriasis;
Crusta lacted.
Sulphur.—Scrofulous subjects, and those with “un-
healthy” skin — every injury suppurates; papular, vesicu-
lar, and pustular eruptions, with voluptuous itching,
increased by scratching, and by the warmth of the bed.
Has a wide range of application. .
VARIETIES.—Prwrigo; Favus; Impetigo; Acme; Eczema;
Porrigo capitis; Lichen; Scabies.
SKIN DISEASEs. - 87
SKIN DISEASES.
Acne.—Amt. tart., Bell., Hep. Sulph., Kali brom., Kali
tod., Merc., Puls., Sulph. - -- -- *
LOCAL.-Puncture each pimple with the fine point of a
lancet; encourage bleeding by warm water, then apply hot
water several times daily, ten minutes at a time. Press out
all comedos. If indolent, apply a stimulating lotion — B.
Sulph. Subl., 3ij; Camph., Zj; Aqua, 3iv, Mix. To pre-
went, attend to diet (avoid fats) and hygiene (wash parts
well every night with castile soap and soft water, making
friction with flannel). * > -
Alopecia.-Ars., Fluor.ac., Phos., Phos, ac., Sulph.
LOCAL.-R. Tr. Canth., 3.j; Ac. acet., 3.jss; Glycerime,
3Ss: Spts. Rosemary, 3.jss; Agua Rosa, ad 3 viij. Mix.
Apply to scalp, and rub in well night and morning.
Barber's Itch.-(Tinea Trycophytina). Shave care-
fully and apply OINT. Merc. precip. rubr. -
Chloasma.-Sepia, Sulph., Lyc., Guar. -
Comedo.—Baryta carb., Bell., Nitr. ac., Sulph. . .
LOCAL.— Press out the “grub”; shampoo the face, fol-
low by friction with flannel. Apply a lotion of Boraa, and
water. Treat dyspepsia, amenorrhoea, leucorrhoea, or other
attendant disorder.
. Ecthyma.-Amt. tart., Ars., Lach., Merc., Juglans.
* LoCAL.—Remove scabs and treat the local sores with
§ Calendula lotion. Correct cacheavia by diet, air, and baths.
Ü Eczema.--Croton tig., Rhus, Canth., Graph., Ars.,
§ Merc., Hep. sulph. Cºe's C//( &ez-. -=
^: Local.-- Early stages, soothing lotions. Itching may be
§ $º by lotion of Croton or Rhus. To protect the sur-
- face from air, use — B. Ovide of Zinc, Zij; Calamine
Sºpowder., 3ss; Glycerine, Zij; Rose water, 3viij. Mix. In
, chronic eczema, wash with mild soap, to remove scabs, then
anoint with Cosmoline, twice daily. In eczema of the
§ hands, with acute inflammation, soak them every night in a
* R weak solution Soda, bicarb., in water hot as can be borne,
Sten or twenty minutes. Then anoint with Ol. Olivae, Aqua
$ calcis, parf. aeq., Bism. Submit., 3j. Mix. If the itching
Cº § is severe, add Mur. &c. dil., Zj. Apply on soft muslin
Š * and cover with oil silk, Eczema Impetigimodes.—Use an
ointment of powdered Graph. and Vaseline. . . . . . . .
Erythema.-Acom., Apis, Bell., Mez., Rhus.
Erythema Nodosum.—Arm., Apis., Rhus.
Herpes.— Herpes Labialis: Rhus., Nat. mur., Merc.,
Hep. sulph. Herpes Circinatus: Tell. Herpes Zoster
(Shingles): Ars., Rhus., Mez.
Local.— Herpes Zoster: Protect from irritation; anoint
with Vaseline, dredge freely with flour, and cover with a
layer of cotton wool.
88 KEY NotEs of MEDICAL PRACTICE.


Intertrigo.-Cham, Calc. carb., Hep. Sulph., Merc.,
Sulph. ºlºr -
OCAL.- R Ge ‘ī. parts clean and dry. Anoint with
Hydras, and Wºº. Dust with equal parts Owide of
Zinc and Lyc. seeds. Borac. ac. and Vaseline, very effica-
cious to allay itching. Af
Lichen.—Sulph., Ant, crud., Apis., Ledum.
Local,— Frequent alkaline baths. Soothing applica-
tions to allay itching. Improve the general health.
Pemphigus.-Jêhus, Ars. -
Pityriasis.—Ars., Canth., Graph., Me2. -
IlocAL.—Frequent baths, with hard rubbing. Apply—
B. Boraa, Ej; Glycerine, 3.j; Rose water, to 3viij. Mix.
Prurigo.—Ars., Mez., Rhus, Sulph.
LoCAL.- Use daily cold bathing. A void stimulants in
drink or diet. Avoid scratching. Apply cold compress of
Me2. lotion.
Pruritus.-Calad., Ac. mit., Collins., Lyc., Mez.
LOCAL.-Treat the primary condition on which it depends.
Relief may sometimes be obtained from the use of grain
3 doses of Chlo. Hyd. Hamam. lotion to the part, or Amodyne
lotions. I?. Opium, eight grains; Kreos., ten drops; Was-
line, 3ij. Mix. Camph., Ej; Boraa, Zij; Alcohol, 3.jss;
wº Rose water, to 3viij. Mix. Local applications of a 4 per
\º cent. Solution of Cocaine give great relief.
Psoriasis.-Ars., Graph., Merc., Sep., Sulph.
LOCAL.--Soften the scales by applying a wet compress,
covered with oiled silk; when sufficiently macerated, remove
º and apply—R. Red precipitate, finely powdered,
hite precipitate, ad five grains; Vaseline, 3.j. Mix.
Tinea Versicolor.— First wash well with soap, then
º Hyposulphite of Soda, 3v.j; Rose water, Évj. Mix.
–Liliemthal.
TFrticaria.--Ant., crud., Apis, Ars., Dulc., Rhus, Urt.
7trens. JYºti ſ-wa (v.
. . Of late I have found Chloral, in grain doses, sufficient.—Hughes.
LOCAL.—Warm bath often rapidly curative. To allay
itching — Gründelia lotion. Or, warm water acidulated
with Acetic ac.

HORDEOLUM-OPHTHALMIA NEoNATORUM. 89
DISEASES OF THE EYE.
HORDEOLUM.
REMEDIES. . .
Pulsatilla, Mercurius, Hepar sulph., Staphysagria,
Sulphur. -
LoCAL.-Hot compresses, Open the abscess when it
points. Local application of Iodine, early, will sometimes
abort.
BLEPHARITIS MARGINALIS.
- REMEDIES. -
Mercurius, Arsenicum, Graphites, Calcarea carb., Hepar
sulph., Pulsatilla, Silica, Sulphur. - -
LOCAL.-Remove the exciting cause, Soak the crusts
with solution Soda bicarb., ten grains to 3.j water. Rest
the eyes. A void irritating atmosphere. Observe strict .
cleanliness. UNGUENTS: B. White precipitate (Hydrar;
Amm. ('hlo.) one-half grain to Vaseline, j. R. Red pre-
cipitate (JIydrar. Oacid. rubr. ) two grains to Vaseline, 3.j,
for severe cases. -
CATARRHAL OPHTHALMIA.
(CONJUNCTIVITIS SIMPLEX.)
IRIEMEDIES.
Aconite, Belladonna, Euphrasia, Pulsatilla, Sulphur,
Arsenicum, Graphites. -
Local...—Cold compresses. Boraa, solution (eight grains
to fºj water); or, Boracic ac. (five grains to fºj water), a
few drops in the eye three times a day.
PURULENT CONJUNCTIVITIS. -
IREMEDIES.
Acomºte, Argentum nit., Pulsatilla, Apis mel., Calcarea
carb., Calcared phos., Hepar Sulph., Mercurius, Sulphur.
Local.—Cold compresses. Keep the eye clear of secre-
tions. e
OPHTHALMIA NEONATORUM.
REMEDIES.
Argentum mit., Pulsatilla, Hepar Sulph., Mercurius,
Apis mel. - -
90 REY NOTES OF MEDICAL PRACTICE.
Local.—Cleanliness. Constant removal of the discharge
every five, ten, or fifteen minutes, day and night, until
discharge lessens, then not so frequently. Brush the everted
lids with Arg. nit. Solution (one grain to fºj). If the cornea
becomes affected, Atrop. Solution (one-eighth grain to f3.j
water), a drop in the eye every three hours.
GONORREHOEAL OFHTHALMIA.
- IREMEDIES.
"Argentum nit., Pulsatilla, Apis mel, Calcarea phos.,
Hepar sulph., Mercurius, Sulphur. -
oCAL.-Cold compresses; ice bags; constant removal of
discharge. Apply Arg. nit. Solution (five to ten grains to
fáj. aqua) once daily. Use Chlorine water (dil. one-half,
or Boracic ac. (4 per cent.), in cleansing the eye. Corneal
implication requires Atrop. or Esér. Solution (four grains
to fºj aqua). -
PHLYOTENULAR OPHTHALMIA.
- IREMEDIES.
... Mercurius cor., Aurum, Calcarea carb., Sulphur, Rhus,
Graphites, Arsenicum.
ocAL.— Shade the eyes. Bandage rarely necessary.
Severe pain may require solution Atrop. once or twice
daily. + -
GRANULAR LIDS.
IREMEDIES.
d Aconite, Euphrasia, Arsenicum, Mercurius iod., Bella-
O70,700.
LOCAL.-Cold applications; ice bags. Sulphate of Cop-
per or Alum to granulations. Tannic ac. (ten grains to
Glycerine 3.j), applied by camel's-hair brush to thickened
conjunctiva; or, solution Arg. nit. (five grains to fºj. aqua).
W. cornea involved and pain, Atrop. Solution may be
llSCT Ulle -
, KERATITIS.
DIFFUSE.-Apis, Ars., Awr., Baryta iod., Hep. Sulph.,
Merc., Sulph.
LOCAL.—Atrop. Solution (two grains to f$j aqua) if there
is much pain.
PHLYCTENULAR.— Ars., Graph., Calc. carb., Merc.,
Euphr., Hep. Sulph. -
LoCAL.—Smoke-colored glasses. Cleanliness. Yellow oa:-
*de of Merc. (two grains to 3.j Vaseline), a piece the size
of a millet seed between the lids once a day.

IRITIS — MIDI) LE EAR. - 91
SUPPURATIVE.—Merc, sulph., Hep, sulph., Calc. phos.
LOCAL.- Hot applications applied fifteen minutes, then
off half an hour, then again applied. Atrop. solution;
Sometimes Eser. solution. -
ULCERATIVE.— Hep. sulph., Calc. phos., Merc., Ars.,
Sulph. -
LOCAL.- Bandage. Atrop. Solution if the ulcer is cen-
tral; Eser. when the ulcer is peripheral.
IRITIS.
SEROUS.–Gels., Bry., Kali hyd., Phos.
PLASTIC.—Merc. Sol., Merc. cor., Hep. Sulph., Bell.
SUPPURATIVE.-Hep. Sulph., Merc. Sol., Sil., Sulph.
SYPHILITIC.—Kali hyd., Merc. cor, Asafoet., Awr., Nitr.
QC. -
LOCAL.— Hot, dry applications. Atropine solution (four
rains to 3.j aqua), one drop every three or four hours.
eep the eye and that side of the head warm.
GLAUCOMA.
IREMEDIES.
Colocynthis, Arsenicum, Gelsemium, Belladonna, Bryo-
'nia, Phosphorus. -
Local.-Iridectomy. Eser. Sulphate (two grains to f3.j
aqua), a drop every two to three hours, to contract the
pupil. Complete rest of the eyes during attacks.
DISEASES OF THE EAR.
OTALGIA.
IREMEDIES.
Acomºte, Belladonna, Pulsatilla, Arsenicum, Mercurius.
Local.— Hot, dry applications; Acom. tincture in hot
water instilled into the ear; Morphine or Atropine (one
grain to fºj) in hot water, and three or four drops in the
ear. (All these solutions are very dangerous if there is any
perforation of the drumhead.)
MIDDLE EAR–ACUTE INFLAMMATION.
- REMEDIES.
Aconite, Pulsatilia, Belladonna, Mercurius, Hepar sulph.
92. KEY NOTES OF MEDICAL PRACTICE.
º ; warm Olive oil and Laud-
anum, equal parts; hot water (110° F.) introduced by a
medicine dropper, or from a small sponge. Open the
Eustachian tube with an air bag; puncture the drumhead
if bulging; avoid poulticing. º
SUPPURATIVE INFLAMMATION.
(OTORREIOEA.)
IREIVIIEDIES.
Silica, Sulphur, Calcarea carb., Arsenicum.
Local.— Cleanse the ear with absorbent cotton on a
wooden toothpick, and apply Boracic ac., pulverized. If
necessary, syringe the ear with warm water and Carbolic ac.
(ten drops to fºij aqua) or Boracic ac, solution (ten grains to
f3.j aqua), and dry the ear with absorbent cotton afterward.
% stoid complication — Incision over mastoid process, one
inch long, and about three-fourths of an inch from, and
parallel to, the auricle.
CONSTITUTIONAL DISEASES.
ERYSIPELAS.
PROGNOSIS.— Generally favorable. Unfavorable in
the aged; in drunkards; if gangrenous; if thrombosis oc-
cur; extension to the larynx; high degree of blood poison-
ing; phlegmonous variety; metastasis to the brain.
LEADING REMEDIES.
Belladonna. – Smooth, bright, shiming red skin; con-
gestion of head, with throbbing carotids; intense fever;
tendency to attack brain; delirium.
The remedy so long as color is bright-red, and fever high.-Hughes.
Apis.- Burning, stinging pain in the affected part; skin
pale; a dematous swelling ; dryness of the throat; a dema
glottidis.
Rhus tox. — Vesicular erysipelas; dark, bluish redness
of the affected part, with burning and itching. -
SPECIAL REMEDIES.
Graphites.—Wandering erysipelas.
Cantharis.-Vesicular. From Arnica.
Aconite.— Fever. Phlegmomous erysipelas.
Stramonium, Rhus.— Secondary meningitis.
Iachesis ºf ark purple; threatened gangrene.
ERYSIPELAs—ARTICULAR RHEUMATISM. 93
Lycopodium, Hepar sulph.-Local, without fever.
Hepar sulph. — Phlegmonous; to promote suppuration.
l Arsenicum-Typhoid condition; disorganization of
blood. -
Graphites, Sulphur.—To complete cure, and remove
swelling. -
GENERAL MEASURES. -
The best local treatment is application of cloths moist-
ened in tepid Water, containing Veral. vir. tincture, a
drachm to two ounces of water. As soon as there is evi-
dence of suppuration in the subcutaneous cellular tissue,
make long and free incisions through the skin. After incis-
ing, apply a poultice, and provide for thorough drainage
and escape of pus. Do not expose the skin to variations of
temperature. Do not paint with collodion, unless the inflam-
mation is of very limited extent. Dry flour or powdered
starch dusted over will allay suffering from heat and pain.
Give plenty of pure air.
Diet.— Keep up the strength by nourishing food, milk,
broths, and beef essence; cool drinks to slake thirst.
ACUTE ARTICULAR RHEUMATISM.
syNoNYM : Rheumatic Fever.
PROGNOSIS.—Seldom fatal. Unfavorable : Delirium
and coma; scanty excretion of solids in the urine; previously-
existing heart disease.
LEADING REMEDIES.
Aconite.— Intense febrile movement: pulse full and
strong; great thirst, anxiety, and restlessness. Especially for
inflammation of large joints, which are red, swollen, and
exceedingly sensitive to contact. +.
No remedy more adapted to rheumatism.—IIempel. -
Bryonia.-Fever of adynamic form; the articular swell-
ing pale, or dark-red, and exceedingly painful, aggravated
by contact or the slightest motion. Follows well after
Acon. -
A leading remedy for acute and chronic.— Baehr.
Rhus. –Adynamic fever; great restlessness; parts red
and swollen; pains drawing, tearing, burning; feels worse
when at rest; better on continued motion. Especially lower
extremities, and when brought on by getting wet. e
Occupies a high place among the remedies for rheumatism.—
Płughes. - -
Mercurius.-High fever; quick, hard pulse; obstinale
inflammation of a single joint; puffy swelling, pale or light-
red; tearing, burning pains; deep-seated, as if periosteum
affected; much worse at night; sour perspiration, without
94. KEY NOTES OF MEDICAL PRACTICE.
relief; breath foul; tongue with thick, yellow coating; ap-
petite gone; very sensitive to cold. : -
Pulsatilla.-Sub-acute cases, with little fever, the pains
shifting frequently from part to part; pains violent, draw-
ing, and jerking; not much redness or swelling; chilliness.
In sub-acute rheumatism extremely useful.—Hughes. -
SPECIAL REMEDIES.
Sulphur.— Chronic rheumatism. - -
Invaluable to prevent the lingering of convalescence, or the pass-
ing of the disease into a chronic form.--Hughes.
Caulophyllum.—Rheumatism of the wrists and finger
joints, and of small joints. . . - -
Actaea.—Articular rheumatism of the lower extremities;
severe attack; sudden onset.
Viola od.— Rheumatism of wrists in persons of highly
nervous organization. -
Belladonna.— Red, shining swelling. Frequent doses
at night for insomnia. - -
“China, Sulphur.—Acute articular; fever of remittent
type.
Spigelia.--Carditis of rheumatic fever.
CHRONIC RHEUMATISM.
... " REMEDIES. <e
Bryonia, Rhus, Rhododendron, Ledum, Pulsatilla, Dul-
camara, Sulphur, Mercurius, Rali hyd., Kali bi.
GENERAL MEASURES.
Rest and warmth are the cardinal principles in the treat-
ment of rheumatism. Keep the patient quiet, in a warm
bed, and covered with soft blankets. Do not let a draft of
air strike him, or let him get the slightest chill. Cover the
affected joints with raw cotton, keeping it on for days. Use
no baths if the skin acts freely; if, however, the skin is hot
and dry, give the patient a hot pack. Examine the heart
at every visit. If the pain is excessive, great relief will
follow the use of
. B. Carbonate of potash - - - - - - 3 j;
Tr. Opium - - - - - - - - - 3 vi;
Warm water - - - - - Oj. Mix.
Apply locally by a soft cloth, and cover with dry cotton.
I have seen so much relief, follow its use that I should be sorry to
deprive a sufferer of it.—Hughes. -
Diet.—The use of beer, ale, wine, brandy, and all malt
or spirituous liquors, must be strictly prohibited. Use no
Sweets. Lemonade is harmless,
IDROPSY. 95
DROPSY.
LEADING REMEDIES.
Arsenicum.—Great debility and prostration; anxiety;
restlessness; emaciation; dyspnoea; burning thirst; Gedema
i. face, hands, and feet, and anasarca from disease of the
eart. -
Smitable in all forms of dropsy, more particularly that depending
on heart disease, and oedema of the lungs.—Baehr. * =
Apis.-Acute febrile dropsy; dropsy complicated with
strangury, suppression, or other urinary disorder. Unab-
Sorbed effusions after serous inflammation. Post-Scarla-
tinal dropsy. Absence of thirst and suddenness-of Oedema
indicate this remedy.
Apocynum can.— Restores urinary Secretion. Urine
scanty, thick, yellow, and turbid. Has cured anasarca,
hydrothorax, and ascites, and hydrocephalus supervening
on typhoid. (Of no use in hydrocephalus from tubercular
meningitis, or ascites from cirrhosis of liver.) g
DOSE.-Oue to five drops of mother-tincture, or drachm
doses of infusion of fresh root, an ounce to a quart of water.
, Has made many brilliant cures.—Hale. -
Digitalis.--Small, feeble, irregular pulse; pale face;
livid lips; distressing dyspnoea.
#ſº cardiac dropsy. Must give large doses.—Hughes.
Valuable in almost every variety; often succeeds in most desper-
ate cases.—Ruddock.
Bryonia.-CEdematous swelling of joints. Hydro-
thorax. Dropsy associated with chèst symptoms—cough,
dyspnoea, stitching pains in region of heart; disease of liver.
Helleborus.-- Urine scanty, dark-colored, depositing
sediment like coffee-grounds. Useful in hydrocephalus,
hydrothorax, amasarca, and dropsies following scarlet and
intermittent fevers.
Senecio.—Abdomen very tense; feet and legs swollen;
urine scanty and high-colored, or profuse and watery. With
liver symptoms, from peritonitis, or abdominal tumors.
China. – Dropsy from exhausting discharges. General
debility; countenance pale or sallow; organic offections of
liver or spleen. -
Aconite.—Recent febrile dropsies.
Ferrum.—Anaemic or chlorotic females.
Sulphur.—CEdematous swellings following skin affec-
tions or suppressed eruptions.
GENERAL DROPSY.—Digit., Apis, Ars., Bry., Apoc.,
Sèneqa.
tºpsy OF
HEART.—Digit., Spig., Ars.
CHEST.-Bry., Digit., Ars., Hell.
JoLNTS.—Acom., Puls., Bry., Iod.
96 KEY NOTES OF MEDICAL PRACTICE.
BRAIN.—Hell., Apis, Merc., Bry.
ANKLES.—Ferr., Bry., Chin., Ars.
ABDOMEN.—Apoc., Ars., Chin., Crot.
ScroTUM.—Iod., Rhod., Puls., Graph.
Dost.—“Dropsy requires to be treated with larger doses
than almost any other disease.”—Baehr.
GENERAL MEASURES.
If the abdomen be so distended as to seriously embarrass
respiration and the heart's action, evacuate with trocar and
canula, or aspirator. Introduce in mesian line, midway be-
tween the navel and pubes, Draw a sheet around the abdo-
men, and tighten it as fluidis gradually withdrawn. If the
legs are much swollen, the skin tense, make an incision three-
quarters of an inch long over each malleolus. Keep a warm
sponge, moistened in weak Carbolic ac, solution, to each in-
CISIOT). -
Diet.— Give all the water that patient wants—large
quantities of soft water are beneficial. In renal dropsy a
systematic course of skim-milk diet has proved beneficial.
The patient should be well nourished, receiving a liberal
quantity of nutritious, digestible food. .
Hygiene.—Warm baths and vapor baths are useful in
promoting perspiration. The clothing should be warm, and
the abode high and dry. - . - -
DIPHTHERIA.
PROGNOSIS.— Grave. Unfavorable: Exudation dark,
thick, extensive; extension to larynx or posterior nares;
great fetor of breath; early pharyngeal paralysis; slow and
Čntermittent pulse; persistent vomiting; epistaxis; great
glandular swelling. The younger the child, the more un-
favorable. Favorable: Affected surface small. So long as
the exudation confines itself to the fauces and anterior pil-
lars of the pharynx, and is not thick or putrid, the prog-
nosis is favorable. & -
- LEADING REMEDIES.
Rali bi-Croupy cough, preceded by wheezing and
panting; pain in chest; uneasiness in stomach; nausea;
fauces covered with dirty-yellow exudation, which is tough,
stringy, and tenacious; discharge from nostrils of yellow,
corrosive mucus.
In nasal ºth; I find it specific; in laryngeal, it does all that
medicine can do.—Hughes. t
Mercurius cyan. — Malignant diphtheria. The disease
comes on suddenly, develops º and patient is rapidly
prostrated. Putrid sore throat; the exudation dark-gray,
thick, and putrid, occupying the whole throat, and extend-
ing to the nasal fossie, . -
DIPHTHERIA. - 97
Bromine. —Laryngeal diphtheria, the exudation begin-
ning in larynx, or beginning in fauces and extending to
larynx. Suffocating cough, with hoarse, whistling, croupy
sound. Iodine in sthenic cases.
Belladonna.- Mild cases. Great dryness and redness
of throat, with high fever.
Suitable only in the beginning.—Râue.
Phytolacca.-Throat dry and swollen; difficult deglu-
tition; exudation grayish-white; great prostration; high
fever; violent aching in back and limbs.
Acts in truly specific manner.—Hughes.
My experience has been very favorable, giving it in One or two
drops of §. tincture.—Bayes.
* Apis mel.— Great prostration from beginning; great
occlema of throat and tonsils; surface glossy, and of purp-
lish color; burning pain and dryness of throat, extending
into ears; dirty-gray exudation; high fever; Cedematous
swelling of face and neck.
I have seen striking results from it, and can commend it highly.—
Hughes. 3. - -
Mercurius iod.— Great swelling of parotid and sub-
maxillary glands; tonsils much swollen; putrid sore throat.
Cases marked by great putridity, with dirty coating on
tongue, and fetid breath.
Lachesis.--Small amount of exudation; throat purple,
or livid; prostration very great, with weak pulse; cold,
clammy perspiration. *
Muriatic ac.— Exudation gray; breath foul; lips dry,
blackish, and cracked; tongue dry; the membrane begins
to invade the larynx and nose, from which there is a dark-
ish, fetid discharge; extremities cold; pulse weak and com-
pressible; general prostration.
It has some efficacy when symptoms of blood-poisoning are pres-
ent.—Hughes.
Kali perm.— Breath very foul; general and excessive
prostration; foul exudation over fauces, with extension into
masal fossae, with thin, excoriating discharge from the nose.
Septic forms.
Cantharis.-Excessive pain on swallowing; throat
looks as if blistered:- expectoration of blood; extreme pros-
tration; sinking turns; cold extremities; scanty urine, with
albuminuria.
It has served me well.—Hughes.
GHARGELES AND SIPRAYS.
Alcohol.— Diluted with three parts water. Use as a
gargle.
Rali perm.— Four grains to 3viij. aqua. Use as a
gargle when the exudation is putrid, the breath foul, or
there is a thin discharge from the nose.
7
98 KEY NOTES OF MEDICAL PRACTICE.
Liquor calc. chlor.—Use in an atomizer as a spray to
the throat. - -
Of virtue in the most malignant cases.—Neidhard.
- - GENERAL MEASURES.
Quarantine the patient, if possible, in a light, airy,
upper room. Send other children from the house. Keep
the sick-room well ventilated. Temperature 70° F. Throw
all soiled rags into the fire; disinfect all soiled linen. Do
not inhale the patient’s breath, or let a piece of the mem-
brane come ºn contact with a mucous or abraded surface.
Absolute rest in the recwmbent posture is necessary.
Early in the disease let the patient take bits of ice in the
mouth. Later, use the steam atomizer, and at frequent and
regular intervals let the patient inhale the vapor. If the
secretions are putrid, the antiseptic gargles and sprays must
lbe used at frequent intervals in order to be of benefit. Keep
the nasal cavities clean. I’ut Chlorine water into the spray
cup of the atomizer. In convalescence there is danger of
paralysis of the heart on over exertion. Patient should not
attempt to swallow solid food till the muscles of the pharynx
are fully restored. In adynamic cases do not use cold
drinks or cold applications. r
Diet.—Highly important to keep the patient well
nourished. Begin early. Give to the patient all the milk
that he can be induced to, take—iced, boiled, warm from
the cow, or in any way to suit his fancy. Occasionally give
a glass of milk with a beaten egg in it. Beef tea and coffee
better as stimulants than alcohol. Make a cup of strong
coffee, add scalded milk one-half; sweeten to taste; beat the
yolk and white of an egg together, pour the hot coffee and
milk over them, and serve. This is very mourishing and
stimulating. If the patient cannot swallow food, he must
be nourished by enemata. Give plenty of water to slake
thirst. Ice cream and water ices may be given freely, only
taking care not to chill the stomach.
ASIATIC CHOLERA.
SYNONYMS: Serous Cholera; Malignant Cholera.
PROGNOSIS.—Always grave. Varies, however, ac-
cording to the period of the epidemic, as it is most deadly
at the commencement of an epidemic, whereas those occur-
ring later in its course are more apt to be followed by
recovery. -
Complications.—Suppression of the urine; gastritis
and enteritis; pulmonary congestion; meningitis; sloughing
of the cornea; abscesses over the body; coagula in the
ºut or pulmonary arteries; haemorrhage of the
OWOIS. - -
ASIATIC , CEIOLERA, . - 99
LEADING IREMEDIES.
Camphor.—Early in the attack. Patient suddenly loses
strength, and looks pinched and blue; the skin becomes
very cold; the voice deep and husky; the skin shrivels;
intense distress and anguish at pit of stomach and burning
in the bowels, the patient tossing in agony; sometimes
nausea and vomiting, but generally the evacuations both up
and down are moderate and infrequent. DOSE.-“Give the
patient three to five drops of the tincture, on a little sugar,
every five minutes, and, in the intervals, assiduously rub
him on the neck, chest, and abdomen with the same
medicine, until the icy coldness of the body gives place to a
return of vital warmth.”—Flahºmemamm. - -
It is our firm belief that Camph. is an almost infallible remedy if
given from the very onset.—Dr. Russell. -
Very few of the cases went into collapse when Camph. was given in
the first stage.—Dr. Proctor. -
Veratrum alb.- Cases marked by eacessive vomiting
and purging, with violent abdominal pains. Especially
indicated when attack commences with vomiting and purg-
ing. Pale and sunken countenance; hollow eyes, with blue
margins; repeated and violent vomiting, with frequent,
copious, watery, rice Water evacuations; violent colic, espe-
cially about the umbilicus. DOSE.—“Almost all observers
agree in recommending the lower preparations, even the
strong tinctures, frequently repeated.”—Baehr.
Arsenicum.—Sudder, and evtreme prostration; vanish-
ing of the pulse; great dyspnoea; inexpressible anguish;
constant tossing about; violent thirst, yet the least quantity
of liquid is thrown up immediately; burning distress in
the region of the stomach; complete suppression of urine.
The medicine most trusted in collapse.—Hughes. -
Cuprum ac.— Loss of consciousness; spasmodic cramps
of ſingers and toes; audible gurgling of liquids down the
Cesophagus; ineffectual efforts to vomit; the diarrhoea, has
ceased, but loud gurgling in bowels, indicating paralysis of
the intestines. Symptoms indicating general paralysis of
organism. Also recommended as prophylactic. Give doses
of the remedies at frequent intervals. 4.
SPECIA.L. REMEDIES.
Hydrocyanic ac.— Pulselessness; respiration slow,
deep, gasping, taking place at long intervals. -
It would seem at times to restore animation to a corpse.—Dr.
I?ussell. -
Secale, Phosphorus.-Profuse, watery stools, after
violence of attack is past.
Phosphoric ac., Rhus.--Supervening typhoid con-
dition. - - - -
Terebinthima., Cantharis.- For continued suppres-
sion of urine, if Ars. fail.
* 100 KEY NOTES OF MEDICAL PRACTICE.
GEFINIERAL MEASURES.
Place the patient immediately in a warm bed. Keep
him at perfect rest on his back, and surround him with hot
bottles. Make friction with warm flannels. The room
should be warm, but well ventilated. No food can be
taken. Enemata of warm milk, even though rejected, are
beneficial.
Use antiseptic precautions in disposing of discharges and
soiled linen, as directed in Part IV.
Diet.— During the prevalence of cholera it is not neces-
… sary that those unaffected should adopt a rigid system of
dietary. Better continue taking the ordinary wholesome
food to which one is accustomed, than to make any decided
change. Of course, during cholera season, as at all times,
unripe fruit, decaying vegetables, decomposing meats, and
drinks of bad quality are to be avoided with the greatest
care. It is a mistake to forbid the use of fruit simply
because it is fruit. That which is fresh, ripe, and clea?v may
be indulged in. But unripe fruit, or that which is in the least
decayed, should be avoided at all times, and more especially
in cholera season. As a rule, succulent vegetables, such as
cabbage, squash, corn, cucumbers, and the like, as well as all
rich foods, salads, and pastries, should be avoided. The
rule should be, to avoid everything which would be liable to
create indigestion, or to produce looseness of the bowels.
Fruits and vegetables which come from market should be
well washed with pure water before being eaten. No nourish-
ment can be given to cholera patients at the time of the
attack. After the violence of the attack has passed, Scalded
milk, diluted with water, may be sparingly administered.
But great caution must be eacercised throughout the period of
convalescence. No solid food should be given until recovery
is fully established, and the stools are consistent and fecal.
Any violation of the above rule may be followed by fatal
relapse. T)uring the period referred to give only scalded
milk and light broths.
Convalescence.—A return to ordinary diet must be
gradual, as an attack of indigestion may excite relapse.
Give no solid food till stools are consistent and fecal. Begin
with milk, thin gruels, chicken broth, and digestible liquid
food. -
Precautions.— Close all surface wells, and those in the
vicinity of drains and cesspools. Remove all filth, and use
disinfectants freely. Corpses should be immediately placed
in a coffin containing a mixture of lime, charcoal, and
carbolic acid, and at once disposed of by burial or crema-
tion. In cholera season direct your patients to observe
regular habits in all things. All drinking-water 'must be
boiled and filtered. Give strict attention to the first appear-
ance of a diarrhoea.
*.
CEIOLERA INFANTUM. 1013
CHOLERA INFANTUM.
PROGNOSIS.— Uncertain. Favorable : Cessation of
vomiting; diminution in frequency and quantity of dis-
charges; quiet, natural sleep; even temperature of the
body and limbs; diminution of thirst; returning appetite.
Unfavorable : Extreme restlessness and jactitation; or,
early apathy, stupor, or convulsions; incessant and obsti-
nate vomiting; excessive frequency and copiousness of
stools; Hippocratic countenance; extremities cold, blue, and
shrunken. To detect the earliest loss of flesh, examine inside
the thighs.
LEADING REMEDIES.
Veratrum alb.--Vomiting and purging, the latter pre-
dominating. After vomiting or purging, great eachaustion,
cold sweat on forehead; severe colic; stools profuse and
watery.
The chief remedy.—Jousset.
A remedy of great value, and one very often required.—Bell.
Ipecac.—Vomiting, and almost constant naused; stools
grass-green, or white, with fermented appearance, like
yeast; colic and sick stomach before and during stool.
Werat. alb. and Ipec. are undoubtedly the most important of all
remedies.—Rawe, - +
Arsenicum.—Great prostration ; eactreme restlessness
and unquenchable thirst; cold extremities: face pale and
cadaveric; skin dry and shriveled; stools thick, dark-green,
or dark, watery, offensive. - &
The symptoms which most clearly distinguish it are the character-
istic thirst and restlessness.—Bell.
Croton tig.—Yellow, watery stool; aggravation from
food and drink; stools expelled suddenly and with great
force. .
ań" proper application will render success certain and brilliant.—
Podophyllin.— Gagging, and empty retching, without
Vomiting; moaning, with half-closed eyes and rolling head
from side to side; stools profuse, painless, watery, with.
meal-like sediment.
Ranks among the first to be referred to.—Bell.
Mercurius.--Dark-green stools, slimy or bloody, fre-
quent, excoriating, and Scanty, with tenesmus and colicky
pains; tongue coated, swollen, soft, and flabby.
Camphora. —Attack very sudden; great and rapid
sinking; child in stupor; utter prostration; face pale, livid,
purple, icy cold; vomiting and purging sometimes absent.
AEthusa.-Child lies in an unconscious state. Grave
symptoms—thumbs clenched; eyes fixed and staring, pupils
dilated; great prostration; continual gagging; great fre-
quency of stools; symptoms of hydrocephaloid.
Suitable to a severe form of cholera infantum.—Bell.

102 REY NOTES OF MEDICAL PRACTICE.-
Aconite.—Early in attack, with hot skin, quick pulse,
thirst, restlessness, high fever; 'stools green, watery, with
cutting pain and tenesmus. - -
Only useful in very beginning.—Bell. 2 .
Belladonna. – Hot head; flushed face; cold feet; great
dryness of mouth and lips; great drowsiness, with sudden
starting during sleep; stools green. s
Calcarea carb. — Sour vomiting; open fontanelles; old-
looking, wrinkled face; profuse sweat on head during sleep;
cold extremities; emaciation; bloated abdomen; stools
whitish, watery.
- The stools of less importance than the person and concomitant
symptoms.-Bell. -
Apis mel.—Tongue dry and shining; no thirst; skin
hot and dry; stools greenish, yellowish, slimy mucus; ab-
domen tender to pressure; symptoms of hydrocephaloid;
stupor, interrupted by shrill cries; head hot ; eyes red;
hands cold and blue; abdomen tender, sunken; urine Sup-
pressed.
One of our most precious remedics, corresponding to a low and
dangerous condition.—Bell. -
GENERAL MEASURES.
Keep the child in a cool, shaded place, and let it have an
abundance of fresh air. . Avoid close, ill-ventilated apart-
ments. No matter how sick it may be, take it riding, or, if
possible, boating on the water. Cool, fresh, pure air nec-
essary to recovery. Give it frequent, cool sponge baths, or
full baths, putting it into water at 85° F., and gradually
cooling it down to 75° F. - .
Diet.— Of highest importance. If the child cannot
nurse at the breast, its food should consist of fresh, pure
milk, diluted with barley water and lime water. (Vide
Part IV., Infant Diet.) If there be great debility and pros-
tration, give beef tea, or wine whey. Use no starchy foods
whatever. If sufficient food cannot be taken by the stom-
ach, use inunctions of oil to the abdomen and extremities.
If water be rejected from the stomach baths will supply
fluid for the blood, and bits of ice slake thirst. Absolute
cleanliness of bottle, and absolute purity of milk and other
food, will accomplish all that can be in this direction.
DIABETES MELLITUS.
LEADING REMEDIES.
Phosphoric ac. — Frequent urging to urinate, pain in
the loins, emaciation and prostration. Particularly valua-
ble in cases of nervous origin. Dos E. – 1x diluted, several
times a day.
Stands in the highest place among the remedies for diabetes.—
Hughes.
IDIABETES MELLITUS — LITH AEMTA.. 103.
Uranium nit.—Cases originating in dyspepsia or
assimilative derangements; excessive thirst. Dosſº.-‘‘The
practitioners who have employed it have generally given
strong and increasing doses of the first-decimal tritura-
tion.”—IHughes. -
Arsenicum.— Insatiable hunger; unquenchable thirst;
pale skin; loss of strength; dryness of mouth and throat;
excessive urination; watery diarrhoea.
CoNSULT —Helom., Kreos., Plumb., Arg. mit.
GENERAL MEASURES. -
The diabetic should be warmly clad in flannels, and
avoid cold winds, and exposure of all kinds.
Diet.—Must be free from starch and sugar. Exclusive
milk diet often benefits. Gluten bread must be substituted
for that made of white flour. -
AVOID.—Vegetables: Arrowroot, asparagus, bread, bis-
cuit, beans, beets, crackers, carrots, macaroni, oat meal,
pastry, potatoes, peas, rice, Sago, Sugar, turnips, tapioca,
vermicelli. .
Fruit: Apples, grapes, pears, bananas, peaches, plums,
pineapples, raspberries, and other sweet fruits. t
Beverages: Wine, beer, brandy, ale, cider, and all alco-
holic and sweet drinks. - - , ,
ALLOWABLE.—Vegetables: Artichokes, cabbage, celery,
cresses, cucumbers, olives, greens, lettuce, pickles, spinach,
mushrooms. . . -
Fruits: Lemons, cherries (sour), currants, gooseberries,
strawberries, and acid fruits generally. : • . .
Meaſs: Beef, mutton, poultry, game, fish, oysters, cheese,
eggs, etc. 3 *
Gratify the thirst by an abundance of soft water.
LITHAEMIA.
SYNONYMS : Lithiasis; Uric-acid Diathesis.
CAUSES.–Over-indulgence in stimulants, or rich, nitro-
genized food, with a sedentary life. . . . .
- REMEDIES.
Plumbum, Nua. v., Lycopodium, Sepia, Sulphur, Hepar
sulph., Calcared carb., Podophyllin, Hydrastis, Arsenicum,
Nitro-mººn’. ac.
Regimen.—Active out-door eſcºrcise. Daily Salt water
sponge-bath. Keep warmly clad, and avoid chill.
Diet.—Highly important. Avoid meats, oysters, eggs.
Adopt mixed vegetable diet. Celery said to be especially
beneficial. Use no stimulants — wines, brandy, ale, or beer.
Use no pastries, sweets, or anything which will cause indi-
gestion. Avoid late dinners and late suppers. Eat slowly,
and masticate thoroughly. Drink an abundance of pure,
soft water. Vichy water has cured. * , ,
104 KEY NOTES OF MEDICAL PRACTICE.
PART II.
OBSTETRICs.
ABORTION.
LEADING REMEDIES.
Sabina. –Threatened abortion in the early months of
pregnancy. Sensation of heat and soreness in the womb,
with drawing pain from the back through to the pubes.
Sometimes succeeds even if pains and a red discharge have
set in. *
One of the best remedies we have to prevent abortion.—Guernsey.
Secale.—Threatened abortion in the later months. Even
when decided haemorrhage is present, ten-drop doses of
tincture every three or four hours check it, pregnancy going
on to full term. Copious flow of black, liquid blood; worse
from slightest motion. -
Secale and Sab. most in repute for correction of the habit of abor-
tion.—Hughes.
Aconite.— Rapid pulse; hot skin; great excitement of
the circulation.
Acon. will accomplish more than any other remedy, if there be
great circulatory excitement.—R. N. Foster.
Actaea.— Rheumatic subjects; irritable uterus; com-
plains much with even slight pains.
Has been successfully used to prevent habitual abortion.—Hale.
Caulophyllum.—Severe pains in back and loins; uterine
contractions feeble; slight flow.
Viburnum.— Given before membranes are injured,
when pains are spasmodic, often succeeds.
Arnica.—When from fall, blow, or other injury.
Ipecac.—Nausea; discharge of bright-red blood; faint-
IlêSS.
c GENERAL MEASURES.
Morphia sulph., by hypodermic injection, when symp-
toms are urgent, will sometimes succeed when it is too late
to accomplish anything by other drugs. DOSE.— One-eighth
to one-quarter grain. Repeat if necessary. Deodorized
ABORTION — MISCARRIA.G.E. º 105
Tr. Opium, by rectal injection, keeping woman quiet on her
back for days, sometimes tides over. Also, Svapnia, in
one-half grain doses, every thirty or forty minutes, will
often stop the pains, the patient going on to full term.
Predisposition to abortion may often be corrected by
administering the appropriate remedy. Dose, twice daily,
from cessation of menses until after the period at which the
accident has before occurred. Apis, Caul., Act., Helon.,
Sep., and Sulph., will be found particularly useful.
In subjects of habitual abortion, build up the general
health and strength by generous diet, systematic exercise,
an abundance of fresh air, and regular bathing. All ten-
dency to cough, indigestion, diarrhoea, constipation, rheu-
matism, irritable bladder, ovarian disease, or other malady,
should be corrected by appropriate medication.
Should miscarriage threaten, direct the patient to lie
down at once, on a bed having a hard mattress, with light
covering over her. In this position she must remain at
perfect rest, avoiding all motion, and mental excitement.
This is very important, and must be insistéd upon. Keep
the apartment cool and quiet. Whatever food is taken must
be plain and unstºmulating, such as tapioca, rice, toast, or
milk; beverages should be cold.
MISCARRIAGE.
If the womb lose the fruit of conception prior to the
seventh month, it is called miscarriage; after that period,
premature labor. The latter is to be treated as labor at full
term. If the sac rupture in early months, the liquor amnii
escapes, and, of course, repair cannot take place, so that
there will be constant leakage, and abortion is hard to pre-
vent; but the threatened catastrophe may be averted by
long-continued rest. If the rupture is near the cervix, how-
ever, abortion is timevitable.
SIGNs.— Increasing frequency and severity of pains;
continued flow; and, especially, protrusion of ovum.
TREATMENT.--Tampom immediately. Never tampom the
vagina after the seventh month. An exception may be made
to this, however, if the physician can stay by the patient
and keep his hand over the uterus.
The best tampon is a large sponge; moisten it, wring it
dry, compress it, and crowd it into the vagina through a
speculum. Do not leave a sponge in the vagina longer than
three or four hours. At the end of that time take it out,
and renew if necessary.
In the absence of the above, a tampom, may consist of
pledgets, or small balls, of raw cotton, êach one tied with a
string, one end of which should protrude, to facilitate re-
moval; or, a soft silk or cambric handkerchief may be
2 - ?
106.
KEY NOTES
OF MEDICAL PRACTICE.
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MISCARRIAGE.-- PARTURITION. . . . 107.
employed, inserting first one corner, and gradually stuffing
in the entire kerchief. All tampoms should be well oiled.
before insertion, using carbolized oil.
Do not leave any tampon in longer than twelve hours:
When it is removed, the entire contents of the womb will
probably be expelled. If not, repeat, first washing out the
vagina, with carbolized water, or, what is equally as good,
water with a little whiskey or alcohol in it. Eacamine care-
fully all clots, which come away, to see if they contain the
entire ovum. - -
Profuse harmorrhage is to be treated by the tampon, cold,
and the appropriate drug, or injections of hot water (110°
+ - º -
If a portion of the ovum or placenta remain in the
uterus, take measures to bring it away without delay, using
a wire curette in preference to a blunt hook. Depress the
uterus, with one hand placed above the pubes, and attempt
its withdrawal with the finger of the other, using gentle yet
persistent effort. Failing in this, use the placental forceps,
or wire curette. If the mass be allowed to remain, there is
danger of secondary ha-morrhage, or of septicæmia. After-
treatment, as after labor.
TO DETERMINE SEX IN UTERO.
The only method possessing any element of reliability is
by the rate of the foetal heart beat, according to the follow-
ing table: - . T -
From 110 to 125, almost certainly male;
From 125 to 130, probably male;
From 130 to 134, doubtful — chances male;
From 134 to 138, doubtful—chances female;
From 138 to 143, probably female;
From 143 to 170, almost certainly female.
PARTURITION.
TARE. To CASE of TABOR.— Forceps, soft-rubber cathe-
ter, Ergot, Chloroform, Ammonia: For perimeorrhaphy—
decapitating hook.
ExAMINATION.— Observe — condition of bladder and rec-
scissors. For craniotomy— perforator, craniotomy-forceps,
curved needles, silver wire or silk sutures, blunt-pointed :
tum, vagina, and os and cervix uteri; condition of mem-
branes; pelvic capacity; determine presentation and position;
Make out presentation before membranes rupture. Do not
press on membranes during a pain. - .
RIGID Os UTERI.-Aconite.—Os hot, dry, and sensitive;
patient ſeverish and restless. . : .
108 KEY, NOTES OF MEDICAL PRACTICE.
Belladonna.—Spasmodic rigidity of the muscular fibers
of the cervix.
Gelsemium.— Give five to ten drops of Gels. in a cup
of hot water, in divided doses. •.
It often acts like magic in producing dilatation, and promoting
labor. —J. S. Douglas. - -
LOCAL.—Apply Bell. cerate. Warm vaginal injections.
Digital dilatation.
ToUGH MEMBRANES.—Notch the finger-mail like a saw,
and rub it to and fro on the bag until it gives way; or use
silver catheter, or a lead pencil.
TUMEFACTION OF ANTERIOR LIP.-In interval of pains
press the tumor up above the crown of the head, and keep
it there during two or three pains, until it is fully retracted.
CYSTOCELE.— Evacuate bladder by means of soft-rubber,
or silver (male) catheter, or, failing in this, use aspirator to
draw off contents.
HYMEN.—Make crucial incision, if spontaneous rupture
does not occur.
RIGID PERINEUM.—Apply hot fomentations. Between
the pains, with two fingers, make backward traction on the
perineum to overcome the rigidity and cause the muscles to
relax.
Chloroform.—Should not be given to complete anaes-
thesia. It is in the following conditions contra-indicated:—
1. Do not give it to a woman who has a tendency to
flood at every confinement.
2. Do not give it when labor is complicated with severe
vomiting, or with heart or lung troubles.
3. Do not give it to complete anaesthesia, except for
operations, convulsions, or spasms of cervix, and then one
person should devote his entire attention to it.
4. Stop its administration if the pulse becomes weak or
the respirations irregular.
AFTER-PAINS.
LEADING REMEDIES.
Arnica.—Violent pains, with bruised, Sore feeling,
pressure on the bladder, and retention of urine; after diffi-
cult labor.
Gelsemium.—Numbness of extremities; uterine cramps
extending upward and backward. Use drop doses of the
tincture.
The medicine on which I am accustomed to rely.—Hughes.
Crocus.-For severe and long-lasting after-pains.
No drug that I know of equals it.—R. N. Foster.
Actaea.— Rheumatic subjects; excessive irritability, and
over-sensitiveness. Macrotin acts very promptly. -
AFTER-PAINS — PLACENTA PRAEWIA. 109
Caulophyllin.—After pººl and exhausting labor.
Spasmodic pains across the lower part of the abdomen,
extending into the groin. -
Belladonna. – Severe bearing down, as if everything
would protrude; pains appear and disappear suddenly; the
least jar hurts her. .
Chamomilla.-Great nervous excitability; pains very
distressing, rendering patient irritable and ill-natured.”
Coffea.—Great sensitiveness, with nervous excitability;
pains driving to despair; wakefulness.
Secale.— Pains long and severe.
Ignatia.-Cramp-like, with sadness and sighing.
GENERAL MEASURES.
Hot fomentations over the abdomen, or warm vaginal
injections, sometimes relieve. If due to clots retained in
the uterus, make pressure on the fundus, and evacuate con-
tents of the womb.
As a rule do not attempt to check after-pains for at least
six hours after delivery, as they are often merely caused by
efforts of the uterus to expel clots or portions of mem-
brane. *
DYSTOCIA.
PROLAPSE OF CORD.
(Frequency—1 in 300 or 400.)
If there be no pulsation in the cord, do not interfere.
Otherwise, place the patient in knee-chest position, and, if
possible, reposit the cord well into the uterus with the hand,
or by means of a loop of tape attached to the end of a gum
catheter. Failing in this, terminate labor as quickly as
possible by the forceps.
PLACENTA PRAEVIA.
(Frequency—1 in 500.)
If there be hamorrhage due to placenta praevia, imme-
diately draw off the water by means of a silver catheter
passed through the placenta. Keep up a firm pressure on
the fundus, so that the presenting part shall impinge on the
lacenta. Now tampom the vagina and wait for dilatation.
o not neglect the bladder. When dilatation is complete,
and the placenta is implanted centrally, oil the back of the
hand, pass it between the placenta and uterine walls, and
first deliver the placenta, and then deliver the child with
the forceps. If the placenta is implanted laterally, work at
one side, and deliver the child with forceps.
BRAXTON, HICK's METHOD.— Bring the patient to the
* edge of the bed and administer chloroform. Then turn by
110 KEY NOTES OF MEDICAL PRACTICE.
the bi-manual method. Introduce the whole hand into the
vagina; pass one or two fingers into the cervix (do not wait
for the cervix and os to become sufficiently dilated to admit
the whole hand); rupture the membranes and turn. If the
placenta is in your way, try to rupture the membranes at
its margin, but if this is not feasible, do not lose time—
perforate the placenta with your finger, get hold of a leg as
soon as possible, and bring it down. The leg and breech,
by this method, act as tampon to the ruptured vessels of the
placenta. Do not evtract the child at once — let it come by
itself, or use only gentle and rare traction. The child will
generally be born in one or two hours.
, POST-PARTUM HAEMORRHAGE.
As soon as it is discovered that the woman is “flooding,”
quickly but carefully pass the hand into the uterus, and
turn out all clots, fragments of º etc., clearing the
uterus of all contents—grasp the fundus with the other
hand (previously dipped in cold water, if this can be done
without delay), and hold the uterus firmly, pressing it down
into one of the iliac fossae with a firm, grasping pressure.
Elave the nurse pour a small quantity of cold water upon
the abdomen from a height of Several feet. As quickly as
possible follow this bypassing the nozzle of a syringe into
the cavity of the uterus, and inject a stream of hot water—
110° to 115° F. If the delay would be too great in provid-
ing for hot-water injection, use cold water, or pass a piece
of ice into the uterus. * a
As soon as the hamorrhage has been sufficiently controlled,
to guard against a recurrence, lower the shoulders and
elevate the hips; tie bands about the extremities, as near to
the body as possible (let them be smug, but not too tight);
put on a Snug binder, with a compress over the uterus; give
indicated remedy—Ipec., Chin., Secale, Sab., etc., accord-
ing to indications on page 122.
If alarming flow persist, compress the abdominal aorta
to left of spine, on a line with the umbilicus, or, as last
Tesort, inject into the uterus a solution of perchloride of
from — two-ounces to one pint of water. This, preferably by
means of a fountain, syringe, should be slowly and gently
injected through the uterus, previously seeing that it is
clear of clots. Thransfusion is often successful in restoring
the Woman even when exsanguine.
VERSION.
PopALc.—Best performed before rupture of the mem-
branes. Os must be dilated or dilatable. Evacuate the
VERSION — FORCEPS DELIVERY... 111
bladder and rectum. Anasthetize the patient. Bring the
hips to the edge of the bed. Bare, the arm, and anoint the . .
arm and hand, except the palm. Use the hand whose palmar
surface corresponds to the face of the child. Work between
the pains. With one hand on the abdomen, introduce the
other into the vagina; pass it on between the membranes
and the uterine walls; carefully search for the feet; rupture
the membrancs; grasp one foot and bring it down, at the
same time pressing the head upward with the other hand, to
aid the turning process. After the breech has become
engaged, labor may be at once terminated, or left to the
efforts of nature. - -
CoMBINED METHOD.—To be employed when the os is but
slightly dilated. Introduce one or two fingers of one hand
into the os, with the other hand on the abdomen. Deter-
mine the location of the head and breech, and, by combined
action of the two hands, gradually “work” the head down-
ward and the breech upward, until the head is brought to
present at the os, when the membranes should be rup-
tured. -
WHEN REQUIRED–Version is called for in placenta-
praevia, prolapse of cord, transverse presentation, presenta-
tion of arm, death of mother, rupture of uterus, convul-
sions, or any state in which speedy delivery is demanded,
or where the forceps will not accomplish the delivery of the
child.
FORCEPS DELIVERY.
Parts must be dilated or dilatable. Evacuate the bow-
els and bladder. Anaesthetize the patient, unless the child’s
head is at the outlet, when it may not be necessary. Im-
merse the blades in warm water. Have the woman lying
across the bed, with her hips at the edge, the thighs sepa-
rated, and held by assistants. Rupture the membranes, if
still intact. Anoint the convew surfaces of the blades with
lard or oil. Take position between the separated limbs of
the patient. Take the male blade into the left hand; hold
it almost upright; pass two fingers of the right hand a
short distance within the cervix, on the woman's right side,
between the foetal head and uterine wall, then introduce
the point of blade along the inside of the fingers, and pass
it, gradually lowering the handle, until the convexity of the
child's head is well grasped by the fenestrated portion of
the blade; depress the handle near to the perineum. Now
take the female blade in the right hand, and, beginning
with the blade upright, in similar manner, but by reversed
movements, pass the blade in the right side of the Vagina
and cervix, bring the handle down, and lock the two. Pro-
ceed gently, and use no force. -
112 REY NOTES OF MEDICAL PRACTICE.
TRACTION.—As a rule, make traction only during a
pain. The direction, if the head is high, should be first
downward; but as the head gradually descends, more and
more upward, until just before the head escapes from the
vulva, when traction is almost at right angles with the long
axis of the woman's body. Generally, the direction in
. which the blades point determines the line of traction.
WHEN 'I'O USE THE FORCEPS.
PRECAUTION.— If the forceps must be resorted to, it is
better not to delay; rather use them a little early in the
labor, than wait too long.
1. In the second stage, as soon as labor flags; pains
severe, uterine contractions sufficiently powerful, yet the
head makes no descent or advance.
2. Presentation fair, head in the vagina, soft parts
swollen, the perineum rigid, and the pains, though severe
and trying, cease to be actively progressive.
3. In lººp. positions, where rectification of
the position and normal rotation cannot be effected.
4. In cases of puerperal convulsions, dangerous ham-
orrhage, extreme exhaustion, rupture of the uterus when
the head is within reach of the forceps, some cases of pla-
centa praevia, after first trying the colpeurynter or tampon,
uterine-motor stimulants (Ergot), and dilating the os.
5. In complicated labors, when the hand or arm descends
with the head; prolapse of the cord — other expedients
having been tried in vain. -
6. In breech presentations, to extract the after-coming
head as soon as the body has been delivered. In such cases
delays are always dangerous to the child. .
7. In moderately contracted pelvis, when the head is so
compressed as to require assistance.
8. In cases of pendulous abdomen, where we have a pen-
dulous uterus, so that the expulsive pains are misdirected.
9. In face presentations, where the difficulty lies in the
lower outlet, and we fail to bring the chin forward under
the symphysis pubis; even here the forceps are preferable to
turning.
10. In cases of complete impaction of the foetal head, the
forceps are always indicated.
11. When the mother has an organic disease of the
heart; is subject to attacks of violent palpitation, followed
by syncope; is in the last stage of pulmonary phthisis; has
a hernia liable to strangulation, or is asphyxiated.
12. In prolonged labor for want of uterine power, and in
complete inertia of the womb.
13. Any other complications or emergencies that may
suddenly set in during labor, causing a delay calculated to
endanger the life of mother or child.—T. G. Comstock,
CRANIoToMY—RETAINED PLACENTA, 113
CRANIOTOMY.
Place the patient in position as for the application of the
forceps. Evacuate the bladder and rectum. Pass the
fingers of the left hand up to the foetal head, and carefully
pass the perforator along its palmar surface until it reaches
the head, taking care that none of the maternal soft parts
be injured. Perforate the cranium; break up and evacuate
its contents. Ea:pulsion of child may sometimes be effected
by the forces of nature. If not, apply craniotomy forceps,
and deliver much the same as in ordinary forceps case.
Twins.
As soon as the first child is born and separated from the
mother, apply a binder about the abdomen, and wait for the
expulsion of the other. Do not attempt removal of the
placenta of the first child until after the birth of the second.
If the two placentu remain in the vagina, twist the cords
together and deliver in the ordinary manner. But be
sure to tie the placental end of the cord of the first child as
Soon as it is delivered. - -
ASPHYXIA OF THE NEW-BORN.
Clear the air-passages of mucus, etc., with finger wrapped
with a handkerchief, the child being inverted. Provide for
supply of fresh air. Make upward friction on lower limbs.
Sprinkle the face and chest alternately with hot and cold
water, or, slap the buttocks. If not very soon successful,
resort to artificial respiration. Infant on its back; draw
the tongue forward; carry the arms well above the head;
then bring them down to the sides, with elbows flexed, and
press them against the sides of the chest. Repeat about
twenty-five times per minute. As soon as respiration is re-
stored, apply heat to the body and extremities, and give five
drops of brandy in half a teaspoonful of milk and water.
RETAINED PLACENTA.
If due to uterine inertia, grasp the fundus through the
abdominal walls, and manipulate to excite contractions. If
the placenta is adherent, pass the hand into the uterus, and
gently and carefully detach. Leave no fragments. See to
it that the uterus is firmly contracted afterward. Follow
by antiseptic injections. If from hour-glass contraction,
insinuate the hand, in Gonical shape, into the ring, and
8
114 KEY NOTES OF MEDICAL PRACTICE.
gradually and steadily overcome the resistance of the circu-
lar uterine fibers. Inhalations of Amyl nit. Will aid.
ADHERENT PLACENTA.
Pass the hand into the uterus, and gently and carefully
detach the placenta from the uterine walls, being sure that
no fragments remain,
An excellent method, also, is to inject cold water into
the placenta through the umbilical cord. -
METHOD.—Divide the umbilical vein transversely, secure-
ly tie into it the nozzle or tube of a fountain Syringe, and
inject cold water slowly and carefully. .
This method is unfailingly successful in causing the
detachment and expulsion of the adherent placenta, and
does no harm to the mother.
PUERPERAL ECLAMPSIA.
(Frequency—1 in 500.)
LEADING REMEDIES.
Belladonna. – Convulsive movement of limbs and mus-
cles of the face; dilated pupils; red or livid countenance;
fixed or convulsive eyes; foam at the mouth; involuntary
escape of urine and feces; renewal of the fits at every pain:
more or less tossing between the spasms, or deep sleep, with
grimaces, or starts and cries, with fearful visions.
If the patient is actually in a convulsion, or the fits are recurring
rapidly, Bell. is the classical remedy.—Hughes.
Gelsemium.— In those cases in which the spasms occur
with a rigid os uter. DoSE.— Five drops of tincture.
Veratrum vir.— Great arterial tension, with full, hard,
bounding pulse. DoSE.—Three drops of tincture. , -
Hyoscyamus.- Bluish color of face; twitching and
jactitation of almost every muscle in the body— of face,
eyelids, and all. Almost constant delirium.
A valuable remedy when due to reflex excitability.—Hughes.
Aconite.—Hot, dry skin; thirst; restlessness; cerebral
congestion; general plethora.
Acts like a charm.—Guernsey.
Opium.—Sopor, with stertorous breathing; incoherent
wanderings, with redness, swelling, and heat of the face.
Chamomilla.—From mental emotion, excited by a fit
of anger; great excitability.
- GENERAL MEASURES.
Remove all sources of irritation; empty the bladder and
rectum. Place a piece of rubber, or similar substance, be-
tween the teeth. If all other means fail, give Chloroform
PUIERPERAL MANIA. 115
to control the paroxysms, and terminate labor as soon as
possible. If the urine is albuminous, and convulsions are
wrapmic, then, too, the pressure on the ureters must be re-
lieved by emptying the uterus. ! If convulsions persist, and
the cervix is unyielding, incise it.
PUERPERAL MANIA.
CAUSES.— Great drains upon the system from too fre-
quent pregnancies, prolonged lactation, or ha-morrhage.
Loss of sleep. Also mental shock following delivery. Her-
edity predisposes.
DURATION.—Twelve weeks (sometimes less) to six
months in most cases. The longer it persists after six
months, the more doubtful is ultimate recovery.
PROGNOSIS.— Generally favorable both as to life and
mind. Mortality slight under proper treatment. Melan-
cholia more grave than Mania.
Stramonium.— Furious rage; loquacious delirium;
throwing off the bedclothes; nymphomania; lascivious talk.
In puerperal mania, it stands highest among remedies.—Hughes.
Belladonna. – Paroxysms of rage; insomnia; marked
congestion of the brain, with eyes bright and shining.
Hyoscyamus.-Delirium of mild type; incessant, inco-
herent talking.
Simple mania, characterized more by agitation than excitement,
due to the existence of obscure illusions and hallucinations.—Lawson.
Cannabis ind.— Mental delusions of an exalted char-
acter.
... Cimicifuga.- “Worthy of most confidence in puer-
peral melancholia.”— Hughes.
Mercurius.-Symptoms pointing to phrenitis.
GFIENERAL MEASURES.
The cardinal principles in treatment are to give the
woman rest and food. She must have sleep, and must be
kept well mourished. In order to procure sleep give Chloral
hyd., thirty to forty grains. After the patient has become
narcotized its effect may be maintained by rectal injections
of the same medicine, the dose being increased by one-
fourth.
If food and medicine be refused by the patient, they
must be forcibly administered. The food must be liquid in
form — milk, Soups, broths, gruels. The patient must be
securely held by assistants, a dessertspoon forced between
the teeth and held in that position, when liquid food, a
tablespoonful at a time, may be deposited in the mouth.
If this method fail resort must be had to feeding through
the nares. Attach a soft-rubber catheter (No. 8) to the
116&- KEY NOTES OF MEDICAL PRACTICE.
tube of a fountain syringe, and, the patient being held, pass
the catheter (previously lubricated with Glycerine) through
one nostril to the fauces and beyond into the oesophagus.
In this way a quart of milk, containing the medicine when
desired, may be administered. Repeat two or three times a
day. - --
Skillful nurses should have entire charge of the patient,
all family friends, and especially the husband, being rigidly
excluded. Change of air and scene sometimes has a
marked effect as convalescence approaches.
LACERATION OF PERINEUM.
PREVENTION.— Freely lubricate the perineum, with cos-
moline, oil or lard, internally and externally. With two fin-
gers in the dilated anal orifice, and the thumb on the crown
of the child’s head, make pressure upward and forward,
toward the pubes. -
FREQUENCY.—Average of six observers, 27 per cent. of
all cases; more frequent in primipartu than in multiparaº.
Examine for it after every labor.
OFERATION.
IMMEDIATE.-As soon as the placenta is delivered cleanse
the vagina, and if the laceration is slight, tie the knees to-
gether. If considerable, cleanse thoroughly, bring the wound
together by interrupted silver-wire sutures, three or four to
the inch. Enter suture about an inch from the cutaneous
margin of the wound, bringing it out on the mucous mem-
brane of the vagina, very near the raw surface; carry it to
the other side; bring together, and twist the ends. Often
the wound will heal without operation if a pad, about the
size of two fingers, made of cloth, be placed up against the
perineum and kept in place, the knees tied together, and
ordinary precaution used. -
SEcond ARY. — Patient should be in good health; child
weaned; time, a few days after monthly period.
INSTRUMENT.—Scalpel; scissors, curved on the flat; long,
rat-toothed forceps; blunt-edged perineum needle; surgeon's
needles, curved; silver wire; needle holder; flexible cath-
eter. .
Patient etherized; lithotomy position; labia held apart
by hands of two assistants; shave the hair from the part;
two fingers in the rectum; draw the surface tense; begin in
the angle of the fissure, next to the rectum, and freshen the
surface in triangular shape by snipping with the Scissors and
denuding with the knife; torsion bleeding arteries; be sure
that the entire area of the surfaces to be brought into ap-
position is freshened. Success depends on the care with
which the sutures are applied. Pass the perineum needle
LACERATION OF CERVIx. - 117
from the cutaneous surface, deeply through, the tissues, and
bring the point out on the vaginal surface, close to the edge
of the wound; charge the eye of the needle with "an end of
the suture, and withdraw the needle; unthread it; pass it
through the fold on the opposite side; thread it with the
vaginal end of the wire; withdraw the needle, carrying the
suture in its track. Beginning at the angle, pass sutures at
regular intervals, two or three to the inch; coapt the parts,
and secure the ends of the sutures by twisting, leaving long
ends, which are to be brought together and Secured in a
short piece of rubber tube.
- AFTER-TREATMENT.
Draw the urine; put a pad between the knees, and bind
them together; pass catheter three or four times daily, and
keep the vagina clean by mild Carbolic injections. Draw
the urine with care, and hold a piece of lint to catch any
drip. Protect the parts by the free use of Calendula oint-
ment, prepared with Vaseline. Regulate the diet so as to
restrain the action of the bowels for five or six days. Ite-
move the sutures, with great care, on the seventh day, and
let the knees remain bound together for a week following;
after that, only at night. Patient should not assume up-
right position for two weeks. •
LACERATION OF CERVIX.
PREVENTION.—“With adequate dilatation there can be no
laceration. The indications are, to procure early, prompt,
and thorough dilatation, by means of fingers and forceps.
If expulsive efforts set in before cervix is sufficiently dilated,
urge patient to restrain voluntary efforts; oppose rapid ex-
pulsion by pressure against the presenting part, and divert
its movements into the proper channel.”—R. N. Foster.
- TREATMENT. s
INDICATED.—When it is the cause of sub-involution, neu-
ralgia, or other serious ill health. Do not operate if pelvic
peritonitis or cellulitis present, as indicated by tenderness in
neighboring connective-tissue, on pressure with the finger.
PRELIMINARIES.—Large hot-water vaginal injections, once
or twice daily, for several weeks; scarification of cervix if
mucous follicles enlarged and cystic. -
INSTRUMENTS.—Vaginal douche; Sims' speculum; vol-
sella; double tenaculum; bistoury and scissors; dissecting
forceps; short needles, straight and curved; needle holder: ,
medium silver-wire sutures. - i
TIME.—The week following the menstrual flow.
OPERATION. .
Patient anaesthetized; lithotomy position; large, carbol-
ized, hot-water vaginal injection should be administered
118 IKEY NOTES OF MEDICAL PRACTICE.
just before the operation; dilate the vagina with speculum;
draw down the cervix with volsella or tenaculum; approx-
imate the edges of the cleft, to see how much tissue must
be removed; now open the cleft with double tenaculum, in
the hands of an assistant; with long-handled, curved scis-
sors, freshen the edges of the cleft in V shape, the broad end
in the angle of the cleft, and the narrow one toward the ex-
ternal os; hook up with small tenaculum the portion to
be removed and keep it on the stretch while it is being sep-
arated, and if possible, remove it in a single piece from side
to side; get rid of all cicatricial tissue, particularly in the
angle of the cleft, using bistoury, but looking out for the cir-
cular artery, near the vaginal junction, where tissues must
be removed very superficially. If there be much bleeding
during the operation, hot-water injections, from time to
time, will check. Let the wºndenwded portions, which will
form the walls of the future cervical canal, be broad, and of
uniform size and shape.
SUTURES.–If the tissues are soft, use a round needle; if
dense, lance-pointed; sutures eight inches long; introduce
the upper one first,-three or four for each side; pass be-
meath one denuded portion, across the fissure, then beneath
the other. In double laceration, pass sutures of both sides
before tying any. Tie the sutures from above downward.
Make accurate approximation of vaginal edges. Remove
the sutures, carefully, on the seventh day, the uppermost
one first.
AFTER-TREATMENT.
Confine the patient to bed for two weeks; empty the
bladder by catheter for forty-eight hours; after that, give a
water injection after every act of micturition. If much
discharge, warm, carbolized injection once or twice daily.
PHILEGMASIA DOLENS.
LEADING REMEDIES.
Aconite. — Fever; high temperature; rapid pulse; rest-
lessness; thirst.
Belladonna. – Skin moist; sharp pains in leg; cerebral
congestion. -
Bryonia.-Sharp, shooting pains, aggravated by least
motion. *
Pulsatilla.-Thirstlessness, and in the characteristic
subject. If patient not doing well under other remedies.
Hamamelis.--When symptoms depend on phlebitis
extending from uterine into crural veins.
GENERAL MEASURES.
Leg more elevated than thigh; straight or bent, as is
more comfortable to the patient, supported on cushions.
PUIEREPERAL FEVER. 119
Insist upon absolute rest in bed. Apply heat and moisture,
by light poultices, or by flannel stupes, or Hamamelis
formentations, covered with cotton wool and oil silk. After
the acute stage is past, bandage with roller from toes to hip
while the cedema continues. Watch for collections of pus; if
found, evacuate at once. Do not use friction or rubbing at
any stage, lest emboli be detached. Bring up the general
health by appropriate constitutional treatment. Do not use
the leg until all disease has disappeared; this is important.
PUERPERAL FEVER.
LEADING REMEDIES.
Aconite.— If there be chill, followed by high inflamma-
tory fever, with hot, dry skin; quick, hard pulse; mouth
and tongue dry; great thirst; vomiting; urine scanty, red,
and hot; cutting, burning, lancinating pains in uterus and
abdomen, which is hot to touch, and excessively sensitive to
slightest pressure.
I believe it to be a most valuable remedy.—Dr. W. S. Playfair.
Veratrum vir.— Early stage only. Nausea and violent
vomiting; empty retching; much congestion of the head;
full, hard pulse. By some preferred to Acon. for the first
signs of congestion, inflammation, and fever.
Belladonna. – Intense congestion; painful retching
and vomiting; abdomen excessively sore and painful; can-
not bear the slightest jar; violent clutching pains in
abdomen, with great heat; meteorism; painful bearing
down in pelvis; suppressed lochia; congestion of head,
with flushed face and red eyes; throbbing headache and
delirium.
When the inflammation attacks the peritoneum, Bell. most fre-
quently required.—Hughes.
An excellent remedy for the vomiting.—Baehr.
Bryonia. – If peritoneum involved, and exudation has
begun. Stitching, lancinating pains in abdomen, worse
from slightest motion; lochia suppressed; digestive organs
much involved, though without vomiting; fever not very
violent. -
Colocynthis.-Severe, cutting, colicky pains in bowels;
eaccessive tympanvites, thin watery diarrhoea. During par-
oxysms of violent pain, complexion pallid, skin alternately
cold and hot, pulse quick, distressing vomiting.
Quite well indicated when tympanites is excessive.—Hughes.
An important remedy.—Baehr.
Arsenicum.— Sudden sinking of strength; cold,
clammy perspiration; insatiable thirst; constant vomiting;
burning pain in abdomen; great anguish; extreme restless-
ness; rapid prostration; symptoms of decomposition of
the blood.
120 .
KEY NOTES of MEDICAL PRACTICE.
Veratrum alb.-Violent vomiting and diarrhoea; sup-
pressed lochia; icy-cold extremities; Hippocratic counten-
ance; cold perspiration; cold breath; threatened collapse.
... Deserves preference if disease sets in suddenly, with great vio-
lence.—Baehr. - - -
Nux v.—When the uterus itself is inflamed — puerperal
metritis. - - - - - -
I have been astonished at the rapidity of its action.—Hughes.
GENERAL MEASURES. - •
Wash out the vagina and uterus twice daily with a weak
solution of Kali perm. or Carbolic ac. Introduce the nozzle
of the syringe well through the cervix: wash the cavity of
the uterus thoroughly until the water issuing from the
vagina is no longer colored. Unsafe to trust this important
treatment to the nurse. Apply over the abdomen a thin
poultice containing an ounce of Thºrpentime. If tympanites
very distressing, enema of Turpentine very serviceable.
Use every antiseptic precaution in management of the case.
Diet.— Bits of ice in mouth to slake the thirst and allay
vomiting. Important to sustain vital strength by abundant
nourishment. Give hot milk, strong beef tea, meat broths,
and, if prostration great, café and latt. If food distasteful,
give albumin water. Give small quantities of food at fre-
quent intervals.
AGALACTIA.
- LEADING 18FMEDIES.
Asafoetida.-Eaccessive sensibility of vital organism;
veins of breast much distended.
In high repute.—Hughes. -
Belladonna.- Breasts large and heavy; headache;
flushed face; cerebral congestion.
May afford great aid.—IIempel.
Pulsatilla.-Often called for — promotes the secretion
in many cases.
China. – Debility from loss of animal fluids, particularly
of blood. -
Calcarea carb.- Leucophlegmatic constitution; ex-
tremities cold and damp; inclined to too frequent and too
profuse menses. -
Sometimes a single dose will effect the desired innprovement.—
Hughes. . -
Urtica urens.— Entire lack of milk after parturition.
- GENERAL MEASURES.
Warm applications to the breast will favor secretion. A
strong decoction of the castor-oil plant (Ricinus Communis).
*. hot by means of Soft cloths, has been often success-
fully used.
wº
MASTITIS. - - - 121
DIET.—The use of porter, ale, and other liquors, founded
on false principles. The patient should have an abundance
of nutritious, easily digestible food, such as milk, cocoa,
fresh meats, eggs, broths, and whatever harmless food the
appetite may crave. Milk diet is the best. iº
MASTITIS.
LEADING REMEDIES. -
Bryonia.-Breasts heavy, hot, hard, and painful, but
not very red; breasts gorged with milk; severe stitching
pains in breast; feels sick on first sitting up. Dos E. –Sixth
or twelfth dilution.—Hughes. &
The great medicine for mastitis. Specific for mastitis neonatorum.
— Hughes. -
Belladonna. – Breasts swollen, hard, glossy, with red
streaks running in radii; throbbing, stitching pain, accoln-
panied by headache and fever. r
Phytolacca.-- Chill, fever, painful engorgement, and
swelling; the drawing of milk impossible; the gland full of
hard, painful modosities. X-
In ordinary caked breasts it is considered to be specific.—I?aue.
Hepar sulph. —Threatening suppuration, or after sup-
puration has begun; the discharge is scanty, and there is
still great hardness of the inflamed parts.
Fhosphorus. -Phlegmonous inflammation; breast swol-
len, red in spots or streaks, hard nodosities. Fistulous
openings, with watery, discolored, offensive, ichorous dis-,
charge. -
Has cured fistulous conditions of breast left behind after milk
abscess.-Hughes. - - -
Apis.- Burning, stinging pains, with Oedema.
Conium.—When from contusion. “Specific.”—Hughes.
Silica.-Chronic fistulous openings; profuse secretion
of pus.
Graphites.—When there are so many old cicatrices from
former abscesses, that the milk can scarcely flow.
It has never failed me.--Guernsey.
GENERAL MEASURES.
As soon as hardness appears, rub with olive oil, from
circumference toward the center. Support the breast with
sling of broad handkerchief. Apply warm fomentations,
by a basin lined with flannel saturated with hot water and
Phyt. tinct. If pus has begun to form, poultice. In open-
ing abscess, make incision to correspond with radius, and at
most dependent part. In old sinuses and chronic suppurat-
ing surfaces, two or three times daily inject Labarraque’s
Solution (Liquor Soda, Chlorimata), one part to ten of
Water,
The most active stimulant of chronic abscess or sinus I have ever
known.—Dr. Jacobus. *
122 JKEY NOTES OF MEDICAL PRACTICE.
Binding the inflamed breast snugly, so as to give it firm
support against the chest, by broad roller passed round and
round the body, will avert the formation of abscess. Re-
apply the binder daily, and continue until the inflammation
has subsided.
SORE NIPPLES.
Arnica. — Nipples feel sore after nursing.
Silica.- Much ulceration and suppuration.
Phytolacca.-- Nipples sore and excoriated.
Graphites.— Minute vesicles, exuding glutinous fluid.
GENERAL MEASURES.
The nipples should be carefully washed after each nurs-
ing, and the Ghild’s mouth thoroughly cleansed before and
after being put to the breast. When sore, Hydras. and
Glycerime, equal parts, applied, will often cure. If there
are suppurating Sores, apply a lotion of Calend. tinct., a
drachm to an ounce, on soft cloths. If there are deep
fissures or cracks, touch the raw surfaces with scale of Arg.
nºt. Lotion of Phyt. exceedingly useful; apply in cracked
or excoriated nipples, or fissures of syphilitic origin. Until
the nipple is entirely well, cover it with rubber shield while
the child, nurses. In those who are subject to sore nipples,
bathe daily with Armica lotion.
METRORRHAGIA.”
LEADING REMEDIES.
Ipecac.—After labor or miscarriage; continuous flow of
bright-red blood; the patient is cold and pale; gasps for
breath; chilliness and nausea.
Very frequently used.—Guernsey.
The first remedy I make use of is always Ipec.—Jahr.
Sabina. –After miscarriage or parturition; plethoric
subjects; haemorrhage profuse, painful; blood fluid, and
mixed with clots; drawing pains from back to pubes, pre- .
cedes the flow.
Will help in many cases.—Baehr.
Used in frequency next to ſpec.— Guernsey.
China. – Heaviness of head; ringing in ears; obscura-
tion of sight; fainting; face and extremities cold and pale;
drowsiness; weak pulse; twitching and jerking of muscles.
After loss of much blood.
Will be found of very great service.—Guernsey.
Secale.— Haºmorrhage from atony of uterus, after pro-
tracted labor, or in feeble, cachectic subjects; uninterrupted,
painless flow of dark, fluid blood; great prostration; faint-
METRORRHAGIA — MENORREIAGIA. 123
ness; palpitation of heart; convulsive movements; cold
skin.
Flooding in feeble, cachectic women.—Lilienthal. -
Belladonna. – Profuse discharge of bright-red, hot
blood, with downward pressure; severe pain in the back;
great vascular eaccitement; throbbing of carotids; flushed
face; red eyes; full, bounding pulse.
Very frequently indicated in uterine haemorrhage, particularly in
that after labor.— Guernsey.
Crocus. – Pressure and feeling of weight in pelvis, with
feeling of Something rolling in abdomen, and discharge of
dark, stringy, viscid, tenacious blood.
Frequently called for in post-partum haemorrhage.—Guernsey.
GEENERAL MEASURES.
TAMPON.— Put the patient in Sims' position; with left
forefinger, or Sims' speculum, retract the posterior vaginal
wall; with pledgets of cotton, or free end of roller bandage,
pack the vagina posteriorly to cervix; then anteriorly; then
centrally; until firmly filled by plug, taking care not to
obstruct the urethra. After sufficient time has elapsed,
remove piecemeal, the patient in same position. Or, take a
large sponge, moisten it, and then squeeze all the water out;
compress it into small bulk, and pass it into the vagina
through a speculum.
MENORRPHAGIA.
LEADING REMIEDIES.
Crocus. – Discharge black, viscid, stringy, and tena-
cious; earthy-yellow face; debility and palpitation.
Invaluable in functional form.—Hughes.
Sabina.— Plethoric subjects; uterine hyperamia; draw-
ing pain from back to pubes: blood bright-red. º -
Will cure large number of cases.— Matheson.
Ipecac.—-Very profuse; constant nausea.
Secale.— Blood dark; without pain; increased by slight-
est motion. -
Often proves curative.—Hughes.
Hamamelis.-- Profuse, dark, thin blood.
Chamomilla.- Black, clotted discharge, with severe
pains in the back; excessive sensibility, local and general.
Has undoubted control.—Hughes.
Nux v.–Menses too early and too profuse; stops for a
day or two, and then returns; irritability; sedentary habits.
Trillium.— Menses every fourteen days, lasting seven
or eight days; in interval, profuse, yellowish leucorrhoea;
blood at first bright-red, but later is pale. º
For active flow we possess no better remedy.—Hale.
'124 REY NOTES OF MEDICAL PRACTICE.
Calcarea carb.-Menses too early, and too profuse and
long-lasting; anaemic Condition; mal-nutrition; congestion
of head. ... = .
Sulph. and Calc. carb... successfully, administered during interval
between periods required in majority of cases to insure a radical cure.
—Ltturie, w - -
- GENERAL MEASURES.
Hot water bag to lower dorsal and lumbar regions.
DYSMENORREIGEA.
LEADING REMEDIES.
Actaea.—Severe pains in back, down thighs, and through
the hips; hysteric spasms, cramps, and tenderness of hypo-
gastrium; between menses, debility, neuralgic pains, ten-
dency to prolapsus; rheumatic, irritable uterus.
Caulophyllum.–Spasmodic dysmemorrhoea; bearing-
down pains; scanty flow; sympathetic spasms of adjacent
organs, as bladder, recturin, bowels; hysterical spasms of
chest and larynx. - -
I have had great success with Macrolin and Caul., 2x trituration.
Viburnum.–Spasmodic dysmenorrhoea; excruciating,
colicky pains in lower part of the abdomen, coming on sud-
denly, preceding menstrual flow, lasting for hours; should
be given for a week previous to the flow, in tincture or 1x.
Cocculus.-Sharp, Gramp-like pains, with scanty menses;
disiention of abdomen. - *
Crocus. – Dysmemorrhoea due to spasm of cervix; men-
strual blood thick and dark. -
Chamomilla.-Pressure in uterus resembling labor-
pains; discharge dark and clotted, with tearing pains; fre-
quent desire to urinate; uterine neuralgia; excessive irrita-
bility and impatience.
Pulsatilla.- Menses delayed and scanty; pains so vio-
lent she tosses about with Gries and tears; blood dark and
clotted; flows at intervals; great chilliness; uterine con.
gestion. -
Belladonna.-Menses too early and too profuse; blood
bright-red; great downward pressure in genitals; face red
and bloated; cerebral congestion. Congestive dysmenor-
rhoea. . .
SPECIAL REMEDIES.
BIamamelis.-Of ovarian origin.
Borax — Dysmenorrhoea with sterility.
Collinsonia.- Much pelvic congestion.
Coffea.—Excessive nervous excitability.
Sepia.-Chronic, with leucorrhoea and debility.
Gelsemium.–Spasmodic, to palliate during attack.
AMENORRHGEA. 1:25
GENERAL MEASURES.
Hot fomentations across the hypogastrium, or hot sitz-
bath at time of the attack if free flow. If flow is scanty,
spinal ice-bag to lumbar and Sacral regions; warm drinks;
in the spasmodic form, Gels. at the time of the attack gives
great relief. DOSE.-Three to ten drops first-decimal, fre-
quently repeated. - - - -
AMENORRHOEA.
LEADING REMEDIES.
Pulsatilla. – Delayed, suppressed, or scanty menstrua-
tion; pains in abdomen or loins; hysterical symptoms;
nausea, and vomiting; palpitation of the heart; loss of appe-
tite; deranged digestion; pale face; lassitude; chilliness,
and headache.
For the great majority of cases.—Hughes.
Actaea.— Pain in left breast and side; rheumatic ten-
dency; headache; nervous excitement: peevishness; when
from uterine derangement. IIysterical subjects.
Sepia. — Delayed menses. Sallow complexion; fair, Sen- .
sitive skin; feeble, delicate subjects: leucorrhoea; haemor-
roids and evidence of portal and pelvic congestion.
Conium.— General torpor of the organs. The breasts
become enlarged and painful at every period. Complicated
with ovarian or uterine disease, or chlorosis.
Aconite.—Sudden suppression from cold; congestion of
head or chest; young, plethoric girls.
Bryonia.— Bleeding from the nose in place of inen-
strual discharge; dry, shaking cough; oppression of chest;
heaviness or pressure in head.
Phosphorus.- Delicate constitution; weak, sensitive
lungs; cough ; expectoration of blood, and pain in the
chest. .
Calcarea carb.-Scrofulous subjects, and those in-
clined to incipient tuberculosis; cold, damp feet.
Ferrum.—T)elay of first menses; debility; languor;
palpitation; indigestion; leucorrhoea; sickly complexion;
puffiness of face or ankles. .
Calc, and Ferr. are the chief remedies.—le. W. Foster. -
Nux v.–Patient of dark complexion, vehement dispo-
sition, sedentary habits; acute indigestion; constipation.
Graphites.— Menses delayed, Scanty, and painful; con-
stipation; tendency to eczematous cutaneous eruptions.
Next to Puls. in frequency of usefulness.-Hughes. .
| Sulphur.—Scrofulous eruptions; temporary flushes of
leat. - -
126 REY NOTES OF MEDICAL PRACTICE.
GENERAL MEASUIRES,
Keep the feet warm, and the abdomen covered with flan-
nel. Warm foot baths are useful, or, the cold sitz bath.
Sit in a bath, with water at 58° or 60° F., five to ten
minutes, at bedtime, keeping the legs and feet warm, and
the shoulders well covered. After the bath, the patient
should be well rubbed, and retire to bed. This is to be
used only in the functional variety. When due to constitu-
tional derangement, apply the special remedy, and prescribe
nourishing diet, out-door exercise, and every means to
restore the general health. In atomy of uterus electricity,
with Comium.
LEUCORRPHOEA.
LEADING REMEDIES.
Alumina. – Profuse, yellow, acrid, corroding discharge,
with burning in genital organs, the parts being corroded
and inflamed; worse before and after the menses; constipa-
tion; inactivity of the rectum.
Ammonium carb.-Watery, burning discharge from
the uterus; profuse, acrid, milky leucorrhoea; menses every
fortnight, black, coagulated, and profuse; weak, delicate
subjects. - -
Calcarea carb.-Profuse, milk-like, or yellowish dis-
charge, with Soreness and swelling of the vulva; too early
and too profuse menses; scrofulous subjects, very sensitive
to cold, with constant cold, damp feet.
Pulsatilla.--Discharge thick, like cream; or, milky,
sometimes giving rise to a burning sensation; indigestion;
chilliness; nausea and trembling. Especially for those of
relaxed fiber and lymphatic temperament, in whom the
menses are irregular, delayed, and scanty.
Vaginal leucorrhoea, in chlorotic subjects.—Hempel.
Specific for morbid activity of cervical glands.-Hughes.
Sepia.-- Pressure and bearing down in pelvis; stinging
pain in ovarian region; discharge variable—thick, creamy,
yellowish, bland or excoriating, offensive. Leucorrhoea at
puberty, during pregnancy, or at climacteric.
Debility and passive uterine congestion, in those who have borne
many children.—Hughes.
Helonias.-Uterine leucorrhoea, from atony or.conges-
tion ; general debility from over-lactation, or other drain on
the system. -
Hydrastis.—Yellow discharge of an extremely tenacious
character, often offensive, frequently with long shreds in it.
Often accompanied by derangement of the liver and
stomach. - -
PRURITUS VULV AF — OVARITIS. 127
GENERAL MEASURES.
Attention to the state of the general health, of which
this is usually but a local expression, is necessary. Irriga-
tion of the vagina with cold water is beneficial. Calend.
water or Hydras. water are better than astringent solutions
as injections.
PRURITUS VULVAE.
IREMEDIES.
Arsenicum, Sulphur, Mercurius, Rhus ven., Chryso-
phanic ac. -
GENERAL IMIEASURES.
Apply compress wet with Borate Soda, two ounces; Sal-
*cylic ac., one ounce; water, one quart. Also, dilute Chryso-
phanic ac., locally. , Grain doses of Chloral hyd. are often
very effective. Carbolic ac. lotion locally often relieves.
&
OVARITIS.
LEADING REMEDIES.
Apis.- Inflammation of right ovary; numbness in right
side, extending down the thighs; sharp, lancinating, sting-
ing pains in ovary. This is one of our most reliable reme-
dies in ovarian affections.
Pulsatilla. – Sub-acute ovaritis, with menstrual sup-
pression, nausea, chilliness, pressure on bladder and rec-
tum; pains so violent she tosses about in all directions,
with cries and tears.
I believe it to be far superior to most of the remedies ordinarily
recommended.—Hughes.
Belladonna. – Hard swelling of ovary, with stitching,
throbbing pains; constant bearing down in pelvis; perspi-
ration; glistening eyes; cerebral congestion.
Lachesis.-Inflammation of left ovary, with swelling.
tensive, pressing pains and stitches; cannot bear slightest
pressure on ovarian region.
Hamamelis. –An excellent remedy in more intense
form, when the peritoneal covering is not involved.
SPECIAL REMEDIES.
Aconite.— Much fever.
Mercurius sol.—Threatened abscess.
Hepar sulph.--To check suppuration.
Thuja.-Chronic of left side; much pain.
Conium.— Chronic ovaritis, with induration.
128 KEY NOTES OF MEDICAL PRACTICE.
GENERAL MEASURES.
Hot fomentations, containing Hamam., over affected
part. Rest. -
CLIMACTERIC,
ILEADING IREMEDIES.
Actaea.—Pain in left side; pain at vertex and irrita-
bility of disposition; faintness at epigastrium.
It rarely fails to relieve.—Hughes.
Lachesis.-Hot “flushes,” burning in the vertex, and
faintness.
Of great service.—Bayes.
Gelsemium.—Flushes of heat; burning pain in top of
head.
Glonoine.—Rush of blood to the head; great giddi-
ness; throbbing, beating, roaring in the cars. -
A most efficicnt rennedy.—Hughes.
Platina. –Vertigo; palpitation; headache; roaring in
the ears. For those in whom menstruation has been pro-
fuse and prolonged.
Amyl nit. — Flushes of heat. Give by inhalation.
GENERAL MEASURES.
Frequent warm baths are helpful in tiding the patient
over this critical period.
FRACTURES. 129
PART III.
SU R (; ER Y.
FRACTURES.
GENERAL CONSIDERATIONS.
PROGNOSIS.—Simple fractures, if properly treated,
usually recover without deformity. Eacception: fracture of
the clavicle.
Compound fractures may be complicated by serious
injury and suppuration or gangrene of the soft parts, erysip-
elas, and septic fever. Prognosis grave in bad cases;
guarded in the majority.
Ununited fracture, or delayed union, liable to occur in
(1) intra-capsular fractures of femur and humerus; (2) frac-
tures of olecranon and patella; (3) fractures of the tibia in
debilitated subjects.
Fibrous union occurs occasionally in cases of delayed
ll Ill OIl,
SIMPLE FRACTURES.
GENERAL RUILES FOR TREATMENT.
1. Reduction, or setting.
2. Immobilization until union is established.
Setting must be carefully and properly done.
Immobilization accomplished by means of fixed and
removable dressings.
Fixed dressings are made of plaster of Paris, starch; and
the like.
Removable dressings are fracture boxes and splints.
f PLASTER, OF PARIS BANDAGE.
To apply a plaster of Paris bandage:
(1) Wrap the limb in sheet cotton; (2), bandage it evenly
with a common roller bandage; (3) prépare three to six
gauze or cheese-cloth bandages, two or three inches wide,
and five yards long; in the meshes sprinkle thickly dry
plaster of Paris, and re-roll them; (4) place them in a dish,
9
130 KEY NOTES OF MEDICAL PRACTICE.
cover with hot water, and leave them in it until the plaster
is well wet; it is then ready to apply; (5) prepare a strip of
tin or heavy card-board, one inch wide, and as long as the
splint is to be; place this on the anterior surface of the limb
—its use is to serve as a protection to the limb when cutting
off the splint; (6) apply plaster Qf Paris rollers as an ordi-
nary roller bandage; (7) º a small quantity of plaster of
Paris moistened in a dish, and frequently rub some over the
bandage as it is being applied; (8) when all is done, hold
the limb in proper position until the plaster sets, i.e., five or
ten minutes.
Cautions.— Do not make the plaster too thin; apply
quickly and evenly; do not bandage too tightly; protect
by cotton upper and lower edges from touching the skin.
In removing, cut on the strip of tin or card-board, with
a heavy-bladed knife, a pair of
Henry’s Plaster Cutters, or, better
still, an old steel case-knife filed
..like a coarse saw.
STARCH BANDAGE.
To apply a Starch Bandage:
(1) Apply sheet cotton; (2) bandage with ordinary roller;
(3) prepare some starch; (4) apply other roller bandages,
and, during the process, rub on plenty of starch; (5) keep
the limb in proper position until firm.
FRACTURE BOX.
The fracture box is used in treating injuries of the leg.
It consists of a solid bottom six inches
wide and two feet long; two hinged
sides, six inches wide and two feet
long, which hook on to a foot-rest
eight inches long and four inches
wide, put at right angles with the
bottom. The box is carefully padded
with cotton or oakum, to receive the injured limb. -
Used in treatment of compound or comminuted frac-
tures, or simple fractures with much effusion.
sº
SPLINTS.
Splints may be improvised of strips of wood, 3% to 94
inch thick, or of heavy manilla board, or sole leather, etc.
In order to mold manilla board or leather to the limb,
immerse it in boiling water until pliable, then mold to the
limb, pad with Cotton, and retain in position by means of a
bandage.
Caution.—Always pad splints well; especially protect
any bony prominences from pressure, and thus avoid
sloughing of the skin. -


COMPOUND FRACTURES. 131
Extension must be applied in some cases to keep the
fragments from over-riding. Generally necessary in frac-
tures of the femur and humerus — occasionally in fractures
of the tibia and fibula. - -
If the patient is seen immediately after the accident,
before ºft. has occurred around the fracture, a fixed
dressing may be applied. If so, watch carefully, daily, for
the following indications for removing the same: (1) great
pain (probably due to displaced fragments); (2) obstructed
circulation (examine the fingers and toes for coldness,
cyanosis, and swelling); (3) looseness of dressing.
If there be effusion about the fracture, rest the limb tem-
porarily in fracture box or army splint, and apply hot
formentations until the swelling disappears, then dress perma-
mently. *
ARMY SPLINT.
A temporary splint may be
made of a blanket which is
folded lengthwise to a width
sufficient to act as a splint in sº
any given case (usually frac-
tures of the leg). Roll from
both ends; put the limb between the roils, and tie a bandage
around them in three places.
In cases of fractures near joints, remove the dressings
daily as soon as expedient (from fourteen to twenty-one
days after injury), and practice passive motion for five or
ten minutes, to prevent troublesome anchylosis.
COMPOUND FRACTURES.
GENERAL RULES FOR TREATMENT.
The question of amputation may require the best judg-
ment of the experienced surgeon. - -
POINTS IN FAVOR OF THE OPERATION.
1. Crushing or tearing injury, rather than a fall, bfow, etc.
2. Rupture of main artery, and conditions of collateral
circulation.
3. Amount of haemorrhage.
4. Condition of patient, whether the system would be
able to stand the long drain of healing.
5. Shock, reaction, etc. -
Treat the external wound antiseptically; remove all for-
eign matter, dirt, gravel, splinters, etc.; remove all detached
pieces of bone in comminuted gompound fractures; remove
all soft tissues that are very badly crushed; wash with anti-
septic solution (Corrosive Sublimate, 1:1,000; Carbolic acid,
five per cent.); provide for free drainage; place the limb in
a fracture box, or in a fenestrated fixed dressing.
'N

132 ECIEY NOTES OF MEDICAL PRACTICE.
UNUNITED FRACTURES.
RULES FOR TREATMENT.
1. Rub the fractured ends against one another for two
or three minutes, to irritate, and cause inflammation.
2. Wire the fragments together by drilling holes. Use
silver wire. -
3. Build up patient’s general health.
Separation of articular cartilages is treated on the same
principle as fractures occurring near the point involved.
SPECIAL FRACTURES.
FRACTURE OF THE SKUILL.
PROGNOSIS.— Depends upon the brain's injury (con-
cussion, compression, or laceration) rather than the fracture.
Compression and laceration are grave complications, and
often fatal.
Compound or depressed fractures, or fractures of the
base, are much more serious than simple fractures of the
vertex.
TREATMENT.
In simple fractures without depression, keep the patient
perfectly quiet in bed. In compound fractures, try to
establish quick union of the external wound; dress it anti-
septically; keep the patient in bed. In depressed fractures
the fragment should be elevated if there are symptoms of
compression, or irritation of the brain. Trephine, if neces-
sary to raise it.
TREPETINING.
Instruments Necessary.—Scalpel, forceps, artery for-
ceps, trephine, bone elevator, quill or straw, sponges, anti-
septic dressing, needles and silk, carbolized catgut.
Shave the hair from around the seat of operation; wash
with antiseptic wash. If the bone is not exposed, make a
U-shaped incision through the soft parts over the injury,
and reflect them back so as to expose the fracture. It may
be possible to elevate the depressed fragments without using
the trephine, if a small splinter can be removed, and thus
make an entrance for the elevator underneath the depressed
piece; otherwise, apply the trephine on the sound portion
of the skull, the edge touching the line of fracture. Saw
evenly. After starting, withdraw the center-pin, and again
saw. After passing the diploë, go very slowly, in order not
to wound the dura mater. Probe the groove frequently
with a quill or straw. As soon as the dura mater is felt at
one point, tilt the trephine toward the opposite side, and
proceed very gently until the circular piece is entirely de-
tached; then remove with the elevator. The depressed
TREPHINING—FRACTURE OF NASAL BONES. 133
fragment can then be raised by inserting the elevator, and
using the sound part of the skull as a fulcrum.
Cautions.—Avoid trephining over any sinus or large
vessel. Avoid wounding membranes. -
In dressing, provide for free drainage by inserting a small
tube across the base of the U. Sew up edges; dress antisep-
tically, and bandage with handkerchief or Capelline.
HANDKERCHIEF BANDAGE.
Use a piece of cloth, one yard Square; fold diagonally;
put the diagonal on the forehead; pass the two ends be-
hind the occiput, and around
to the forehead again; fasten;
fold the point hanging at the
back up over the vertex, and
fasten.
CAPELLINR.— Roller, two
inches wide, and six yards
long. Begin at the forehead;
pass backward and forward
until the vertex is closed in ; then encircle the head hori-
zontally a few times, and fasten by pins at occiput and fore-
head.
Fractures of the base of the skull are treated by absolute
reSt.
FRACTURE OF THE NASAL BONES
PROGNOSIS.—Results not always favorable; may be
some deformity; obstinate injury to treat.
TREATMENT.
Replace fragments by inserting a female catheter in the
nares, and manipulating. Plug the nostrils with cotton for
two or three days in cases of marked deformity.
FRACTURE OF THE FACIAL BONES.
They are rare, and very difficult to treat. No rules can
be given. Surgeon must rely on his good judgment and
knowledge of anatomy in each case.
FRACTURES OF THE INFERIOR MAXILLA.
PROGNOSIS.—Union in two to four weeks in simple
fractures, usually without deformity. Comminuted frac-
tures apt to result in deformity.
TREATMENT.
In simple fractures of the horizontal portion, use a four-tail
bandage. Remove any tooth that interferes with coaptation.
The upper jaw answers for a splint. Feed the patient on
liquids, milk, broths, etc., by means of a rubber tube, or
bent glass tube, passed between the cheek and teeth, to the
space behind the molars, or through an opening made by an
extracted tooth.

134 KEY NOTES OF MEDICAL PRACTICE.
SIMPLE FRACTURE. .
- - IDRESSING}. •.
(1) Make a four-tail bandage of a piece of cloth, one yard
long and four inches wide; (2) mold a piece of (a) leather,
or (b) cardboard to the chim,
or (c) make a straight piece of
wood, four inches long and
one and one-half inches wide,
for chin to rest on; (3) pad
splint with cotton, and hold
in position; (4) apply four-
tail bandage to the chin, the
lower tails passing over the
vertex, the upper passing
back of the occiput, and
joining at the forehead; (5)
fasten by pins where the
strips cross, and hold them
in position by a piece of
ad to occiput longitudinally
over the vertex.
COMMINUTED FRACTURE.
TREATMENT.
These fractures are difficult to treat. It may be neces-
sary to drill holes in fragment and wire them together, using
silver wire. Kingley’s interdental vulcanite splint is suc-
cessful in some cases, but a dentist is required to make it.
DRESSING}.
Process.--(1) Replace the fragments, and take a plas-
ter of Paris cast of the teeth and jaw; (2) from this model
a vulcanite mold is made, in which the lower jaw fits; (3)
in this mold two stout wires are fastened, which run out
the corners of the mouth and along the outside of the
- cheeks; (4) the mouth is fit-
ted to the lower jaw; (5) a
bandage is passed under the
chin, and around the wire
wings. By this means the
mold is held firmly on the
fracture of the jaw. The
lower jaw thus dressed may
then be bandaged to the up-
- per one; but the patient may
be allowed to open the mouth for the introduction of liquid
food.
FRACTURE OF THE HYOID BONE.
PROGNOSIS.—Rarely fatal, but difficult to treat;
parts are in such constant motion.


FRACTURE OF SPINE. - 135
TREATMENT.
Reduce by manipulation, inserting finger of one hand in
patient's mouth. . Use anaesthetic if necessary. . Keep pa-
tient perfectly quiet. Apply neck-collar of leather to im-
mobilize the neck. Feed on liquids by means of tube, or
introduce food well back in the mouth.
FRACTURE OF TEIE SPINE.
PROGNOSIS.—Very grave. Complete fractures are
usually fatal, particularly when in cervical and dorsal re-
gions. Some cases recover, but usually paralysis remains.
Fracture of the vertebral processes not dangerous. t
Complications.—Concussion and compression of spine;
paralysis of limbs, bowels, and bladder; bed-sores.
s TREATMENT.
Perfect quiet in all cases. Extension and counter-exten-
sion advisable in some cases. Extension of head is accom-
plished by means of a leather head-rest, such as is used in
the treatment of Pott's disease, to which is attached a weight
of three or four pounds, passing over the head of the bed.
Extension of body accomplished by raising the head of the
bed by two bricks under the legs. Mold sand-bags to the
patient's sides, to prevent his moving. .
GENERAL IMEASURES.
Pay particular attention to the bladder; if paralyzed,
catheterize every four hours, and keep parts scrupulously
clean to avoid cystitis and sloughing, often fatal complica-
tions.
FRACTURE OF THE CLAVICLE.
PROGNOSIS.—Usually some deformity; impossible to
keep the fragments in exact apposition, on account of op-
posing action of attached muscles. Union established in
two to four weeks. *
TREATMENT.
Keep shoulder elevated, and rotated outward and back-
ward. Best results obtained by keeping patient on his back
• for two weeks. - -
IDRESSING.
(1) Put a small pad in the axilla;
(2) raise shoulder by a sling under
the elbow; (3) hold arm to the side
by a bandage around the chest; (4)
if one fragment tilts up, put a com-
press of cotton on it, and draw it
down by a strip of adhesive plaster
two feet long and two or three inches
wide, running from the anterior to
the posterior part of the chest.

136 KEY NOTES OF MEDICAL PRACTICE.
FRACTURE OF THE RIBS.
PROGNOSIS.–Speedy union (in two to three weeks)
if uncomplicated. If complicated with visceral injury
(lungs, heart, liver, etc.), the danger is increased. The
danger then is from shock, haemorrhage, and inflammation.
TREATMENT.
Keep patient in bed two weeks. Immobilize the wounded
side, by strips of adhesive plaster two inches wide, and long
enough to reach from spine to sternum, applied so as to over-
lap one another. Put a broad cloth bandage tightly around
the chest, and hold in place with shoulder straps. Remove
the dressing in one month. Apply the adhesive strips dur-
ing the act of expiration.
FRACTURE OF THE STERNUM.
PROGNOSIS.— Usually favorable if uncomplicated.
TREATIMIENT.
If fragments overlap they can be set during a deep
inspiration; dress as for fractured ribs — adhesive strips
across the front of chest, and broad cloth bandage.
FRACTURE OF THE SCAPULA.
PROGNOSIS.— May be some deformity.
TREATMENT.
Raise the arm by a sling; put a pad over the scapula and
in the axilla; bandage the arm and chest.
FRACTURES OF THE FIUMERUS.
I. FRACTURE OF THE ANATOMICAL
NECIX.
PRO GNO SIS.— Bony
union.
TREATMENT.
(1) Pad in the axilla; (2)
molded leather or manilla
board splint to the shoulder;
(3) bandage the arm evenly;
(4) support the hand and fore-
arm in a sling.
II. FRACTURE THROUGH THE SURGICAL NECK.
PROGNOSIS.–Usually favorable; occasionally fibrous
..union, or atrophy of the bone.

FRACTURES OF THE HUMERUS. 137
TREATMENT.
(1) Pad in the axilla; (2) carry the elbow forward and
inward; (3) splint to the outer side of the arm; (4) bandage;
(5) sling.
- III. FRACTURE OF THE SHAFT.
PROGNOSIS.—Delayed union occasionally; non-union
not uncommon. In oblique fractures union with shorten-
ing may result. -
TREATMENT.
(1) Long outside splint; (2) short inside splint; (3) band-
age and sling. May be necessary to attach a weight to the
elbow if the fragments over-ride and cause shortening.
IV. FRACTURE NEAR. THE LOWER, END.
PROGNOSIS.—The nearer the elbow the more un-
favorable. Danger of anchylosis of the joint from disuse.
TREATMENT.
(1) Dress on a right-angled padded elbow splint; (2)
bandage; (3) sling. At the end of ten days or two weeks,
take off the bandage and practice gentle motion of the
elbow; if the fragments are united, repeat this every day to
prevent anchylosis. s
FRACTURES OF THE ULNA.
I. FRACTURE OF THE OLECR, ANON PROCESS.
PROGNOSIS.— Ligamentous union not unusual.
TIREATIMIENT.
Dress the arm in extension by long posterior splint. In
third week attempt passive motion of the elbow joint.
II. FRACTURE OF THE CORACOID PROCESS.
PRogNosis.-Favorable.
TREATMENT.
Dress at right angles on an angular elbow splint.
Fractures of the shaft of the ulna or radius are treated
on the same plan as fractures of both bones of the forearm.
FRACTURE OF BOTH BONES OF THE FOREARM.
PROGNOSIS.— Usually favorable. May be some
deformity, and may be some interference with pronation and
Supination of the hand.
TREATMENT.
(1) Dress the arm held between pronation and Supination
with an anterior and a posterior broad, flat, well padded.
138 KEY NOTES OF MEDICAL PRACTICE.
wooden splint; (2) use interosseous graduated compress, if
the bones are crowded together; (3) keep elbow at right
angles, and suspend hand and arm in a sling; (4) immobi-
lize the wrist, but leave the fingers free.
FRACTURES OF LOWER END OF THE RADIUS.
(COLLES AND BARTON'S FRACTURES.)
PROGNOSIS.–Some deformity apt to remain, par-
ticularly displacement of the ulna outward, and tilting back-
ward of the lower fragment.
TREATMENT.
Simplest and most efficient method of dressing is to
use two straight padded splints; the dorsal, three inches
wide, extending from the elbow to the metacarpus, padded
heavily over the lower fragment to force it forward; the
anterior, three inches wide, extending from the elbow to
the wrist, padded heavily over the upper fragment.
Use passive motion of the fingers and wrist in two weeks,
to prevent anchylosis.
FRACTURE OF THE METACARPAL BONES.
TREATIMENT.
Use thickly padded palmar splint.
FRACTURE OF THE PHALANGES.
- TREATMENT.
Dress on narrow finger-splint applied on the dorsal or
palmar surface.
FRACTURE OF THE PELVIC BONES.
- PROGNOSIS.— Grave. Apt to be complicated with
rupture of the bladder, urethra, or rectum.
TREATIMIENT.
Rest in bed. Fragments may sometimes be replaced by
manipulation in the rectum.
If bladder or urethra is injured, pass a catheter, and
retain it if necessary.
Perineal section demanded in some cases of extravasation
of urine.
FRACTURES OF THE FEMUR.
I. INTRA-CAPSULAR, . FRACTURE OF THE NECR.
PROGNOSIS.— Unfavorable. Rarely bony, usually
ligamentous, union; sometimes non-union.
FRACTURES OF THE FEMUR. 139
* TIREATMENT.
Quiet rest in bed for three or four weeks; leather hip-
splint; good diet; keep the patient's strength up. At the
end of four weeks, let the patient up on crutches.
II. EXTRA-CAPSULAR, FRACTURE OF THE NECK.
PROGNOSIS.— Better than in intracapsular; union,
bony; but there is apt to be some lameness; union in six or
eight weeks.
TREATMENT.
If not impacted, the treatment is the same as for fractures
of the upper and middle parts of the shaft.
Let patient get up on crutches in four weeks.
III, FRACTURES OF THE UPPER, AND MIDDLE THIRDS OF THE
SHAFT.
PROGNoSIS.-Deformity not uncommon from Over-
riding and displacement of the fragments. Union in from
six weeks to two months.
TREATMENT.
1. Extension.—Apply two E--IL-
swansdown plaster strips, three
inches wide, one on each side of
the leg, from the knee down to a
few inches above the ankle; to
the free ends of the straps, which
should reach eight or ten inches
below the sole of the foot, fasten
a bit of wood, four inches by
two, and attach a cord and
weight to this.
2. Bandage from the toes
up to the groin, holding four
padded wooden splints running a
on the four surfaces of the É
thigh over the fracture.
3. Apply Liston's long side-splint.
4. Put the patient on a hard bed.
5. Raise the lower end by means of bricks.
6. Mold sand-bags or cushions to the sides of the leg.
7. Use a weight -
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º 2.
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teen lbs., according
to the age of the
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Allow patient to get up and exercise on crutches in four
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or a starch bandage on for protection.
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140 KEY NOTEs of MEDICAL PRACTICE.
IV. FRACTURE OF THE LOWER THIRD.
PROGNOSIS.–Favorable, unless the knee joint is
involved. •.
TREATMENT.
Dress on a double inclined plane.
Fractures of the shaft of
the femur may be treated by
plaster of Paris fixed dressing,
which is applied while the
limb is held in extension.
* * ,
a s grg"Tºº iſ a tº " . , ſ: ; :: * * * * * * * * * * * * * * * * * E-
232*::=
FRACTURE OF THE PATELLA.
PROGNOSIS.— Guarded. Fibrous union not uncom-
mon. Anchylosis probable, unless passive motion is used.
TREATMENT.
Dress limb with knee in extension, and thigh slightly
flexed, on an inclined plane.
Effusion reduced by hot fomentations, or aspiration.
Draw the fragments together by two strips of plaster, one
and one-half inches wide, and
long enough to pass obliquely
around the knee. Apply them
on the figure-of-eight plan.
Bandage firmly to prevent ef-
Hºº fusion. Union in six to eight
=A weeks, Practice passive mo- .
tion in three or four weeks.
FRACTURES OF THE TIBIA.
PROGNOSIS.—Usually favorable; may be delayed, or
non-union. Union occurs usually in six or eight weeks.
TREATMENT. . -
Put the leg in a fracture-box for two or three weeks; then
dress in plaster of Paris or heavy pasteboard splints, and let
the patient get about on crutches.
FRACTURES OF THE SHAFTS OF THE TIBIA AND FIBULA.
PROGNOSIS.— May be some deformity from shorten-
ing. Delayed union sometimes. Union in six to eight
weeks.
- TREATMENT.
If there is effusion, use a fracture box and hot fomenta-
tions. If shortening, apply extension below the fracture —
weight about three pounds. Put on a fixed dressing in two
or three weeks; plaster of Paris, or heavy board splints. In
four or five weeks, allow patient to go about on crutches.






FRACTURES OF FIBULA. . . . 141
DELAYED OR, NON-UNION OF FRACTURED TIBIA.
1. Produce irritation by rubbing the fractured ends
together.
2. If that fails, operate.
Instruments.-Scalpel, bone forceps, or Small saw,
bone drill, silver wire, needles, silk, etc.
OPERATION.
(1) Make a linear incision across the fracture; (2) snip
or saw off any Fº points of bone; (3) drill holes
obliquely through the edges of both fragments, and pass a
wire through them; (4) draw the pieces together firmly by
the wire. One or two wires are sufficient.
Provide for drainage; close the edges; dress antisepti-
cally, Remove the wire in two or three weeks. - -
FRACTURE OF FIBULA.
(POTT'S FRACTURE.)
PROGNOSIS.— Favorable. Some trouble with the
ankle apt to remain.
TREATMENT.
Dupuytren’s Method.—Padded board splint, six inches
wide, and reaching from the knee to two inches below the
foot; pad most heavily above inner malleolus; apply to the
inner aspect of the leg; bandage the foot firmly to it by
means of figure-of-eight bandage; fasten the knee firmly;
do not apply the bandage over the fracture.
Union in six weeks. The patient may get about on
crutches in two or three weeks.
142 KEY NOTES OF MEDICAL PRACTICE.
DISLOCATIONS.
GENERAL CONSIDERATIONs.
SIMPLE DISLOCATIONS.
PROGNOSIS.— Good in recent, simple dislocations, if
properly treated. Danger of becoming again dislocated if
the joint is used too freely or too soon after reduction.
This may lead to habitual dislocation.
If a dislocation is not reduced shortly after the accident,
the displaced bone becomes more or less firmly adherent in
its new position; the old articular cavity becomes filled with
inflammatory products, and the result is an irreducible
dislocation. -
Ball-and-socket joints are reducible after a longer period
than any other kind. Dislocated shoulders have been:
reduced at the end of four months; the hip at the end of
two months.
. - TREATMENT. - -
Reduction.— Reduce as soon as possible after the acci-
dent. Anaesthesia is often required to relax the muscular
contractions and deaden pain. Reduction is best accom-
plished by manipulation (see special dislocations).
Obstacles to Reduction.— (1) Contraction of muscles
(overcome by anaesthetics); (2) very small rupture in the
capsule of the joint, which is closed by the overlapping of
the soft parts; overcome by manoeuvring, or by subcutane-
ous incision of the capsule, if necessary. -
In the reduction by manipulation everything depends
upon a correct anatomical knowledge.
AFTER-TEEATMENT.
(1) Subdue synovial inflammation after reduction by
cold or hot compresses; (2) keep the joint at rest for about
two weeks before attempting any motion. .
If motion is attempted too soon, there is danger of re-dis-
1ocation.
HABITUAL DISLOCATIONS.
PROGNOSIS.–Unfavorable for a permanent cure.
Danger of becoming dislocated anew every time there is an
extra strain upon the joint.
TREATMENT.
Reduce, and immobilize the joint until it has become a
little stiff, then practice gentle motion. Treatment often
fails.
IRREDUCIBLE DISLOCATIONS.
PROGNOSIS.—Reduction is out of the question on
account of adhesions, and obliteration of the original
articular cavity. -
COMPOUND DISLOCATIONS. 143
TIRIEATIMIENT.
An effort may be made to make a false joint at the point
where the head is adherent.
COMPOUND DISLOCATIONS.
IPROGNOSIS.— Grave. It is much more serious than
a compound fracture. The danger is from suppuration,
Septicæmia, hæmorrhage, etc. -
J TREATMENT.
Resection or amputation is demanded in many compound
dislocations, especially of the larger joints. If it is deemed
advisable to attempt to save the limb, use a thoroughly
antiseptic dressing, and dress in a convenient position if
anchylosis occurs. -
DISLOCATION COMPLICATED WITH
FRACTURE. *
PROGNOSIS.— Guarded. Danger of anchylosis of the
ioint.
J TIREATIMIENT.
Reduce the dislocation; dress as for an ordinary case of
fracture. In ten days practice passive motion of the joint
very gently. Repeat at the end of five days, and after that
as often as deemed advisable.
SPECIAL DISLOCATIONS.
DISLOCATION OF THE LOWER. J.A.W.
PROGNOSIS.— Good. May be reduced after four
months’ standing. If not reduced, the jaw will accommo-
date itself to the new position, and, in time, a certain
amount of motion will be acquired.
TREATIMIENT.
Reduction.— Depress the lower jaw sufficiently to free
the condyle from the eminentia articularis of the temporal
bone, and then push it back to its place.
1. Depress the lower jaw by inserting the thumbs behind
the molar teeth and drawing downward. Protect the
thumbs from injury by wrapping cloth around them.
2. A piece of wood may be used as a fulcrum, by placing
it between the molars, and then prying upon the chin.
When the condyle is free, push the jaw into position.
DISLOCATION OF THE VERTEBRAE.
PROGNOSIS.—Very grave. If recovery follows, the
patient is apt to be paralyzed.
- TREATMENT.
Any treatment other than absolute rest is extremely
dangerous, Patients are apt to die during attempts at
144 KEY NOTES OF MEDICAL PRACTICE.
reduction, but some recoveries have followed such endeavor.
The indications are to use sufficient extension to disengage
the locked parts, and then replace the displaced portion with
gentle pressure. '.
DISLOCATIONS OF THE CLAVICLE.
PROGNOSIS.— Guarded so far as perfect recovery is
concerned. Danger of habitual dislocation.
TREATMENT.
- Easily reduced, but difficult to retain in position.
DISLoCATION OF THE ACROMIAL END.
Pass a bandage from the elbow up the back, over the dis-
location, down the front, under the elbow, up the back, over
the shoulder, across the front of the chest, under the oppo-
site shoulder, around the back, and then bind the injured
member to the chest by two or three turns of the bandage.
DISLoCATION OF THE STERNAL END.
Keep the chest thrown forward, and the shoulders back;
strap a compress over the dislocation with an adhesive
plaster. -
DISLOCATIONS OF THE HUMERUS.
PROGNOSIS.–Usually good. Occasionally reduction
is difficult.
VARIETIES.—Sub-glenoid; sub-coracoid; Sub-clavicular:
Sub-Scapular.
f
TREATMENT.
SUB-GLENOID DISLOCATION.
Anaesthetize the patient if necessary to overcome muscu-
lar contractions. While an assistant extends the arm
downward parallel with the body, the surgeon pulls the
head of the humerus toward the socket.
If alone, the surgeon may seat the patient in a chair, and
resting one foot on the chair, place the knee in the axilla,
and extend the arm over the knee.
Sometimes much difficulty is experienced in setting.
SUB-CORACOID DISLOCATION. *
The treatment is the same as for sub-glenoid dislocation.
SUB-CLAVICULAR DISLOCATION.
Use sufficient extension to free the head of the humerus
from the tendons of the biceps and coraco-brachialis, and
then proceed as in the sub-glenoid dislocation.
- SUB-SCAPULAR DISLOCATION. -
This is a very rare dislocation. Treatment is simply
extension outward and downward.
N. B.- In all dislocations, immobilize the joint for at
least two weeks. -
DISLOCATIONS OF THE ELBOW. 145
DISLOCATIONS OF THE ELBOW. -
PROGNOSIS.—Usually good. Forward dislocations
of the radius liable to become habitual.
VARIETIES.— (1) Dislocation of both bones backward, or
forward; (2) lateral dislocation of both bones; (3) dislo-
cation of one of the bones.
TREATMENT.
DISLOCATION OF BOTH BONES BACKWARD.
Place the knee in the bend of the elbow, flex the fore- .
arm, and make extension on the hand and wrist.
DISLoCATION of Both Bones Forward.
Rare. Forced flexion of the forearm and pressure will
reduce it. - - - -
DISLOCATION OF THE HEAD OF THE RADIUS,
Reduction accomplished by extension of the forearm
and pressure upon the head of the radius toward the Socket.
Dislocations of the ulna very rare.
DISLOCATION OF THE WIRIST.
PROGNOSIS.–Good. Simple dislocations of the
wrist are rare. Usually complicated with fracture of the
radius (Colles' Fracture).
TREATIMIENT.
Extension of the hand and pressure upon the displaced
bones will reduce this dislocation.
DISLOCATION OF THE FINGERS.
TIREATIMIENT.
Easily reduced by extension. Bind on a splint for a
week after reduction.
DISLOCATION OF THE THUMB.
Bend the metacarpal joint into the palm of the hand.
Press the first phalanx of the thumb backward. Pull the
thumb downward toward the tips of the fingers, flex the
thumb into the palm of the hand.
DISLOCATIONS OF THE HIP. * - - -
PROGNOSIS. — Usually favorable. Sometimes diffi-
cult to reduce. Safe to attempt reduction four weeks after
Injury.
VARIETIES.— (1) Dislocation on dorsum ilii; (2) disloca-
tion in Sciatic notch; (3) dislocation into thyroid fora-
men; (4) dislocation on pubes,
TREATMENT.
DISLOCATION ON THE DORSUM ILI1.
Anaesthetic required in all dislocations of the hip. Put
10 • . .
146 KEY NOTES OF MEDICAL PRACTICE.
the patient on his back. (1) Flex the knee and hip well; (2)
adduct the thigh; (3) rotate outward; (4) suddenly bring
limb down in a line straight with the body. -- -
DISLOCATION INTO THE SCIATIC NOTCH.
Method of reduction the same as for dislocation on dor-
sum ilii. -
DISLOCATION INTO THE THY ROID FOR AMEN.
(1) Flex the hip and knee; (2) abduct; (3) rotate inward;
(4) adduct; (5) straighten the leg.
DISLOCATION ON THE PUBES.
Same as in dislocation into thyroid foramen.
DISLOCATIONS OF THE PATELLA.
PROGNOSIS.— Usually favorable, unless there is com-
plete rotation on the axis.
VARIETIES.—Lateral, and on its own axis.
TREATIMIENT.
Lateral dislocations reduced by relaxing the quadriceps
extensor, and manipulating the patella. (1) Put the patient
on his back; (2) flex the thigh; (3) hold the knee in ex-
tension; (4) press the patella into position. If rotated, try
to reverse it by manipulation. It is not always possible.
Ruptures of the ligamentum patellae, or of the quadri-
ceps tendon, are treated by stitching the ruptured ends
together with carbolized catgut or silk. Operate under
antiseptic precautions, and do not open the knee joint.
DISIOCATIONS OF THE TIBIA.
PROGNOSIS.–Favorable in simple dislocation; usu-
ally incomplete.
VARIETIES.—Lateral, backward, and forward dislocations.
TREATMENT.
(1) Lateral dislocations reduced by extension and pres-
sure, or rotation in the proper direction; (2) backward dis-
locations reduced by extreme flexion; (3) forward disloca-
tions by extreme extension. Compound dislocations usually
call for immediate amputation.
DISLOCATION OF THE ANKLE JOINT.
PROGNOSIS.—Usually favorable. May be compli-
cated with fracture of fibula, i.e., Pott's fracture.
TREATMENT.
Simple dislocations easily reduced by extension and press-
ure in proper direction.
DISLOCATION OF THE TARSUS.
PROGNOSIS.— Guarded. Difficult to reduce.
TRIEATIMIENT.
Attempt reduction by extension and pressure. Resection
required in compound dislocations.
AMPUTATIONS. 147
AMPUTATIONS.
GENERAL CONSIDERATIONS.
PROGNOSIS.—The prognosis is influenced by (1) age;
(2) general health; (3) circumstances demanding amputa-
tion.
1. The younger the patient, the more favorable the out-
look. . -
2. Tubercular diathesis, broken-down constitutions from
disease or dissipation, cloud the prognosis.
3. Amputations after accidents, acute joint diseases, etc.,
are more formidable than in chronic diseases.
Death occurs from (1) shock; (2) ha-morrhage; (3) blood-
poisoning, etc.
OPERATIONS.
VARIETIES.—(1) Flap; (2) circular; (3) mixed skin-flap,
and circular of muscles. - -
1. Flap operations made by lateral or antero-posterior
flaps of the muscles and skin. t
2. Circular operations made by first cutting through the
skin transversely around the limb, reflecting the skin cuff,
a distance equal to one-half the diameter of the limb, and
then cutting through the muscles to the bone. Retract the
muscles as much as possible, and saw the bone.
3. The mixed operation consists in making skin-flaps,
reflecting them back to a proper point, and then making
circular cuts of the muscles.
STEPS OF AN OPERATION.
Instruments. –Amputating knives, bone saw. bone for-
ceps, artery catch-forceps, ligatures, needles and silk, an
Esmarch's bandage, or tourniquet. Have plenty of assist-
ants. - -
1. Apply Esmarch's bandage to the limb; use compres-
sion of subclavian and femoral arteries in the shoulder or
hip-joint amputations. .
2. Wash the parts thoroughly with antiseptic solution.
3. Divide the soft parts by flaps, "circular, or mixed
method. -
4. Saw the bone, removing any sharp edges with bone
forceps.
5. Search for main artery and ligate.
6. Loosen the bandage cautiously; secure bleeding arte-
ries and ligate.
7. Irrigate the flaps with antiseptic solution. *
8. Control capillary oozing by compression, by hot water,
or, if necessary, in rare cases, by solution of Sulphate of
77°07). …
148 KEY NOTES OF MEDICAL PRACTICE.
9. Wash all clots off the flaps, and stitch them together,
- after providing for drainage by inserting a drainage tube.
10. Dress the wound antiseptically.
AFTER-TRIEATMENT.
Treat shock by stimulation, giving teaspoonful doses of
brandy every half-hour.
Allay pain with Morphia, one-eighth grain doses, when
necessary. w
Treat secondary hapmorrhage by (1) elevating stump, and
using pressure; (2) by opening wound, and securing bleed-
ing vessel. jº
Treat surgical fever by Aconite.
Treat blood-poisoning by Baptisia; Sulphate of quinia,
one grain every two hours, and stimulation, giving a milk
punch every three hours. -
SPECIAL AMPUTATIONS.
AMPUTATION AT THE SHOULDER JOINT.
Mortality.—Two out of three recover.
OPERATION. ,
Lateral flaps. Have one assistant compress the subcla-
vian, by pressing it against the clavicle; another to hold
the limb; a third to be in readiness to seize arteries.
1. Make external flap to include most of the deltoid
muscle. The curve of the flap should extend from the
acromion process downward, outward, and backward, almost
to the posterior border of the axilla.
2. Open capsule, and free the head of the humerus of
muscles attached to tuberosities.
3. Dislocate the head outward; pass the knife close to
the inner side of the humerus; cut downward, and finally
ºrd, through the remaining soft parts, to make the inner
8,0.
º, Assistant should follow the knife closely during this
procedure, and grasp the axillary artery before, or, as it is
being severed. Ligate it at once, and then the vein. Next
secure and ligate the circumflex, sub-scapular, and any
other arteries. -
Complete the operation as directed in General Consider-
ations.
AMPUTATION OF THE ARM.
OPERATION.
Use flap, or circular method. Have one assistant hold
the arm. -
1. A º Esmarch's bandage.
2. Make antero-posterior flaps.
3. Hold them back with retractor, and saw the bone.
6. Secure and ligate the brachial artery.
SPECIAL AMPUTATIONS. 149
5. Loosen the bandage cautiously, and ligate other bleed-
ing vessels. -
6. Complete the operation as directed in General Consid-
erations. *
AMPUTATION OF THE FOREA.R.M.
Use the mixed method.
1. Apply Esmarch’s bandage.
2. Make antero-posterior skin-flaps, the forearm being
held between pronation and supination.
3. Make circular incision of the muscles.
4. Divide the interosseous membrane.
5. Protect the soft parts by a three-tailed retractor, and
saw the bones. -
6. Four arteries to be ligated, the radial, ulnar, anterior,
and posterior interossei.
ºplete the operation as directed in General Consider-
Cºlº,077. S.

AMPUTATION OF THE FINGERS.
Usually done by disarticulation.
I. DISARTICULATION AT THE PIHALANGEAL ARTICULATIONS.
Control haemorrhage by an elastic rubber tube tied
around the base of the finger.
1. Strongly flex the joints of the finger, and make an
incision in the crease of the knuckle, thus opening the
joint.
2. Divide the lateral ligaments.
3. Make long flap of the muscle in front of the disartic-
ulated phalanx. º
Complete the operation as directed in General Considera-
tions. ſ
II. DISARTICULATION AT THE METACARPO-PHALANGEAL JOINT.
Apply an Esmarch bandage at the wrist.
1. Make a pear-shaped incision from the knuckle around
the finger.
2. Sever the lateral ligaments of joint, and disarticulate.
Complete the operation as directed in General Considera-
tions.
AMPUTATION AT THE HIP JOINT.
Mortality.—The most formidable major operation in
surgery. About one-half the cases die.
OPERATION.
Have one trusty assistant to compress the femoral artery
at the brim of the pelvis; a second to hold and manipulate
the limb; a third to secure the arteries.
Draw the patient to the end of the table, so that the
buttocks shall project.
An abdominal tourniquet may be used.
150 KEY NOTES OF MEDICAL PRACTICE.
1. While second assistant holds the leg slightly flexed,
adducted, and rotated inward, the surgeon inserts the knife
between the anterior superior spine of the ilium and great
trochanter. The point should pierce the capsule and emerge
in front of the tuberosity of the ischium. Cut downward,
close to the bone, until third assistant can put his fingers
into the wound and seize the femoral vessels, then complete
the anterior flap, making it from seven to ten inches long.
2. Open the joint, if it was not done before, and disar-
ticulate the head of the femur; the second assistant at the
same time extending the thigh and rotating outward. -
fl 3. Finish the amputation by making a short posterior
8,
P. * ... •
4. Ligate the femoral, profunda, obturator, and sciatic
arteries.
Complete the operation as directed in General Considera-
tions.
AMPUTATION AT THE THIGH.
The operation resembles that of the arm.
Ilateral flaps are preferable at the lower third.
The circular method may be used.
The arteries to be ligated are femoral, profunda, external
circumflex, and anastomotica magna.
AMPUTATION OF THE LEG.
Mixed method very serviceable. In sawing the bones,
complete the division of the fibula first, and bevel off the
sharp anterior edge of the tibia. gy
AMPUTATION AT TFIE ANKLE.
Syme's Operation. — Disarticulation at the ankle
joint.
1. Make incision from half an inch below the inner mal-
leolus, across the dorsum of the foot to the outer malleolus.
2. From the ends of this incision make a second, running
downward and slightly backward under the heel.
3. Carefully dissect the os calcis, and disarticulate at the
ankle.
4. Ligate the anterior tibial, and both plantar arteries.
AMPUTATION OF THE FOOT,
Chopart's Operation.— Disarticulation between astra-
galus and the os calcis on one side, and Scaphoid and cuboid
bones on the other.
1. Short dorsal flap, beginning from prominence of
scaphoid to one inch behind the fifth metatarsal.
2. Disarticulate. - -
3. Make long plantar flap extending to the roots of the
toes. - -
4. Ligate the dorsalis pedis, plantar, and digital arteries.
Complete as under General Considerations.
SPECIAL AMPUTATIONs—TRACHEOTOMY. 151
Lisfranc's Operation.— Disarticulation between the
tarsus and metatarsus.
1. Dorsal incision from one inch before prominence of
scaphoid to base of fifth metatarsal.
2. Disarticulate; remembering that the second metatarsal
is back about half an inch.
3. Make long plantar flap.
Complete as directed under General Considerations.
AMPUTATION OF THE TOES.
Operations similar to those on the fingers.
CUT THROAT.
PROGNOSIS.— Guarded. If an important vessel is
injured, death is almost immediate. Death may occur pri-
marily, from (1) ha-morrhage; (2) Suffocation; secondarily,
from (1) blood-poisoning; (2) pneumonia.
TREATMENT.
1. Ligate the bleeding vessels.
2. When the larynx or trachea is injured, remove clots,
and insert a tracheotomy tube, if necessary. t
3. Provide for free drainage, and stitch the edges
together.
4. Keep the head flexed on the chest.
5. Feed vigorously. If the oesophagus is injured, use a
stomach tube.
6. Watch the patient, and prevent suicidal attempt.
FROST BITES.
Warm the frosted members gradually. Avoid hot water
and fires at first. Use friction with cold flannels, furs, etc.
After circulation is restored, treatment the same as for
burns.
Dress with carbolized oil (Carbolic acid, 1 oz., Linseed
oil, 1 pint), and wrap in cotton. If gangrene follow, wait
for line of demarcation, and amputate.
TRACHEOTOMY.
Indications.— (1) foreign bodies in trachea, bronchi
or pharynx; (2) scald of glottis in children; (3) prelimi-
nary to extensive operations about the jaws and throat
(administer anaesthetic through tracheal tube); (4) croup
and laryngeal diphtheria, with laryngeal dyspnoea, indi-
cated by presence of considerable exudation in larynx, and
respiration so difficult that there is sinking in of the
sternum and of the supra-clavicular spaces with each inspi-
ration. Contra-indicated.—Auscultate posterior chest — if
OIle ºns seriously obstructed, tracheotomy is contra-indi-
cated. -
152 REY NOTES OF MEDICAL PRACTICE.
Instruments.—Scalpel, curved bistoury, tenaculum,
two strabismus hooks, two or three catch-artery forceps,
sponges, tube with tapes. - -
Chloroform may be given if time permit. Local anaes-
thesia by ether spray or by Cocaine. If no anaesthetic is
used, wrap the child in a shawl to secure the limbs.
OPERATION.
Place the patient on a firm table in front of a good light;
put a small, firm pillow (quart bottle rolled up in a towel
will answer) under his neck to make the trachea prominent.
The operator standing on the right side of the patient
seizes the trachea between the thumb and finger of the left
hand and fixes it until exposed by the incision. The incis-
ion should be free, extending from cricoid cartilage, from
one and one-half to two or more inches downward, includ-
ing integument and cellular tissue. It is to be deepened by
successive cuts, or by hooking of tissues aside ...? the tra-
chea is reached, the operator keeping strictly in the median
line. -
The trachea reached, four or five rings should be cleared
by blunt hooks or handle of scalpel. The operator then
hooks the tenaculum into the trachea at the highest point
exposed, and making traction upward (now for the first
time releasing the trachea from the grasp of his left hand),
with the sharp bistoury cuts from below upward a sufficient
extent of trachea to admit the canula. The wound may be
held open with the blunt hooks until, by suction, the tra-
chea is cleared of blood, mucus, or other foreign matters.
The outer tube may then be inserted, and secured by tying
tapes about the neck. The inner tube, slightly moistened
with glycerine, may be put in place, the opening covered
with several thicknesses of gauze, to filter the air, and the
patient placed in bed. The tube should be large enough to
permit quiet breathing.
During the operation the bleeding vessels may be seized
with catch-forceps, which are allowed to fall toward the
sides of the neck, making lateral traction. Free haemor-
rhage should be checked by forcipressure, if time be lim-
ited, or torsion, if not, before trachea is opened. General
oozing, from congestion, is best checked by opening of
trachea relieving congestion, and by pressure of canula.
Should thyroid isthmus appear in track of incision, hook
upward or downward, or incise it.
After operation, the inner tube must be removed often,
and thoroughly cleansed, the small bristle brushes used for
feeding-bottles answering well; or, a stiff feather, properly
trimmed. -
If operation be made for foreign body, the trachea may
be held open and the body extracted by suitable forceps; if
this is not feasible, insert tube and wait. º
HERNIA — HERNIOTOMY. 153
HERNIA.
Reduction.—Taavis.-Anaesthetize the patient; place
him in Supine position with legs drawn up. Resisting
forces. tightness of constricting ring, and swelling of
strangulated viscus, Manipulate the hernia as nearly as
possible in the line of axis of the ring — compress gently,
but steadily, for a long time. While keeping up pressure
with one hand, with finger and thumb of other manipulate
the neck of the tumor back into the abdomen. Effort may
be made to dilate the constriction with the finger at the
internal abdominal ring. Pass the finger along the inguinal
canal, carrying the integument before it until the constrict-
ing ring is felt, which is generally easily done; the finger is
then insinuated into the opening, and if the band of oppos-
ing fibers does not readily yield, gentle pressure is made
against the upper border of the ring until it is felt to give
Way, when a resort to gentle taxis will often be successful.
When reduction occurs the bowel goes back suddenly, with
a gurgle. Aspiration by No. 1 needle occasionally facili-
tates reduction after failure of gentle taxis. Or, give the
patient twenty minims Laudanum, place him in a warm
bath for twenty minutes, then between warm blankets, and
try taxis.
Taxis should be gentle and thorough, and tried only once before
resorting to operation.—Adams.
Unskillful taxis is a more frequent cause of death than the knife.
—Hamilton. -
Indications for Operation.— Symptoms of intestinal
obstruction with an irreducible hernial protrusion.
HERNIOTOMY.
Instruments.-Scalpel, forceps, director, artery for-
ceps, ligatures, retractors, hernia director, hernia knife,
Sponges, and accessories. -
Shave the parts and empty the bladder. Patient anaes-
thetized, supine, thigh slightly abducted and rotated out-
ward. Note positions of spine of pubes, Poupart's liga-
ment, femoral artery. Make incision free enough to give
access to stricture. Divide the coverings of the sac layer
by layer, on director. Tie and cut superficial epigastric
artery, if exposed. When sac is exposed reduce the hernia
without opening, if possible. If the hernia be still irreduci-
ble, raise a small fold of the sac at the most dependent
point and make a small opening, from which a little fluid
will escape; introduce the director, and on this enlarge
IIlCISIOI).
Division of Stricture.— If point of stricture is at
eacternal ring, make the incision upward and outward; if at
%utermal ring, insinuate the left index finger, and pass the
154 REY NOTES OF MEDICAL PRACTICE.
finger nail under the stricture; pass the hernia knife flat,
along the palmar surface of the finger, through the stric-
ture, turn the edge of the knife directly upward, and cut a
"mere notch — one-eighth or one-quarter inch — by pressure
of the knife, not by sawing motion. The hernia may now
be returned by gentle manipulation.
If the gut be gangrenous or ulcerated, an artificial anus
7must be formed. If the omentum be inflamed, tie it with a
stout ligature, and cut off the inflamed portion.
After reduction of the hernia, dress the wound aseptically,
and apply compress and bandage. Provide for drainage.
AFTER-TREATMENT.
Rest in bed; liquid food till the bowels act; enema if
the bowels do not act in ten days. Peritonitis, treat as from
other causes.
TREATMENT OF WOUNDS.
(ANTISEPTIC METHOD–LISTERISM.)
1. Check hamorrhage by torsion, acupressure, forcipres-
sure, or catgut ligature, cut short.
2. Cleanse wound of all foreign bodies.
3. Irrigate with antiseptic solution—Carbolic acid (1:40),
Prince's Lottom. -
4. Provide drainage by carbolized horsehair, glass-silk,
catgut, or perforated rubber tube. .
5. Bring edges into exact apposition by carbolized silk or
gut sutures.
6. Apply antiseptic dressing.
The principles of wound dressing are — (1) make wound
aseptic, and (2) preserve it so.
The first principle may be carried out in operation
wounds, by allowing nothing (fingers, instruments, etc.)
to touch the parts unless previously disinfected by thorough
Washing in an antiseptic solution; the second, by use of
Some form of dressing which shall prevent access of un-
purified air to the wound. Taking an amputation wound
for illustration, the dressing may be efficiently made as
follows: The wound surfaces having been thoroughly disin-
fected, drainage provided, and sutures adjusted, the line of
the wound, and half an inch or more of the surface on each
side, are covered with Iodoform dusted on thickly; over
this is placed a strip of aseptic oiled silk, perforated;
directly on the oiled silk is placed Lister's antiseptic gauze,
eight layers wrung out of 1:40 Carbolic lotion, a layer of
mackintosh, a top layer of dry gauze, and a bandage evenly
and firmly applied. Drainage tubes are to be cut off
flush with the skin, and secured, if in danger of slipping,
by transfixing the end with a safety pin, at right angles to
the wound.
CONCUSSION OF THE BRAIN. 155
In a large percentage of cases there will be no necessity
for changing the first dressing for four or five days, when
drainage tubes may be removed, and the dressings repeated.
In cases where wounds are not inflicted by the surgeon
the same method of dressing is to be followed, after
thoroughly disinfecting the wound by irrigation with Car-
bolic lotion (1:20 or 1:40). Always provide free drainage.
Where there is tension on wound edges, relieve by deep
sutures adjusted at some distance. Use deep sutures, pref-
ºy of silver wire, fastened by means of buttons at each
€11(1.
If, after removal of a tumor (e.g., mammary gland) deep
cavities exist, under the flaps, apply pressure by pads of
gauze, so adjusted as to keep the deep portions in exact
apposition. Complete immobilization of wound necessary.
Other antiseptics may be used — Boracic, or Salicylic, acid;
Boro-glyceride; Naphthaline; Corrosive sublimate (1:1000)
or Terebeme.
Under this, or any efficient antiseptic method, wounds heal by first
intention, patients are free from fever, and cases pursue an aseptic
course.—Adam.8.
CONCUSSION OF THE BRAIN.
DIAGNOSIS.— Three stages. (1) Collapse. Feeble
pulse; feeble respiration; pallor of skin; cold extremities;
dilated pupils. Duration of first stage, half an hour to
three hours or more. (2) Reaction (vaso-motor paresis).
Patient restless, moans, turns on his side, draws up his
knees, vomits. Can be roused, and will answer questions.
Duration — several hours. (3) Sleepy Stage. Pulse re-
laxed, full, irregular; skin warm, even hot; face flushed;
pupils contracted. Patient overpowered with sleep, from
which it is difficult to rouse him. Duration — a day to a
week. -
At any time the presence of symptoms of non-symmetrical
paralysis — weakness of one limb, one side of the face, a
single eye-muscle — indicates more than concussion, there is
laceration or contusion. Enuresis, or prolonged retention,
has like significance.
PROGNOSIS.— Generally favorable.
TIREATMENT.
Early, put the patient in a comfortable position, and
maintain the heat of the body by warm blankets and other
means. Give no stimulants. In the third stage, give a
non-stimulating diet; keep the patient quiet, and attend to
the bowels and bladder. Remedies, Arnica and . Opium.
During compalescence, let the patient be very quiet, espe-
cially avoiding all mental effort.
156 KEY NOTES OF MEDICAL PRACTICE.
COMPRESSION OF THE BRAIN.
DIAGNOSIS.— Symptoms: Complete insensibility;
j. one or both, dilated; respiration labored, stertorous;
pulse full and slow ; skin warm and moist; sometimes strabis-
mus; often hemiplegia; paralysis of sphincter ani; retention
of urine.
PROGNOSIS.— Grave.
TREATMENT.
Depends upon cause, whether depressed bone, extrava-
sated blood, inflammation, suppuration, or foreign body.
Depressed bone calls for the use of the trephine (page 132);
also, extravasation, when from injury and known to be
accessible. In all cases —(1) dark room; (2) head high; (3)
head shaved; (4) head cool; (5) low diet; (6) keep the
bowels open, and watch the bladder.
IDIFFERENTIAL IDIAGNOSIS.
CONCUSSION. COMPRESSION.
1. Comes on instantaneously, 1. Comes on gradually, and
and passes off gradually. tends to get worse.
2. Insensibility, from which 2. In 86m8ibility, total.
patient can be partly aroused.
3. Re8piration feeble, like that 3. Re8piration stertorous, slow,
of a person in a faint condition. and puffing.
4. Pulse weak, irregular, and 4. Pulse full, slow, and labored.
frequent.
5. Special senses dulled. 5. Special senses paralyzed.
6, Pupils variable; usually sen- 6. Pupils, one, or generally
sitſve to light. both, widely dilated. *
7. Stomach irritable; nausea 7. Stomach insensitive.
or vomiting, with reaction.
8. Bowels relaxed, but sphinc- 8. Bowels torpid, but sphincters
ters not paralyzed. may be paralyzed.
9. Bladder can expel water. 9. Bladder paralyzed; conse-
quent retention.
ABSCESS.
LEADING REMEDIEs.
Hepar sulph.--To avert threatened suppuration; or,
when suppuration is inevitable, tumor hard, hot, swollen,
with throbbing pains.
Mercurius.--To avert suppuration. Glandular abscess,
with nocturnal pain; tumor hard, shining, red, beating, and
stinging.
Belladonna.— Bright redness of affected part, burning,
throbbing pain, erysipelatous appearance.
ABSCESS—LOCAL TREATMENT OF ULCERs. 157
Silica.-Fistulous openings, hard to heal; discharge
thin and watery; abscess of bone; chronic abscess.
Calcarea carb.-After suppuration completed, to pro-
mote healing; strumous abscess. -
Sulphur.— Profuse discharge; tendency to recur; ema-
ciation; hectic; strumous abscesses.
SPECIAL REMEDIES.
China. – During excessive discharge.
Ledum.— From injuries or splinters.
Arsenicum.— Fetid, sanious discharge; or threatened
gangrene. -
Mezereum.—Abscess in fibrous or tendinous structure,
or from abuse of Mercury.
Rhus tox. —Abscess of axillary or parotid glands; dis-
charge thin and sanious.
GHENERAL MEASURES.
Remove splinter or other foreign body which irritates;
cover with poultice until “ripe’’ for lancing; open abscess
at most dependent point, as soon as pus has formed. All
abscesses of size require drainage after incision. Deep-
Seated abscess, in proximity to, or underlying, important
structures, blood vessels, etc., may be opened by Hilton's
method, i.e., incise the skin, push the grooved director
through the tissues toward the purulent collection; as soon
as pus issues along the groove of the instrument, pass the
dressing or polypus forceps; open them, and withdraw, thus
making a free opening for the discharge, without endanger-
ing the vessels. Labarraque's Solution (Liquor Soda, Chlo-
7'inatae), one part to ten of water, is an excellent stimulant
for old abscesses and sinuses.
Chronic abscesses should never be opened except under
strict antiseptic precautions.
In Whitlow, or abscess beneath periosteum, lance clear to
the bone, early. In theeal abscess, lance in the middle lime,
to avoid digital arteries, which run along the sides of the
finger.
Occasionally, cure of extensive abscess has followed repeated aspi-
ration.—Adams.
LOCAL TREATMENT OF ULCERS.
HEALTHY.
Cleanliness; dress with Calendula lotion (3j to 3 ij warm
water); protect from external irritation.
UNEHEALTHY.
Indolent.— Remove source of irritation; remove fungus
granulations by knife or caustic Argentum nit.; stimulate the
surface of the ulcer with Carbolic ointment (3j to 3.j Vase-
158 KEY NOTES OF MEDICAL PRACTICE.
*
line), or powdered Iodoform. For oºdema of edges, scarify,
or use poultices. Apply rubber bandage. METHOD.—After the
ulcer has been thoroughly cleansed (preferably by an antisep-
tic solution), if upon the leg, apply a bandage from the toes
up, with just sufficient tightness for each turn to hold the one
preceding without reverses; dress twice a day. Healthy
action being established, treat as healthy ulcer, or, if the
extent be large, hasten cicatrization by skin-grafting.
Irritable.— Keep part at rest; apply hot water by com-
ress or irrigation; dress with amodyne poultices — hops or
ſºamm ; apply caustic thoroughly once; do not strap or
ll]Cl.
Inflamed.— Keep the part at rest and elevated; dress
with antiseptic poultices — Carbolic, Charcoal, Sodium and
Zinc chlorides; avoid compression and caustics.
Sloughing.— Occurs in debilitated and starved cases.
Treat constitutional condition; build up general health by
good, nourishing food, and tonics. Local.— Same as for
inflamed, unless very active, when Bromine (pure Bromine
one drachm, to eight ounces of water) may be employed.
IREMEDIES.
Arsenicum.— Ulcer inflamed ; raw-looking surface,
which is red and hot, and bleeds on slightest touch; thin
discharge, mixed with blood; edges of Sore hard and irreg-
ular; intense burning pain.
Lachesis.-‘‘Irritable” ulcer; phagedienic and slough-
£ng ulcer; threatened varicose ulcer; large ulcers, tending
to extend rapidly, surrounded by small ulcerations or pus-
tules; surrounding skin presenting mottled, dark-blue, or
purple appearance. ..'.
Sulphur.—Excessive itching, burning, gnawing pains;
bleeds easily; secretion thick yellow, or thin fetid; margins
elevated, and surrounded by pimples; considerable adjacent
swelling, and discoloration of skin.
To begin the treatment of all chronic ulcers.-Jah?". -
Mercurius.-Deep ulcer; tendency to spread; discharge
thin and offensive.
Belladonna. –The surrounding skin is the seat of
chronic inflammation, of erysipelatous appearance.
Eali bi- Deep ulcer of leg, with hard base and over-
hanging edge. t
Mezereum.—“Mercurio-syphilitic ulcer of lower ex-
tremity.”—Dunham. -
Sanguinaria.— Old, indolent ulcers, with callous edges,
and ichorous disgharge.
Hamamelis. –Varicose ulcers. "
Phytolacca.-Ulcerations of mucous membranes.
Scrofulous Ulcers. —Caldarea carb., Silica, Sulphur.
TREATMENT OF GANGRENE–CARBUNCLE. 159
TREATMENT OF GANGRENE.
Traumatic.— In lacerated and contused wounds of ex-
tremities; bones badly crushed; large vessels torn ; limb
generally disorganized; if gangrene feared, amputation
should at once be practiced.
In case of gangrene of an extremity, after attempt being
made to save it, amputate at once, and in all varieties of
traumatic gangrene where the limits of the disease can be
well defined, and the whole extremity is involved. Super-
ficial slowghs are not to be taken for entire destruction of
the limb. The extent of destruction of tissue being small,
bring about speedy separation of slough by poultices and
hot dressings. Remove dead pieces, as they loosen, with
scissors and forceps. During sloughing, use locally antisep-
tic poultices, and carbolized hot-water dressings. During
local reaction, no pressure is to be used on injured part.
Gangrene from extreme heat, cold, or escharotic, treat
on expectant plan till the line of demarcation is formed;
then amputate, if entire thickness of the limb is involved.
Gangrene from infiltration of urine in perimeo, imme-
diately make free incisions to relieve tension, and give free
vent to collections.
Gangrene from arrested circulation, after ligation of
arterial trunk, apply warmth by cotton, etc., and keep up
patient's strength until collateral circulation is established.
CARBUNCLE.
LEADING REMEDIES.
Arsenicum.— Malignant carbuncle; great prostration
and restlessness; small, irregular pulse; cold sweats; diar-
rhoea and fever.
Bryonia.-‘‘Hastens the process of suppuration, reduc-
ing the period many days.”—Jahr.
Belladonna. – Smooth, bright-red swelling, tense skin.
Apis. – For extension of erysipelatous swelling.
Lachesis.-- Parts look purplish; low, inflammatory con-
dition; blood-poisoning.
Arnica.- In repeated doses, early, sometimes disperses.
Silica.-After suppuration, to check excessive ulcera-
tion, and promote healthy granulation.
GFIENERAL MEASURES.
A commencing carbuncle may be successfully aborted by
injecting into its center, by hypodermic syringe, several
drops of pure Carbolic acid.
Iodine, locally, has dispersed. Also lime water and
Camphor. Early strapping beneficial; encircle with tightly
160 REY IN OTES OF MEDICAL PRACTICE.
applied, broad, adhesive straps, which will draw the edges
together; remove straps daily after the discharge has begun,
and cleanse the surface; keep well poulticed; not necessary
to incise unless the tension is extreme. After suppuration
is established, dress with Carbolic ac. and Glycerine; if
gamgrene threaten, dress with powdered charcoal, frequently
renewed—every three to six hours.
Never use the knife in carbuncle complicating diabetes.
DISSECTION WOUNDS.
Suck the wound immediately, and apply Carbolic acid, or
cauterize with Nitrate of silver. If the wound becomes
inflamed, dress with hot poultices; internally, Arsenicum ;
if great prostration, give Carbonate of Ammonia.
INSECT STINGS.
For stings of bee, Fº wasp, etc., apply Aqua,
ammonia, or tincture of Ledum pal; moist clay poultice, if
nothing else at hand; remove sting when visible.
SNARE BITES.
Tie a broad ligature tightly about the limb, above the
wound, so as to check circulation; suck the wound, and cau-
terize with Nitrate of silver, strong Carbolic acid, or a nail
heated red-hot.
Apply ligature, and, as soon as possible, inject with
hypodermic syringe a solution of Permangamate of potash
(1:100), as nearly in line of penetration of the serpent's
tooth as possible.
The Emperor of Brazil has recently bestowed on Dr. Lacerdo
$20,000, for his discovery of this antidote.
Stimulate by injecting Ammonia into the veins, or by its
internal administration. Keep the patient quiet, and con-
serve the strength. Artificial respiration must be employed
if the breathing fall to ten per minute.
The ligature must be occasionally slackened, that the
poison may but slowly enter the system, and the limb not
suffer from complete stoppage of circulation for too long a
time.
SPRAIN.
Give the part absolute rest; immerse immediately in
hot water, until pain, and swelling are reduced; after-
ward, dress with cloth wrung out of lotion of Rhus,
Aconite, Arnica, or Hypericum, and covered with oil silk.
After the pain has been lessened by immersion in hot water,
envelop the part in absorbent cotton, and apply a bandage
firmly, exerting through the cotton uniform elastic compres-
sion of the parts,
HYDROPHOBIA — BURNS AND SCALDS. 161
Arnica.-Contused appearance.
Rhus.--When tendons are involved.
Aconite. — Heat, redness, and swelling.
Hypericum.—Nerves involved, or lacerated.
HYDROPHOBIA.
Belladonna.—As soon as a person has been bitten, ad-
minister Belladonna..in a low dilution, and keep him under
its influence for at least six weeks. Also administer it if the
characteristic convulsions Set in at any time, with great
burning and accumulation of frothy mucus in the throat,
constricting sensation when attempting to Swallow, redness
and bloatedness of the face, foaming at the mouth, and
tetanic convulsions.
It is only in the largest quantities that its remedial power has been
most frequently observed.—IIughes. - -
Stramonium.—Convulsions attended by frightful
dreams; agitated sleep; . sudden shrieks; insensible and
dilated pupils; disposition to bite and tear things with the
teeth.
Reputed a specific for the disease in China.-Hughes. • -
Scutellaria.-Nightly restlessness; frightful dreams;
rapid and unequal action of the heart, with pain, tremu-
lousness, and twitching of the muscles. -
Has been found very successful in many cases, both as preventive
and curative.—Lawrie. - - -
GENERAL MEASURES.
Immediately suck the Wound (do not let it come in con-
tact with an abraded surface of the mouth), wash it out with
a stream of warm water and apply freely pure Carbolic acid;
or, actual cautery may be applied. Give Belladonna treat-
ment.
IN ATTACK.—Vapor bath, or Turkish bath, temperature
107° F., said to have been successfully used. Give the
patient bits of ice. - -
BURNS AND SCALDS.
CLASSIFICATION.
FIRST DEGREE.— FIyperacmia; erythema; irritation or
inflammation of the skin, without vesicles.
SECOND DEGREE.—Vesication; inflammation of the skin;
formation of vesicles and bullae.
THIRD DEGREE.— Eschars; gangrene, Superficial or deep;
involving the skin or any other subcutaneous tissues; car-
bonization of a part, or of the entire body.
PROGNOSIS.–If one-half, or even one-third, of the
surface is burned or scalded, death is inevitable. In other
11 -
162 REY NOTES OF MEDICAL PRACTICE.
cases, result depends on location, intensity of heat, nature
of medium, age, temperament, and constitution of patient.
TREATMENT.
Local. —Apply immediately one of the following:
Carbolized Vaseline (Carbolic acid five per cent.).
Carbolized Olive Oil (11 parts oil to 1 part liquid Car-
bolic ac.). -
Flow, and lard, equal parts worked together.
White lead paint. Equal parts Lönseed oil and Lime
water.
Bicarbonate of soda. Fine wood charcoal. -
Dress to exclude air and keep up warmth of the part.
Probably no dressing equals the carbolized Vaseline.
Use that which can be most quickly obtained. Spread on
a thick layer, cover with gauze and Cotton-Wadding, and
bind lightly. Leave first dressing on as long as possible—
until offensive nature of discharge or discomfort demand its
removal. Dress in such a way as to facilitate future dress-
ings bit by bit. Do not expose too large a surface at once.
Blisters should be pricked, and contents evacuated, leaving
the skin as a protective covering. In dressing, irrigate with
carbolized water, a drachm to the pint.
Iodoform, sprinkled on, relieves the pain; put other
dressing over it.
In eactensive burns or scalds, use continuous tepid bath,
90° to 100° F. In burns or scalds of the extremities,
immersion of the part in a tepid bath gives great relief.
During cicatrization, prevent deformity by position,
attained by splints and mechanical appliances. Employ
skin-grafting to promote healing of ulcers.
GENERAL.-Treat shock by artificial warmth, rest, and
repeated doses of Camphor. For depression, Ammonia as a
stimulant. In exhaustion from profuse suppuration, give
mourishing food.
Rhus.- Burns of first and second degree.
Rali bi...—Indications of ulceration of duodenum.
Cantharis.—Vesication; scanty and high-colored urine.
HAEMORREIAGE.
Ligature.—Cut down upon the bleeding point, and tie
above and below the wound. In case this would involve a
large and deep incision, tie “in continuity.” Materials:
silk, hemp, catgut. Instruments: forceps, retractors,
directors, artery forceps, tenaculum (sometimes, aneurism
needle). Secure the vessel, tie with reef knot, and, unless
catgut used, one end of the ligature must be left hanging
out of the wound. The ligature must be smooth, round,
strong, and well waxed. -
HAEMORREHAGE — EPISTAXIS. - 163
Torsion.—Draw out the vessel and make three or four
sharp rotations of forceps. In large arteries continue the
rotation till sense of resistance has ceased, but do not twist
off the ends. In small arteries the number of rotations is of
no importance, and ends may be twisted off or not.
Acupressure.— Compress vessel between needle and
loop of wire, like the common hare-lip suture. In arteries
of medium size, the needle may be removed in four hours.
Adapted to scalp wounds, and when varicose veins burst.
Cautery. — For haemorrhage from the neck of the womb
after operation.
Compression.— By tourniquet, Spanish windlass, or
digital. w
CAROTID.— Press along inner edge and lower half of
sterno-mastoid muscle. .
SUBCLAVIAN.— Push firmly with the thumb in the sub-
clavian triangle behind the sterno-mastoid.
BRACHIAL.-Inner border of coraco-brachialis and biceps.
FEMORAL.— Under Poupart's ligament, midway between .
anterior superior spinous process of the ileum and the
pubes. . . -
ABDoMINAL AoRTA.— Short distance above and to the left
of the umbilicus. - - .
In wounds of the palm, or where many inosculating
vessels are injured, pack the wound tightly with picked lint
or other available substance, and apply a firm bandage.
Put the limb upon a splint to insure perfect rest.
Flexion.— In wounds below the shoulder, put arm-pad
or roll high up in tile axilla, and bind the arm to the side.
In wound of palmar ſtreh, put compress in bend of elbow,
flex the forearm on the arm, and pronate the hand. In
haºmorrhage from plantar vessels, put a pad in the popliteal
space, flex the leg on the thigh, and the thigh on the abdo-
men. Or, hang the leg, in the bend of the knee, over a
sharp chair back. - .
Styptics.-Ice, applied directly to bleeding surface.
JPersulphate of iron (Monsel's solution); Tannic acid, Gallic
acid, Matico, Alum. Water 120° F. -
GENERAL MEASURES. -
For faintness and weakness caused by loss of blood—
horizontal posture; absolute rest; Ammoniſt; Ether; wine.
Esmarch's bandage, to drive blood from limbs to vital
centers. Transfusion.
EPISTAXIS.
when slight, apply pressure to cheeks, at their junction
with the alae nasi; use nasal douche of hot water, 110° F.;
164 KEY NOTES OF MEDICAL PRACTICE.
ice to the nape of neck; use Tammim as snuff; use styptics
in solution — Alum, Iron persulphate. Enjoin quiet on the
part of the patient; keep the neck straight.
Plug the mostril if the hamorrhage is severe; pass a loop
of double thread, by means of a catheter or Bellocq's canula,
along the floor of the nose to the pharynx, seize the loop and
fasten it to a plug of lint or cotton already attached to a
string, which is brought out of the mouth and retained for
withdrawal. By means of the double thread in the nose,
draw the plug into the posterior nares, and tie the ends of
the thread over a plug inserted into the nostril in front.
Remove by the string through the mouth when no longer
needed. -
TJRETHRAL HAEMORREHAGE.
Locally, use cold applications, hot injections, Hamamelis,
or, introduce catheter, and apply compression by means of
a bandage. If from an external, longitudinal wound, make
close coaptation by fine sutures, and draw the urine with a
small catheter four or five times a day. In transverse
wound, after ha:morrhage is checked, introduce sound at
intervals during the healing process, to prevent stricture.
In haemorrhage into tissues about deep urethra, make free
incisions to relieve tension, use antiseptic irrigation, and
keep urethra patent by use of catheter or sound.
RECTAL HAEMORRHAGE.
When beyond control by use of ordinary remedies, if
from a vessel within reach, apply ligature; if general and
styptics and hot water fail, use tampon. To plug properly,
take cup-shaped sponge or wad of cotton, pass a stout
double ligature through the middle, and pass this into the
bowel beyond the source of the haemorrhage. Pack the
rectum below with pledgets of cotton, and then draw threads
tight, and fasten them over a compress of cotton placed
externally, thus making even pressure in all directions. A
stiff catheter or tube may be placed before plugging, to
allow escape of flatus.
UTERINE HAEMORRHAGE.
Method of plugging vagina. – Put patient in Sims'
position; with left forefinger, or Sims' speculum, retract
posterior vaginal wall; with pledgets of cotton, or free end
of roller bandage, pack vagina posteriorly to cervix, then
anteriorly, then centrally, until firmly filled by plug, taking
care not to obstruct urethra. After sufficient time has
elapsed, remove piecemeal, patient in Same position.
VENESECTION — SHOCK. 165
Or, introduce large, moist sponge through a speculum.
Do not let tampon remain without change more than three
or four hours.
VENESECTION.
Instruments.- Bleeding-tape, or bandage; bowl; lan-
Cet; pad; sponge and water.
Patient recumbent. Apply tape to middle of upper arm,
tight enough to congest veins, but not to affect pulse. Hang
the arm down a little while; then choose the spot, usually
the median basilic vein (look out for brachial artery); pass
the lancet gently and obliquely into the vein, and enlarge
the opening without deepening the incision. If necessary,
make the patient work his hand, opening and shutting it;
or grasp some small object. When sufficient blood has
been withdrawn, remove the bandage from the arm, apply
a pad to the wound, and bandage it by figure-of-eight. Wear
the arm in a sling for several days.
SHOCK.
Loosen everything about the neck and chest that can
impede the respiration; body recumbent, head low. Main-
tain temperature of body — warm room; warm blankets;
hot bottles to the extremities, between the thighs, and in
the axillas; hot compress over cardiac region; warm affusion
to head; frictions. If much blood has been lost, and the
vaso-motor mechanism is not paralyzed, employ transfusion.
Stimulants, not too freely; brandy, Ammonia, Ether. Do
not i. fluids down a patient who cannot swallow. Ether
has been used with great success. Inject, hypodermically, -
thirty minims every five or ten minutes until the patient is
able to swallow, then substitute brandy and Ammonia, by
the mouth. In the absence of Ether, employ intra-venous
injection of Ammonia, ten minims of liquid Ammonia fortis
— degree of dilution not material.
Digitalis.-Ten minims, hypodermically, as a cardiac
stimulant, very beneficial.
If there is a mangled limb to come off, and shock is
slight, give Ether, and operate. If the shock is so grave
that reaction is doubtful, wait several hours till the pulse
begins to regain strength. If the temperature is below 96°
F., do not operate.
When reaction sets in, give warm, nourishing, liquid
food, small quantities, frequently repeated— coffee and
Scalded milk, equal parts; milk, beef tea, Soup.
166 KEY NOTES OF MEDICAL PRACTICE.
ADMINISTRATION OF ANAESTHETICS.
A. C. E. Mixture. • - -
Alcohol (by measure), - - - - - 1 part;
Chloroform “ - - - - - - 2 parts;
Ether & & - - - - - - 3 parts.
Use much as you would Chloroform. Make it afresh just
before it is required for use. This is the favorite anaesthetic
at Guy's, and at most of the London hospitals. It is almost
as safe as Ether, while being free from many of the latter's
objectionable qualities.
Chloroform.— Commence gently; limit dose to smallest
quantity capable of producing insensibility — fifteen drops
on a towel to begin with; permit free access of air.
Ether.—Two drachms to begin; no air; push vigor-
ously, especially in the stage of excitement. -
. Precautions.— Do not push an anaesthetic too much at
first ; watch the quantity used; allow plenty of air with
Chloroform ; have provision for admitting a free supply of
fresh air; carefully watch the pulse and respiration,--
especially the latter; have dressing forceps ready to grasp
the tongue. Do not let a flame come near Ether vapor.
TREATMENT OF DANGEROUS SYMPTOMS.
* Give fresh air; pull the tongue well forward; if any
difficulty, the tongue may be drawn from off the glottis by
placing the thumbs alongside of the nose, and the index
fingers behind the ascending ramus of the lower jaw, and
drawing it forward; clear the throat of blood, or vomited
matter; hot affusions to the head; invert the patient; arti-
ficial respiration; inhalations of Nitrite amyl. Galvanism —
One pole on the throat, near the phrenic nerve, the other at
the pit of the stomach; or, through the skin at the sides of
the nose.
LOCAL ANAESTHESIA.
Cocaine.—A solution of the Hydrochlorate of cocaine up
to five per cent. can be made without the addition of an acid.
The Solution is always cloudy, but when filtered becomes as
clear as distilled water. The addition of an acid is to be
avoided, as even a very small quantity causes a strong burn-
ing sensation. - - .
For operations on the eye use a two-per-cent. Solution.
With the patient's head thrown back a little, depress the
LOCAL ANAESTHESIA – HARE-LIP. 167
lower lid while the patient looks up. Into the cul de sac
thus formed, instill two minims of the solution. Now have
the patient alternately look down and up two or three times,
when the cornea will become covered with the solution.
For the removal of foreign bodies, one such instillation is
generally sufficient, anaesthesia being sufficiently complete
at the end of from three to five minutes. d º
If more complete anaesthesia is desired, repeat this in-
stillation once or twice, at intervals of from three to five
minutes. Three instillations will produce anaesthesia lasting
for about twenty minutes, sufficient for almost any opera-
tion.
Use in almost all operations on the eye – removal of for-
eign bodies, cauterization of corneal ulcers, puncture of
cornea for paracentesis, tattooing cicatrices, iridectomy, ope-
ration for pterygium, and even for removal of cataract.
In many minor surgical operations, also, it is all-sufficient.
Inject under the skin four minims of a four-per-cent. Solu-
tion, and repeat as necessary. Avoid producing Constitu-
tional symptoms.
Local anaesthesia may also be produced by the applica-
tion of two parts of crushed ice to one part of salt, in a
gauze bag. Do not freeze the part. Ether spray is also
effective. - .
HARE-LIP.
Best time to operate, third to fifth month of infancy.
Contra-indicated — during dentition or ill health. Chloro-
form unnecessary. Apply small bag of pounded ice and salt,
or inject a solution of Cocaine into the edges of the fissure,
till local anaesthesia is induced. Child held in assistant’s
lap. Secure the limbs by rolling him lightly but firmly in a
shawl. Assistant to check hamorrhage by holding each side
of the upper lip between finger and thumb. Begin by sepa-.
rating, with the knife, the two sides of the lip from the jaw
subjacent, unless the former structures be already very free.
Then pare the edges of the cleft. Remove enough tissue,
especially from the apex of the cleft, and the junction of the
cleft with the edge of the lips. Coapt the edges, insert two
“hare-lip” pins; enter and exit one-quarter inch from the
fissure; pass deeply, nearly reaching mucous membrane.
The lower" one secures the coronary artery. Secure with
hare-lip suture. Interrupted wire suture at red border of
lip. Sharp ends of pins nipped off. Pieces of lint placed
beneath the ends of the pins. Strapping, broad at ends and
narrow in middle, brought across lids. All pins must be
removed on third day, very gently, lips being well supported
at the time, and strapped immediately afterward. Instead
of pins, the interrupted suture of wire, aseptic silk, or gut,
may be used. . •
gº
168 REY NOTES OF MEDICAL PRACTICE.
NAEVUS.
Capillary navi may be successfully treated by successive
paintings with liquid Carbolic acid, Nitric acid, Lunar caus-
tic, or by puncture at various points with a hot needle. More
extensive forms may be treated by (1) compression; (2)
ligature, which should be subcutaneous, to avoid scar; (3)
eaccision; (4) by ligature of vessel of supply.
Injections into mavi should never be employed.
INTUSSUSCEPTION.
Plumbum.—Colic and fecal vomiting.
Opium.— Meteorism, and stercoraceous vomiting.
Aconite, Belladonna. —To obviate inflammation.
Nux v.–To correct irregular and excessive peristalsis,
GENERAL TREATMENT.
Early in the Attack. — Place the patient on his back,
hips elevated, shoulders low; introduce a long tube into the
rectum, passing it as high up as possible, and slowly inject
large quantities of warm water or olive oil. As the fluid is
coming away, manipulate the abdomen with the hands, so
as to move coils of intestines. Repeat the entire process
several times, if necessary. Sometimes it is well to anaes-
thetize the patient preparatory to operation. Also try invert-
ing the patient. In children, inflate the bowel with air until
the abdomen is much distended. Keep stimulants at hand,
as syncope sometimes occurs. *
In cases where the above measures fail, and the diagnosis
of obstruction is clearly made, perform laparotomy with
antiseptic precautions. Operation, preferably in median
line, consists in exposing peritoneum by incision of three to
five inches, checking all haemorrhage, opening peritoneum,
Searching for obstruction, and relieving it according to its
nature. *
THORACENTESIS.
Indications.—Amount of effusion great, with dyspnoea;
old effusion, which remains stationary. -
OPERATION. tº
Use aspirator; needle moistened with oil: slight prelim-
inary incision. Introduce near the axillary line, in the fifth
intereostal space on the left side, the fourth on the right, or
Seventh, near the angle of the scapula, posteriorly. Insin-
uate the needle with a twisting motion, near the upper bor-
der of the lowermost rib of the two. Then plunge the
needle Smartly through the pleura, turn the cock of the
aspirator, and collect the fluid.
PARACENTECIs ABDOMINIs—HAEMORRHOIDS. 169
Dangers.—Wounding intercostal vessels, lung, or dia-
phragm; rupture of pleura or capillaries by excessive suc-
tion with aspirator; admission of air.
PARACENTECIS ABDOMINIS.
Indications.— Called for if the amount of effusion is so
great as to seriously embarrass respiration or the heart's
action.
OPERATION. -
Make ink-mark exactly in median line, midway between
umbilicus and pubes. Turn the patient on his side, near the
edge of the bed. Bladder must be empty. Ascertain by
percussion the presence of fluid at the spot to be pierced.
Apply a broad flannel belt, or a sheet, around the abdomen,
the ends crossed behind, and held by an assistant, who
gradually draws it tight as the fluid is withdrawn. Tap
through a hole cut in the cloth at the proper point. Incise
the skin at point selected, and introduce the trocar. Draw
off the fluid slowly. When all is out, seal the wound with
plaster, and pin the band tightly around the abdomen.
Dangers. — (1) Haemorrhage, from not keeping to mid-
dle line; (2) wound of bladder, from not emptying it;
(3) wound of bowel, from not tapping in a thoroughly dull
spot, or from plunging the trocar too deeply; (4) fainting.
PNEUMATIC ASPIRATION
May be practiced in any part of the body, and is a safe
procedure as long as only the fine needle (No. 1) is used.
Aspiration with the larger needles is to be practiced with the
same caution as tapping with the trocar, the risk of aspira-
tion equaling that of tapping when the larger needles are
used. -
HEMORRHOIDS.
Internal.—Of capillary variety—viz.: elevated thick-
enings of the mucous membrane—best treated by applica-
tion through a speculum, with a wooden spatula or a glass
rod, of pure Nitric acid. Forcible dilatation of sphincter
occasionally cures by relief to circulation during partial
paralysis of sphincter following dilatation. Internal haem-
orrhoids, more or less pendulous, are best treated by (1) In-
jection of mixture of equal parts of Glycerine and Carbolic
acid. To do this safely, clamp the base of the pile with the
forceps, so as to interrupt the circulation; with hypodermic
syringe, charged with the mixture, insert the needle into the
substance of the hamorrhoid, and inject M. V ad x. Repeat.
170 KEY NOTEs of MEDICAL PRACTICE.
the injection at intervals of three or four days until the tumors
shrivel and slough away; (2) Ligature. Patient under Ether;
dilate the sphincter, forcibly seize ha-morrhoid with forceps;
with curved scissors dissect the hamorrhoid slightly from
the mucous membrane from below upward, thus avoiding
vessels which always enter a pile from above; transfix the
pile with a threaded needle, and tie firmly on each side:
repeat the process on all internal piles. Confine the patient
strictly to bed for a week. Ligatures come away generally
in four to five days. Patient should take no exercise of
amount for ten to fourteen days.
External hamorrhoids, when seen early, i.e., during
first forty-eight hours, should be incised, and the clot of
extravasated blood, which gives pain by causing tension of
tissues, turned out. Always incise in line radiating from
anal center. If ancient, and source of annoyance, remove
by scissors, clipping away tab of thickened integument in
line radiating from anal center.
* ANAL FISSURE.
When productive of slight degree of suffering, may be
treated by application of Iodoform, in powder or supposi-
tory. A single application of Nitrate of silver to a fissure
will sometimes suffice. Severe forms only amenable to
treatment by incision or forcible dilatation.
To incise, expose the part thoroughly and cut through
the base of the fissure deeply enough to divide the super-
ficial fibers of the sphincter muscle directly under it, then
apply Iodoform, cotton pad, and T bandage.
To dilate, put the patient under Ether, insert the thumbs
into the rectum back to back, and stretch the sphincter
until the thumbs tough the tuber ischii, or the sphincter is
thoroughly relaxed. Dress as above.
RECTAL STRICTURE.
Gradual dilatation with bougies at intervals of three or
four days, safest but slowest method. If the stricture be
thin and bridle-like, nick the edge of constriction at three
or four points in its circumference, and pass a bougie.
Posterior rectotomy to be employed if stricture irritable
and of Small caliber. Patient under Ether; with straight,
probe-pointed knife, cut through the stricture and sphincter
toward the coccyx, keeping the incision strictly in the
median line. Keep the patient recumbent, pack the wound
with antiseptic cotton, and, as it heals, pass a bougie to
preserve the caliber of the rectum.
RECTAL FISTULA—RETENTION OF URINE. 171
RECTAL FISTULA.
Three Varieties — result of abscess in submucous tissue
of rectum — internal, external, and complete. -
INTERNAL should be made complete by passing a probe,
bent into hook shape, into rectal opening and making it
project the integument, cut down on the end of the probe,
and operate as for complete fistula.
ExTERNAL should be made complete by passing director
into external opening to the thinnest portion of the rectal
wall, determined by the finger in the rectum, and forcing
the director through into the rectum. ... •
CoMPLETE fistula may be treated by incision on director,
or, in timid patients, by elastic ligature. To incise, put the
patient under Jºther, pass a grooved director through fistula,
bring the point out at the anus, and cut all overlying tissue;
slit up sinuses leading into the fistule, pack the wound with
oakum for first forty-eight hours, and then dress with
Iodoform, keeping the patient recumbent until the wound
is fairly filled by granulations.
To ligature, take a solid rubber cord, Já inch in diameter,
pass a silk cord through the fistula by means of an eyed
probe; draw the rubber cord through double, pull it tense,
and tie tightly, overtying the rubber knot with silk to pre-
vent slipping. Under this method the patient may move
about. -
COCCYGOTDINIA. -
If obstinate, divide subcutaneously all muscular and
ligamentous structures from the borders and tip of the
coccyx. If the coccyx be luxated and displaced, or carious,
remove it.
RETENTION OF URINE.
From Stricture. — Put the patient in a warm bath to
relax spasm; pass a small catheter, or filiform bougie, which
use as a guide for tunneled catheter. If filiform bougie or
small catheter passes, tie in for continuous dilatation, re-
placing it by larger size in twenty-four hours. If stricture
is impassable, relieve the bladder two or three times in
twenty-four hours by aspiration, supra-pubic. After two
or three days, attempt the passage of instrument again. If
the instrument cannot be passed, and fistulous opening
exist, perineal section should be performed.
From Enlarged Prostate. — Pass a soft rubber cathe-
ter, Mercier's elbowed catheter, or over-curved gum-elastic
catheter. If retention has existed for some time, do not
empty the bladder at once, but at the third or fourth cathe-
172 IXEY NOTES OF MEDICAI, PRACTICE.
terization, after which keep the bladder clear of residual
urine. When the bladder is completely closed by hyper-
trophy of prostate plus inflammation, supra-pubic aspira-
tion may be practiced twice or thrice daily, until the catheter
may be passed.
If catheterism impossible, supra-pubic puncture and introduction
of permanent tube relieves retention, and, when done early enough,
is followed by subsidence of prostatic overgrowth.-Adams.
CIRCUMCISION.
Draw the foreskin well forward and hold it by compres-
sion between the blades of forceps applied where section is
deemed best; cut off the portion included in the forceps;
split up the mucous membrane to the corona, turn it back,
trim the edges, and unite them to the skin by numerous fine
sutures of catgut. In infants sutures are unnecessary.
Dress by enveloping the part in a strip of sheet lint, which
should be kept moist with 1:40 Carbolic lotion. Treat
haemorrhage by torsion if not spontaneously checked.
Local anaesthesia may be produced prior to operating by
injecting a four-per-cent. Solution of Cocaine. Inject four
minims at four different points—on the dorsum, near the
franum, and at each side — in all, sixteen minims. In ten
or fifteen minutes anaesthesia will be complete.
GANGLION.
Rupture it by placing the patient's wrist on your knee,
... steady it with your fingers while you squeeze the
ganglion, with the ends of both your thumbs, against
the ridge of bone beneath. Other methods failing, employ
subcutaneous puncture, and follow either method by
pressure with pad and bandage.
BTUNION.
Remove pressure of boot, which is always the cause:
restore toe to natural position by mechanical contrivance.
Use corn plaster, soap plaster, arnica plaster. If it dis-
charge, use stimulating dressings. When inflamed, poul-
tices or fomentations.
CORNS.
Soak the foot in a warm bath half an hour or an hour;
extract the hard head with the finger nail, or a blunt instru-
ment; dress with Armica lotion; wear during the day arnica
plaster, and felt, with a hole in the center. Repeat this
several days, and wear easy shoes, and there will be no more
return.
IN• GROWING TO E NAIL — SYPHILIS. 173
IN-GROWING TOE NAIL.
With the point of a penknife insinuate a bit of cotton
beneath the side of the nail, and between the edge of the
flesh and the overlapping nail. Poultice and rest if much
inflammation.
If scraping nail down the middle fails to relieve, pare
away overlapping flesh — remove underlying portion of
nail; or, these measures failing, remove entire nail by avul-
Sion under anaesthetic.
THE WENEREAL.
SYPHILIS.
Definition.—A specific, infectious disease, having a
period of incubation, and characterized by the appearance
of a chancre, then by eruptions on the skin and mucous
membranes, subsequently by chronic inflammations of the
cellulo-vascular tissues and the bones, and finally by small
tumors, or gummata.
One attack affords protection against a second. The
initial lesion is always a chancre, whether the source of
infection be a chancre or a secondary lesion. A perfect
recovery from syphilis is possible (Keyes). -
Initial Lesion.—Varies. May be hard, desquamating
papule, a raw erosion, or a superficial ulcer. Indurated
chancre — generally solitary, shallow ; borders adherent and
sloping; base indurated; floor grayish; the secretion thin,
Scanty, non-purulent. It is indolent, and generally painless.
Period of Incubation.—A chancre (if not modified by
treatment) will usually be followed by secondary symptoms
within fifty days, and always within six months. It may be
as short as ten days. *
PRIMARY STAGE.
LEADING FREMEDIES.
Mercurius isol.—This is the only remedy worthy of
confidence in the treatment of recent, uncomplicated chan-
cre. Chancre with red edges, lardaceous bottom, painful
and readily bleeding; indurated base and margin. -
DOSE. – 1x to 6x trituration, a grain night and morning.
Stands in the front rank.-Franklin.
Enjoys universal confidence.—Hughes.
Only remedy for the uncomplicated forms.-Baehr. -
Mercurius cor.— For phagedænic chancre; ulcer
secreting thin, ichorous pus. Secondary symptoms make
early appearance.
174 IXEY NOTES OF MEDICAL PRACTICE.
Mercurius iod.— Painless chancres; glandular system
largely involved; inguinal glands large, swollen, but not
inclined to suppurate. 2 ”
Arsenicum.–Gangrenous chancre. Ulcers with florid,
unhealthy granulations; or, Secreting a watery, corrosive,
offensive fluid. *
Only efficient remedy.—Baehº'. . .
In gangrenous, never fails.—Jahr.
Nitric ac.—For chancre of some weeks' standing that
has been treated with large doses of Mercury. Ulcer bleeds
easily and profusely; pale, flabby, prominent granulations;
fungous growths; corrosive discharge.’
Arsenicum iod.— For swelling of inguinal and axillary
glands, threatening suppuration. -
Excels all other remedies in the rapid cure of venereal bubo.—H
Noah Martin.
|BUBO.
Requires the same treatment as the chancre from which
it proceeds. For acute bubo, Mercurius sol. : for indolent
bubo, Mercurius Žod.
LOCAL.— Observe strict cleanliness of the parts. To pri-
mary sore, apply simple lint, soaked in cold or tepid Calem-
dula lotion, renewed every three or four hours. Chloral
hydrate solution, twenty grains to 3.j Aqua, hastens healing
process. If discharge fetid, sprinkle with powdered Chlorate
of potash, and cover with wet compress; renew frequently.
For Sloughy wicers, apply slightly caustic solution Nitric
acid, or Carbolic acid. -
GENERAL.—Avoid stimulants, excitement, over-exertion,
and excesses of all kinds. Ilet the surroundings be the most
favorable, hygienically, that can be procured. Have fresh
air, moderate out-door exercise, and a plain diet. Encour-
age in the patient hopes of ultimate recovery. Frequent
bathing of the skin is very beneficial.
TABLE GIVING USUAL PERIOD OF DEVELOPMENT OF LESIONs.
- TO SUAL MAY DELAY
I, ESION, NO. I)AYS. AS LONG AS
1. Roseola . . . . . . . . . . . . . . . . . . 25 to 45 . . . . . . . . . . . . . . . . . . . . 12 months.
2. Lichen . . . . . . . . . . . . . . . . . 28 to 65 . . . . . . . . . . . . . . . . . . . . 12 * {
3. Mucous patches . . . . . . . . . . 30 to 70 . . . . . . . . . . . . . . . . . . . 18 § {
4. Sec'd aff. fauces . . . . . . . . . . 50 to 70 . . . . . . . . . . . . . . . . . . . . 18 { {
5. Vesic. erup . . . . . . . . . . . . . . . 55 to 90 ... . . . . . . . . . . . . . . . (5 tº º
ti. Pustular . . . . . . . . . . . . . .45 to 80 . . . . . . . . . . . . . . . . . . . . 4 { %
7. Rupia. . . . . . . . . . . . . . . . . . . . 7 ms. to 2 yrs............. 4 { %
8. Iritis . . . . . . . . . . . . . . . . . . . . 2 to 6 months............ 1 year.
9. Sarcocele . . . . . . . . . . . . . . . . . 6 to 12 “ . . . . . . . . . . . 3 years.
10. Periostitis ........ . . . . . . . . 4 to 6 “ . . . . . . . . . . . . 2 “ .
11. Tuberc. erup. . . . . . . . . . . . . . 3 to 5 years . . . . . . . . . . . . . 2 “
12. Serpig. erup. . . . . . & e º s 2 e e ... 3 to 5 “ . . . . . . . . . .20 *
13. Gummy tumors........ . 4 to 6 “ . . . . . . . . . . . . 15 “
14. Onychia. . . . . . . . . . . . . . . . . - 3 to 6 “ . . . . . . . . . . . . 22 “
15. Exostosis . . . . . . . . . . . . . . . . 2 to 6 “ . . . . . . . . . . . . 20 “
16. Ostitis . . . . . . . . . . . . 2 to 4
17. Destruct. Vel. pal ... . . . . . 2 to 4 “ . . . . . . . . . . . . 20 **
SYPHILIS. - 175
No one who has had syphilis should marry until he has
been free from all symptoms for a period of at least three
years.
CHANCRE. CHANCROID.
1. A general blood-disease. 1. A local tissue-disease.
2. From inoculation with 81/phi- 2. From inoculation with chan-
litic virus. Croidal virus.
3. Incubation, ten to sixty days, 3, Incubation, none.
Ol' Ill Ol'C, -
4. Auto-inoculation impossible. 4. Auto-inoculation always pos-
Sible.
5. Lesion, usually an excoriation 5. Lesion, a rapidly spreading,
or indurated shallow ulcer. soft ulcer.
6. Number, usually single. 6. Number, often multiple.
7. Secretion scanty, Serous, Sall- 7. Secretion, creamy, free.
guinolent.
8. Edges slanting, adherent. 8. Edges, pºpendicular OI ll Il-
dermined.
9. Generally painless. 9. Often painful.
10. Phagedaena very rare. 10. |º not uncommon.
11. Bubo invariable; seldom sup- 11. Bubo in about one-third the
purates. cases; often suppurates.
12. Second attack very rare. 12. Second attack possible.
13. Local treatment unimportant. 13. Local treatment. highly in)-
portant. -
SECONDARY AND TERTIARY.
LEADING REMEDIES.
Mercurius.— Feverishness; rash; sore throat; rheuma-
toid pains, aggravated by rest and the warmth of the bed;
erythematous, papular, and Squamous eruptions; Superfi-
cial ulcers in the throat; iritis; fauces and tonsils swollen,
inflamed, and ulcerated; emaciation, with slow, hectic fever.
Eali hyd. — For secondary and tertiary forms, particu-
larly in those who have been over-dosed with Mercury.
Nodes; gummata; erythema; tubercular skin eruptions;
ulcers on tonsils; periostitis; coryza; iritis; ulceration of
nose, mouth, or throat, with corrosive, burning discharge;
Pain in nodes quickly relieved, and the nodes soon disap-
pear. DoSE.—Give one to five grains of the crude drug ter
die ; in obstinate cases, fifteen to twenty grains ter die.
We have nothing to take the place of the Iodide of potash in ter-
tiary syphilis.-Hughes.
No remedy surpasses this as an antidote to the syphilitic poison in
the secondary, and especially in the tertiary form of the disease.:-
Franklin. -
Aurum.—Syphilophobia; ozaena, with caries of nasal
and facial bones; ulcers of nose and mouth, with fetid
discharge; nodes of cranial bones; sarcocele; lupus; syphil-
itic rheumatism; suicidal melancholia.
Covers nearly the whole field of the tertiary, with its cachexia.--
Hughes. . -
Nitric ac.— Ulceration of the mouth, and cracks about
the commissures of the lips.
176 IXEY NOTES OF MEDICAL PRACTICE.
Kali bi...—Indolent ulceration of the tonsils. Affections
of the throat, eyes, skin, and periosteum. -
RUPIA.—Thuja.
SARCOCELE.-Awr.
IRITIS.—Merc., Kali hyd.
GUMMATA.—Merc., Kali hyd.
OzAENA.—Awr., Kali bº., A'ali chlor., Kali hyd.
CoNDYLOMATA.—Ac. wit., Thuja, Merc., Amt. tart., Ac.
hos. -
p CARIEs of Bone.—Awr., Mez., Phos., Kali hyd., Merc.,
Ac. fluor.
ULCERATION OF THROAT.—Merc., Kali bi., Ac. mit., lod.,
Ralf tod., Hydr., Ac. fluor.
CHANCROID.
SYNONYMI: Soft Chancre.
DEFINITION.—A virulent, local, contagious ulcer, never
giving rise to constitutional symptoms, its effects being
limited to the vicinity of the sore, and the neighboring lym-
phatic glands. -
It is never transmitted by inheritance. It is auto-inocu-
lable. A person may have repeated attacks. The prognosis
is always favorable.
TIESION.—A round or oval ulcer, surrounded by a faint,
pink areola, with abrupt edges, sharply cut at right angles
to surface, often slightly undermined, the bottom being
irregular, Soft, and covered with pultaceous, dirty-yellow
llS.
p IREMEDIES.
Mercurius, Arsenicum, Acid mit., Kali bi., Hepar sulph.,
Phosphoric ac., Silica. .
IlocAL.—Touch with strong Nitric acid. Before cauteriz-
$ng, cleanse surrounding parts with Carbolic lotion. Do not
cauterize unless the whole of diseased surface can be acted
on. Chancres beneath phimosed prepuce, treat by frequent
injections Carbolic lotion (1:40), using syringe with long
nozzle.
When caustic not used, best application is Iodoform ;
dust on powdered crystals, cover with dry lint, and use
retaining dressings.
Dressings of all kinds must be changed frequently, and
opposing surfaces kept apart. Destroy old dressings; use
no greasy applications.
PARAPHIMOSIS.
If strangulation occur, effect reduction. In phimosis, if
swelling so great as to prevent the use of syringe, or if
sloughing threaten, slit up the prepuce by double incision,
CHANCROID—GONORREICEA. 177
or remove altogether, and treat as phagedaena. Otherwise,
hot local baths to reduce Cedema. -
PHAGEDAENA.
Immerse the entire diseased part in a bath at 98°F., and
maintain this heat for nine or ten hours per day. Use hip
bath; continue for several days after sore puts on healthy
appearance. Let the patient go to bed at night, dressing
the sore with Iodoform. If disease not arrested, make bath
continuous; full bath, in which patient can lie down, will
accomplish this. If milder measures fail, cauterize. Check
all haemorrhage at once; apply to bleeding point pledget of
lint soaked in solution Persulphate of iron, retained by firm
bandage. •
GENERAL.— Rest; good food; good ventilation. In
phagedaena, tonics and Cod-liver oil.
BUIBO.
To favor resolution, use pressure and dry heat. If sup-
puration be found to be inevitable, promote with poultices;
open by free incision across the line of Poupart's ligament,
as soon as presence of pus is manifest, and treat same as
local sore. Aspiration of no service.
GONORREHOEA.
ACUTE STAGE.
LEADING REMEDIES.
Gelsemium.— In recent cases. Discharge moderate;
much irritation; considerable heat; little pain; Smarting
and redness at meatus. DOSE— One to two drops every three
hours.
Has a striking effect on the acute stage of gonorrhoea, usually
bringing relief in twenty-four to forty-eight hours. Fully ninety per
cent of cases report speedy relief.-Adams.
Cannabis sat, tinct.—Smarting, burning, stinging, dur-
ing micturition; constant urging; copious, thin discharge;
prepuce swollen and painful; strangury, pains extending
into scrotum, with dragging in testicles. -
' A characteristic indication for this remedy is priapism.—Adams.
Cantharis, 2x. —When urinary symptoms indicate that
inflammation is extending toward bladder; ardor wrinae;
cutting, stinging pain during and after micturition.
Particularly called for when blood occurs, either free or mixed
with discharge.—Adams.
Mercurius, 2x. — “When inflammatory process is
accompanied by free exudation into submucous tissue and
thickening of the urethral walls, producing great diminu-
tion in the size of the stream of wrine, and chordee,”—
Adams. -
12
178 REY NOTES OF MEDICAL PRACTICE.
IIOGAL.-Astringent and irritative injections are of
doubtful utility. Observe strict cleanliness of the part. To
absorb and remove discharge, keep a piece of lint over the
meatus, retained by drawing the prepuce over it, or a piece
of soft linen, with a hole in the center, drawn like a collar
just back of the corona glandis, and the corners then
brought forward, with the prepuce over it. Avoid use of
warm and cumbersome dressings; tissue paper is best.
Renew dressings frequently, and destroy old ones. Wear a
light suspensory for the scrotum.
If, after well conducted course of treatment, a “drop or
two” still appear, suspect incipient stricture, and use me-
chanical dilatation.
DIET.-Avoid all greasy, fried, or highly seasoned
articles– pepper, vinegar, Salt, coffee, or tea. Salad dress-
ings, asparagus, acid fruits, tomatoes, strawberries, pas-
tries, and particularly all malt, vinous, and spirituous
liquors should be strictly prohibited. Let the diet be light;
plain milk diet best. Drink large quantities of soft water.
GENERAL.—Rest in recumbent posture will greatly pro-
mote recovery. In any event, to as great an extent as
possible, avoid physical exertion, and all sexual excitement.
CHORDEE.-Empty the rectum by enema before retiring.
Sleep on hard mattress, with light bed-clothes; room cool
and well ventilated. When erection occurs, evacuate blad-
der; stand on cold oil-cloth. Medicinal treatment as for
original disease. External application of Camphor-ice
along urethra, at night, has prevented chordee.
INJECTIONS.-- Useful in but small number of cases.
Hot mucilaginous infusions best — gum water, linseed water,
with a little Hydrastis. Any injection which causes greater
pain than very slight Smarting will do more harm than
good. In any case, must be employed very early— later, of
I] O llSČ.
RETENTION OF URINE.—Avoid passage of catheter if
possible! Quiet mental anxiety; inject in perineum Morphia
% grain, and Atropia 1-120 grain; repeat in an hour;
place patient in hot bath, submerged to the chin, until the
flow of urine begins; if signs of syncope appear, remove
him from bath, put a hot mush poultice over the hypogas-
trium, and give an enema of hot water and soapsuds. All
other means failing, aspirate the bladder.
STAGE OF DECLINE.
LEADING REVIEDIES.
Mercurius iod.— Discharge free and mucoid; patches
of induration found along urethra.
Sepia. — Chronic mucoid discharges, without pain. Es-
pecially gonorrhoea of females. -
GonoRRHCEA–URETIIRAL STRICTURE. 179
Hepar sulph.— Muco-purulent discharge in those who
have had several attacks. &. -
Thuja.-Thin, whitish, painless discharge. Sub-acute
and chronic cases, especially when there is inflammation of
prostate. .
Sulphur.— Much thickening along urethra.
Silica.-Cases of long standing, with slight, shreddy
discharge. -- -
INJECTIONs.— May be used in this stage. Half a grain
of Argentum nit., Zinc sulph., or Plumbum acet., to ounce
of water. Powdered IIydrastis Ess. to 3.j. water, excellent
in cases of long standing.
Short-nosed, hard-rubber syringe holding Eij. First
clear the urethra by urination, or warm water. Insert the
nozzle just within the meatus; compress the sides of the
urethra with thumb and finger above the syringe tip; inject
slowly. . Retain the injection for a minute or two, manipu-
lating the urethra.
If the discharge persist, pass slowly a full-sized, smooth,
steel sound, at intervals of three or four days.
GLEET.
- --~ Wº. *
Treat by slightly asſºt injections, and remedies as
indicated above. But a permanent cure demands treatment
of the accompanying
URETHRAL STRICTURE.
Chronic urethral discharge always indicates stricture,
and the latter must be treated. Pass an olive-pointed
bougie, not beyond the prostate, using no force. If the
meatus be contracted, with keen-edged bistoury cut down-
ward and backward in the median line, and insert a piece of
oiled lint to prevent primary adhesion. Make gradual dila-
tation at point of stricture with olive-pointed bougies up to
No. 8, then steel sounds. Never use a steel sound smaller
than a No. 9. -
Leave bougie in situ only a few moments, and introduce
larger sizes at intervals of two days, more or less, according
to patient's urethral sensibility. Use no force. Make
haste slowly. Gradual dilatation should be carried up to
normal size of urethra, as ascertained by bulbous bougie, or
urethrometer. Traumatic and resilient strictures, and those
of the penile urethra, should be treated by over-distention
and urethrotomy combined.
*.
O/~~~~ S-/--
180 KEY NOTES OF MEDICAL PRACTICE.
EPIDIDYMITES AND ORCHITIS.
LEADING REMEDIES.
Pulsatilla. —Sub-acute inflammation, the glands alone
being affected; pain shooting down the back or into the
thigh, and changing suddenly.
Hamamelis.--Dull, heavy pain in testicle, at times ex-
cruciating. Scrotum hot, congested, and swollen; the skin
tense, smooth, and Shining.
Aconite. — Fever; hot, dry skin; full pulse; great vascu-
lar excitement.
Belladonna. – Great sensitiveness of nervous system,
with intolerance of pain, which is of neuralgic character.
Clematis. – Orchitis following chronic urethritis.
Arnica, Conium. — From contusion.
GENERAL MEASURES.
Absolute test in bed—do not let the patient rise even to
relieve bladder or bowels; support the testicle so as not to
drag on the cord; apply hot Hamamelis fomentations;
after inflammation has subsided, strap with adhesive plaster
so as to make pressure. Relief of tension of tunica vagi-
nalis is promptly afforded by puncture, a straight, three-
cornered surgical needle being passed through the scrotum,
and six or ten punctures being made in the envelope of the
testis.
HYDROCELE.
REMEDIES.
Iodine, Calcarea carb., Silica, Aurum, Pulsatilla,
Rhododendron, Graphites, Kali hyd.
Operative Treatment. — In infants acupuncture, caus-
ing the fluid to escape into areolar tissue of scrotum, often
CUll'éS.
Palliative Treatment.— For adults, evacuate the con-
tents of the sac with aspirator or trocar. Method.—Make
out the position of the testicle; grasp the tumor firmly in
the left hand, with the testicle occupying the middle of the
palm. Plunge the needle or the trocar º upward
and backward into the juncture of the middle and lower
thirds of the hydrocele.
Radical Cure.—Tap the hydrocele with a small trocar;
empty the sac of all fluid and inject liquid Carbolic acid,
twenty to thirty minims, manipulating the sac so as to bring
the acid into contact with its entire surface, allowing the
i. to remain. Confine the patient to room for forty-eight
Olli’S.
.This method is followed by a radical cure in most cases, and is un-
attºměd-by fever-or-other complications.—Adams.
THE TEMPERAMENTS. 181
P A RT IV.
MISCELLANEA.
THE SEVEN AGES.
. Infancy—from birth to 7th–10th month;
. Childhood — from 1st to 2nd dentition;
Boyhood—from 2nd dentition to puberty;
Adolescence — from puberty to 20th – 25th year;
. Early manhood — from 25th to 45th year;
. Later manhood — from 45th to 60th year;
. Old age — from 60th year onward.
i
THE TEMPERAMENTS.
SANGUINE TEMPERAMIENT.
The form is full and round, neither very gross nor very
spare, and the muscles firm and elastic. The complexion is
florid and ruddy, from the rich capillary circulation.
Arterial blood abounds, the veins being small, the circula-
tion active, and the pulse full and quick. The bodily func-
tions are quickly and easily performed. Mind and body
are quickly stimulated into action, and there is great endur-
8,1] CG. .
There is an intense animation and buoyancy of spirits,
and in the mental sphere rapid thought, vivid imagination,
and quick perception.
Subjects of this temperament are prone to congestions,
inflammations, and fevers, and all diseases are inclined to
take on inflammatory action.
IREMEDIES.
Acomºte, Belladonna, Bryonia, Gelsemium, Veratrum
ºn'.
NERVOUS TEMPERAMENT.
The habit is spare, the frame somewhat angular, the
7muscles spare, and not well defined. The skin is dark, dull,
182 KEY NOTES OF MEDICAL PRACTICE.
earthy, or sallow, and hot and pungent to the touch. The
cranium is large. The circulation is languid, with a pre-
ponderance of the venous system; the pulse variable and
easily excited. The face has the lineaments of energy, and
movements are hasty and abrupt. -
The mental powers are large, and capable of persistent
exercise. The affections are violent, and the sexual passions
usually very strong. Sensations have an intensity far in
excess of the exciting cause. f
The individual is subject to neuralgia, nervous diseases,
spasmodic affections, and mental disorders.
REMEDIES.
Atropia, Igmatia, Coffea, Valerian, Moschus, Phosphorus,
2 incum. -
LYMPHATIC. TEMPERAMENT.
The body is heavy, inclined to corpulence, the flesh full
but soft ; the joints and hands large, and the feet broad and
flat. Complexion sallow or pasty; the hair light or reddish.
The pulse is slow and easily compressed. The bodily func-
tions are slow and languid. The chest and heart are in-
adequate in bulk to the rest of the body,
The mental processes are slow, though there is great
firmness and constancy, and usually good judgment.
These subjects are inclined to glandular enlargements,
catarrhal affections, abscesses, and dropsies. There is slight
power of resistance to acute diseases, with a tendency to
take on the chronic form, especially of the strumous and
asthenic kinds.
REMEDIES.
Arsenicum, Iodine, Calcarea, Hepar sulph., Mercurius,
Sepia, Silica, Sulphur.
BILIOUS TEMPERAMENT.
Habit spare; muscles hard-knit; tendons wiry; com-
plexion swarthy, with a yellowish tinge; sharp features;
dark and deep-set eyes. They are characterized by violence
of reaction to irritation, particularly of the biliary appara-
tus, with disturbances of the digestive functions, dark-
colored urine, and constipation. The bilious derangement
engenders melancholy, ill humor, and acrimony of temper.
REMEDIES.
Nua, vomica, Chamomilla, Bryonia, Sulphur, Podo-
phyllön, Aloes. . . -
LEGAL MEDICINE. 183
LEGAL MEDICINE.
Expert Testimony.—A physician is in law an expert
as to all matters embraced within the range of his profes-
sion. It is not necessary that he be at the time in actual
practice. It is not necessary that he should have made the
particular disease involved in any inquiry a specialty. But
if he has devoted himself exclusively to one branch, and has
had no experience in that subject to which he is called to
testify, his testimony is inadmissible. A practicing physi-
cian, whose knowledge of the particular subject of inquiry
(e.g., insanity) was derived from study alone, has been held
competent to express an opinion as an expert. Medical
books are not admissible in evidence.
An expert cannot be compelled to attend during the
entire trial for the purpose of hearing all the testimony.
The law is extremely conflicting as to whether profes-
sional men can be compelled to testify as eagerts without
extra compensation. In England it is settled that addi-
tional compensation is required. In the United States the
question is open, with the weight of authority in favor of
the English rule.
In the absence of any statutory provision to the contrary,
it is well settled that a physician or surgeon may be com-
pelled to disclose any communications made to him in pro-
fessional confidence. This rule has been abrogated in
several of the states by express statutes.
Physicians and surgeons shall be incompetent to testify as to infor-
mation obtained in a professional capacity from a patient.—Missouri.
No person duly authorized to practice physic or surgery shall be
allowed or compelled to disclose any information which he may have
acquired in attending any patient in his professional character, and
which information was necessary to enable him to prescribe for such
ºt as a physician, or to do any act for him as a surgeon.—New
Skill Demanded.—A physician's charge is more on ac-
count of his skill and knowledge than of the time given to
his patient's case. He is held to exercise ordinary care and
skill, but is not held to produce any benefit to the patient.
The only defense against a suit for physician’s service ren-
dered on employment is, first, as to the unreasonableness
of the charges, or, second, actual malpractice. But a phy-
sician must adhere to the system and the custom of the
branch of the profession he has avowed.
Collections.—A physician has a right to demand and
sue for reasonable charges for professional services rendered
upon employment, either in advice or aid. -
Books of original entry only are received as evidence. A
bill of items may be demanded by the debtor.
When a patient receives, without objection, the services
of an assistant, or a student, he is bound to the prjneipal
184 KEY NOTES OF MEDICAL PRACTICE.
for the same. But where partners both attend a patient,
they must recover in the firm's name.
A bill for services rendered to a servant must be collected
from him, unless the master expressly agrees to pay for the
same. A minor may be held responsible for medical aid
rendered him. -
Either the husband or wife, or both jointly, may be held
for services rendered to one of the family. A city must
pay for services rendered by a physician called by a police
officer, if the case is urgent, and the regular City Physi-
cian and Surgeon is absent.
Good Will.—A physician, may sell the “goodwill" of
his practice, or his business, and may contract that he will
not, within certain places and times, practice his profession;
but an agreement not to practice his profession at all is
unlawful and cannot be enforced, because it is against
public policy.
Jurors.-Practicing physicians are exempt from duty as
jurors.
Liability of Physician.—A physician is liable for any
damage caused by malpractice. He is also liable for all
acts of an assistant or student done in the regular course of
business.
Malpractice.—A physician or surgeon must bring
to the performance of his duties as a professional man
at least ordinary skill and knowledge, and must apply
without mistake what is settled in his profession; and must
have the knowledge of the best and leading authorities in
his science, down to the time the act is performed, or he is
liable for damages that may accrue from his practice.
LAW REGULATING THE PRACTICE OF MEDICINE IN THE STATE
OF ILLINOIS.
Every person practicing medicine, if a graduate in medi-
cine, shall present his diploma to the State Board of Health,
for verification; if found to be genuine, the State Board of
Health shall issue its certificate to that effect, and such
diploma and such certificate shall be conclusive as to the
right of the lawful holder of the same to practice medicine
in this state. If not a graduate, the person practicing medi-
cine in this state shall present himself before said Board
and submit himself to such examinations as the said Board
shall require, and if the examination be satisfactory to the
examiners, the said Board shall issue its certificate in ac-
cordance with the facts, and the lawful holder of such
certificate shall be entitled to all the rights and privileges
herein mentioned. - -
INFANT DIET. 185
Any person removing to another county to practice shall
ſº the certificate, in like manner, in the county to which
he removes.
The State Board of Health may refuse certificates to
individuals guilty of unprofessional or dishonorable conduct,
and they may revoke certificates for like causes.
Any person shall be regarded as practicing medicine,
within the meaning of this Act, who shall profess publicly
to be a physician, and to prescribe for the sick, or who shall
append to his name the letters “M.D.”
INFANT DIET.
In order to prepare cow's milk so as to adapt it to the
wants of the infant organism, it must be diluted by the
addition of a mucilaginous liquid, such as gum-Arabic water,
barley water, gelatine, or oatmeal water, and some Bicar-
bonate of soda, sugar, and a little salt added, in about the
following proportions:
Fresh milk, - - - - - - - - - 1 teacupful;
Hot water, - - - - - - - - 1 C &
Soda (bicarb.), - - - - - - - % teaspoonful;
Sugar of milk, - - - - - - - 1 & 6
Salt, - - - - - - - - - - A little;
Gelatine, - - - - - - - - - 1 tablespoonful.
First dissolve the soda, the sugar, the salt, and the gela-
tine in the hot water, and then add the milk.
Make it fresh at each feeding. This is about the right
proportion for a baby of four months; under that age de-
crease the proportion of milk slightly; over that age, in-
crease it. In place of the gelatine, oatmeal water, barley
water, or gum-Arabic water may also be used, substituting
a cupful of either for the pure water which is used when
gelatine is employed. The addition of some gelatinous fluid
seems to favor the digestion of the milk. .
Oatmeal Water.—Soak a teacupful of oatmeal in a
pint of water, with a little salt added, over night. Strain
thoroughly, through a napkin, next morning.
Barley Water.—Take a teacupful of pearl barley, and
soak it for half an hour in a little lukewarm water, pre-
viously salted. Drain off the water, pour the barley into a
#. of boiling water, and let it simmer one-half hour; when
done, strain into a pitcher.
Gum-Arabic Water.—Dissolve pure gum-Arabic in
water, one part to ten, by bulk.
For very young babes, use the gum-Arabic water, in the
proportion above given; for older children, barley water if
the bowels are loose, oatmeal water if there be constipation.
A little gelatine added to the mixture of milk and water
may be substituted for any of the above.
186 KEY NOTES OF MEDICAL PRACTICE.
DIET IN CHOLERA INFANTUM.
Keep the child cool, let it have plenty of fresh air, and
let it have no food in which the process of fermentation has
begun. Avoid starchy foods. *
. The milk and barley water, prepared as above, may be all-
sufficient. Keep litmus paper on hand, and test the milk
frequently; if it show any acidity, reject it.
Albumin Water.— Gently stir the whites of two eggs
into a half pint of cold water, and sweeten with a little
Sugar of milk.
This is the most simple food that it is possible to obtain,
and may be resorted to when all others fail.
Wine Whey.—Heat a pint of fresh milk to the boiling
point; add slowly a wineglassful of sherry wine, and let it
gently simmer until the curd forms. Strain the whey
through a cloth, and sweeten. This is nourishing and stim-
ulating.
DIET IN FEVERs.
Give no solid food to a fever patient. Let all food be
simple but fivutritious. Give food at frequent intervals and
in small quantities. Food for fever patients should be fluid
in form, easy of digestion, and highly nutritious. Those
who have been properly nourished make the best recoveries.
- In typhoid, and diseases in which the bowels have been
affected, no solid food must be given until the stools are
again consistent and fecal. -
Milk is the best food that can be given. So long as the
patient can take it, none other need be sought for.
Beef Tea, in the stage of depression, is useful as a stim-
ulant.
RECIPE.—Take one pound of fresh meat, cut very fine,
soak in one-third of a quart of cold water over night. In
the morning remove the meat, saving the water in which it
has soaked. Put the meat in two-thirds of a quart of water,
and let it simmer for two hours, keeping the water up to its
original level by replacing what is lost by evaporation. Now
pour the beef broth into the cold liquor in which the meat
was soaked, squeezing the meat as dry as possible. The meat
which remains should be spread on a tin plate, and dried in
an oven. When perfectly dry it can be easily reduced to a
powder in a mortar. Mix this meat powder in the liquor,
and you have all the elements of the meat in a fluid form.
Salt to taste, and add twenty drops of Muriatic acid and
three grains of Pepsin. -
This is the § preparation of beef tea which contains
all the elements of the meat.
RECTAL AIIMENTATION. - 18?
RULES FOR MARING BEEF TEA.—Never let beef tea boil.
Always begin with cold water. Cut the meat very fine, and
remove all fat, gristle, and bones. The proper proportion
is a pound to a pint. After making, carefully remove all
traces of fat. To warm up beef tea, put it in a bowl, and
set the bowl in a vessel of ſo Water. -
Egg Nog.— One egg; one glass of milk; one dessert-
spoonful of brandy; one dessertspoonful of sugar. Care-
fully scald the milk, and let it afterward become cold. Beat
the sugar and egg up together to a froth, put into a glass,
add the brandy, and fill up with the milk. If wanted in a
hurry, the milk may be used without scalding. -
Mutton Broth.--Take a pound of fresh mutton, free
from fat; Cut into thin slices with a sharp knife; put into a
suitable dish, salt, pour over it a quart of cold water, and
let it simmer over a slow fire for an hour; then let it boil
for an hour longer. Strain off the broth, refusing the meat
fiber. Season with salt.
*
RECTAL AILIMIENTATION.
Preparatory to giving an enema, empty and wash the
rectum by giving an injection of clean, warm water.
Force the enema in slowly.
Throw it as high up as possible.
Inject at intervals of two hours.
Inject no more than half a teacupful at a time.
Let the enema have a temperature of about that of the
body – 98° or 100° F. -
Warm Milk, with a little salt in it, makes a simple and
readily absorbed enema. Heat the milk to the proper tem-
perature, inject every two hours, and the patient is getting
considerable nourishment.
Beef Tea, made according to the recipe given, makes a
very nutritious enema. The Pepsim and Muriatic acid are
necessary to fit it for absorption.
Cod-liver Oil.— Chop fine a half pound of beef pancreas;
cover this with water and allow it to stand for an hour in a
warm place. Strain through a cloth. Mix an ounce of this
pancreas solution in a half ounce of Cod-liver oil, and use
as an injection in those cases in which it is desired to supply
the system with fat.
NUTRIENT SUPPOSITORIES.
Take a quantity of the whole beef tea, set the basin con-
taining it in another vessel of hot water on the stove, and
evaporate the water from the beef tea until it becomes of a
188 ECEY NOTES OF MEDICAL PRACTICE.
creamy consistence. Now add an equal quantity of Cacao
butter, melt both together, pour into a dish, and allow the
mixture to cool and solidify. With a warm knife cut into
bits, and shape like a pigeon’s egg. These nutrient supposi-
tories, introduced into the rectum at frequent intervals, will
afford nourishment to the system in the neatest and cleanest
way in which artificial alimentation can be practiced.
MILK DIET.
Diabetes, Bright's disease, dyspepsia, and some other
diseases, undergo great improvement on an exclusive milk
diet. The following rules will aid in carrying out this treat-
ment: -
Use fresh milk. The milk may be taken cold or warm,
but it must not be boiled in the warming.
The first day take from four to sia: pints. This would be
from two to three glassfuls taken every two hours during
the day.
It is better to divide the day into equal periods, and take
frequent draughts—even though a glassful be taken every
hour — than to take a large quantity on the stomach at once.
The quantity of milk should be increased from day to day
until five or six quarts are taken daily. This quantity, six
quarts, need not be exceeded.
In diabetes, mothing else must be taken while the milk
diet is used. If at the end of a week there is no improve-
ment, the treatment may be abandoned. If the treatment
be of benefit it will be denoted by a diminished amount of
urine, less sugar, and improvement in the general health.
It should be continued from three to six weeks after all
sugar has disappeared from the urine.
POULTICES.
Cataplasms are local baths—they supply heat and
moisture to a part, soften the cuticle, relax the skin, dilatc
the vessels, lessen tension, and relieve pain.
Used in —Pneumonia, pleurisy, bronchitis, pericarditis,
peritonitis, other internal inflammations, rheumatism,
lumbago, and to mature abscesses.
Rules.—Do not remove one poultice till next is ready to
replace it. A poultice should be applied as hot as it can be
borne. Change a poultice every two or three hours by day,
every four hours at night. To make a poultice retain heat
longer, cover with oil silk or cotton wool. Peritonitis re-
quires a thin poultice; cover with cotton wool. In suppu-
rations, do not let poultice be larger than the abscess it is
intended to cover.
POULTICES — MOIST FOMENTATIONS. 189
Linseed Meal.—Put sufficient hot water into a hot bowl,
sprinkle the meal into the water, stirring vigorously until
the required consistency is attained, and lastly stir in a
small quantity of olive oil. Spread smoothly and evenly on
a piece of muslin, and cover with a piece of cheese cloth.
Oatmeal poultices may be prepared in a similar manner.
Starch. —Add a little cold water to the starch, and blend
the two into a pap; then add sufficient boiling water to .
bring it to the required consistence, and spread on cloth.
This is neat, bland, and unirritating.
Disinfecting Poultice.—Anoint the part with Car-
bolic oil (1:10), and apply a pad of carded oakum, Wrung
out of hot Water.
Fly Blister. — Spread a thin layer of Cantharides ce-
rate on a piece of brown paper, soft leather, or, preferably, a
piece of adhesive plaster. Leave free margin around the
salve. Moisten skin with vinegar, cover surface of plaster
with tissue paper moistened with vinegar, apply and Secure
by adhesive straps. From two to twelve hours minimum
and maximum time to leave plaster on.
Chloral Blister.—Take a piece of adhesive plaster of
suitable size, moisten it, and sprinkle on Some powdered
Chloral hydrate. Apply to the part where vesicant action
is desired. r -
Cantharidal Collodion.— Dissolve gun-cotton in an
ethereal solution of Cantharides. Apply by means of a
camel's hair pencil. This makes a very effectual and easily
regulated vesicant.
Mustard Poultice.— Mix some linseed meal in a quan-
tity of boiling water, to creamy consistence, then add same
quantity of mustard as of meal used, stirring constantly.
Spread on a cloth, cover with gauze, and apply.
A mustard poultice should remain from ten minutes to
half an hour, according to strength. Indicated when mild
and rapid counter irritation is required.
MOIST FOMENTATIONS.
Used to relax spasm, as intestinal, renal, and biliary colic.
Directions.— Place a fold of flannel cloth in the middle
of a towel, twist the ends of the towel, and dip the portion
containing the flannel into boiling water, take out and
wring it until as much water as possible is pressed away.
Take out the flannel and apply it to the painful part. Or,
sprinkle a fold of flannel with warm water, and run a very
hot flatiron over it. Compresses lose their heat rapidly,
and must be frequently renewed.
Turpentine Stupe.— If slight counter irritation be de-
sired, sprinkle the fomentation with Turpentine.
190 REY NOTES OF MEDICAL PRACTICE.
Poppy Fomentation.—Sprinkle the fomentation with
Lanſdanum, if sedative action be desired.
DRY FOMENTATIONS.
When dry heat is required, put into a flannel or muslin
bag, of suitable size, a quantity of hot Sand, hot salt, hot
bran, or hot cornmeal. A hot plate, wrapped in a cloth,
answers well. A rubber bag filled with hot water is the
most perfect. Put Acetate of Soda into a tin can, tightly
closed, of suitable shape; set this in boiling water for thirty
minutes; remove, wrap in flannel, and apply to painful part.
It will give off heat for many hours.
COLD APPLICATIONS.
Ice-bags.-Put pounded ice, with a little water, into a
bladder or rubber bag, filling it only half full. Use for re-
frigeration and to contract the vessels, and reduce conges-
tion, especially in inflammation of the brain.
Cold Cloth.- Cloths may be simply wrung out of cold
water, or, put some salt and pounded ice into a tin basin,
set this on a wet cloth, stir, and the cloth beneath may be
quickly frozen to any required degree.
Cold Drop.–Stand a vessel of cold water on a table
higher than the patient's bed, put one end of a long strip of
lamp-wick into the water, and lay the other across a cold
cloth which is applied to the inflamed part. A continuous
stream of cold water is thus conveyed to the part, and the
water which passes from it must be caught in a basin on the
other side.
- Cold Cap.–Stitch upon a mus-
lin cap, made to fit the head, a
coil of rubber tubing, arranged
spirally, with the two ends free.
Wet the cap, and put it on the
head, then place one free end in a
bucket of cold water, suspended
at a height, and the other in
another bucket on the floor. Let
the water siphon from the upper
to the lower bucket. When the
upper one becomes empty, reverse
their relative positions.
This is a very efficient method
of refrigerating the head in cere-
- bro-spinal meningitis, and in
“brain fever,” when it is desired to apply continuous cold.

IBATHS. 191
BATHS.
TEMPERATURE OF BATHS.
13ATEI. WATER. . . . WAPOR. AIR.
Cold, - - 33° to 65°F.
Cool, - - 65° to 75°
Temperate, 75° to 85° -
Tepid, - - 85° to 92° - 90° to 100° - 96° to 106°
Warm, - 92° to 98° - 100° to 115° - 106° to 120°
Hot, - - 98° to 112° - 115° to 140° - 120° to 180°
Bran Bath.-Boil four pounds of bran in one gallon of
water, strain, and add the liquor to sufficient water for ai
bath. Use to allay irritability of skin, and to soften it in
squamous diseases. * X-
Salt Bath. –Add rock-salt in the proportion of one
pound to four gallons of water. Use as an invigorating
bath, and to lessen susceptibility to cold.
Alcohol Bath. – An ounce of Alcohol to the quart of
water. Use for same purpose as Salt bath.
Sulphur Bath.-Twenty grains of Sulphurel of potas-
sium to a gallon of water. For skin diseases and rheuma-
tism.
Mustard Bath. – Add a handful of mustard to the or-
dinary hot bath, or a smaller quantity to a foot bath. Use
when stimulating action is required. -
Cold Douche.— Lower patient's head, place rubber
cloth under, and pour cold water from a pitcher over Crown
of head, the pitcher being slowly and gradually raised higher
and higher, so that the water may fall with more force.
Use in sunstroke, and intense cerebral congestion.
Wet Pack. — Spread a comfort and several blankets on
the bed, and over these a sheet wrung out of cold water.
Remove all of the patient’s clothing, lay him in middle of
sheet, draw the edges of sheet over, and wrap the patient
in it snugly, then draw over one side after another of
blankets and comfort, and make all snug. Put cold wet
compress on forehead. -
Use to reduce temperature in typhoid, and to develop
delayed eruption in scarlet, and other specific fevers.
It develops the rash, greatly reduces the fever, quiets the pulse,
renders the skin moist and comfortable, and abates the restlessness
and wandering.—Ringer". -
Blanket Bath. — A blanket is Wrung out of hot water,
and wrapped around the patient. He is to be packed in
three or four dry blankets, and allowed to rest quietly for
thirty minutes. The surface of the body should then be
192. REY NOTES OF MEDICAL PRACTICE.
well rubbed with warm’ towels and the patient made com-
fortable in bed. This is an easy means of inducing perspi-
ration.
Vapor Bath.-Improvised. Place patient, with clothing
removed, in large, cane-seated chair, and surround both
completely with blankets, letting them extend to the floor,
and be secured about patient’s neck. Under the chair place
basin of hot water, with alcohol lamp beneath it; bring
water to a boil, and patient will soon be brought into a state
of perspiration which-may be carried to any desired extent.
Use in uraemia, Bright's disease, and whenever diaphoresis
is required.
Mercurial Bath. — Given as above, by adding a metal
plate, with lamp beneath, on which is put sixty to one-hun-
dred-and-eighty grains Bisulphuret of mercury. Used some-
times in treatment of Secondary syphilis. -
VENTILATION.
To purify the atmosphere of a sick-room, nothing equals
an abundance of pure, fresh air.
To ventilate a room, and at same time avoid a draft,
raise the lower sash, and shut it down upon a folded blanket
placed beneath it, leaving an aperture of several inches be-
tween lower edge of upper, and upper edge of lower sash.
DISINFECTANTS.
No. 1.
Copperas (Sulphate of Iron).-This is a cheap and
good disinfectant for many purposes. It can be obtained at
any drug store. In warm water it will soon dissolve by
stirring. When put into cold water let it stand all day, or
over night. Use in about the following proportions:
To a bucket of water, add - - 2 lbs. copperas.
To a tub of water, add - - - 20 lbs. copperas.
To a barrel of water, add - - - 40 lbs. copperas.
This can be used for privy-vaults, water-closets, catch-
basins, cesspools, etc. Pour into water-closet about a
bucketful at a time, once or twice a day.
No. 2.
Chloride of Zinc.—This is one of the best of disin-
fectants. It is superior to the Copperas Solution, but being
more expensive, is not so available for use in large quanti-
ties. Prepare in proportion of —
Chloride of zinc, - - - - - - - - 1 pound.
Water, - - - - - - - - - - - 2 gallons.
* DISINFECTANTS. - 193
Throw this into kitchen sinks, house drains, cesspools,
water-closets, and the like. Also use it in chamber-vessels,
about the sick-room.
No. 3.
- Bichloride of Mercury (Corrosive sublimate).-A so-
lution consisting of one part of the Bichloride of mercury
to 1,000 parts of water is one of the most efficient disinfec-
tants known. It can be used for water-closets, urinals,
sinks, and Césspools, or for soaking clothing, towels, bed-
ding, and other fabrics. Corrosive sublimate is a dangerous
poison, and should be carefully handled.
No. 4.
Carbolic Acid.—This is an excellent disinfectant if
used sufficiently strong, but a weak solution does little good.
Two ounces Carbolic acid to one quart water — for night
vessels, sinks, and water-closets.
One pint Carbolic acid to five gallons water—for drains,
Sewers, and cesspools.
No. 5.
Quicklime. — Unslacked lime may be used to throw
about wet places, in damp cellars, under buildings or side-
walks, or into privy-vaults. Outbuildings, stables, and
sheds should be whitewashed.
INo. 6.
Chloride of Lime.—This may be strewn about barns
and outhouses, and thrown into cesspools, drains, and
SøWel’S. w
Do not use Chloride of lime about the house. Other dis-
infectants, which are less offensive, are at the same time
equally efficacious, and some even of greater value.
No. 7.
Charcoal.—This is very useful to cover heaps of filth,
pools, and wet places. Sometimes it is better not to disturb
an old cesspool; but, instead, cover it over with charcoal.
Dry earth may be similarly used, and it is almost as good.
No. 8.
For Soiled Clothing.— Make a solution in the follow-
ing manner:
. of zinc, - - - - - - - - 1 pound.
Carbolic acid, - - - - - - - - - 2 ounces.
Water, - - - - - - - - - - - 4 gallons.
Keep a tubful of this near the sick room, and into it
place all soiled bed-linen and clothing. -
13
194 KEY NOTES OF MEDICAL PRACTICE.
If clothing be subjected to a temperature of 212° F.
(100° C.) for an hour, either by boiling or baking, it effectu-
ally destroys all germs.
After all, the best disinfectant is fire, and, if possible,
everything which has been in contact with the sick had bet-
ter be burned. -

No. 9.
For Air of Sick-room.— Put into a saucer–
Permanganate of potash, - - - - - % ounce.
Oxalic acid, - - - - - - - - - - % ounce.
Water, - - - - - - - - - - - 1 ounce.
Mix well. In two hours, add small, quantity more of
water. This will emit enough ozone, which is an active dis-
infectant, for a large room.
Fumigation.—To fumigate a room, put some Sulphur
(Brimstone), broken into pieces, in a tin vessel, and set this
on a brick which is placed in a tub having a little water in
the bottom. Set the Sulphur afire, and hasten from the
room, having all windows and doors tightly closed, and all
cracks well stuffed, even to the keyhole. Keep the room
closed for six hours, then open and air it. Eighteen ounces
of Sulphur should be used for each space of one thousand
cubic feet — a room ten feet square.
SAINITARY MEASURES
To be observed during the prevalence of cholera, yellow
fever, typhus, and other infectious diseases:
Where absolute cleanliness eacists infectious diseases do
not prevail. This is the key to the entire subject of pro-
phylaxis. -
Cholera is most destructive where human life is massed
on low, undrained sites which have been long occupied.
Those who live in clean, dry, airy, and well drained locali-
ties have little to fear from its visits.
But cities and towns must’ prosecute a rigorous system
of Scavenging, and the work must be thoroughly done.
Every spot where there is any organic matter liable to decay
must be thoroughly cleansed. All deposits of garbage,
débris, or filth of any kind, must be removed, and the places
purified by the free use of disinfectants. The scavenger
must clean alleys of the accumulations which they usually
contain, and all places once cleaned must be kept clean.
The garbage thus gathered should be removed to a great
distance, and, if possible, burned.
Cesspools and sinkholes must be drained till dry, disin-
fected, and then filled up with dry earth, and kept dry.
In towns each house owner should clean up the back
yard, so often the receptacle for garbage, gather it into a
heap and burn it.
DISINFECTANTS. 195
In cities sewers should be flushed again and again, and
everything washed and cleansed that will bear it—courts,
yards, areas, passages, and pavements.
In flushing sewers solutions of Chloride of lime or Per-
manganate of potash should be used in large quantities.
But once a place is clean and dry, let it remain so;
moisture favors the decay of organic matter and the devel-
opment of germs. -
If stagnant pools have been left until the cholera has
actually come, do not then disturb them, but throw in an
abundance of disinfectants, and cover with dry earth or
charcoal.
All kitchen refuse and scraps should be burned. This
can easily be done in stoves and ranges.
Outhouses should be whitewashed, cleansed, and lime
scattered in all corners and cracks.
Damp cellars should be drained and dried, ventilated,
whitewashed, and have lime scattered about all dark corners.
In houses the drain pipes, sewer pipes, and all plumbing
must be put in perfect order, that there may be no leakage
of sewage and no escape of gases.
Flush all water-closets daily by pouring down a bucket-
ful of disinfectant solution.
In typhoid fever, cholera, and epidemic dysentery, the
discharges should be burned. This can be accomplished by
mixing the excretions with a sufficient quantity of charcoal
or sawdust, and burning this in a brisk fire in a furnace or
stove, which may be devoted to that purpose.
DRINKING WATER.
The germs of cholera, typhoid fever, and epidemic dysen-
tery are conveyed by means of drinking-water more than by
any other one agency.
Hence, to avoid these diseases, use only water which is
absolutely pure. -
Use no well water which contains surface drainage.
Do not take water from a pitcher or other large vessel
standing in a close room.
All drinking-water should be boiled and filtered. Do not
simply warm it, but let it boil. -
he flat taste of boiled water may be corrected by filling
a large bottle half full of the water and shaking it violently,
so as to mix it with air. -
Keep all drinking-water in glass or earthen vessels which
have been well scalded.
196 KEY NOTES OF MEDICAL PRACTICE.
MICROSCOPICAL EXAMINATION OF THE
URINE.
GENERAL RUILES.
1. Sediment in the urine has no significance unless
deposited within twenty-four hours.
2. Albumin in the urine does not indicate kidney disease
unless accompanied by tube casts. The most fatal form of
Bright's disease (contracted kidney) has little or no albu-
IIll Il. '
3. Every white crystal in urine, regardless of shape, is
a phosphate (except the oxalate of lime, which has its own
peculiar form), when the urine is alkaline.
4. Every yellow crystal is uric acid if the urine is acid,
or a wrate if the urine is alkalime.
5. Mucous casts, pus, and epithelium signify disease of
the bladder (cystitis), or of other parts of the urinary tract,
as determined by the variety of epithelium.
6. The urine of females can often be differentiated from
that of males, by finding in it the tessellated epithelium of
the vagina.
7. Hyaline casts (narrow), blood, and epithelial casts,
signify acute catarrhal nephritis. Much albumin.
8. Broad hyaline casts, and epithelial, dark granular,
and oil casts, signify chronic catarrhal nephritis. At first,
much albumin; later, less.
9. Hyaline and pale granular casts and little or no
albumin signify interstitial nephritis.
10. Broader casts are worse than narrow casts, as far as
diagnosis is concerned, for the former signify a chronic
disease. -
11. The urine should be fresh for microscopical exam-
ination, as the micrococci will change hyaline casts into
granular casts, or devour them entirely, in a short time.
12. Trommer's test should never be trusted to alone, if
the amount of sugar is small.
.13. The microscope gives better ideas of the exact con-
dition of affairs in the examination of urine than the vari-
ous chemical tests.—Dr. H. F. Formad.
MICROSCOPICAL APPEARANCES OF URINE. 197

198
KEY NOTES OF MEDICAL PRACTICE.
URINALYSIS.
*
Aïbumin.
Blood.
Pus.
Mucus.
Bile.
Sugar.
Sugar.
TUrea.
TUric Acid.
Phosphates.
chlorides.
Render urine slightly
acid—if not already so —
by Acetic or Witric acid;
boil, and add one-tenth
bulk Wićric acid.
Heat the urine, then add
Caustic potash, and heat it
again.
Let urine stand till sedi-
ment deposits; pour off
super-matant fluid; add to
remaining sediment equal
volume Liquor potassae.
Add to freshly voided
urine some Acetic acid; if
considerable turbidity ap-
pear, add Hydrochloric
acid. -
Place &mall $.".
urine and a few drops of
red “fuming”. Witric acid
side by side on porcelain
dish, and allow them to
gradually intermingle.
Add to urine a few drops
solution Cupric Sulphate,
then its own volume Liquor
potassae, and boil. (Albu-
min must be absent.)
Take two specimens; to
one add a bit of yeast; set
side by side for twenty-four
hours in temperature of 75°
to 80° F., then take specific
gravity of each.
Take equal parts urine
and Nitric acid, mix in a
test-tube and set aside.
Take urine g. 6., add
Hydrochloric acid, one-
eighth part; set aside for
twenty-four hours.
Boil the urine; if there
is a cloudy deposit, add
one-tenth part Włtric acid.
Slightly acidulate urine
with Witric acid, and add
few drops solution Witrate
of silver.
A white, cloudy
deposit on boiling,
which remains after
addition of the acid.
=Albumin.
A dirty, yellowish-
red sediment, blood-
red color by trans-
mitted light=Plood.
Mix well, and a
viscid, gel a ti no u 8
mas8, which pours
like white of egg=
Pus.
If turbidity dis-
appear, the urine
becoming , clear on
addition of the HCl.
=Mucus.
A play of colors—
green, blue, violet,
red, and yellow or
brown = Bile.
A § itate of
brick-dust-like sedi-
ment= Sugar.
If specimen which
contained the yeast
has lower sp. gr.
than other=Sugar.
Crystals of Witrate
of urea — visible to
naked eye — indicate
excess of Urea.
A precipitate of
square crystals= Uric
(IC20.
If the urine clears
wp on addition of the
acid=Phosphates.
Clumpy, white pre-
cipitate= Chlorides.
ea:pectation of sickness, for the adult male.
sickness increases with each year of life.
IEXPECTATION
OF
SICRINESS.
199:
EXPECTATION OF SICKNESS.
The following table gives the expectation of life and the
The amount of
The young man.
of twenty-one is ill one-half week a year, while the man of
sixty is ill two weeks and three-quarters on the average.—
Dr. Cl. T. Campbell (Pop. Sci. Mon.).
Expectation Expectation
Expectation of sickness - Expectation of sickness
Age. of life — for Age. of life — for
years and that year— years and that year —
decimals | weeks and decimals. weeks and
decimals. decimals.
21. 41.5 .450 41. . . . 27.4 .763
22.'. 40.8 .455 42. . . . 26.7 .803
23 . 40.2 .460 43. . . . 26.0 .843
24. . 39.5 .465 44. 25.3 .885
25 . . 38.8 .470' 45 24.5 .930
26 . 38.1 .476 46. 23.8 .980
27. . 37.4 .483 47. 23.1 1.035
28. . . . || 36.6 .491 48 22.4 1.095
29 . . . . . . 36.0 .499 49. 21.6 1,166
30. . 35.3 .509 50 20.9 1.230
31 . 34.6 .520 51. . . 20.2 1.308
32. . . . 33.9 .532 52. . . . 19.5 1.396
33. . 33.2 .545 53. . 18.8 1.494
34 . 32.5 .560 54. . 18.1 1,604
35. . 31.8 .578 55... 17.4 1.730
36. . 31.1 . 599 56. . 16.7 1.875
37. . . 30.3 .624 57. . 16.0 2.040
38. . . 29.6 .653 58. . 15.4 2.230
39 . . 28.9 .686 59. . 14.7 2.450
40. 28.2 .723 60. . 14.1 2.700
VITAL CAPACITY.
Definition.—The capacity of the lungs, in cubic inches
of air, as measured by the spirometer.
The vital capacity varies according to sea, height, weight,
age, and disease.
Sex.—The vital capacity of man exceeds that of woman,
of same height, by about thirty-eight inches.
Height.—There is an increase of eight cubic inches in
vital capacity for every inch in height between five feet and
six feet.
Weight.—Excess in body weight is associated with
diminished capacity in the proportion of about one cubic
inch per pound excess.
200 Kīy NOTES OF MEDICAL PRACTICE.
Age.—From thirty to sixty years, the vital capacity
decreases nearly one and one-half cubic inches per year.
Disease.—In lung diseases the vital capacity is always
diminished, and bears a certain relation to the extent of the
lesion.
TABLE º
GIVING WITAL CAPACITY OF MALES AND FEMALES, AT DIFFERENT
HEIGHTS. -
FEET, INCHE8. M. F. FEET. INCEIES. M. F.
4 - - - 7 - - - - 126 - - - 88 5 - - - - - - - 198 - - - 160
4 - - - 8 - - - - 134 - - - 96 5 - - - 5 - - - - 206 - - - 168
4 - - - 9 - - - - 142 - - - 104 5 - - - 6 - - - - 214 - - - 176
4 - - - 10 - - - - 150 - - - I12 5 - - - 7 - - - - 222 - - - 184
4 - - - 11 - - - - 158 - - - 120 5 - - - 8 - - - - 230 - - - 192
5 - - - 0 - - - - 166 - - - 128 5 - - - 9 - - - - 238 - - - 200
5 - - - 1 - - - - 174 - - - 136 5 - - - 10 - - - - 246 - - - 208
5 - - - 2 - - - - 182 - - - 144 5 - - - 11 - - - - 254 - - - 216
5 - - - 3 - - - - 190 - - - 152 (j - () - - - - 262 - - - 224
Of twelve phthisical patients examined, those who had
lost over three-tenths of their vital capacity, only three
lived longer than four months, as shown by the following
table:
PATIENT. I,OST. SURVIVED. PATIENT. LOST. SURVIVED.
TNo. 1 - - - - - 4-10 - - - - - 12 ds. No. 7 - - - - 4-10 - - - - 4 ms.
** 2 - - - - - 5-10 - - - - - 8 ms. ** 8 - - - - 3-10 - - - - 8 “
** 3 - - - - - 4-10 - - - - - 2 * * * 9 - - - - 3-10 - - - - 4 “
** 4 - - - - - 2-10 - - - - - 6 “ ** 10 - - - - 3-10 - - - - 3 “
** 5 - - - - - 4-10 - - - - - 2 whºs. ** 11 - - - - 3-10 - - - - 2 **
** 6 - - - - - 6-10 - - - - - 2. “ ** 12 - - - - 3-10 - - - - 3 *
Phthisis.--To examine sputum for elastic fibers, mix it
with soda solution (R. Liquor Soda, 3.j., Aqua, 3ij. M.) and
boil five minutes. Then dilute with equal quantity distilled
water, and pour into a flat porcelain vessel. The particles
suspended in the water may be taken out and examined
under a microscope. The fibers are brown, slightly reticu-
lated, and a fraction of a millimeter in length.
ARRANGEMENT OF THE TEETH.
a & # 3 + .
# # # # #
O © "S
# 5 § 3 ;
Upper Jaw 2 1 4 1 2=10
Temporary Teeth, - - 20
Lower Jaw 2 1 4 1 2–10
ad td
ă ă ă ă ă ă ă
§ 3 ; # 5 § 3
- a 3 E 3 tº 3
- Upper Jaw 3 2 1 4 1 2 3=16
Permanent Twº }*
Lower Jaw 3 2 1 4 1 2 3=16
ARRANGEMENT OF THE TEETH. 201
PERIODS OF ERUPTION OF THE TEETH.
TEMPORARY TEETH. 20.
6th or 7th month, two middle incisors.
9th “ two lateral incisors.
12th “ first molars.
18th ‘‘ eanines.
24th “ two last molars.
PERMANENT TEETH.
6th or 7th year, the four anterior or first molars.
7th ‘‘ two middle incisors.
8th ‘‘ two lateral incisors.
9th “ first bicuspids.
10th “ second bicuspids.
11th to 12th ‘‘ canines,
12th to 14th “ second molars.
17th to 21st “ last molars or “wisdom teeth.”
Early closing of the fontanelles indicates early dentition,
and vice versa.
The teeth of rachitic children are about one month late.
The “wisdom teeth.” aro the last to come and the first
to go. :
£ildren have been born with teeth (New York Medical
Journal, Vol. xxii, p. 444). Richard III is said to have been
born with teeth. Cases are recorded where adults never cut
teeth (Boston Medical Journal, March 6th, 1879, p. 183). , A
man said to be over one hundred years old, cut a complete
front set of teeth (German “Ephemerides,” dec. ij. ann. 3,
p. 57). Complete third sets have been cut.
TEMPERATURE.
1° Centigrade = 1.8° Fahrenheit.
Rule.—To convert Centigrade into Fahrenheit, multiply
by 1.8 and add 32.
Example.—37°C. × 1.8-H 32 = 98.6°F.
Rule.— To convert Fahrenheit into Centigrade, deduct
32 and divide by 1.8.
Example.—104°F. – 32 + 1.8 = 40°C.
EQUIVALENTS.
F. C. F. C. F. C.
97.0° = 36.1° 100° = 37.7° 104° = 40.0°
98.0° = 36.6° 101* = 38.3° 105° = 40.5°
98.6° = 37.0° 102° = 38.8° 106° = 41.1°
99.0° = 37.2° 103°– 39.4° 107° = 41.6°
202 KEY NOTES OF MEDICAL PRACTICE.
An increase of one degree Fahr. above 98° corresponds
with an increase of ten beats of the pulse per minute.
If, in the first week of a supposed case of typhoid, the
temperature fall to normal, for however short a space of
time, it is not typhoid. *
Average temperature in health, 98.6° F. (37°C.). In rec-
tum and vagina it is 0.9° to 1.3° F. higher. The daily range
rarely exceeds 1.8° F. (1°C.) above or below the average.
The axillary temperature may fall to 97°F. without col-
lapse, or rise to 100°F. without fever. --
In an instance of injury to the spine after a fall, reported by Mr.
Teale to the Clinical Society (London Lancet, March, 1875), the young
lady lived, though the temperature reached above 122°, and ranged for
days between 112° and 114°F.—Da Costa.
HYPODERMIC MEDICATION.
Select for injection, flexor side of arm, over biceps
muscle, or abdomen, near umbilicus. Pinch up fold of in-
tegument between thumb and forefinger, insert point of
needle well beneath integument, inject slowly, withdraw
carefully. As a rule, not more than one-half usual dose, as
given by the mouth, should be injected.
TABLE OF DOSES.
Muriate of Morphine, - - - - - - - - gr. 3% to 3%
Sulphate of Morphine, - - - - - - - - gr. 3% to 3%
Sulphate of Atropine, - - - - - - - - gr. 14t to #5
Strychnine, - - - - - - - - - - - gr. Tºn to ºn
Sulphate of Soda, - - - - - - - - grs. 2
Sulphate of Quinine, - - - - - - - grs. 2 to 4
Squibb's liquor of Opium, - - - - - gtt. 5 to 40
gtt. 3 to 20
- gtt. 10 to 20
- gtt. 10 to 20
- gtt. 15 to 30
Magendie's solution, - - - - - -
Tincture of Hyoscyamus, - - - - -
Tincture Cannabis, - - - - - - -
Ergot, Fl. Ext., - - - - - - - -
ATOMIZED FLUIDS FOR INHALATION.
The following drugs may be used in the form of spray.
The dose mentioned is to be added to one ounce of water:
Acidum Carbolicum, - - - grs. 1 to 2
Acidum Sulphurosum, - – fl. drs. 2 to 8
Acidum Tannicum, - - - grs. 3 to 12
Alumen Exsiccatum, - - grs. 3 to 20
Aqua Laurocerasi, - - min. 5 to 20
Argenti Nitras, - - A- - - - grs. 1 to 3
Borax, - - - - - - - - - - grs. 5 to 20
Extractum Belladonnae, - - - - -, grs. # to 1
\
Extractum Conii, - - grs. 5 to 10
ATOMIZED FT, UIDS FOR INHALATION. 203
Extractum Cannabis Indicas, - - - - - - gr. 4 to 1
Extractum Opii, - - - - - - - - - - gr. 4 to 2.
Ferri Ammonio-Sulphas, - - - - - - - grs. 3 to 6
Hydrargyri Perchloridum, - - - - - - - gr. tº to 4
Liquor Arsenicalis, - - - - - - - - - , min. 3 to 8
Liquor Calcis Saccharatus, - - - - - - - fl. drs. 1 to 4
Oleum Terebinthinae, - - - - - - - - min. 1 to 5
Potassas Chloras, - - - - - - - - - grs. 5 to 10
Potassae Permanganas, - - - - - - - grs. 2 to 4
grs. 2 to 10
grs. 2 to 10
Potassii Bromidum, -
Potassii Iodidum, - - -
Tinctura Ferri Perchloridi,
min. 3 to 20
grs. 3 to 15
Sodii Chloridum, - - * tº - - grs. 5 to 40
- - min. 5 to 30
Tinctura Iodi, - - - * - - min. 1 to 15
Tinctura Opii, - - - . .
Zinci Sulphas, - - - - -
Test for Chloroform.—When equal parts of Purified
Chloroform and colorless, concentrated Sulphuric acid are
shaken together in a glass-stoppered vial, there should be
no color imparted to either liquid, or, but a faint tinge of
color imparted to the acid after twelve hours' standing;
neither should there be any sensible heat developed at the
time of mixing.
Chloroform, as it evaporates from bibulous paper, should
give but little foreign odor, and the paper should be left
odorless after evaporation. Chloroform should not be used
for inhalation without having been subjected to these tests. .
Iodoform.—To destroy the odor of, add three grains of
Cumarim to a drachm of Iodoform. Mixing Iodoform with
Peppermint oil also masks its odor.
Rubini’s Camphor.—Equal parts by weight of Cam-
phor and spirits of wine, 60 degrees over proof. The spirits
will dissolve and hold in solution its own weight of Camphor.
Catgut.--To prepare chromicised catgut:—Qne part of
Chromic acid is first added to five of water. One part of
the solution thus made is then mixed with five of Glycerine.
Steep the gut in this for a week, and it will be capable of re-
sisting the action of the tissues for a fortnight. .
Leeches may be kept for a long time in a jar of water
to which has been added a very small quantity of a one-third
solution of Salicylic acid.
º
204 REY NOTES OF MEDICAL PRACTICE.
Ice.— To keep in sick-room,
tie a piece of flannel loosely
over the mouth of the bowl, put
the pounded ice in the nest
formed by the depression as the
cloth hangs down in the bowl,
and cover with another piece
of same material. In this way
it will last throughout a warm
night. Break bits off, as
wanted, with a pin.
HARDENING BANDAGES.
Starch Paste.—Starch is stirred in cold water to a uni-
form, cream-like consistence, and then, constantly stirring,
boiling water added to produce a clear, thickish mucilage.
Starch Bandages are made by drawing through this
paste ordinary roller bandages, of strips of muslin. -
Starch Splints.--Dºw strips of pasteboard once
quickly through hot water, then thickly smear both sides
with the paste.
APPLICATION.— Pad recesses º with cotton-
wool, apply moist flannel roller, lay starth splints over this,
and then bandage with starch roller.; Envelop whole with
dry roller bandage. -
Plaster of Paris.- Mix in porcelain dish, constantly
stirring, pouring on sufficient water to make paste consist-
ence of thick cream. It stiffens in five to ten minutes. To
delay setting, add more water, or powdered borax; to
hasten, use hot water, or add common salt.
APPLICATION.—Cover limb with dry roller bandage. then
apply plaster bandage over this.
WEIGHTS AND MEASURES.
To learn to write prescriptions, in terms of Grammes, is
really a very easy matter indeed, it being only necessary to
bear in mind the following approacimate
EQUIVALENTS:
1 Grain (gr.) equals .06 Gramme (Gm.);
1 Drachm (3) equals 4. Grammes (Gm.);
1 Ounce (3) equals 30. Grammes (Gm.); hence,
To convert Grains (or M.) into Grammes, multiply by .06;
To convert Drachms (or f3) into Grammes, multiply by 4;
To convert Ounces (or f3) into Grammes, multiply by 30.*
* More accurately, .065 (.06); 3.9 (4); 31.1 (30).

SIGNS OF DEATH. * 205
N. B.- Use an upright line in the decimal place.
EXAMPLES.
Iodoform Powder. Gm.
B. Thymol, - - - - (m j) - - - - - 06
Iodoform, - - - (grs. xxx.) - - - - 1 |80
Calamine, - - - - (3) - - - - - 4
Starch, - - - - (3.j) - - - - 30
Mix.
Bromidia.
B. Ext. Cannabis Ind., Gm.
Ext. Hyosciami, - aa (grs. iij.) - - 18
Brom. Potass., - - - - - - - - -
Chloral Hyd., - - ad (3v.j) - - - 24
Syrup simpl., - - - (3.j) - - - 30
Aqua pura, - - - - (3ij) - - - 60
Mix.
SIGNS OF DEATH.
1. The entire and continuous cessation of the heart's
action. This must be tested by a practiced ear, using the
stethoscope. Or, tie a ligature tightly about a finger; the
part beyond the constriction will, if there be circulation,
become bluish-red, while, where the ligature is applied,
there will appear a narrow white band. If, during life, a
little Ammonia solution be injected subcutaneously, a port-
wine congestion is set up in the surrounding parts; no such
redness results when the operation is performed on a dead
body. -
2. The entire and continuous cessation of respiration.
Test by the surface of a cold mirror held over the mouth; if
moisture condense, breathing has not ceased. Hold a light
feather over the lips, to see if there be a current of air pass-
ing. , Set a glass of water on the chest – motion, if present,
will be indicated by the images of surrounding objects re-
flected from the surface of the water.
Six hours after cessation of signs of life, if the muscles
do not respond to a strong electrical current, life is cer-
tainly eactinct.
ARTIFICIAL RESPIRATION.
To be resorted to in all cases of suspended animation if
the respirations fall below ten to the minute.
Remove all clothing from chest and arms. Clear mouth
of mucus. Patient on back, with small, firm cushion, or
roll of clothing, under shoulders. Pull tongue forward
and secure it by string tied over tongue and under chin.
Stand or kneel behind and at head of patient. Grasp the
arms just above the elbows, and draw them gently and
206 REY NOTES OF MEDICAL PRACTICE.
steadily outward, upward, and backward, till they meet
tº the head, keeping them in that position for two
SeCODCIS.
Then flex the arms at the elbows and return them slowly
to the sides of the chest, and press the arms firmly against
the chest, holding them there for two seconds. Repeat this
process at the rate of fifteen or eighteen times a minute.
hen spontaneous respiration has become reëstablished,
cease further effort, and proceed to induce circulation and
warmth.
In changing operators do not miss a single movement.
Occasionally . w a little of the vapor of Ammonia, or a
little snuff, into nostrils. Persevere in this treatment for
hours. .
After breathing has been restored, promote warmth by
rubbing limbs upward, with firm, grasping pressure, and
energy, using flannels, handkerchiefs, etc. Continue the
friction under the blankets, or over dry clothing. Promote
warmth by the application of hot bottles, hot bricks, blad-
ders of warm water, etc., to the pit of the stomach, armpits,
between the thighs, to the soles of the feet. Provide at all
times for a free supply of fresh air. .
As soon as the patient can swallow give hot water, by the
teaspoonful, and follow it by wine, diluted brandy, or coffee.
Put him in a warm bed, and encourage a disposition to
sleep.
TRANSFUSION.
To support a patient until transfusion can be performed—
keep the head low; raise the limbs; make friction from the
distal ends toward the body, and then apply Snug bandages
about the limbs up to the body. Gently, but firmly, kneading


TRANSFUSION. 207
the abdomen with the hands (if no wounded or diseased con-
dition of the part prohibit) will drive the blood to the heart.
The object to be attained is to fill the blood-vessels, and
get up vascular tension, so that the heart will have something
to contract upon. For this purpose use the
Solution of Schwartz.
R. Distilled water, 100° F., - 2 pints.
Common salt, - - - - 1% drachms.
Liquor sodas, - - - - - 20 drops. Mix.
Select median basilic vein at elbow, or internal saphenous,
in front of internal malleolus. The collapsed vein is some-
times hard to find — cut down upon it, expose it freely, and
pass two ligatures under it. With one ligature, tie the vein
at the exposed portion which is nearest the hand or foot;
push the other ligature to the other end of the wound.
Open the vein by raising the upper wall with a fine pair
of toothed forceps, beneath which an ob}ique slit is to be
made with Scissors, so as to make a small, flap-like opening.
Raise the flap, and pass in the bulbous point of a canule
(glass, vulcanite, or silver), directed toward the center of
circulation. Tie this in the vein with the second ligature.
Have ready a glass funnel, to
which is attached a foot of rubber
tubing, with the camule at the other
end. Have the tube guarded by a
clip. Pour the Solution into the
funnel; open the clip, and let the
Solution start from the mouth of the
canule, when the clip must be shut,
and the point immediately intro-
duced into the vein. Now open the
clip, raise the funnel and the
patient’s arm, and the Solution will
be forced into the vein by hydro-
static pressure. - -
Admit mo air. A few small bub-
bles of air do no harm—the quan-
tity to cause death must be consider-
able. Inject no clots or foreign
particles, which may act as emboli.
Keep the Solution in a clean, warm,
glass vessel.
Inject slowly. Quantity — a half-
pint to a pint. If signs of dyspnoea appear, stop the injec-
tion by lowering the funnel, and wait for it to subside.
During process keep Solution warm by wrapping funnel
with hot flannels. * =
As soon as the funnel is nearly empty, withdraw the canule
from the vein, apply a compress, and treat as simple wound.

208 REY NOTES OF MEDICAL PRACTICE.
POISONING.
EMETICS.
Apomorphia.-Solution in water, 1:50; inject five
to ten drops hypodermically. This is the most prompt and
efficient emetic known. . *
Ipecacuanha.-Powdered, thirty grains in water.
Sulphate of Zinc.—Thirty grains in water; repeat if
necessary. Prompt and º
Sulphate of Copper.— Five to ten grains dissolved in
water.
Mustard.— A tablespoonful in a half pint of warm
water.
Common Salt.—Two tablespoonfuls in a half pint of
tepid water. -
ANTIDOTES.
For Opium.—Atropia sulph., one-fortieth grain, or Tr.
Belladonna, fifteen drops, repeated in fifteen minutes if
necessary. Strong coffee, ad lib.
For Arsènić-Tălyzed iron, ounce doses frequently
repeated. Hydrated peroa;ide of irom, give ad lib. Iron
rust.
For Strychnine.— Chloral, thirty grains, repeated if
necessary; Bromide of potassium, 3ss.; Animal charcoal,
ad lib.; Tammic acid, ad lib.; Chloroform ; Ether; Nitrite
of amyl, by inhalation. -
For Acids.--Lime water, ad lib., chalk and water;
Magnesia, mixed in water; Ammonia and water, 3.j to
3viij. ; ashes; plaster from the wall; tooth powder, in
water; soap and water. -
For Alkalies.—Vinegar, freely; Acetic acid and water;
lemon juice; Muriatic acid, freely diluted with water; any
dilute acid.
For Narcotics.-Coffee, strong, given freely; Nitrite
of amyl by inhalation; Ammonia ; galvanism ; stimulants.
Multiple Antidote.—B. Saturated solution Sulphate
of irom, 3ijss; water, 3xx; Calcimed magnesia, 3ij; Animal
charcoal, 3j. -
Keep Iron solution separately, and the Magnesia and
Charcoal mixed in a bottle of water. When required for
use, pour all into bottle together, and shake. Give ad lib.,
a wineglassful at a time.
This is a perfect antidote to Arsenic, Zinc, and Digitalis;
it delays the action of Salts of copper, Morphine, and
Strychnine, and slightly influences Salts of mercury.
Stimulants.—Wine, whiskey, brandy, Ammonia, tea,
coffee, Ether. - .
Instruments.—Stomach pump; hypodermic syringe;
soft-rubber catheter; enema syringe.
POISONING. . 209
GENERAL DIRECTIONS.
Emetic.— Give that emetic which can be most speedily
obtained. If it be a corrosive poison, give copious draughts
of demulcent drinks, followed by an emetic, and the appro-
priate antidote. If the emergency be great, and no emetic
at hand, give copious draughts of tepid water, even though
it be dirty or greasy; then run the finger down the throat,
to excite vomiting. The action of an enetic is facilitated if
large quantities of fluid be swallowed.
Depression.— If present, must be combated by Stimu-
lants, warm application to the extremities, friction, galvan-
ism, and, if the respirations fall below ten per minute,
artificial respiration must be employed. Catheterize blad-
der in prolonged cases.
Battery.—One pole at the side of the neck, the other
over pit of stomach, or muscles of the chest. Or, touch the
two poles to different attachments of the muscles of the
chest, using strong current, sufficient to excite pain, and
produce efforts at crying.
Flagellation.— In poisoning with marcotics, to combat
the depression, and keep patient from sinking into fatal
stupor, slap the skin with wet towels, spat the skin sharply,
rub the soles of the feet with a stiff hair brush; make every,
effort to rouse him. Walking the patient only adds eahaws-
tion to stupor — better lay him on a lounge and use
flagellation.
Douches.— To aid in rowsing when there is stupor and
depression, dash cold and warm water alternately, upon the
head and chest. In apparently hopeless cases, two or three
sharp blows on the chest, delivered in quick succession,
will sometimes restore the heart's action. -
Stimulation.—Alcoholic stimulants may be used if the
poison is not a narcotic. Coffee may be employed as a
stimulant in Belladonna, Opium, and other narcotic poison-
ing; give an enema of a pint of hot, strong coffee. Am-30,
ºnomia may be given by inhalation, or by injection into all
veins. Strong tea is an excellent stimulant, and it also
antidotes many poisons; give by the stomach, if possible.
Whiffs of Ether, by inhalation, will stimulate the heart's
action.
Demulcerts.-In cases of poisoning by corrosive sub-
stances, give, after the administration of the antidote and
emetic, large quantities of mucilagimous drinks; preferably
White of egg and water. -
Demulcent Drinks.- Milk; white of an egg and
Water; oil; linseed tea; gruel; flour and water; boiled
* Give in large quantities. -
210 REY NOTES OF MEDICAL PRACTICE.
IKINID OF POISON. TREATMENT.
- Provoke repeated vomiting;
TUnknown. Give demulcent drinks;
Multiple antidote ;
Stimulate, if necessary.
ſ Provoke repeated vomiting;
Opium, | Give stron ë.
g g coffee, etc.;
#. Inject Belladonna ;
Chioral. ' Bouse by flagellation;
I’8,1, Artificial respiration.
Provoke repeated vomiting;
Arsenic— Give dialyzed Iron, etc.;
Paris Green, Give dose Castor oil;
Scheele's Green. | Secure rest :
U Stimulate, if necessary.
- Provoke vomiting once or twice;
Strychnine, Give purgative :
Picrotoxine. Give Chloral, etc.;
Secure absolute quiet.
Acids—
Sulphuric, Give an alkali ;
Nitric, Provoke vomiting;
Mwrèatic, Demulcent drinks; -
Oaxalic, Stimulate, if necessary.
Carbolic. |
Aºi. | ſ Give an acid (vinegar): .
Soda, 3. K Provoke vomiting;
Pota,sh | Demulcemi drinks;
5 Sºfa', & gº Yº
Lyé. - U Stimulate, if necessary.
ſ Provoke repeated vomiting;
Give strong tea, freely;
Give raw eggs and milk;
Give dose Castor oil;
Stimulate, if necessary.
Corrosive Sublimate
Tartar Emetic.
- Provoke vomiting; -
| Sulphate of copper, Sol. gr.S. iij,
Phosphorus. &v4t }~ every 5 ms., till emesis;
48.4.4% vs. wº # , Salts, 3.SS.;
. . U No
oils or fats.
Nitrate of Silver | { Strong solution salt and water,
- .#2' wery freely;
(L'umar Cawstic.) Provoke repeated vomiting.
POISONING. - 211
IKIND OF POISON. TREATMENT.
Give Epsom salts repeatedly;
Provoke repeated vomiting;
Give demulcent drinks;
Give dose Castor oil.
Sugar of Lead.
Provoke vomiting;
Stimulants, freely;
Aconite. Digitalis tinct. gtt. xx, hypo-
erm. ; mustard over heart;
Artificial respiration.
Provoke vomiting;
tº tº ſº tº Give strong tea ;
Digitalis. Give stimulants;
| Recumbent posture.
ſ Provoke vomiting;
- Stimulants, freely;
#. Hot, strong coffee; . .
Hermlock, 5 0. tinct., gtt. iij-V, or
| 9 ism fla.or-
Tobacco. J Cold to head, galvanism, flag
ellation;
U Artificial respiration.
«Žºv--. ſ Abundance of fresh air;
Pull tongue forward, clear the
mouth;
Loosen clothing, - head low ;
Chloroform, Alternate cold and warm
Carbonic Acid Gas. } Y douche;
Inhalations Amyl nitrite —-Am-
monia ; -
ARTIFICIAL RESPIRATION!— Bat-
tery.
Stomach pump, or emetic;
Ammonia and water;
Battery and flagellations;
Cold douche to head;
Artificial respiration.
Alcohol. |
L
Decayed Meats | { Provoke vomiting ;
Give purgative :
and Vegetables. .. charcoal, freely.
If particles of glass have
been swallowed, let the patient
eat large quantities of bread
crumbs, to envelop it — then
give emetic. Do not let it pass
wnto the bowels.
Glass.
*



INDEX.
ABDOMINAL typhus, 5.
Abortion, 104.
Abscess, 156.
Acne, 87.
Acupressure, 163.
Adherent placenta, 114.
After-pains, 108
Agalactia, 120.
Ague, 19.
“ pernicious, 22.
Albumin in urine, 198.
& 4 water, 186.
Alcohol bath, 191.
Alcoholism, 75.
Alopecia, 87.
Amenorrhoea, 125.
Amputations, 147.
Amputation at ankle joint, 150,
* , at hip joint, 149.
{ { at shoulder joint, 148.
$ (, of arm, 148
{{ of fingers, 149.
{ { of foot, 150.
$ $ of leg, 150.
{ { of thigh, 150.
{ { of toes, 151.
Amyloid kidney, 67.
Anaesthesia, local, 166.
Anaesthetics, 166.
Anal fissure, 170.
Angina pectoris, 43.
Antidotes, 208.
Antiseptic surgery, 154.
Apoplexy, 74.
Apomorphia, 208.
Army splint, 131.
Artificial respiration, 205.
Ascaris lumbricoides, 60.
Asiatic cholera, 98.
Aspiration, 169.
Asphyxia of new-born, 113.
Asthma, 33.
Atomized fluids, 202.
BANDAGES, hardcning, 204.
Barber's itch, 87.
Barley water, 185.
Bathing the patient, 8.
Baths, 191.
Bath, alcohol, 191.
** blanket, 191.
“ bran, 191.
** mercurial, 192.
“ mustard, 191.
“ salt, 191.
“ sulphur, 191.
Bath, vapor, 192.
Barton’s fracture, 138.
Bed for typhoid patient, 8, .
Beef tea, 186.
Bile in urine, 198.
Biliary calculus, 64.
Bilious fever, 21.
Bilious headache, 50.
“, temperament, 182.
Bladder, diseases of, 69.
Blepharitis, 89.
Blood in urine, 198.
Brain, compression of, 156.
“ concussion of, 155.
“ congestion of, 72.
Brain fever, 72. •
Bran bath, 191.
Break-bone fever, 19.
Bright's disease, 66.
Bromidia, 205.
Bronchitis, 31.
capillary, 33.
Bubo, 174, 177.
Bunion, 172.
Burns, 161.
- CALCULUS, biliary, 64.
Calculus, renal, 68.
gº º, 203,
ancrum oris, Ge
Capelline, 133. &lude/,
Carbuncle, 159. —-.
Cataplasms, 188.
Catarrh, nasal, 25.
Cautery, 163.
Catgut ligature, 203.
Cerebral meningitis, 72.
Cerebro-spinal meningitis, 11.
Cervix, laceration of, I17.
Chancre, 173.
Chancroid, 176.
Chills and fever, 19.
Chloasma, 87.
Chlorides, excess of, 198.
Chloroform, use of, 166.
& 4 test, 203.
Chloral blister, 189.
Cholera Asiatica, 98.
Cholera infantum, 101.
Chorea, 81.
Circumcision, 172.
Cirrhotic kidney, 67.
Climacteric, 128.
| Climate, in phthisis, 41.
Cocaine, 166.
Coccygodinia, 171.
214
INDEX.
-
Cod-liver oil, 187.
Cold cap, 190.
“ cloth, 190.
“ douche, 191.
Cold drip, 190.
“ pack, 191.
Colic, 56.
“ lead, 57.
Collapse, temperature, 5.
Colles' fracture, 138.
Comedo, 87.
Compression of brain, 156.
Concussion of brain, 155.
Congestion of brain, 72.
{ { liver, 61.
& C lungs, 36.
Congestive chill, 22.
Conjunctivitis, 89.
Constipation, 57.
Çonsumption, 37.
Convulsions, 82.
Cord, prolapse of, 109.
Corns, 172
Cough, 29.
“ whooping, 30.
Coryza, 25.
Craniotomy, 113.
Croſſºp, catarrhal, 28.
.*** false,83. -
“ . . pseudo-membranous, 28.
Cystitis, 69.
Cystocele, 108.
DEATH, signs of, 205.
Delirium tremens, 75.
Demulcents, 209.
Dengue, 19. -
Diabetes mellitus, 102.
Diagnosis of measles, 18.
tº 4. typhoid, 10.
{{ typhus, 10.
* * Scarlatina, 18.
{ % Small pox, 18.
Diarrhoea, 51.
Pº, in cholera infantum, 102,
Diet, in diabetes, 103.
“ in fevers, 186.
“, for infants, 185.
Diphtheria, 96.
Disinfectants, 192.
Dislocations, simple, 142.
{ complicated, 143.
& © compound, 143.
{ % habitual, 142.
{ { irreducible, 142.
Dislocation of ankle joint, 146.
$ $ clavicle, 144.
{ % elbow, 145.
{{ fingers, 145.
$6 hip, 145.
$6. humerus, 144.
{ % jaw, 143.
{{ patella, 146.
# * : tarsus, 146.
6% tibia, 146.
Dislocation of vertebrae, 143.
& ſº wrist, 145.
Dissection wounds, 160.
Doses, hypodermic, 202.
Douche, cold, 191.
Dissection wound, 160.
Drinking-water, 195.
Dropsy, 95. -
Duration of pregnancy, 106.
Dysentery, 53.
Dysmenorrhoea, 124.
Dystocia, 109.
EAR, diseases of, 91.
Eclampsia, puerperal, 114.
Ecthyma, 87.
Eczema, 87.
Effusion, pleural, 38.
Egg nog, 187.
Emetics, 208.
Endocarditis, 42.
Enemata, 187.
Enteric fever, 5.
Entozoa, 60.
Enuresis, 70.
Epididymitis, 180.
Epilepsy, 81.
Epistaxis, 26, 163.
Eruptive fevers, 13.
Erysipelas, 92.
Erythema, 87.
Ether, use of, 166.
Eye, diseases of, 89.
Expectancy of life, 199.
Expectancy of sickness, 199.
Expert testimony, 183. -
FEBRIS icterodes, 23.
Fever, cerebro-spinal, 11.
“ intermittent, 19.
“ jail, 9.
“ puerperal, 119.
“ remittent, 21.
“ scarlet, 13.
** ship, 9.
“ typhoid, 5.
“ typho-malarial, 12.
“ typhus, 9.
Fevers, continued, 5.
{ % eruptive, 13.
{{ eriodical, 19.
Fissure in ano, 170.
Fistula, rectal, 171.
Fly blister, 189.
Fomentations, 189.
Forceps delivery, 111.
Fracture box, 130.
Fractures, compound, 131.
{ { simple, 129.
{ { ununited, 132.
Fracture of arm, 137.
* @ clavicle, 135.
4 & facial bones, 133.
{ { femur, 188.
£ 6. fibula, 141.
* { hand, 138.
INDEX. 215
Fracture of humerus, 136.
{{ hyoid bone, 134.
{ { jaw, 133.
{ { nasal bones, 133.
{ % patella, 140.
{{ pelvis, 138.
tº º radius, 138.
{ { skull, 132.
{{ spine, 135.
, “ ribs, 136.
44 scapula, 136.
{ { sternum, 136.
{ { tibia, 140.
t “ ulna, 137.
Frost bite, 151.
Fumigation, 194.
GANGLION, 172.
Gangrene, 159.
Gastralgia, 47.
Gastric catarrh, 46.
{{ fever, 12. -
“ headache, 50.
* * ulcer, 48.
Glaucoma, 91.
Gleet, 179. -
Glottis, oadema of, 26.
Gomorrhoea, 177.
Granular kidney, 66.
Granular lids, 90.
Gum-Arabic water, 185.
Gummata, 176.
HAEMATEMESIS, 49.
Haematuria, 71.
#; 36.
Haemorrhage, 162.
( * post-partum, 110.
& S. rectal, 164. :
§ { urethral, 164.
& A uterine, 164.
Haemorrhoids, 58, 169.
Hare-lip, 167.
Hardening bandages, 204.
Hay fever, 27.
Headaches, 50, 51.
Headache, congestive, 77.
nervous, 77.
{{ sick, 50.
Heartburn, 47.
Heart, diseases of, 42.
Hemicrania, 77.
Hepatitis, 62.
Hernia, 153.
Herpes, 87.
Herniotomy, 153.
Hives, 88.
Hordeolum, 89.
Hour-glass contraction, 114.
Hydrocele, 180.
Hydrocephalus, acute, 84.
{ % chronic, 84.
Hydrophobia, 161.
Hydrothorax, 39.
Hymen, imperforate, 108.
Hyperaemia of brain, 66.
Hypodermic medication, 202.
Hysteria, 81.
ICE bag, 190. -
Imperforate hymen, 108.
Infant diet, 185.
Influenza, 27.
In-growing nail, 173.
Intertrigo, 88.
Intussusception, 168.
Iodoform, 203. -
Itch, barber's, 87.
Iritis, 91.
“ syphilitic, 91.
JAIL fever, 9.
Jaundice, 63.
Jurors, 184.
KIDNEY, amyloid, 67.
{ % red granular, 66.
Kidneys, diseases of, 65.
Keratitis, 90.
LACERATION of cervix, 117.
Laceration of perineum, 116.
Laryngismus stridulus, 83.
Laryngitis, 28. -
Lead colic, 57.
Leeches, 203.
Legal medicine, 183.
Lente's solution, 28.
Leucorrhoea, 126.
Lichen, 88.
Ligature, 162. -
Lisfranc's operation, 151.
Listerism, 154.
Lithaemia, 103.
Lithiasis, 103.
Liver, congestion of, 61.
“ diseases of, 61.
Local anaesthesia, 166.
Lung fever, 34.
Lungs, congestion of, 36.
Lungs, dedema of, 36. .
Lymphatic temperament, 182.
MALPRACTICE, 184.
Mania, puerperal, 115.
Mastitis, 121.
Measles, 15.
Meningitis, cerebral, 72.
{. cerebro-spinal, 11.
Menorrhagia, 123.
intercurial bath, 192.
Metrorrhagia, 122.
Microscopic urinalysis, 196.
Milk diet, 188.
Milk leg, 118.
Miscarriage, 105.
Morphine habit, 76.
Morbilli, 15.
Mucus in urine, 198.
Mumps, 45.
Mustará bath, 191.
Mustard poultice, 189.
216
INDEX.
Mutton broth, 187. e
Myocarditis, 42.
NAEWUS, 168.
Nail, *..."; 173.
Nasal catarrh, 25.
Nephritis, parenchymatous, 66.
Nervous diseases,
Nervous temperament, 181.
Neuralgia, 78.
Nipples, sore, 122.
Noma, 45.
Nursing, in typhoid, 8.
OATMEAL water, 185.
Obstetrics, 104.
CEdema glottidis, 26.
“ of #. 36.
Opium habit, 76.
Ophthalmia, 89.
$4. catarrhal, 89.
${ gonorrhoeal, 90.
{{ neonatorum, 89.
44 phlyctenular, 90.
Orchitis, 180.
Otalgia, 91.
Otorrhoea, 92.
Ovaritis, 127.
. Oxyuris vermicularis, 61.
Ozºena, 25.
“ syphilitic, 25.
Ozone, 192.
PARACENTESIS abdominis,169.
Paraphimosis, 176.
Palpitation of heart, 43.
Parotitis, 45.
Parturition, 107.
Pemphigus, 88.
ferièaritis, 42.
Perineum, lacerated, 116.
&\ rigid, 108.
Peritonitis, 55.
Periodical fevers, 19.
Perforation of stomach, 49.
Perforation of bowel, 6. \
Pernicious ague, 22.
Pertussis, 30.
Phagedaena, 177.
Phlegmasia dolens, 118.
Phosphates, excess, 198.
Phthisis, pulmonary, 39.
Piles, 169
Pin worms, 61.
Pityriasis, 88. e
Placenta, adherent, 114.
* { praevia, 109.
& & retained, 113.
Plaster bandage, 129.
Pleuritis, 37.
#; 39. tion, 169
*neumatic aspiration, 169.
; 34.
Pödalić version, 110.
Pºisoning, 208.
** sº - s
Poisons, 210, 211.
Poppy fomentation, 189.
Post-partum ha-morrhage, 110.
Pott's fracture, 141.
Poultices, .188.
Premature labor, 105.
Prolapse of cord, 109.
Prurigo,
Pruritus, 88.
& © vulvae, 127.
Psoriasis, 88.
Puerperal eclampsia, 114.
* {, fever, 119.
{ % nania, 115.
Pus in urine, 198.
QUINSY, 45.
Quinine, solution, 23.
RECTAL alimentation, 187.
{ % fistula, 171.
{ { haemorrhage, 164.
{{ stricture, 170.
Remittent fever, 21.
Renal calculus, 68.
Respiration, artificial, 205.
Retained placenta, 113.
Retention of urine, 171.
Rheumatism, 93.
Rigid os, 107.
“ perineum, 108.
Rose cold, 27.
Rubeola, 15.
Rubini's camphor, 203.
Rupia, 176. -
SALT bath, 191.
Sunguine temperament, 181.
Sanitation, 1
Sarcocele, 176.
Scalds, 161.
Scarlet fever, 13.
Schwartz, solution of, 163.
Sciatica, 79.
Sex, to determine, 107.
Serous cholera, 98.
Shingles, 87.
Ship fever, 9.
Shock, 165.
Sick headache, 50.
Sick-room, 7.
Simple continued fever, 12.
Signs of death, 205.
Skin, diseases of, 85, 88.
Small pox, 16.
Snake bites, 160.
Solution of §: 23.
{ % chwartz, 207.
Sore nipples, 122.
Spanish windlass, 163.
Spasmodic croup, 83.
Splints, 130.
Spotted ſever, 11.
Sprains, 160.
Starch bandage, 130.
Stimulants, 208.

INDEX. - • 217
Stimulation, 209.
Stings of insects, 160.
Stomatitis, 45. *
Stricture of rectum, 170.
“. . urethra, 179.
St. Vitus’ dance, 81.
Stye, 89.
Styptics, 163.
§. in urine, 198.
Sulphur bath, 191.
ś 129.
Syphilis, 173.
& © secondary, 175.
{ % tertiary, 175.
4 & treatment of, 135.
TAENIA Solium, 60.
Tampon, 105.
Tape worm, 60.
Teeth, eruption of, 201.
“ permanent, 201.
{{ jº.
l
Temperaments, bilious, 182.
tº º lymphatic, 182.
* & nervous, 181.
{{ sanguine, 181. -
Temperature, 5, 201.
Tetanus,
Throat cut, 151.
Thoracentesis, 168.
Tinea versicolor, 88.
Tonsilitis, 45.
Torsion, 163.
Tough membranes, 107.
Tourniquet, 163.
Trachedtomy, 151.
Transfusion, 206.
Trephining, 132.
Turpentine stupe, 189.
Twins, 113.
YN
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74 & 4
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IGHT & LEONARE) .
Typhoid fever, 5.
Typho-malarial fever, 21.
Typhus fever, 9 e
Typhus, abdominal, 5.
ULCERS, 157.
“ healthy, 157.
* b. inflamed, 158.
{ { irritable, 158.
§ { sloughing, 158.
Uraemia, 69.
Urea, excess of, 198.
Urethral haemorrhage, 164.
|Uric-acid diathesis, 103.
# , excess of, 198.
Urinalysis, 198.
Urine, retention of, 171.
Urticaria, 88.
|Uterine haemorrhage, 164.
VACCINATION, 17.
Vapor bath, 192.
Variola, 16.
Varioloid, 16.
Venereal, the, 173.
Venesection, 165.
Ventilation, 192.
Version, 110.
Virus, vaccine, 17.
Vital capacity, 199.
WATERBRASH, 47.
Wet pack, 192.
Weights and measures, 204.
Whooping cough, 30.
Wine whey, 186.
Worms, 60. -
Wounds, treatment of, 154.
YELLOW fever, 23.
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