BQERI CQ. i 231SutterStSanFranc:^ Kg BSHIIFORNIA COLLEGE A DIGEST OF EXTERNAL THERAPEUTICS WITH NUMEROUS FORMULA ARRANGED FOR REFERENCE BY/ EGBERT GUERNSEY tfANKIN, A. M., M. D PHYSICIAN TO THE METROPOLITAN HOSPITAL, DEPARTMENT OF PUBLIC CHARITIES, NEW YORK. Second Edition Revised and Enlarged. BOERICKE & RUNYON CO., NEW YORK. 1900. -.too VIM WB330 au \^oo COPYRIGHTED BY BOERICKE & RUNYON CO. 1900. T. B. & H. B. COCHRAN, PRINTERS LANCASTER, PA. THIS BOOK is DEDICATED TO EGBERT GUERNSEY, M. D., PRESIDENT OF THE MEDICAL BOARD OF THE METROPOLITAN HOSPITAL, NEW YORK, WITH THE AFFECTIONATE REGARD OF THE AUTHOR. Preface of the Second Edition. The demand for a second edition, in so brief a period after the appearance of the first, is an evi- dence of approval for which the author desires to ex- press his appreciation and gratitude. The book has been carefully revised and recent matter incorporated. It is obvious in a work of this character, that while the author's approval of the matter presented should generally be understood, some subjects are of so recent a date as not to war- rant a definite conclusion. March 1, 1900. E. G. R. 226 Central Park South, West Fifty-Ninth Street, New York. Preface to the First Edition. It is not the purpose of this book to give undue prominence to external therapeutics, but to present the subject in a condensed and easily accessible form. No attempt has been made to cover completely so wide a field. The remedies and remedial measures include those which are the more important and generally ac- cepted, and have been selected from well known and recent writers. A wider range of authorities might have been presented, but it was found that after a certain number had been searched, \vhile new names were added, new subject matter was not thereby obtained. The following have been so frequently cited as authorities that the author desires to acknowl- edge his indebtedness : Goodno, Tyson, Anders, Pepper, Allbutt, Ruddock, Stedman's Twentieth Century, Practice of Medicine; Foster, Barthe- low, Ringer, Hare, Therapeutics; Harrison Allen, Local Therapeutics ; Carleton, Bangs and Harda- way, Genito-Urinary Diseases ; Van Harlingen, Kip- pax, Jackson, Crocker, Hardaway, Hyde, Shoemaker, Unna, Diseases of the Skin; Burt, Shoemaker, Ma- teria Medica ; Keating and Coe, Southwick, Cowper- thwaite, Dudley, Diseases of Women ; Bosworth, Lennox Browne, Ivins, Ingalls, Bishop, Diseases of Vlll PREFACE TO THE FIRST EDITION. Nose and Throat; Burnett, Boyle, McBride, Bacon, Roosa, Buck, Diseases of the Eye and Ear; Kelsey, W. and H. B. Allingham, Andrews, Gant, Diseases of the Rectum and Anus ; Jacobi, Holt, Diseases of Children; Wyeth, Dennis, Park, Treves, Holmes, Helmuth, Surger}^; Treat's International Medical Annual for 1896, 1897 and 1898, andSajous' Annual. September 1, 1899. E. G. R. 226 Central Park South, West Fifty-Ninth Street, New York. NOTE. The initials and abbreviations which appear at the end of paragraphs throughout this work are explained by the Key of References on page 723. Digest of External Therapeutics. ABSCESS. ACUTE ABSCESS. If seen early, suppuration may sometimes be pre- vented. The following measures are recommended with this end in view: Rest and elevate the part ; cleanse the surface with Antiseptic Soap and spray with a 2 per cent, solution of Carbolic Acid or Hydrogen Peroxide for ten min- utes every two hours, or apply compresses suturated in hot solutions of Corrosive Sublimate 1-4,000. If the lesion is situated on the lower extremity the same solutions may be employed in the form of baths. Cocaine : When pain is very severe the anode sponge of a galvanic battery, saturated in a 10 per cent, solution of cocaine, may be applied for five minutes every three bours, with a current not ex- ceeding five milliamperes ; during the intervals apply Warm Fomentations with Borated or Camphorated Water or an Infusion of Poppies. (Saj.) Menthol: 10 to 50 per cent, ethereal solutions painted on with a camel's hair brush two or three times a day control small abscesses. (Al.) Menthol Phenol : A 5 per cent, solution in warm water has been used successfully for its anaesthetic 2 2 DIGEST OF EXTERNAL THERAPEUTICS. and antiseptic qualities in painful abscess of the finger. A 2 per cent, gauze may be employed as a dressing with good effect. (B. M. S. J. 1, 20, 96.) Carbolic Acid : See Carbuncles and Boils. Nitrate of Silver : This drug is very highly praised by Mr. Higginbottom, the author of the method, who regards it as efficacious in subduing external in- flammation: "The affected parts should be well washed with soap and water then with water alone to remove every particle of soap, as soap decomposes nitrate of silver, then -wiped dry with a soft towel. The concentrated solution of nitrate of silver, 4 scru- ples to 4 drachms of distilled water, is then applied two or three times on the affected surface and beyond it on the healthy skin to the extent of two or three inches. The solution may be applied with a soft piece of linen on the end of a stick. In about twelve hours it will be seen whether it has been well applied. If any inflamed part is unaffected the solution must be immediately reapplied." The following also mentioned under cellulitis is not only applicable to that condition, but will also prove effective in abscess, under its influence in conjunc- tion with moist heat infiltration assumes a more kindly hue and pus is sometimes absorbed : Ichthol, 10 parts. Resorcin, 5 parts. Mercurial Ointment, 35 parts. Lanolin, 50 parts. (Pk.) Alum and Plumb. Acetate : The following (for- mula of Von Bulow) is highly endorsed as effective for subduing local inflammation, it is non-poisonous, ABSCESS. 3 astringent, mildly antiseptic, and almost non-irritat- ing : J*. Aluminis, 5 V J- Plumb. Acetat., ^ixss. Aquae, Oij. M. Sig. Filter and allow to stand twenty hours before using. (W.C.) Cold : In local inflammations is generally preferred to heat by patients ; use ice bag or Leiter's coil. (W.) Continuous Antiseptic Applications : When the skin is broken, in place of poultices apply layers of gauze soaked in solutions of bichloride and cover with rubber dressing. This will act somewhat as a poul- tice. (W. C.) A hot water bag may also be applied over the gauze. Poultices : Will sometimes abort, as well as hasten maturation ; they are generally made of flaxseed meal, and should be applied only up to the time of suppuration, never after, or to open incisions. (W. C.) Tr. Opii or Tr. Bell.: Poured over poultices use- ful to relieve pain. If suppuration is unavoidable, incise as soon as presence of pus is ascertained. For anaesthesia of the surface: Cocaine 5 per cent, solution, twenty drops subcutaneously near the abscess; sprays of Ethyl Chloride, Ether, or Ethyl Bromide ; the latter especially valuable. (Sj.) Incision : The parts should first be thoroughly cleansed and rendered aseptic. The incision should be planned so as to run parallel with' important structures, and of sufficient depth to freely expose the cavity ; the opening should be made in as depend- ent a portion as possible to facilitate drainage. Ab- scess of the limbs should be opened longitudinally, in 4 DIGEST OF EXTERNAL THERAPEUTICS. those of the anus and breast, the incisions should radiate from the part. Deeply seated abscesses and those near large vessels should be opened hy Hilton's method ; this consists of making an incision through the skin and deep fascia; a director is then pushed into the abscess cavity, the escape of pus showing when this is reached ; a pair of closed dressing for- ceps is then inserted, and withdrawn with distended blades, thus enlarging the opening, a counter open- ing may be made if possible when the cavity is deep, and a drainage tube inserted. (Whar.) After evacuation of pus, some surgeons irrigate the cavity ; others leave it to nature or pack with iodo- form gauze for the first twenty-four hours and irri- gate at the second dressing. (W. C.) The following solutions are used for irrigation : Mercuric Bichloride : 1-4,000 or 5,000. Carbolic Acid : 1-40 or 50. Hydrogen Peroxide : 18, or stronger. Boric Acid: Saturated solution. Alumnol : 1-5 or 10. Dressing : If the abscess cavit}' is small no drain- age tube is necessary ; a small piece of gauze should be placed between the edges of the incision to prevent adhesion. When the cavity is large a drainage tube or a substitute, such as a strip of iodoform gauze, should be introduced to the bottom of the cavity, and fastened with a safety pin at the surface. (Whar.) The dressing should consist of a strip of gauze soaked in a bichloride solution laid directly over the incision, over this layers of cotton moist- ened with the same solution, then dry gauze; over this in turn a piece of protective or oiled silk, and the whole held in place by a roller bandage. Some sur- COLD ABSCESS. 5 geons use plain sterilized cotton, but, in view of the discharge, the bichloride cotton is preferred by many. (W. C.) In exceptional cases an aseptic poultice, made of flaxseed meal, and a solution of bichloride of mercury, 1-5,000, may be applied. (W.) The frequency of changing the dressing will depend upon the amount of discharge ; as a rule, it should be changed the following day. At each dressing the cavity should be irrigated with the selected anti- septic solution and the orifice and surrounding surface cleansed with a solution of bichloride of mercury 1- 2,000. The drainage tube should be shortened as required and not removed, as it is difficult to insert again. If found protruding between the retaining stitches it should be cut off. In most instances it can be dispensed with on the fourth or fifth day. The presence of a serous discharge indicates its re- moval. A short tube is sometimes necessary during the process of resolution to prevent closure of the orifice and retention of pus. (C. B.) COLD ABSCESS. The majority of abscesses of this variety are tuber- culous, though some may be syphilitic. Ordinarily tuberculous abscesses contain pyogenic membrane, but the syphilitic do not. Abscesses of this class should be opened with every antiseptic precaution. (A.) Aspiration: Should generally be preferred, as evacuation by this method avoids shock and haemor- rhage ; a large needle should be employed to prevent occlusion by masses of thickened lymph. After the removal of pus irrigate freely with a saturated solu- 6 DIGEST OF EXTERNAL THERAPEUTICS. tion of Boric Acid or lodoform. The puncture should be carefully sealed with iodoform gauze and col- lodion. (A.) Another method is as follows : Withdraw the pus with an aspirator, then inject a 5 per cent, solution of Carbolic Acid, afterwards aspirate, and renew the procedure until the solution comes out clear, then apply Lister's bandage with slight pressure. Four days later the same treatment : about five sittings are said to be required. lodoform may be injected in the same way, but should not be renewed as long as the remedy is excreted in the urine (for formula see paragraph on this drug). Boric Acid, 4 per cent, solution, may also be used in this manner. (Sj.) Puncture: This method of evacuating the con- tents of a cold abscess is often preferable to aspira- tion, from the fact that masses of lymph are liable to occlude the canula of the aspirator. The puncture is made with a bistoury ; the opening enlarged with a director and antiseptic irrigations and dressings ap- plied as mentioned. (Whar.) Incision and Curettage : This method is to be con- sidered when aspiration has failed. It is suited to abscesses with few ramifications and those easily ac- cessible to the curette. The strictest and most complete antisepsis is es- sential, and unless this condition can be obtained cold abscesses should not be incised. The incision should be free, the cavity thoroughly disinfected, curetted clean, iodoformized, sutured and treated as a recent wound. The possible presence of necrosed or detached bone should not be forgotten. When a spontaneous opening occurs there should be a free incision, thorough curettage of the abscess COLD ABSCESS. 7 wall, thus transferring the suppurating surfaces into bleeding ones, and thorough irrigation \vith an anti- septic solution. A long drainage tube should be in- serted, and the wound stitched up as far as the drain. (C. B.) Volkmann's curette is recommended, and for irri- gation a 5 per cent, solution of carbolic acid. (Sj.) Hyperdistension of the walls of an abscess cavity \vith an antiseptic fluid, after the removal of pus, was recommended by Mr. Callender. (A.) lodoform : Formulas for injection : lodoform, 10 parts. Glycerine, 20 parts. Mucil. Gum Acacia, 5 parts. Carbolic Acid, I part. Water, 100 parts. Inject 2 or 3 ounces at intervals of three or four weeks. This is safe as far as iodoform poisoning is con- cerned. Billroth's formula is as follows : lodoform, i part. Glycerine, 10 parts. A 5 per cent, ethereal solution is also recommended ; it causes considerable pain ; not more than 3 ounces should be injected. lodoform, i part. Ether, 5 parts. Distilled Water, 5 parts. (Mosetig-Moorhof, Verneuil.) (A.) lodoform poisoning may be prevented by subject- ing it and its excipient (omitting, of course, the ether) to a temperature 212. (Saj.) lodol : As a substitute for iodoform has been rec- ommended on account of the absence from odor but it is not as effective. (See Adenitis.) 8 DIGEST OF EXTERNAL THERAPEUTICS. Resorcin : Cavities may be flushed with a 5 per cent, solution, and afterwards dressed with the powder. (Al.) Iodine : Solutions sometimes employed after free incisions, especially for scrofulous abscesses. (B.) Phosphate of Lime : Gauze soaked in a 5 per cent, solution for packing cavity. (Al.) Potass. Permang.: sj-Oj of water to correct fetor. (B.) Cloves : A 10 per cent, emulsion in olive oil in- jected into tuberculous regions has proved beneficial. A 10 per cent, solution of the essence in olive oil has also been employed. From 30 to 300 drops were in- jected at intervals of a week, the time depending upon the rapidity with which the oil was absorbed. (F.) Naphthalene: The following formula is recom- mended for injection : Naphthalene, ^ij ; alcohol, sij ; water, giv ; the water should be added hot and the whole filtered, since the crystals will clog the syringe ; the solution must be warmed before using; after evacuation the cavity should be gently distended. (Al.) For dressing, the substitutes for iodoform, as Loretin, Europhen, Boric Acid, Methylene Blue, etc. The solutions used for irrigation in acute abscess are equally applicable to those of the cold or chronic variety. ACNE SIMPLEX. Local treatment is of great importance. In a limited number of cases when there is much heat, ACNE SIMPLEX. 9 redness, and acute inflammation, mild \vashes and bland ointments, such as those employed 'for eczema of the face, are indicated. Bathing with hot water, and the use of medicated soaps, such as Sulphur, Ichthyol, Bichloride of Mer- cury, or Salicylic Acid, should precede the use of all lotions and ointments. The bathing should be prac- ticed twice daily, once with hot water and once with soap. In mild cases with little irritation this will often be all that will be required. Boric Acid : Saturated solutions in 96 per cent, alcohol, sopped on or applied with a compress, may be employed with advantage after the use of medi- cated soaps. (Vn.) Hydrarg. Bichlorid.: This is indicated when stronger remedies are required : fy. Hydrarg. Bichlorid., gr. vj-xij. Alcohol., ^iss. Aq. Destill., Jiv. M. Dilute with water at first and gradually increase. The patient should be warned against possible irri- tating effects. (Vn.) " Hebra's Oriental Solution," a popular remedy, is as follows : I*. Hydrarg. Bichlorid., gr. viij. Aq. Destill., ^ iv. Succi Limonis, No. ij. Albumin. Ovi, No. vj. Sac. Alb., 3J. M. The following is much used : #. Hydrarg. Bichlorid., gr. iv-viij. Tr. Benzoin., 3ss-j. Emul. Amygdal. Amar. , ad. ^iv. M. 10 DIGEST OF EXTERNAL THERAPEUTICS. " Gowland's Lotion:" 1 part each of mercuric bichloride, and ammon. chloride, and 200 of emul- sion of bitter almonds ; this forms an excellent prep- aration. (Vn.) Sulphur : Serviceable in more severe cases, and one of the most effective remedies. The addition of camphor is sometimes desirable; the following makes a stimulating lotion : ?fc. Sulphur. Sublimat., ^ij. Tr. Camphor., 33. Aq. Destill., %iv. M. (Ga.) Another combination forming an ointment is : 9r. Sulphur. Praecipitat., 3J. Pulv. Camphor., gr. xx. Ung. Aq. Rosae, Petrolat., aa iv. M. Kummerfield's Lotion : Forms an excellent wash in many forms of the disease ; it is as f ollows : #. Sulphur. Prsecipitat., 3ij-i y - Pulv. Camphor., gr. x-xx. Pulv. Tragacanth., 9j-ij- Aq. Calcis, Aq. Rosse, aa ij. M. (Al.) Other useful formulae are as follows : &. Sulphuris, 3J. Glycerini, 3J. Alcoholis, 3 iv. Aq. Rosse, ^iv. M. (Kp.) Or 9;. Sulphur. Praecipitat., ^iiss. Spts. Vini Rect., .fi 88 - Lanolini, ^iiss. Glycerini, M. xx. M. (Hy.) ACNE SIMPLEX. 11 When the skin is very sluggish the f ollowing : #. Potass. Sulph., 9j. Tr. Benzoin., 3J. Glycerini, giss. Aq. Rosse, ad. 5iv. M. Or fy. Potass. Sulphuret., Zinc. Sulphat., aa 3J. Aq. Rosse, 5iv. M. The ingredients are each dissolved in one half the quantity of water, forming a clear solution. They are then mixed; a white precipitate falls which is to be shaken and applied to the face. Dilute at first and gradually use stronger, not suited to irritable skins. (Vn.) Vlemingckx's Solution : (See Appendix II. for for- mula.) One of the best preparations for acne sebor- rhoeca. Of this take 1 part, and 10 of water and mix in a bottle ; weaker solutions should be used on sensitive skins. Wash the face gently until a slight burning sensation results, allow the lotion to dry on and wash it off the next morning with soap and water; once or twice a week the mixture is made stronger. (B. H.) Sulphur and mercury should never be combined. For the papular variety : In mild cases lather the part with castile soap and hot water, and rub well with a towel. The lather may be mixed with fine sand or marble dust, or sand soap may be used. When comedones are deeply seated and numerous, they should be squeezed out after lathering, using the thumb protected with a handkerchief or a comedone extractor. (B. H.) Sapo Viridis : After removal of comedones this 12 DIGEST OF EXTERNAL THERAPEUTICS. may, in solution, be applied by means of a piece of coarse flannel, using the following formula : #. Sapo. Virid., 3j. Alcohol. Fort., ^ij. Aq. Destill., |iij. Spts. Lavandul, ss. M. Sig. Rub into the skin thoroughly and wash off the next morning. This may be continued until redness and scaling is produced, when bland salves should be applied. When the inflammation has disappeared the green soap may be used again, if necessary, or if the larger comedones have disappeared, apply Vlemingckx's solution. (B. H.) Another method consists in rubbing on the green soap briskly for a few minutes, and then washing it off and powdering with starch or anointing with cold cream. (Vn.) Ichthyol : Recommended by Unna, who used an ichthyol soap for washing the parts night and morn- ing and then applied the f oilowing : 5fe. Ammon. Sulpho-ichthyolayat. , gr-ij^ij- Alcohol is, 96 per cent., Etheris, aa 3 iv. M. The application can remain on over night. If too irritating it can be removed in half an hour and the following applied : #. Acid. Borici, gss. Acid. Salicylici, gr. x. Ung. Zinc. Oxidi, Jj. M. It is advisable to commence with the weaker solu- tions of ichthyol. (Vn.) Resorcin : A good remedy ; 15 to 20 per cent, paste, viz: ACNE SIMPLEX. 13 #. Resorcini, SH 88 - Zinc. Oxid., Amyl. Maydis, aa &]. Ung. Aq. Rosse, gss. Ol. Olivse, q. s. M. Apply at night at first for five minutes, then re- move with a dry cloth ; continue applying each night, lengthening the time until forty-five minutes have been reached. A good deal of redness and scaling may be produced, which should be treated in the same way as described in the use of green soap. (B. H.) A milder preparation suited to less severe cases, when inflammation and congestion have partly sub- sided, is as follows: #. Resorcini, 5J- Glycerini., 3j. Aq. Aurant. Flor., 3 V J- Spts. Vini Rect., iij. M. (Kp.) Naphthol: In severe cases the following paste mav be applied : #. Naphtholi, 9iiss. Sulphur. Praecipitat., gss. Lanolin i, Sapo. Virdis, aa 3ij- M. (Kp.) Allow to remain on fifteen to thirty minutes every night, then remove with cotton soaked in olive oil and wash with soap and water. A severe inflamma- tion and desquamation can be produced by this paste in a few days. As soon as irritation is severe, which may be after two or three applications, the remedy must be discontinued, and cold cream applied. (B.H.) 14 DIGEST OF EXTERNAL THERAPEUTICS. A milder preparation, recommended by Brocq, is as follows : #. Naphtholi, Camphorse, Resorcini, aa gr. viij. Sulphuris, gr. xlv. Sapo. Viridis, gr. xij. Vaselini, 3v. M. Sig. Allow to remain on over night. In acne indurata, Shoemaker recommends the fol- lowing line of treatment : All glandular and subcu- taneous abscesses should be punctured, and the con- tents removed ; a bistoury should be used, which must enter deeply. Ten to fourteen sittings will be necessary. The haemorrhage which will be consider- able may be controlled by cold compresses. Hasmor- rhagic and flabby infiltrations should be scraped out with a sharp spoon, and fringes of skin removed with the scissors. At the end of ten to fourteen days when all large fluctuating nodules have been removed, and small ones only remain, the following is advised : (1) Mechanically express comedones and incise incipient abscesses; (2) Employ constant and vigorous wash- ing with soap (toilet soap, soft soap, spts. sapo. kal., iodine, sulphur, naphthol, etc.), combined with va- por and douche baths ; (3) Apply such remedies as will cause rapid exfoliation of the epidermis as well as of the lining cells of the sebaceous glands, thus re- lieving them of their contents and causing contrac- tion; for this purpase employ the soaps just men- tioned, together with sulphur and mercurial plasters and cold douches ; (4) Protective ointments, lotions and powders. (Sh.) Van Harlingen recommends that after opening ACNE SIMPLEX. 15 larger suppurating lesions, the contents should be gently expressed and pure Ichthyol introduced into the cavity on a small probe or sharpened stick ; he adds that too much pressure should be avoided in emptying the pustules as it is possible thereby to create new foci of suppuration. Carbolic Acid : 5 per cent, solution, for applica- tion to the skin after removal of comedones. (B. H.) Salicylic Acid : 1 to 3 per cent, solution in alcohol especially indicated for the pustular form. (B. H.) A 50 per cent, plaster may by applied after opening pustules. (T. 96.) Vlemingckx's Sol. Spts., Sapo. Kal., Resorcin, and Naphthol may also be used with advantage in this variety of the disease. (B. H.) Oleate of Mercury: 5 per cent., 3 drachms, olive oil 1 ounce, well mixed and applied at night is useful in obstinate cases. (Kp.). Massage with a rubber ball was suggested by J. N. Hyde for indolent and intractable cases. The skin is first operated upon with a disinfected needle, and comedo extractor, until all pustules and sub-epider- mic foci and prominent comedones are removed. The surface is then rendered aseptic by a solution of bi- chloride of mercury or formalin, 1 to 2 per cent., the latter preferred. The massage ball is then firmly ap- plied, and by deep pressure other comedones are brought to view, and then removed. Lastly mas- sage of the surface using the ball with salicylicated cocoa oil or sulphur ointment. (T. 98.) For hasten- ing the disappearance of scales which follow severer types of the disease, massage is one of the best reme- dies; the following ointment is also highly recom- mended for the same purpose : 16 DIGEST OF EXTERNAL THERAPEUTICS. fy. Hydrarg. Prsecipit. Albae, jj Bismuth. Subnit., Qiiss. Ung. Glycerini, ^x. M. (B. H.) Eichoff's Sulphur, Camphor, or Balsam Peru Soaps may be used as an ordinary soap in mild cases, or well rubbed on in severe. (T. 96.) Sea Baths, Hygiene, and Exercise are of great importance. (Ga.) The springs of Richfield, Sharon, and White Sul- phur and others of a similar nature have a reputa- tion for beneficial effects in this affection. ACNE ROSACEA. Treatment will depend upon the stage of the dis- ease and the cause in each case. Sulphur, Resorcin, Naphthol, Green Soap, Sali- cylic Acid and Ichthyol as used in acne simplex, are applicable especially in the earlier stages ; hyper- aemia, small papules and pustules will usually disap- pear under this treatment. (Brocq.) In the first stage soothing remedies are indicated, viz: Tfc. Zinc. Carbonat. 3J. Pulv. Marant., 3J. HyJrarg. Ammoniat. , gr x. Ung. Simplicis, 5j. M. Or, &. Plumb. Acetat., Zinc. Acetat., aa gr. x. Aq. Rosse, Ji. M. Sig. Apply with a piece of old linen, for an hour or two, night and morning. (Sh.) ACNE ROSACEA. 17 Hydrarg. Bichlorid.: Gr. ^4-ij, alcohol 5), or an ointment. (Vn.) In the second stage : Hydrarg. Ammoniat.: Gives good results; use 20 to 25 grains to ung. aq. rosae, 1 ounce, (Sh.) Sulphur : Will be found one of the best applica- tions. Vlemingckx's solution (B. H.), or an oint- ment of 1 to 2 drachms to 1 ounce of ung. aq. rosae may be used. Kummerfield's lotion (see Acne Sim- plex) also forms an effective remedy ; it may be ap- plied from once to several times a day. If a sensa- tion of drawing is caused the preceding ointment of sulphur may be applied in small quantities after using the lotion. (Vn.) Ichthyol: More effective here than in simple acne. It may be used in ointments, lotions, or salves, in the strength of 5 to 10 per cent., and in most cases is said to be all that is required. Unna recommends equal parts of ammon. sulpho-ichthyolate, distilled water, and glycerine. He also makes use of the following varnish : Ichthyol, 40 parts. Starch, 40 parts. Solution of Albumen, i-i^ parts. Water, sufficient to make, 100 parts. The varnish is brushed on at night and dries quickly. In the morning it can be easily removed by washing. (Sh.) Ergot.: Forms an effective application, viz: #. Ol. Ergot., Glycerini, aa ss. Ext. Belladonnae, 3J. M. (Sh.) Iodine : Kaposi recommends the following for ap- 3 18 DIGEST OF EXTERNAL THERAPEUTICS. plication eight to twelve times daily for three or four days, the part to be immediately covered with gutta perch a : I*. lodi Pur., Potass. lodid., aa 3J. Glycerini, 3J-ij- M. Among other remedies used are Mercuric and Sali- cylic Acid Plasters, Chrysarobin 3 per cent, in liquid gutta percha, Goulard's Cerate, solutions of Zinc Sulphate, or of Alum, Pyrogallic Acid, Iodized Glycerine, etc. Poultices : Sometimes when other means have failed hot fomentations, followed by soothing appli- cations, such as oleate of bismuth, are beneficial. (Sh.) Puncture of the Skin : This measure practiced by using fine needles or a knife and followed by spong- ing in hot water will relieve the congestion in chronic stages of the disease. The procedure may be re- peated at intervals of five to seven days. After each operation bland astringent applications should be made. (Sh.) Scarification: When the dilated bloodvessels are very prominent, and the tissues hypertrophied, linear scarification may be performed, using a small bis- toury or a Vidal's scarifier. A large number of sit- tings are frequently necessary. Local anaesthesia may be produced by freezing. The bleeding after operating may be controlled by cold compresses. Scarification is advised as promising a greater degree of success than any other method. (Vn.) Electrolysis : Recommended by Hardaway under conditions which indicate scarification, using a fine needle attached to the positive pole while the patient ADENITIS. 19 grasps the negative. Better results, however, are obtained from the positive pole. A few sittings will cause shrinkage of the vessels. A mild current is used, and the pain is trifling. Scars rarely result. (B. H.) ADENITIS. ACUTE ADENITIS. The first indication of treatment is the removal of any source of irritation or infection. Any wound, abrasion, opening, or natural cavity with which the involved gland connects should receive strict local antisepsis. The part should be placed at rest and free from local irritation. Carbolic Acid : Injection of 10 minims of a 3 per cent, solution into the substance of the gland has proved satisfactory in some instances. (Saj.) Incision : When it is necessary to open the gland the incision should be free, extending through its entire length in order to facilitate the evacuation of its contents. The cavity should be curetted with the sharp curette and packed with iodoform, camphor- ated naphthol, "or salol gauze. (Saj.) For further details of local antisepsis, irrigating solutions and dressings see Acute Abscess. CHRONIC ADENITIS. Under this head are included glandular enlarge- ments of a more or less chronic and subacute type which have not gone on to a suppurative process. In these cases usually the disease is limited to one or 20 DIGEST OF EXTERNAL THERAPEUTICS. two glands, and is generally associated with some external lesion ; when tuberculous the entire mass is involved. General hygiene, sea bathing and sea air for about two months followed by a sojourn in the mountains will prove of great benefit. The follow- ing applications will be found of service : Iodine : The tincture is useful and often effective; it should be painted around rather than on the gland. (F.) Belladonna: The officinal ointment alone or com- bined with officinal Iodine Ointment, equal parts, or with equal parts of Iodide of Lead Ointment. Com- bination appears to increase its efficacy. Cadmium Iodide : May be substituted for iodine, using 1 drachm to 1 ounce of lanolin ; it does not stain the skin but is not so effective. Lead Iodide : The officinal ointment rubbed in twice daily, in non-suppurating forms, does not pro- duce so much cutaneous irritation as other iodine preparations. (Al.) Ichthyol : 10 to 60 per cent, applications give good results and relieve pain. (F.) Mercurial Ointment : For local indurations and enlargements, especially those of bubo and rym- phatic glands. It is usually applied by inunction, the compound ointment containing camphor, which is thought to promote the absorption of mercury, may be preferred. (F.) Mercurial Plaster : Applied over enlarged glands for its resolvent action. (F.) Phytolacca Decandra : The solid extract spread on a cloth is used to prevent the formation of pus. (F.) TUBERCULOUS ADENITIS. 21 TUBERCULOUS ADENITIS. The general line of treatment as recommended for cold abscess is here indicated ; the reader therefore is referred to that subject in addition to the following : lodol : A substitute for iodoform, non-odorous, but less effective ; has given good results in suppurat- ing adenitis. After scraping, it may be employed in the form of powder or solution. Mazzoni's formula for the latter is iodol, 1 part ; alcohol, 14 parts ; glycerine, 32 parts. (Al.) Formalin : Injections are recommended in tuber- culous abscesses. The treatment consists in withdraw- ing the pus by aspiration with a syringe and then in- jecting a solution of boric acid, which is afterw r ards removed by a second aspiration. A quantity of 1 per cent, formalin-glycerine is then injected. After the operation, fever generally sets in, the fluid in the abscess increases considerably and severe pain is felt. These symptoms subside after a few days and in a fortnight the exudation is as a rule absorbed. A second or even a third injection of formalin may have to be given, although absorption often occurs after the first injection. Recovery takes place in a short time. (L. 9, 9, 99.) Teucrium Scordium: An aqueous extract called Teucrin is furnished in hermetically sealed tubes, each containing 45 grains for use by injection. This is injected around the tuberculous gland, the contents of the tube being used. The remedy will setup an inflammatory action around the gland, and bring about the expulsion of the tuberculous deposit. It has been used extensively by Prof. Von Moisteg-Moorhof . (F.) 22 DIGEST OF EXTERNAL THERAPEUTICS. Zinc Chloride Injections: 2 to 5 drops of a 10 per cent, solution excites a growth of fibrous tissue which encapsulates the diseased portion. The injec- tions may be repeated. (B. M., Vol. 5, 91.) Extirpation : This radical measure should be re- sorted to when internal medication has failed ; when the gland involves the face producing deformity; when it is isolated ; when the number of glands in- volved are few ; when it has undergone fibrous degeneration ; and when not freely suppurating. The centra-indications are : Impaired general health, tuberculous deposit in the lungs and joints, and when the ramifications of the glandular chains are extensive ; also, when many are involved, when suppuration has commenced or peri-adenitis is pres- ent this measure is not recommended. (Saj.) Carious Teeth: In children have been found to be a medium by which tuberculous bacilli can gain an entrance and affect the cervical and submaxillary glands ; from this it follows that such teeth should be extracted or filled. (T. 98.) AGALACTIA. Castor Oil : A strong decoction of the leaves ap- plied by means of a soft cloth often proves successful. A handful of the leaves may be steeped in 3 to 4 quarts of boiling water ; the breast should then be bathed for fifteen to twenty minutes; after that spread on over the part a third layer of the steeped leaves and allow them to remain on until dry. This procedure may be repeated. (Saj.) Irritation of Gland : Draw out the milk with pump. ALOPECIA. 23 Hot Applications : Decoction of Marsh Mallow or Broom. (Bt.) Electricity : A mild current of from 3 to 5 milli- amperes may be employed. The sponges of the electrodes should be wet with salt water and applied on each side of the gland, changing the position every few moments so that all the acini may be traversed by the current during a sitting of ten minutes. (Saj.) ALOPECIA. Local stimulation constitutes the general plan of treatment. If the scalp is dry applications should be made up with oil, if greasy, with alcohol. Spts. Sapo. Vir.: (Sapo. vir. giv alcohol, zij) May be used once or twice a week for shampooing ; this removes accumulations of sebum and scales, and stimulates the scalp; after its application, thor- oughly dry the scalp and apply the following : P. Acid. Carbolic., gr. xv. Glycerini, . ij. Aq. Coloniensis, ad ^j. M. This may be applied by means of a comb and Barnes' dropper, rubbing in well with a soft brush. Go over the scalp in a line carefully to avoid making a disagreeable mass, which such application will do if rubbed in carelessly. (Vn.) Pilocarpine : This drug seems to have an action in promoting growth of the hair. The following prep- arations are recommended : 24 DIGEST OF EXTERNAL THERAPEUTICS. 3*. Pilocarpin. Xitrat., gr. ij. Quin. Hydrochlor., gr. viij. Glycerini, ^ij. Aq. Rosae, vj. M. (M. W.) Lassar's ointment, gr. xv 3J (T. 97) ; or made up as f ollows : fk. Pilocarpin. hydrochlor., ^ss. Vaselini, 3 v. Lanolini, ^ij. Ol. Lavandulse, gtt. xxv. M. (Ja.) Cantharides : This remedy enters largely into the formation of " hair tonics," though it is claimed that their effect is not increased by its presence. It is none the less mentioned by most dermatologists and is usually applied in the proportion of Ito 3 drachms to the ounce. Acetic Acid : Has some influence ; it may be used in Cottle's formula, viz : 5*. Acid. Acetici, 5 s8 - Pulv. Boraci, 5J- Glycerini, 5"j- Spts. Vin. Reel., ss. Aq. Rosae, ad_ 3 VT "J- M. (B. H.) Quinine : Largely used. Its influence is probably that of a local stimulant. Bulkier- recommends : 9=. Quin. Sulph., j. Zinc. Sulphat., Tr. Cantharidis, Alcohol. Absolut., Glycerini, aa 5^ v - Spts. Myrciae, ad gvj M. (Al.) ALOPECIA, 25 Another formula (Gerhard's) is the following : #. Quin. Sulph., 3 s5 - Tr. Cantharidis, 5J- Spts. Ammon. Aromat., gj. Ol. Rosmarini, gtt. v. Spts. Myrciae, Jvss. Ol. Ricini, giss. M Sig. Apply with a stiff brush two or three times a day. (Sn. ) Liq. Ammoniac : The following was a favorite of Wilson : #. Ol. Amygdalae, Liq. Ammonise, aa 3j. Spts. Rosmarini, Aq, Mellis, aa giii. M. (Wa.) Medicated Soaps: EichofFs Salicylic Acid, Sul- phur, Resorcin and Tar, useful for shampooing. (Vn.) Resorcin: When there is much scaliness Rohe first washes the scalp with tar soap, and applies a solu- tion of 30 to 60 grains to 13 ounces of spts. myrcia. Brocq recommends the following methods of using this remedy- in alopecia : #. Resorcini, gr. iss. Quin. Hydrochlorat, gr. iij. Vaselini Pur., ^j. M. This is to be applied to that part of the scalp which is devoid of hair, or from which the hair is rapidly falling. If the falling of the hair persists, it is well to incorporate with it 5 to 15 minims of tinc- ture of cantharides, or use the following : 5fc. Resorciui, gr. iij. Quin. Hydrochlorat., gr. v. Sulphur. Prsecipitat. , gr. xxx. Vaselini Pur., 3 j. M. 26 DIGEST OF EXTERNAL THERAPEUTICS. Should these preparations produce much irritation of the scalp, an ointment composed of 20 grains of borax to 100 of vaseline should be applied. After the irritation is relieved, weaker preparations of re- sorcin and quinine can be emplo3 r ed, of which the fol- lowing is an example : #. Acid. Salicylic., gr. v. Resorcini, gr. iij. Quin. Hydrochlorat., gr. v. Sulphur. Precipitat., gr. xxx. Vaselini Pur., j. M. Should the falling of the hair be associated with seborrhoeic eczema, a mercurial ointment, such as that of yellow oxide of mercury, varying in strength from 125 to 1-10, according to the severity of the trouble, should be used. This is only to be rub- bed upon isolated patches at a time. After it has been employed and an alterative effect upon the skin produced, resorcin may be resorted to : ~&. Resorcini, gr. iv. Acid. Salicylic., gr. vij. Vaselini Pur., ^j. M. When the scalp is excessively greasy, the ointment previously employed and the natural oil of the skin should be removed by washing the scalp with a weak solution of ammonium acetate or by using castile soap and warm water. Under no circum- stances should the oily preparations be used con- tinuously without occasional cleansing of the scalp. (P. M.j", 4, 22, 99.) Lassar recommends the following method : First wash the scalp with tar soap, then rub in well a 2 per cent, solution of Corrosive Sublimate ; this is ALOPECIA AREATA. 27 followed by the application of Naphthol 1 to 3 per cent, in alcohol to dry the hair; the scalp is finally anointed with a 2 per cent, solution of Salicylic Acid in olive oil. For use after fevers, the following : p. Sodii Biborat., gr. xxiv. Acidi. Salicy'. gr. viij. Tr. Cantharidis, 3ij. Spts. Myrciae, Aq. Rosae, aa Jj. Aq. Bullientis, ad 3* v - (Vn.) Sulphur : 1 drachm to the ounce in cold cream, al- cohol or vaseline, constitutes one of the best reme- dies when pityriasis or seborrhoea sicca is the cause. (B. H.) Tr. Capsici, 5J-iij-^j ; Chloral, 3J-$j ; Tr. Nux vom. . 5J-5J; Hydrag. Bichlorid., 1-500, are other stimu- lants in use. (B. H.) Many cases do better under an antiparisitic treat- ment. Antiparasitic Soaps should also be considered. (Pf.) Borax : Is useful for cleansing, but its continuous employment is injurious. (Ja.) Yolk of Egg beaten up in Lime Water forms an excellent shampoo. Brushing the hair vigorously in reverse direction to that in which it lies is beneficial. (Rd.) ALOPECIA AREATA. Treatment is regarded by some dermatologists as ineffectual, either for restoring the growth of hair or for preventing the formation of new patches (Ka- 28 DIGEST OF EXTERNAL THERAPEUTICS. posi); many writers, on the other hand, while not claiming very satisfactory results, advise the per- sistent employment of remedies. Local treatment should be directed toward stimulation of the skin. Before application the scalp should be well washed with castile soap or with spirits of green soap. Capsicum and Cantharides : The following is a useful combination : &. Tr. Cantharidis, Tr. Capsici, aa ^ss. Ol. Ricini, ss. Aq. Coloniensis, 5j. M. (Vn.) A formula of Tilbury Fox, which Van Harlingen says he has used with satisfaction, is : I*. Tr. Nucis Vom., Jss. Tr. Cantharidis, 3vj. Glycerini, ij. Aq. Destill., ^iss. Aq. Rosse, 3"J- M. Carbolic Acid: A 95 per cent, solution brushed lightly with a swab over the affected part and then rubbed in is highly recommended by Bulkley. Tricresol: This remedy is credited with produc- ing a growth of hair on the denuded patches in from one and a half to two and a half months. It is pre- eminently an antiseptic and disinfectant, containing the ortho-, meta-, and para-cresols in a pure state, and always of uniform 100 per cent, strength. It is a clear, white, watery liquid, having three times the disinfectant value of carbolic acid, while it is three times less poisonous, and less caustic. It has been * used successfully in a number of cases applied in the following manner : ALOPECIA AREATA. 29 The patch is thoroughly cleansed with benzine, and the remedy applied pure to the scalp and in 50 per cent, dilution with alcohol to the face, with or without epilation. It is well rubbed into the de- nuded patches and into the roots of the hairs for half an inch around by means of a small swab on a holder. The immediate burning pain is readily borne, and passes away in a short time. The skin turns white, and the hair and sebaceous follicles come plainly into view, seeming to gape. In a few hours there is a circumscribed hyperaemia; on the scalp there occurs a very slight transudation of serum, and on the face there is occasionally vesicula- tion. Within twenty-four hours there forms a dry, brownish-reel scale, which falls off in four to ten days, when a new application is required. Slight tenderness is left behind, and the second application should be less vigorous ; but there is never sloughing or scar formation. The remed}^ has been applied in most cases every five days, in some once a week. (J. C. G., 5, 99.) The folio wing course of treatment is that of Balzer : (1) Render the scalp aseptic by applying Van Swieten's Liquor, pure or diluted one half. This may also be continued for a time after apparent cure. (2) Every morning apply, after using the above, the following (Lotio Excitante de St. Low's): Camphorated Alcohol, 125 parts. Ess. Turpentine, 5 " L,iq. Ammonia, i part. (3) At night the following : 30 DIGEST OF EXTERNAL THERAPEUTICS. Yellow Oxide of Mercury, 2 parts. Flowers of Sulphur, 4 " Oil of Cade, 15 " Vaseline, 30 " (T.,99-) Hydrarg. Bichlorid.: This remedy enters into the formation of many lotions ; it may be used in solu- tion of 2 to 3 grains to the ounce, or in combination with other drugs. It forms one of the principal in- gredients in the method recommended by Raymond, \vho promised to restore the hair in sixty days by adopting the following : The surface of the denuded patch is first washed with carbolic soap, and the periphery shaved. This should be done twice a week ; then every morning the following wash is rubbed in with a paint brush for one or two minutes : #. Hydrarg. Bichloridi, gr. vijss. Tr. Cantharidis, 3vj. Bal. Fioravanti, ^iss- Aq. Coloniensis, ^v. M. At night the following solution is to be used in the same way : #. Acid. Salicylici, 3ss. Naphtholi, 3 iiss. Acid. Acetici (crys. ), %ss. Ol. Ricini, ^iiiss. M. (B. H.) Subcutaneous administration of the bichloride has been successfully employed by Moty ; he used a 4 per cent, solution in water, \vith 2 per cent, of cocaine added. Of this a single injection of one drop was made in a medium sized patch, and from four to five about a large patch and at its periphery. There should be intervals of four days between the injec- ALOPECA AREATA. 31 tions. A cure is said to be expected after the fourth series of injections. (Ja.) Pilocarpine : Ointment, gr. xv j. Acetic Acid : Paint the spots until they whiten, then sponge with cold water; repeat three or four times a day. (Ja.) The acetic acid lotion of Besnier is as follows : I*. Acid. Acetic. Crys., gr. xv. . Chloral. Hydrat., 3J. Ether. Sulphuric., ^viiss. M. (T., 99.) Ammonia: The following was recommended by Sir Erasmus Wilson : fy. Liq. Ammoniae Fort., Ol. Amygdalae Dulcis, aa ^ss. Ol. Limonis, ss. Spts. Rosmarini, ad. ^iv. M. Also the following applied with friction : I*. Tr. Aconiti Rad., ^iv. Chloroformi, gij. Liq. Ammoniae, 3J. Pulv. Camphors;, 3J. Ol. Olivse, ad. gij. M. (Vn. ) Cantharidal Collodion: Blisters are sometimes used with success, and are mentioned by many der- matologists. Crocker, after blistering recent patches, directs that the loose hair about the patches be pulled out, and the following ointment rubbed in : #. Chrysarobin., 3ss-j- Lanolin., ^j. Ol. Olivae, q. s. M. Some of the numerous remedies are as follows : Chrysarobin : 3 to 12 per cent, ointment (caution 32 DIGEST OF EXTERNAL THERAPEUTICS. about getting any into the eyes). (B. H.) Oleate of Mercury : 2 to 10 per cent. Iodine : The tincture painted on patches, has been followed by growth of hair; a 33% per cent, solution in collodion is also used. (Ja.) ALOPECIA SYPHILITICA. As the hair will return under constitutional treat- ment local measures, as a rule, are of little import- ance ; if their use, however, is deemed expedient, the preparations mentioned, in preceding paragraphs, especially those containing Bichloride of Mercury, may be employed. AMENORRHCEA. Hot Sitz Baths: For six days previous to the periods or at the time of the period, mustard may be added. (R.) Cold Sitz Baths : Administered as follows : Place the patient in a bath tub with water at 58, keeping the feet and legs warm and shoulders covered ; after the bath the patient should be well rubbed and placed in bed. These baths should be used only in functional varieties. (Ga.) Spinal Ice Bag: Applied to lower dorsal and lum- bar vertebrae ; useful in some cases. (R. ) Warm Water Douches: These are useful, but should not be too hot lest they produce anaemia. (T., 99.) ANESTHESIA. 33 Electricity: One of the most reliable emmena- gogues. Use either the faradic or galvanic current, the former should be tried first. The primary fara- dic current is applied as follows : Negative pole in the uterus, positive pole externally to abdomen ; seance to last fifteen minutes. Galvanism may be used if faradism fails. Electricity is especially useful for long-standing cases which have resisted all other treatment, and in those cases where the parts are poorly developed or atrophied from superinvolution or chronic metritis. (K. C.) Gymnastics, Sea Bathing and Saline Spring Baths, Friction along the Spine and Massage are other ser- viceable remedial measures. ANESTHESIA. Chronic alcoholism, emphysema, and fatty degen- eration of the heart are peculiarly unfavorable condi- tions for the administration of anaesthetics. More disasters arise from the latter cause than from any other. Tumors and abscess of brain are also danger- ous. Very much enlarged tonsils, swollen epiglottis and oedema of the glottis, are centra-indications, but not insuperable. No operation, however slight, should be undertaken until anaesthesia is complete. Enfeebled persons often bear anaesthesia better than the robust, women and children better than men. It is generally safer when given for an operation in dis- ease than for injury. Administration should always be on an empty stomach. At first the anaesthetic should be given slowly. Before administering, an 4 34- DIGEST OF EXTERNAL THERAPEUTICS. ounce or two of whiskey or brandy is recommended by some surgeons. Morphia Subcutaneously is advised by Bernard to enable the inhalation to proceed more quietly. The quantity of the anaesthetic required is much less, and the stage of insensibility more prolonged when the drug is thus given. It is also claimed that it has the property of antagonizing the paralyzing action of the anaesthetic on the cardiac and respiratory centres and thereby prevents shock. Man}- surgeons prefer giving morphia subcutaneously after the operation before recovery of consciousness; this is especially desirable in operations in which the after effects are painful. (B.) Chloroform: This anaesthetic is attended with more danger than ether, but produces less gastric disturbance. It is less disagreeable, and not inflam- mable, and is therefore better adapted for adminis- tration at night. Its action is also more prompt and the narcosis induced by it more sustained, but these advantages are overcome by the greater freedom from danger w r hich ether possesses. Its use, as a rule, when ether is available is not justifiable. It should be preferred, however, in obsterics, because of its prompt action, comparative agreeableness and non-inflammability. It has been shown to be safe in labor -when properly administered. (B.) The respi- ration, countenance and pulse should alwaj's be care- fully watched. The well known A. C. E. mixture, much used in England, consists of Alcohol (95 per cent.) 1 part, Chloroform 2 parts, Sulphuric Ether 3 parts, made up fresh as required. (Ga.) Ether : This agent should always be preferred as an anaesthetic. Administration should proceed at ANAESTHESIA. 35 first slowly, and the drug should not be crowded. The pulse, temperature and countenance should be carefully watched. A period of eight to twelve hours fasting should always precede its use. Mr. George Rowell, of Guys' Hospital, regards the A. C. E. mixture dropped upon Skinner's mask, fol- lowed by!/2 to 2 drachms of ether upon the sponge of Renale's inhaler and 1 to 3 drachms of ether then substituted for the first anaesthetic, as the safest and best method for routine practice in children. (T., 99.) Nitrous Oxide Gas : This is a safe agent for short operations, quickly executed, such as extraction of teeth, opening abscesses, etc. It may also be admin- ietered with excellent effect preparatory to ether. The patient is first placed under the influence of the gas, which is then withdrawn, and the ether applied. This procedure obviates the unpleasant effects of the first inhalations of ether, often less is required, and the after effects less disagreeable. For those persons who particularly dread taking ether, this is to be commended. Experience and care is necessary for this method of administration. A mixture of nitrous oxide gas with 10 to 15 per cent, of oxygen is recommended by Dr. Hewitt, who has devised an apparatus for its administration. Minor operations can be performed under its influ- ence. (T., 99.) Means for Meeting Dangerous Symptoms During the Administration of Anaesthetics. Remove the cone and immediately invert the pa- tient according to Nelaton's method; if respiration has stopped, apply artificial respiration by Silvester's method, forciby draw out the tongue; use faradism 36 DIGEST OF EXTERNAL THERAPEUTICS. to the respiratory muscles ; apply artificial warmth and give amyl nitrate inhalations. Brandy, whiskey and ether are recommended to be given hypodermically, but some observers regard the administration of alcohol and its derivatives in this condition as not only questionable but productive of positive harm. This conclusion does not seem illogi- cal since the patient is already suffering from an alcoholic narcosis. When there are evidences of sudden failure of the heart, as indicated by feebleness or stoppage of the pulse and extreme pallor, whiskey ma}' be injected subcutaneously or by enema ; in the latter instance administer half a cupful with an equal amount of warm water. Hypodermic injections of strychnia may also be given. Oxygen inhalations are of service not only when dangerous symptoms are imminent, but also during an operation, when cyanosis becomes marked, a few inhalations will then prove effective. Intravenous saline injections appear to have a rational basis for administration, as they alter the blood pressure and thereby stimulate the circula- tion. LOCAL ANESTHESIA. Sprays of Ether, Rhigolene, or Ethyl Chloride for freezing the skin. The following is to be used as a spray, the resulting anaesthesia lasts for about five minutes : ffc. Chloroform!, 3J. Etheris, 3 xv. Menthol! , 3J. M. LOCAL ANESTHESIA. 37 Cocaine : Solutions of 4 to 10 per cent, are gener- ally successful on mucous surfaces. In minor sur- gery, and in operations where the circulation can be arrested, solutions of about 4 per cent., subcutane- ously, are of great value. In ophthalmology this agent is most satisfactory, being suitable for all op- erations on the eyeball, except iridectomy for acute glaucoma, and enucleation. In genito-urinary sur- gery it must be used with caution. (M. W.) It is also valuable to render painless manipulations in laryngological, obstetrical, genito-urinary, and rectal practice . ( B . ) The introduction of cocaine through the unbroken skin by means of an electric current has been success- fully employed by Dr. H. Lewis Jones in certain minor surgical operations. For example, in the small electrolytic operations necessary for the re- moval of facial blemishes, such as moles, superfluous hairs, and small capillary naevi, this mode of sparing the patient pain without recourse to general anaes- thesia is very useful. It is much easier to produce an- aesthesia with a solution of cocaine in guaiacol than it has been hitherto with watery solutions. Jones employs a solution of 6 grains of cocaine (not the hydrochlorate) dissolved in a drachm of guaiacol. If a little of this mixture upon a piece of blotting paper be placed upon the skin and a current applied to it, anaesthesia sufficient for the purposes indicated can be produced in about four or five minutes. The posi- tive electrode should be placed on the blotting paper. It should consist of a flat disc of bare metal of suit- able size. Care must be taken that the metal does not touch the skin at any point. The current is then turned on until it reaches about 4 milliamperes for 38 DIGEST OF EXTERNAL THERAPEUTICS. an electrode half an inch in diameter. At first from 10 to 15 cells are necessary to produce this current, for the solution has a high resistance, but soon con- duction improves and the number of cells may be reduced. The action should not be prolonged for more than four or five minutes, since the solution itself is slightly caustic. Common sensation may not be entirely done away with, but the perception of pain is so nearly abolished that the patient will bear the introduction of a needle with calmness. (C. J., 3, 8, 99.) Tropacocaine : A costly drug ; it causes in the eye neither ischaemia, irritation, nor hyperaemia; 3 per cent, solutions are employed. Compared to cocaine its action is quicker, but more transitory. The ac- tion must be kept up by adding a drop from time to time ; mydriasis is slight. It may be employed when it is desired to produce anaesthesia without dilata- tion of the pupil. No harmful effects have been ob- served. (M. W.) Eucaine Hyderchloride : Under this name there are two salts which are different in composition. They are synthetic compounds, allied to cocaine. Eucaine Hyderchloride A is used for general local anaesthesia. Eucaine Hyderchloride B is slower in action than cocaine and less active, possessing half the strength, but anaesthesia is more prolonged, and the heart is not affected, nor the pupils dilated. In ophthalmic practice a 5 per cent, solution is effective ; for the nose and throat an 8 per cent, solution. (M. W.) Holocaine Hydrochloride : Half the strength of cocaine ; as an anaesthetic for operations on the eye, it allows more bleeding, but has no effect on the LOCAL ANAESTHESIA. 39 pupil. Its action is prompt and lasting without mydriasis, or disturbance of accommodation. It is not suitable for hypodermic use on account of its toxic effects. (M. W.) Recent investigations show that this drug has strongly marked antiseptic quali- ties. Dr. J. Guttman in a series of observations of the effects of holocaine in about 150 operations concludes that in many instances it is preferable to cocaine, although it cannot entirely replace it. Both were found to paralyze the terminal filaments of the sen- sory nerves, and the onset, duration, and intensity of anaesthesia were about the same in both. Either may be used on the eye. Holocaine was found to be preferable in the re- moval of a foreign body from the cornea, as it does not produce subsequent mydriasis ; also in strabis- mus, as there is no shrinkage of the muscle. In in- flammatory conditions with blepharospasm it re- lieves the spasm and pain, and, as an antiseptic, is curative. On account of the tendency of holocaine to produce haemorrhage, cocaine is to be preferred when there are atheromatous arteries. The vaso-con- strictor effect of cocaine, and the diminished tension on the eyeball, together with the subsequent deepen- ing of the anterior chamber, are all factors in favor of using it for the performance of an iridectomy under these conditions. When the pupil is small its mydri- atic action aids in cataract operations. The anti- septic action of holocaine and the possibility of sterilizing it are always in its favor. In operations on the throat and nose the taste of cocaine is against it, and the haemorrhage following holocaine, on the other hand, is against it, while cocaine pro- 40 DIGEST OF EXTERNAL THERAPEUTICS. duces a shrinkage not seen with holocaine. (X. Y. M.J. 6, 17, 99.) Orthoform : A white crystalline powder, possess- ing both antiseptic and anaesthetic properties. It is employed locally, in a saturated solution, in a 10 per cent, aqueous solution of the hj-drochloride, in a 10-20 per cent, ointment of the same in lanolin, in a saturated solution in collodion, and as a dusting powder. It is highly commended for burns and painful ulcerations, and appears to be non-poison- ous, more than 700 grains having been used locally on a cancer during the course of a week. (L. II., 97.) As a spray for laryngeal and nasal ulceration 5 grains should be dissolved in 50 minims each of rec- tified spirits of wine and water ; for insufflation in laryngeal tuberculosis 3 grains may be administered . The drug does not produce sufficient anaesthetic ef- fect to permit of an operation, though it is said to render painless operations with the uterus. (B. M. J., L, 98.) (M. C, 12, 97.) Although orthoform is said by most all observers to be perfectly harmless, Brocq reports two cases which throw doubts on this statement. In one an ointment of 1-40, applied to the face, produced great swelling and redness which lasted for nearly three weeks; in another the powder applied to fissure of the vulva caused tumefactions and nodular swelling in various parts of the body. (P. M., 4, 15, 99.) Anaesthesia by Infiltration. Cocaine : Solutions of 4 to 5 per cent, are injected along the seat of the intended incision ; this is not without danger, as the drug necessarily enters the circulation. When the seat of the incision is so situ- LOCAL ANAESTHESIA. 41 ated the part should be ligated and thus cut off the circulation. The wound should be allowed to bleed before the removal of the ligature. A useful formula is as follows : #. Cocainse Hydrochlorat. , gr. ijss. Morphiae Hydrochlorat., gr. ]/^. Sodii Chlorid., gr. iij. Aq. Destill., giiiss. M. The proportion may vary from one-tenth the quantity of cocaine to twice as much or more. In- jections should be made through the true skin and should be numerous enough to produce insensibility of the surface. At the points of injection wheals will appear. (B.) The composition of Schleich's Anaesthetic Salts, to which reference is frequently made, is as follows : According to the Centralblatt fiir die gesammte Therapie for October, 1897, there are three kinds of Schleich's tablets on the market, numbered 1, 2, and " 3, as follows : 1. Cocaine Hydrochlorate, 3 grains. Morphine Hydrochlorate, 0.675 grain. Sterilized Sodium Chloride, 3 grains. To be dissolved in 1,500 grains of distilled water. 2. Cocaine Hydrochlorate, 1.50 grain. Morphine Hydrochlorate, 0.675 grain- Sterilized Sodium Chloride, 3 grains. To be dissolved in 1,500 grains of distilled water. 3. Cocaine Hydrochlorate, 1.50 grain. Morphine Hydrochlorate, 0.075 grain. Sterilized Sodium Chloride, 3 grains. To be dissolved in 1,500 grains of distilled water. Eucaine : This has been found to be a better drug than cocaine for infiltration anaesthesia. It is less irritating and less toxic than cocaine. As it is not 42 DIGEST OF EXTERNAL THERAPEUTICS. decomposed by boiling it admits of thorough sterili- zation. The following forms a stable solution which can be boiled : /2-Eucaine, i part. Sodium Chloride, 8 parts. Distilled Water, 100 parts. Use at temperature of body. Nirvanin : As orthoform and new orthoform can- not be used hypodermically on account of the diffi- culty with which they dissolve, and as their salts are too irritant for that purpose, Einhorn and Heintz have by processes of substitution produced a sub- stance, the hydrochlorate of dietlrylglycocoll-p- amido-o-oxybenzoic-acid-methyl-ester, which is not alone more permanent than cocaine, but also ten times less toxic. In 2 per cent, solutions, injected hypodermicalry, it produces a prolonged regional anaesthesia. It is sold under the name of nirvanin. (M. M. W., 12, 6, 98.) This substance promises to be of great value. When injected under the skin it produces a small cir- cumscribed wheal from which radiates a greater or less zone of anaesthesia, according to the strength of solution used. The length of the anaesthesia is in direct ratio with the strength of the solution, a 1 per cent, solution giving anaesthesia continuing about five minutes, while a 2 per cent, solution gives insen- sibility for twenty-three minutes after the injection. The bactericidal action of nirvanin is shown b} r the fact that a 7 per cent, solution injected with bacillus pyocyaneus became sterile in twelve hours, a 2 per cent, in six hours, and a 4 per cent, in three hours. (M. M. W., 1, 3, 99.) The results of experiments which may be summar- ANEURISM. 43 ized as follows show this new anaesthetic to possess the following properties: It is one-tenth less toxic than cocaine ; the maximum dose is .5 grm. (T 1 /^ gi"-); it is a powerful antiseptic ; its effect is more lasting than that of cocaine ; it is not adapted for applica- tion to the mucous membrane when it is intended anaesthesia should be deep ; it is generally irritating to the eye. The greatest use for this preparation will be on account of its non-toxie and powerful antiseptic properties, and the complete and long continuation of the anaeshesia produced by subcutaneous injec- tion. (M. M. W., 12, 6, 98.) (T. P., 6, 99.) Guaiacol: 1 part with 10 of olive oil by subcutan- eous injection have been used. ANEURISM. Rest is imperative and must be absolute. In some instances the recumbent posture has a favorable effect. (Rd.) Galvanic Puncture: This measure has been suc- cessful in a few instances. Ciniselli reported twenty- three cases with five cures. In the small sacculated variety it may be employed with some hope. First introduce into the sac a needle insulated except at its point ; to this the positive pole is attached, and the negative to a large electrode placed over the abdo- men. The current is allowed to pass from three to four hours. Before operating the apparatus should be tested in fresh blood or egg albumen. Danger from embolism appears to be slight. (Gn.) Another method is that of Loreta; two needles are passed 44 DIGEST OF EXTERNAL THERAPEUTICS. into the sac, and a mild current of electricity is passed through, producing both an electrical and mechani- cal effect (Ty.) Ergotin : Injections of the aqueous extract were first employed by Langenbeck; from 2 to 5 grains are dissolved in water or glycerine and injected into the region of the sac ; or 7 to 10 drops of Squibb's fluid extract may be used. The injections should not be made more frequently than once in two or three days under favorable conditions. (Al.) McE wen's Method: Render the skin aseptic and insert a needle into the sac until it comes in contact with the other side. The needle may be left in for twenty-four to thirty-six hours. Another plan of McEwen was to introduce the needle, as just de- scribed, then to move it about so that the opposite wall of the sac was irritated. The needle was thus moved for about ten minutes, then changed to an- other point without withdrawing. In this instance the needle was left in only a few hours. Success has been attained by this procedure. (G. A. O.) Compression : This method has been successfully employed in peripheral aneurisms ; digital compres- sion is the best plan to be adopted. Relays of stu- dents or others continuously applying compression, for forty-eight hours, have resulted in effecting co- agulation and cure. (Ty.) Injection of Astringents: Solutions of persul- phate or chloride of iron'or lead acetate are danger- ous and should not be used. (G. A. O.) Injection of Gelatin: This method has yielded some remarkable results and seems worthy of further consideration, but as yet the subject is too recent to form a decided opinion as to its value. ANEURISM. 45 The operative proceeding is as follows : A solution of 2 grams of gelatin in 100 grams of saline solution is made ; this is injected under the skin of the thigh into the subcutaneous cellular tissues in a dose of 250 c.cm. The injection is renewed at varying inter- vals of time from every two days to fifteen days. As a rule, 10, 15, of 20 injections are quite enough to obtain a complete cure. Huchard has employed the method in many cases, one of which was very seri- ous, the pulsation of the aneurism being very strong. A complete cure was obtained by means of 20 in- jections. The sole inconvenience attached to this treatment is that it was very painful. Certain pre- cautions have to be observed in this method, for a patient under the care of Boisset, in whom injections had been made on a small scale, lest the blood should cogulate all at once, died very suddenly from embol- ism. The injections must never be made in the neigh- borhood of the aneurismal sac, and still less into the aneurismal sac itself. (P. M. J., 11, 12, 98.) In re- gard to this method of treatment Moyer (Medicine, March, 1898) draws the following conclusions from a review of the literature : (1) Gelatin solutions are of some value in the treatment of saccular aneur- isms; (2) they are of no value in diffused enlargements of a vessel ; (3) the remedy is used empirically, the experimental work affording little or no basis for the treatment; (4) solutions not stronger than 1 per cent should be used ; (5) great care should be ex- ercised in technique failures in asepsis are easily made, as the fluid is a good culture-medium. The solution should be kept in a brood oven to determine bacterial growth; (6) there may be dangers in the treatment, but observations heretofore made are in- 46 DIGEST OF EXTERNAL THERAPEUTICS. sufficient to indicate what they are; (7) absolute rest in bed should be enjoined, and other remedies suitable for these cases may be given at the same time ; (8) it is not a cure for aneurism, but may rank in the future as a treatment; (9) the method is worthy of more extended trial. Morphia: Injected hypodermically, may be re- quired from time to time to allay pain. (G. A. O.) Introduction of Foreign Substances, such as fine wire, catgut or horse hair, have been employed, passage into the sac being effected through a hypo- dermic needle . ( Ty . ) ANGINA PECTORIS. Morphia : Administered hypodermically is the most prominent remedy ; the dose for adults should not be less than ^ gr. (Ty.) It may be effectively combined with Atropine, viz.: atropine, y^ gr. ; morphia, Ys gr. (An.) Ice : The application of cold in the form of ice bags or Leiter's coil to the praecordial region often will afford prompt relief; it is more grateful to some patients than heat, and generally should be first tried. (An.) Heat : Hot fomentations, bran poultices, hot wa- ter bags, etc., may be used if cold is not effective. (R.) Hot Sinapisms : Applied over the region of the heart is a convenient and effective way to employ counter-irritation and affords relief. (Ty.) Nitro- Glycerine : 1 per cent, solution in 1 minim doses hypodermically, frequently repeated if pain ANOSMIA. 47 continues, may be used in cases characterized by high arterial tensi on . ( An . ) Amyl Nitrite: Inhalations of 3 to 5 drops on a handkerchief affords prompt relief in cases where artificial tension is high ; when the vessels are ather- omatous and heart fatty it must be used with cau- tion. (B.) Electricity : Goodno favors galvanism, following the advice of Eulenburg, who recommends the appli- cation of the anode to the sternum, and the cathode to the lower portion of the cervical region of the spine. Faradism is useful in pseudo-angina. (Gn.) ANOSMIA. Strychnine : ^V~T4 S r - m a neutral medium by in- sufflation was employed by Morrell Mackenzie. It should be remembered that alkaloids are more readily absorbed by the mucous membrane of the nose than by that of the stomach. (Al.) Electricity: Galvanism applied daily, using a weak current, increasing the strength according to toleration. Faradism may also be employed, and in hysterical cases applied to the nose sufficiently strong to cause pain, is productive of good results. (T., 99.) Stimulation by Powerful Odors : Powerful but agreeable and non-irritating odors by olfaction are recommended. They should be frequently changed, using half a dozen a day, applying first to one nostril then to the other. Better results are obtained than by strychnine or electricity. (Bos.) 4-8 DIGEST OF EXTERNAL THERAPEUTICS. ANTHRAX MALIGNANT PUSTULE. As soon as recognized thoroughly, Excise and Cauterize the raw, exposed surface with the Gal- vano-Cautery, pure Carbolic Acid, Nitric Acid, or Caustic Potash; applications like iodine, etc., are absolutely useless . ( Gn . ) Carbolic Acid : Subcutaneous injections several times daily of a solution (about 2 per cent.), a little distance from the seat of the lesion has proved effect- ive in preventing the brawny oedema. To prevent extension, the neighboring parts may be bathed with a 10 per cent, solution in oil or glycerine. (An.) After removal of foci by the actual cautery, inject hydrogen peroxide and apply compresses of carbolic acid solution 1-50. (Sj.) Injections of a solution of one part of carbolic acid to five of glycerine are also advised, administering 20 to 30 minims around the sloughing tissues, but not into the same; the needle should be introduced about one inch, and withdrawn slowly while press- ing out the solution; the surface should then be dressed with carbolic fomentations 1-40, which should be continued until the slough separates. (Sj.) Iodine Injection: A 10 per cent, solution or the pyre iodine are recommended in conjunction with the thermo-cautery. (T., 98.) Deep Crucial Incisions: Followed by the applica- tion to the bottom of the incisions of Carbolic Acid 1-20, or Bichloride of Mercury 4 to 15 per cent, mixed with calomel, constitutes another method ; as the solution dissolves, it deepens the cauterization. (Ty.) ANUS, FISSURE OF. 49 Antianthrax Serum : Twenty-seven patients, it is said have been successfuily treated by Scalvo's serum. In a recent case of Dr. Abba and Dr. Pic- cardi, of Turin, 22 c.c. were injected in the evening followed by an injection of 11 c.c. the next morning. The patient recovered and constituted the twenty- seventh case. (G. O., 3, 99.) ANUS, FISSURE OF. Before making any application order enema if the bowels have not already moved, and cleanse the parts externally with some antiseptic wash. Nitrate of Silver: One of the most effective reme- dies, a weak solution of gr. x-xv 3j will often afford relief and should generally be tried first. (Gt.) The crayon applied every two or three days will sometimes effect a cure, but must be used with cau- tion. (K.) Andrews recommends that the part be first cocainized, then touched with the fused nitrate and the following excellent ointment applied : 1*. lodoformi, 3J. Ung. Belladonnse, ^ss. Acid. Carbolici, gr. x. Cosmolini, ifss. M. This should be applied thoroughly every day after irrigation with antiseptic lotions. The silver in solu- tion may be repeated every third day. (Ad.) Goulard's Cerate : Applied on a small pledget of lint will often effect a cure. (K.) Morphine: For diminishing the painful sphincter contractions the following ointment has proved very effective : 5 50 DIGEST OF EXTERNAL THERAPEUTICS. Jjfc. Morphias sulphatis, gr. ^. Ex. Belladonnse, gr. ss. Vaselini, J. M. (Gt.) Sig. Apply at once. Dusting powders are frequently both stimulating and healing, viz: Calomel, lodoform, lodotannin, Bismuth, etc.; one of the most useful is the follow- ing: Ijfc. Hydrargyri Chloridi Mitis, sjij. Zinci Stearatis cum Bal. Peru., ^ij. Sodii Salicylatis, 3J. M. (Gt.) Conium : For the relief of painful defecation : #. Ext. Conii, 3J. Ol. Ricini, ss. Lanolini , ^j. M. (T., 98.) Ichthyol : First anaesthetize the part with cocaine, then apply the remedy pure ; repeat the application for several days ; on the fifth application the cocaine is introduced as far as the internal sphincter, the anus slightly dilated with a Nelaton's dilator, and the fissure more thoroughly touched with the ich- thyol. For recent cases ten applications will be nec- essary, for old, twenty may be required. (T., 98.) A line of treatment followed, it is said, with some success by certain itinerants, is the following : #. Ext. Best. Hamamelidis, 3v. Liq. Ferri Subsulphat., 33. Acid. Carbolici, gr. ij. Glycerini, ij. M. Mix half a drachm of this with half a drachm of ANUS, FISSURE OF. 51 starch, and add one and a half ounces of water ; in- ject this every morning into the bowel. The following is recommended to be applied with a camel's hair brush : I*. Hydrarg. Bichlorid., gr. j. Acid. Carbolic, (crystal). ^ij. Morph. Hydrochlorat., gr. v. Aq. Destill., ^iv. M. After application dust with iodoform. An oint- ment of Mr. Allingham's is the following : 9. Hydrarg. Bichlorid., gr. iv. Pulv. Opii, gr. ij. Ext. Belladonnse, gr. ij. Ung. Sambuci, 5i. M. (Ad.) Hydrastis : The fluid extract applied pure, tends to promote healing (B.) ; also a glycerole of 1 drachm of the tincture to glycerine half an ounce; or the alkaloid in combination with hamamelis, viz.: J*. Hydrastis Mur., gr. j. Tr. Hamamelidis, gij. Aq. Destill., 3j. M. (Rd.) Among other useful remedies are -ffisculus Hip., the cerate to be applied after defecation ; Zinc Oxide with vaseline in the proportion of a drachm to the ounce. Tr. Hamamilis, 1 part to 4 of glycerine for soreness about the parts. Tannin, 1 drachm to 4 4 ounces of glycerine. (Rd.) Opium, Belladonna, and Stramonium Ointments, and lotions of Cocaine form useful palliatives. When local remedies, which in many instances are only palliatives, have failed, incision or forcible dila- tion of sphincter should be employed. 52 DIGEST OF EXTERNAL THERAPEUTICS. Incision : Draw the knife through the ulcer and muscular fibres, which can be done with the use of cocaine injected beneath the ulcer. It is not neces- sary to cut entirely through the sphincter, yet the muscular fibres at the base of the ulcer should be cut through and the incision made deep enough to pro- duce some relaxation of the muscle. (K.) Dilatation of the Sphincter : The patient should be freely anaesthetized ; then the thumbs or index fingers are inserted into the bowel and separated in different directions, care being exercised not to lacer- ate the mucous membrane ; the anus should be thus stretched until it becomes patulous. (Gt.) Daily washing the part with cold water and a soft sponge and avoidance of all local irritation consti- tute the best preventive. The insertion of a piece of soft lint, changed daily, is also of service. (K.) ANUS, FISTULA OF. Some cases will yield to local applications if dili- gently and patiently pursued, though the majority, especially those of long standing, can only be cured by an operation. In recent cases of ischio-rectal ab- scess, with external opening and no internal open- ing, the probabilities of success by the use of local remedial agents are very good. The patient should be kept in bed, the orifice of the abscess enlarged, and free drainage established, followed by injections of Bichloride of Mercury 12000, or some other antiseptic. In older cases, when there is a pyogenic membrane, more vigorous measures are necessary, such as turpentine, iodine, etc. (K.) ANUS, FISSURE OF. 53 In children ascarides will often be found 'to be the cause, upon the removal of which union will gener- ally take place. Tents of sea tangle may be introduced into the ex- ternal orifice of the track for enlarging the opening, permitting free drainage and the application of anti- septic and other remedial agents. (All.) Carbolic Acid : Applied in the following manner, has sometimes been attended with good results : A piece of cotton is placed upon the end of a wire, which has been roughened in order to retain it ; this is dipped in a solution of carbolic acid, 9 parts, with \vater 1 part. After thoroughly cleansing, the wire is inserted to the bottom of the fistula, which is then swabbed with the solution ; a drainage tube is now inserted to the bottom of the sinus. If the treat- ment is successful, the tube will be found to require shortening day by day. The application may be re- peated. (All.) A method of treatment which is said by Andrews, of Chicago, to be that of the so-called " Brinckerhoff Cure " is as follows : #. Ext. Destill. Hamamelidis, 5v. I/iq. Ferri Subsulphatis, 3J- Acid. Carbolici, gr. ij. Glycerin!, 3ij- M. Inject 10 to 15 drops deep into the fistula, and press around its periphery, so that the fluid will sink in more deeply ; then inject equal parts of oil of Eu- calyptus, and Glycerine, and keep the patient in bed for two days. (Ad.) Hydrastis and Hamamelis : The following will prove of service : 54 DIGEST OF EXTERNAL THERAPEUTICS. T$t. Hydrastis Mur., gr. j. Tr. Hamamelidis, 3^J- Aq. Destill., gj. M. (Rd.) For stimulating remedies, Kelsey mentions: Sul- phate of Copper, Balsam of Peru, Nitrate of Silver, Chromic Acid, and Caustic Potash. Antiseptic powders and solutions may generally be employed for cleansing and dressing, as well as for their healing properties. Paquelin Cautery: This agent applied to the whole extent of the fistulous tract may be used in some cases of the tuberculous variety. Operation by the Elastic Ligature is not to be con- sidered except when the knife is refused. (K.) ANUS, PRURITUS OF. See Pruritus. APOPLEXY. During the attack, if possible, convey the patient to a large apartment supplied with plenty of cold air, and loosen the clothing around the neck. Rest: Should be absolute and the head high; if stertorous breathing is present the patient should be placed on the paralyzed side ; the movement of the healthy side will then be free, and the affected side of the cranium uppermost, thus doing away with the influence of gravity. If there is difficulty in remov- ing the clothing, rip up the seams. (Gn.) Ice : Should be applied to the nape of the neck APOPLEXY. 55 and head when there are no symptoms of collapse, but cold applications are contra-indicated when the face is pale and the surface cold. (Ga.) Heat and Sinapisms : Applied to the extremities and axillae are indicated in collapse; cloths wrung out in hot mustard water, and -wrapped around the limbs, and sinapisms to the nape of the neck should be employed, with the hope of bringing about reac- tion. (Gn.) Dry Cups, Turpentine Stupes, and Sinapisms are greatly to be preferred to the old methods of cups and leeches, which, however, may do good, but only from their derivative and counter-irritant eifect. (B.) Chapman's Spinal Ice Bag: This is an import- ant and effective agent. The method of application and indications are fully described in the article on Paralysis. " Bleeding the Patient Into His Veins :" This measure was suggested by Dr. Dawbarn, of New York, and is described as follows : " Apply Esmarch bandage, a tourniquet, or Spanish windlass, to one or more of the extremities as near the trunk as pos- sible. The apparatus should be sufficiently tight to obstruct the return flow through the veins quite thoroughly, but not so much- as to interfere with the arterial flow. Experimental evidence shows clearly that this procedure lowers arterial tension, and favors cessation of internal haemorrhage. The press- ure should be kept up for about an hour, then the blood should be permitted to enter the general circu- lation very slowly. The only objection to this method is that of possible danger in the hands of those who are unskillful and lack judgment." (Gn.) 56 DIGEST OF EXTERNAL THERAPEUTICS. APPENDICITIS. The following, in conjunction with internal medi- cation, is advocated by Dr. M. O. Terry : Colon Enemata : Every three to six hours. In the first instance inject 4 ounces of Glycerine, following with an injection of Soda Bicarbonate, 1 drachm to 1 quart of water; in subsequent enemata 6 to 8 ounces of Sweet Oil are injected after the colon enema. The hips of the patient during the adminis- tration should be well raised. Hot Fomentations of flaxseed are kept applied to the abdomen and hot sweet oil is poured over the poultice and applied to the abdominal walls. (M. T., 11, 97.) Ice : Applications afford relief and may act as a substitute for morphine. (Ty.) Morphine: From a surgical standpoint is con- demned, pain, it is claimed, being relieved by evacua- tions. (Cr.) It is advised by some medical writers to be administered hypodermically, but never by the mouth. (Ty.) Operation : Dr. G. F. Shrady has summarized the indications as follows : 1. The continuously frequent or progressive^ ac- celerated pulse rate is of itself a prime indication for operation. 2. Pain, localized and progressive, is a valuable as- sociated condition. When pain is sudden, severe, and progressive, and accompanied with chill, it means perforation or abscess rupture and immediate opera- tion. 3. Increase of temperature is third in importance > ARTHRITIS. 57 but when associated with one or more of the previ- ous symptoms, and more especially with increase of pulse rate, it makes immediate operation a foregone conclusion. 4. The gradual subsidence of the three cardinal symptoms pulse rate, pain, and temperature is a legitimate reason for postponing immediate opera- tive interference. 5. In cases of abscess it is generally safer, while watching for urgent indications, to wait until adhe- sions have formed a sufficiently protective wall. 6. In cases of recovery after mild attacks and with- out operation we are never sure of recurrence until the latter takes place, when the operation can be done soon enough, and, all other circumstances being equal, preferably in the interval of a succeeding at- tack and when the tissues are not in an inflamed con- dition. The fact must not be overlooked that there are ex- ceptions to all the points named ; that patients with a temperature and pulse almost normal and with little pain may become rapidly worse and die ; that cases which are apparently mild in the beginning may develop most alarming symptoms in the end. Few, however, present these phenomena without some preliminary warning. These are irregular cases and should always arouse suspicion. (M. R., 1, 9, 97.) ARTHRITIS. Lithium Carb.: Garrod has been successful in re- moving gouty deposits from the hands and fingers 58 DIGEST OF EXTERNAL THERAPEUTICS. by the use of lint soaked in a solution of 5 grains to the ounce and kept constantly applied. (Al.) Cold Water Compresses : Applied to the involved joint are often of benefit; a 10 per cent, solution of salicylate of soda may be used for wetting the com- presses. (Sm.) Dry Superheated Air: The application of dry heat at a high temperature has been attended with good results. A special^' constructed apparatus is required for the purpose. (A. S.) Ichthyol : The application of this remedy as rec- ommended for rheumatism is said to be of great benefit in arthritis deformans. (M. T., 10, 99.) See Rheumatism. Cataphoresis : The following method is of value : The positive pole connected with a carbon electrode is immersed in a vessel containing a 2 per cent, solu- tion of lithium chloride, which has been rendered alkaline with lithium carbonate ; the negative pole is placed in another vessel containing a weak solution of chloride of sodium. The part to be treated is im- mersed in the lithium carbonate bath, and a conveni- ent member, as the hand or foot, is placed in the salt solution. The battery should be one of 4-8 Lechanche cells and a current of 10 to 30 milliamperes should be applied for thirty minutes ; some can only stand 10 milliamperes. Good results have also been obtained with salicylic acid and salicylate of soda used in a vsimilar manner. (T., 98.) Galvanism: Applied directly to the joints also affords relief of the pain. ( Gn. ) Massage : This is the most efficient measure for the reduction of swelling, as it promotes absorption ASCAKIDKS. ">{) of the inflammatory extidates and lessens the rigidity of the joints and muscles. (An.) The baths of Hot Springs, Virginia and Arkansas, of Richfield, N. Y., St. Catherine in Canada, Aix les Bains, La Bourboule, Royat, Wiesbaden, Homburg, Gastien, Carlsbad, Wiltbad, Acqui and Battaglia, in Europe are among the most prominent. The selec- tion of one of these springs must depend upon the requirements of each individual case, for what will suit one will not benefit or will positively harm others. When trophi burst and form indolent ulcers which penetrate to the joint, the most effective way to ob- tain resolution is to immerse the part in hot water for some hours daily. (Alb.) APHTHA. See Stomatitis. ASCARIDES. ASCARIDES LUMBRICOIDES. These parasites have their seat in the small intes- tines, but being liable to migrate they may some- times be reached by the injections used for seat worms. ASCARIDES VERMICULARES. Before using any form of rectal injection for the removal of these parasites the bowel should be first cleansed bv an enema of warm water. GO DIGEST OF EXTERNAL THERAPEUTICS. The following injections are recommended : Infus. Quassia, one of the most efficacious; Lime Water, simple and satisfactory ; Salt, 3 tablespoon- fuls to half a pint of water; Salicylic Acid and Bi- carbonate of Soda, half a drachm of each with 1 pint of water. ASPERGILLI. Boric Acid: As a lotion is especially effective after bichloride of mercury lotions. (Al.) Chlorinated Lime: Grains ij-3j, useful for destruc- tion of colonies of these growths in the external meatus. (Al.) Acid Salicylic: 2 per cent, in dilute alcohol. (Bn.) Chinoline Salicylate and Boric Acid: 1 part of the former to 8 to 16 of the latter, give the best re- sults, and should be tried first. For the inflamma- tion after the removal of the growth the above powder of chinoline, or the following recommended by Dr. Hinton, will prove effective : }*. Liq. Plumbi Subacetatis, M.xx. Acid. Acetic. Diluti, M.vj. Liq. Opii Sedativi, M.xx. Aq. Destill., q. s. ad 3J. M. Sig. 10 drops in the ear. Alcohol: Instilled several times a day forms an excellent parasiticide ; after its use the debris may be easily syringed away. (Str.) ASPHYXIA. 61 ASPHYXIA. The conditions produced by the inhalation of ordi- nary illuminating or other poisonous gases, as well as asphyxiation by smoke or hanging, are all essen- tially the same and require the same treatment. Give the patient plenty of air ; dash cold water on the face; administer inhalations of ammonia and slap the epigastrium. If these simple measures have no effect, immediately employ artificial respiration as subsequently described. Asphyxia from Drowning : The treatment should be carried out at once at the place of rescue, except perhaps in extreme weather. Immediately turn the patient over with the face downward, resting on one arm with the wrist under the head in order to cause the water to run out of the mouth and throat. The abdomen may rest on a roll of clothing. Run the fingers into the mouth to clear away any obstruc- tion, then with the patient in this position press each side of the back over the lungs. This is done to expel any water that may be in the upper air pass- ages. Next turn the patient on his back, strip to the waist and rub dry. These procedures should be executed with the utmost rapidity, and during the time they are being carried out, an assistant may apply inhalations of ammonia. If these efforts are ineffectual, employ artificial respiration by Silvest- er's or Marshall Hall's method. Silvester's Method: This method is generally employed. Place the patient on his back with a cushion or a folded coat under his shoulders. Next 62 DIGEST OF EXTERNAL THERAPEUTICS. draw the tip of his tongue forward in order to pre- vent obstruction of the air. The tongue may be grasped with a handkerchief or covered with sand or earth to prevent slipping ; if alone, tie the tongue against the lower teeth by means of a strip of cloth or muslin, carrying the ends around the neck and tying on one side. Now kneel behind the patient and grasp both arms half way between the elbow and wrist, then draw them gently but steadily upward until they meet on the ground above the head. Re- tain them in this position two seconds, then bring them down gently, thus reversing the movement, and press them firmly against the chest walls for about three seconds, causing the elbows to meet over the epigastrium. This manoeuvre should be executed at the rate of fifteen to sixteen times a minute. Marshall Hall's Method: The patient is placed flat on his face. Then gentle intermittent pressure is made with both hands on the back, the body being turned on the side or a little beyond ; then on the face and the same pressure continued. The whole body should be worked simultaneously, and the movements made at the rate of fifteen to sixteen per minute. Michigan Method : The patient is laid on the face and the head upon the arm. Then stand astride the body, and grasp it about the shoulders and armpits and raise the chest high as you can without lifting the head quite off the arm. Hold it in this position for about three seconds, then replace the body on the ground, and press the lower ribs downward and in- ward with a slowly increasing force for three sec- ASPHYXIA. 63 onds, then suddenly let go and commence the move- ment over again. The temperature of the body during the process of resuscitation should be maintained by hot water bottles, hot bricks, flannel, etc. Friction upward should also be employed. Asphyxia Following- Anaesthesia : See Anaesthe- sia. Asphyxia in the New Born: When labor has been long, tedious, and difficult, preparations should be made beforehand for the reception of a probably as- phyxiated child. A table with waterproof sheet and receptacles for hot and cold water should be at hand, also a soft rubber catheter or some such instrument for clearing the throat of mucus. (A) Treatment of the first or comparatively milder forms: Remove all obstructions from the air pass- ages, clearing mucus from the throat and mouth, slap the buttocks, irritate the skin with rubbing, and pass before nostrils some diffusible stimulant, such as camphor spirits, or preparations of ammonia. To remove mucus, pass the finger into the throat or press the trachea with the fingers as low down as the bifurcation and gently squeeze it against the larynx; this forces the mucus into the pharynx, whence by blowing into the mouth it can be forced out through the nose. If the infant does not now begin to breathe, a warm bath should be adminis- tered, or alternate cold and warm baths. (B) Treatment of the second or severe form: The air passages should immediately be cleared of mucus. Then artificial respiration should be practiced ac- cording to the method of Silvester or according to the proceeding of Schultz, \vhich is as follows : Grasp 64 DIGEST OF EXTERNAL THERAPEUTICS. the child by the shoulders, placing the index fingers in the axillae and the thumbs curved forward over the shoulders so as to meet the ends of the fingers ; thus the entire weight of the child's body rests upon or within a circle made by the thumb and first finger of both hands. While the bod} r is thus hanging per- pendicularly, the ribs are lifted out and chest ex- panded, and an artificial respiration produced. The body is now swung forward with some force at arm's length until the operator's arms are about on a hori- zontal line. A somewhat abrupt termination of the movement causes the child's thorax to become sta- tionary, while the lower limbs fall forward upon the abdomen ; the abdominal viscera now press against the diaphragm and produce expiration, the body is returned to the first position and the manoeuvre re- peated. Seven to eight seconds are required for each movement, which should be repeated eight to ten times per minute. After two or three minutes ad- minister a warm bath. (Am.) Blowing into- the mouth is another procedure em- ployed to inflate the lungs. When this is done cover the infant's mouth with a towel and blow in it and press the lungs gently. (Am.) Asphyxia from Foreign Bodies : When a foreign body in the air passages is the cause, invert the pa- tient and forcibly slap him on the back. This pro- cedure is indicated more especially when the object is smooth and round. If this fails laryngotomy or tracheotomy should be performed immediately. (P.) ASTHMA. 65 ASTHMA. Treatment of paroxysms will vary widely in differ- ent individuals, and not infrequently the patient from experience will know the remedies most effect- ive in his case. Cocaine : Regarded by some observers of the first importance, should be applied to the nostrils with an atomizer or ordinary dropper, and repeated every four minutes until relief is obtained. It is claimed that on account of the intimate sympathy between the nasal and bronchial mucous membranes, cocaine thus administered will afford relief. (Bos.) Stramonium : Used by burning the leaves and in- haling the smoke, or smoking cigarettes made of the leaves, or better yet by placing some of the leaves in a pipe and smoking. The drug should be watched. The smoke of about half an ounce of the leaves may be used at a sitting. A sensation of heat in the lungs, fulness of the head and nausea are indications that a maximum impression has been attained. (Al.) The following is for a fuming inhalation : Powdered Stramonium Leaves, j . Powdered Fennel Fruit, gss. Iodide of Potash, gj. Powdered Anise Fruit, gss. Black Tea in Powder, 5J- Nitrate of Potash, j. (T. 97-) Nitrate of Potash : A very common and effective remedy by inhalation. Saturate a piece of blotting paper about five inches square in a strong solution of the saltpetre, allow it to dry thoroughlv, place it 6 66 DIGEST OF EXTERNAL THERAPEUTICS. in a saucer by the bedside and ignite. Many patients will fall asleep amid the fumes. (Al.) Pulv. Lobeliae Comp.: This is prepared as fol- lows : Nitrate of potash, boiled distilled water, 240 parts each; dissolve and add to lobelia in powder, stramonium leaves in powder and black tea in pow- der 240 parts each. Mix well, dry, and add oil of anise 1 part. The fumes of half a teaspoonful or more burnt on a plate may be inhaled six or eight times a day, and the bed room fumigated with the same. This is said to be an imitation of the well known nostrums, Himrod's, Bliss' and the Green Mountain Cures. (M. W.) Morphia : Alone, or with Atropia in doses of *4 gr. and T lrrg r - respectively, subcutaneously, often re- lieves, acting when all other measures have failed. The danger of forming the morphine habit should be considered. (An.) Amyl Nitrite: A few inhalations of from 4 to 6 drops will act speedily in a certain proportion of cases. (Rd.) Ethyl Iodide : Inhalations give good results; use 8 to 10 drops on a sponge. (T., 96.) Chloroform : Direct inhalations, or the fumes of chloroform poured on hot water, will afford quick relief. The danger of the habit should not be forgot- ten. (B.) Arsenic: Formula of Trousseau for arsenical cig- arettes : I*. Potass. Arsenitis, gr. xv. Aq. Destill., ^j. M. Unsized paper is thoroughly wet with this solu- tion, dried, and cut into twenty equal parts, each of ASTHMA. 67 which is to be rolled into a cigarette, and two or three smoked daily. The arsenite of soda may be used under similar conditions in the same way, the strength of the solu- tion being 1 drachm to 1 ounce of distilled water; each cigarette should contain from y tol grain. (B.) Pyridine : Place a saucer containing about a drachm of the remedy in a small room or closet which can be tightly closed. The patient then enters and remains for twenty to thirty minutes ; this can be repeated from two to five times a day. In simple cases it is claimed a cure may be effected in from ten to thirty days. It is said to be useful in asthma from any cause. (B.) Dilute Hydrocyanic Acid : 3 drops to half a pint of hot water ; inhalations of the vapor will often ar- rest paroxysms. This was recommended by Macken- zie and others. Grindelia Robusta : A remedy of value. The plant should be steeped in a saturated solution of nitre, dried, ignited and the fumes inhaled or made into cigarettes and smoked in connection with stramo- nium or tobacco. (B.) Methyl Chloride : Sprays applied rapidly over the back are said to cause an attack to cease in a few minutes. If they are not successful light spraying on the upper part of the chest may be tried. (Sj.) Strychnine : Subcutaneous injection of a combina- tion of the sulphate of strychnine ^ gr. and the Sul- phate of Atrophine 2 ^ T gr. repeated daily, have been use. (Sj.) Belladonna : In pastels with Stramonium, Lobe- lia, or Hyoscyamus. (B.) 68 DIGEST OF EXTERNAL THERAPEUTICS. "Cigarettes d'Espic" are said to be made of the following ingredients. Belladonna leaves, y> parts. Hyoscyamus leaves, 2^ parts. Stramonium leaves, 2^ parts. Phellandrium Aquaticum, i part. Extract of Opium, } part. Cherry-laurel water, q. s. The dried leaves, stripped of their stems, are cut small, well mixed, and then moistened with the opium dissolved in the cheny-laurel water. The paper used for making the cigarettes is also soaked in an infusion of these leaves in cherry-laurel water. Usually in making these cigarettes, a little nitrate of potash is added to the infusion to make them burn freely. (Y.) " Carton Fumigatoire" of the French codex a very useful preparation is thus made : Take 7 ounces of gray unsized paper and 2 ounces of powdered nitre ; take of belladonna leaves, stramonium leaves, digi- talis leaves, and lobelia leaves, each 75 grains ; take of powdered myrrh and powdered oliban, each 150 grains. Tear the paper in pieces and soak it in water, then add the powders previously mixed, and pound and beat them all together. Then spread out the soft paste in tin moulds, and dry it in a stove. Finally cut this quantity into thirty-six pieces, each 6 centimeters long and 4 centimeters wide. One of these is burnt in the patient's room. (Y.) Galvanism of the pneumogastric and cervical sym- pathetic has relieved some cases and entirely failed in others. (B.) This, however, may be said for all rem- edies recommended for asthma. In adopting any of these expedients ventilation BALANO-POSTHITIS. 69 must not be neglected ; the windows should be regu- larly thrown wide open to renew the air of the apartment. It is well to keep the atmosphere of the room moist. (Ga.) The shower-bath is a valuable and potent agent to fortify the body against asthma; the sudden appli- cation of water strengthens the whole system, and renders the body less sensitive to atmospheric changes. Out-of-door exercise, as walking or riding, is also useful, but it should not be taken until one or two hours after a meal, or to such an extent as to occasion fatigue. (Rd.) BALANO-POSTHITIS. In mild cases cleanliness with the application of some bland powder is usually all that will be re- quired. (T.) Tepid Water Injections beneath prepuce frequently applied (W.), and strips of lint laid between the fore- skin and the glans removed as they become moist, are useful. The parts should be bathed every two to six hours with one of the following solutions : Carbolic Acid, 1-100. Mercuric Bichloride, 1-5000. Boric Acid, saturated solution. Succus Calendulae, 10 drops to water 1 oz. Alumnol, 1 to 5 per cent, strongly recommended. Zinc Sulpho-Carbolate, 1 to 5 per cent. After cleansing with an antiseptic solution dusting powders will be found effective, such as Alum, Tan- 70 DIGEST OF EXTERNAL THERAPEUTICS. nin, Bismuth Subnitrate. While using, the parts should be kept separated with a piece of lint. (Cl.) Lead and Opium Wash: Continuously applied for oedema of the prepuce, is very beneficial. (H.) Fid. Ext. Hydrastis : 1 part with dilute alcohol 4 parts as a lotion (Sm.), or the aqueous extract (Ernesty) 10 drops to 1 ounce of water. (Cl.) Hydrogen Peroxide: When pus is present this may be used as a douche. (Cltn.) Nitrate of Silver : A solution of 10 grains to the ounce will be found effective for erosions. (Cltn.) BEDSORES. The utmost care should be exercised to guard against the formation of bedsores. Moisture being a potent factor in their causation, the patient should be kept thorough^ dry and scrupulously clean. Pressure upon bony prominences must be relieved as much as possible with air cushions, and in very protracted illnesses air or water beds should be used when practicable. The exposed parts should be bathed with castile soap and warm water, then carefully dried with a soft towel. The following are recommended for application with the view of hardening the skin and preventing the formation of sores : Olive Oil 3 parts, with 1 part of Laudanum, and 2 of Brandy, was recommended by Florence Nightin- gale. Brandy, Proof Spirit or Alcohol diluted. (Bt.) Collodion, as a protective. (N.) Alum : Used in various ways, the following are advised : BEDSORES. 71 #. Aluminis, 3 ss. Albumin. Ovi, No. iv. Tr. Camphor! , Jij. M. (B.) Or: I*. Aluminis, Sod. Chloridi, aa ^ss. Aq. Destill., Alcoholis, aa Oj. M. (Sn.) Ammon. Nitrate : 5 grains with half an ounce each of alcohol and water, diluted with equal parts of water, was used by Agnew for rubbing on the back. (Al.) Nitrate of Silver: Gr. x-j painted on when the skin is red but not broken, is one of the best preven- tives. (F.) Other useful preventives are Soap Plaster retained in place by adhesive plaster, Decoction of Oak Bark, Glycerine, Glycerine Cream, Opium Liniment, Spirits of Camphor, Hamamelis, Lime Water and Solutions of Gutta Percha. When Sores Have Formed antiseptic washes, such as the following are called for : Hydrarg. Bichlorid., 1-3000-5000. Boric Acid., saturated solution. Hydrogen Peroxide, 1-8 or stronger. Creolin, 5-1000. Pyoktanin, 1-1000. After the application of the selected antiseptic solution, one of the following dusting powders may be used: Acetanilid, Airol, Dermatol, Nosophen, lodoform, Xeroform, or Naphthalin, the latter in the strength of 5 to 10 per cent., the others pure. 72 DIGEST OF EXTERNAL THERAPEUTICS. The same remedies may also be used in the form of ointments. Calendulated Boric Acid : Dusted over the sur- face, is highly endorsed, being employed with excel- lent results at the Middletown State Hospital for the Insane. Calendula : 1 part of the succus with 4 to 5 of a 1 per cent, solution of carbolic acid forms a satisfac- tory lotion for the relief of soreness. (M. H.) Compound Zinc Stearate with a little Tannin may be used with good effect. (Sm.) ' BITES OF INSECTS. Liq. Ammon., Ledum or Rhus Tox. of either 10 drops of the mother tincture to the ounce of water. Lime Water, freshly prepared, a slice of an Onion, Moist Clay. (Rd.) Salicylic Acid: The following will prove effective: Jjfc. Acid. Salicylic! , gr. ivss. Aq. Ammoniae, gtt. xl. Collodii, gr. Ixxvj. M. Or: 5fc. Acid. Salicylici, gtt. xv. Tr. Benzoini, gr. ivss. Collodii, SiJ 88 - M. (T., 97.) Camphorated Chloral : Will quickly arrest pain, and is effective for the bites of scorpions. (M. W.) Ichthyol: A 10 per cent, plasterer an ointment equal parts with lanolin, or the pure drug in severe BITES OF SERPENTS. 73 cases, has been productive of good results. (T., 98.) Potass. Permang. A 2 per cent, solution sub- cutaneously, is the best treatment for stings of bees and other poisonous insects. (M. T., 9, 98.) Cocaine : Solutions will relieve the pain. (M. W.) Nitric Acid : May be used when a cauterant effect is deemed desirable as in the case of stings by espe- cially poisonous insects. (N.) The following is recommended as a preventive : Acetic Ether, 5 parts. Eucalyptol, 10 parts. Cologne Water, 10 parts. Tr. Pyrethrum, 50 parts. (T., 9 8.) BITES OF SERPENTS. Ligation should be applied immediately to the limb above the wound, which should be sucked or incised and allowed to bleed freely. An attempt should be made to express the poison by bandaging the limb downwards. When the ligature is removed it should be slackened slowly. The Chinese apply as many as six tight bands above the wound and generally es- cape. (T., 98.) Cauterants, such as the Actual Cautery, Nitric Acid, Carbolic Acid, or Bromine are generally em- ployed after sucking the wound. (Ga.) (B.) Potass. Permang.: First apply a ligature, then inject subcutaneously a 1 per cent, solution near the periphery of the point of penetration of the serpent's fang. This is regarded in Brazil as a very effective antidote. (Ga.) 74 DIGEST OF EXTERNAL THERAPEUTICS. Tr. Iodine: Painted on the wound until active suppuration takes place, is said to be a trustworthy application for rattle snake bite. (N.) Euphobia Prostata: Used by the Indians and set- tlers in Arizona as an infallible remedy against bites of poisonous insects and snakes, especially the rattle snake. (N.) Aralia Spinosa : A decoction is used by Southern negroes against rattle snake bites. (N.) Calmette's Antivenene Serum: Reports of the successful application of this remedy have been re- ceived from various sources. Apparently there are two factors in snake venom to be dealt with, one which acts locally and the other which causes gen- eral or constitutional symptoms. These can be sep- arated chemically and physiologically, and require different antidotes. The poison in the wound may be treated by a solution of Hypochlorite of Calcium, 160, while for the toxine which causes the consti- tutional symptoms the antivenene serum should be used. A case is reported which was apparently at the point of death, where 20 c. c. of Calmette's serum injected under the skin of the abdomen brought about recovery. This was administered three hours after being bitten ; a second dose of 10 c. c was given on the second day, this being the full amount. (T., 98.) Strychnine: Subcutaneously, has been successfully used in Australia and the East Indies. It is em- ployed in large doses, carefully watching the effects. According to the severity of the condition, amounts varying from f to 3 or 4 grains were given in divided doses in different cases. The symptoms were pro- BLADDER. 75 gressively relieved and no toxic effects from the strychnine were produced. (Sm.) Digitalis and alcoholic stimulants, especially Whis- key, should be administered hypodermically. (B.) BLADDER, IRRITABILITY AND NEURALGIA OF. Full sized Steel Sounds passed every fourth day have been effective in many cases. (Cl.) Nitrate of Silver : Gr. j-ij-gj, 1 to 3 drops applied with the Taylor syringe to the prostatic portion of the urethra, is indicated in some cases. (Cl.) Aqua-puncture has been successful. (B.) BLEPHARITIS. Rest and strict cleanliness should be enforced and any errors of refraction corrected. After the re- moval of the scales, which should be done gently, the following may be used : Hydrarg. Oxid. Flav.: Gr. v, vaseline |j is valu- able for destroying any parasite which may be pres- ent and for keeping the parts clean and secretions soft. (Mac.) On account of the fineness of its parti- cles it is more suitable than the red oxide, which may also be used. (N.) Formalin : May be employed in all cases in solu- tion of the strength of 1 to 2 per cent., beginning with the weaker. It must be prepared fresh, or at the time of using, to insure uniformity of strength. 76 DIGEST OF EXTERNAL THERAPEUTICS. A small cotton mop is used for daily applications. The proportion of cases benefited and the measures of relief afforded constitutes this a superior remedy. (P. M.J., 9, 24, 98.) Chloral Hydrate : 1-10 in solution applied with gentle friction is valuable when the scales are diffi- cult to remove. (T., 97.) A weaker solution of 5 grains to the ounce is also recommended. (T., 98.) Ung. Hydrarg Ammoniat.: Gr. ss-|j. (N.) Tan- nin : Gr. v-3j. (B.) Bismuth Subnitrate: Equal parts with glycerine, in ciliary and granular forms. (Wa.) Sulphur and Resorcin : 2 per cent, each, in an ointment for squamous types. Sulphur Oint- ment : When there is distinct desquamation. Pyro- gallic Acid : 5 to 10 per cent, ointments have given good results. (T., 97.) Nitrate of Silver: Gr. x-gj, applied to the roots of the hair acts well in some cases, followed after- wards with vaseline to neutralize the effects of the silver solution. (Ro.) The crayon may be used on exposed ulcers followed by mercurial salves. (T., 97.) Acetate of Lead : The following is for application to the edges of the lid : Neutral Lead Acetate, gr. ij. Cocaine Hydrochlorate, gr. iij. White Vaseline, gr. xlv. Aristol: Gr. x-gj an effective ointment. (T., 98.) BLISTERS. For healing the milder forms of burns and erythe- ma: Cerat. Cetacei. BOILS. 77 Cerat. Plumbi Subacetatis. Cerat. Resinae. Fid. Ext. Grindeliae Robust., gss., aquae, 3iv-vj. Infus. Sambuci. Ung. Cetacei. Ung. Zinc. Oxidi. (N.) BOILS. Compare Abscess. Hydrarg. Bichlorid.: Solutions of 1-1000 should be used for washing the boil and surrounding parts. (B.H.) Phenol and Mercurial Plaster.: Render the lesion and surrounding surface aseptic with a bichloride solution 11000, then cover the part with the plas- ter, changing daily or oftener. If used before fluctu- ation absorption may be expected. The results of this treatment are excellent. (T., 97.) Van Hoorn recommends that the plaster be changed daily, and the patient be ordered to change the underclothing frequently. Unna's plaster of carbolic acid and mer- cury is warmly endorsed by Hardaway ; the plaster, extending well beyond the lesion, should be used in place of a poultice which is condemned by this author. A small opening is cut in the centre over the conical point of the boil ; thus applied, matura- tion will be hastened. lodoform : When pain is severe, viz.: I*. lodoformi, 3J. Ung. Vaselini Plumbic! , 3J. M. (Hd.) 78 DIGEST OF EXTERNAL THERAPEUTICS. Iodine: The strong tincture, frequently painted on the part, has been used with a view of aborting ; it is regarded, however, as of doubtful utility. Jamie- son and Haller recommended the following : V. Tr. lodi, gj. Acid. Tannici, 355. Pulv. Acaciae, J;ss. M. (Hd.) Carbolic Acid: This remedy is also employed to abort the formation of furuncles ; it is condemned by some observers when used alone for this purpose. (B. H.) The following are the methods of its appli- cation : Inject a 2 per cent, solution, then touch the surface with the pure acid and cover the part with a carbolized dressing, or heat some of the crystallized acid on the point of a probe to the melting point and press the same on the surface of the furuncle. (Sj.) The following is very effective : #. Acid. Carbolici, gr. v-x. Ext. Ergotae, 3J-ij. Pulv. Amyl, Zinc. Oxidi, aa gij. Ung. Aq. Rosae, ^ij. M. Take a piece of absorbent cotten several times the size of the inflamed surface, and spread the ointment on, taking care that no pressure is made to hold the plaster in place except at the edges. This will afford marked relief, and is used by its author (Bulkley) for boils in all stages. It should be changed every twelve hours. (Bk.) Collodion: At the pustular stage for small boils and pimples, employed on account of its contractile power, is often effectual in arresting development. (Al.) BOILS. 79 Resorcin: A thick layer of the ointment made with vaseline has good effect in carbunculous boils. (N.) Arnica: The tincture or extract of the flowers 1 part, and 2 parts of honey, with an inert powder, is used with a view of arresting. (N.) Nitrate of Silver: 5 to 20 grains to 1 ounce of nitrous ether, painted on to abort, is specific if ap- plied early. (R.) See also Higginbottom's method under Abscess. Airol : A 10 per cent, gauze has proved very effect- ive. (T., 98.) Opium : The powdered extract mixed to the con- sistency of a syrup and applied several times a day. (Al.) Pyoktanin Blue: As this agent completely arrests the development of the staphylococcus aureus it should be an effective application. As a dressing it is commonly employed in solutions of 1-2000 to 1-100. As an ointment in strength of 2 to 10 per cent. The deep purple stain which it causes on the skin and linen, and which constitutes an objection to its use, may be removed by dilute hydrochloric or nitric acid, alcohol or cologne water. (F.) Belladonna : A plaster is used to subdue inflam- mation or linen soaked in a solution of Atropine, gr. iv-sj, with water or glycerine for the relief of pain (R.) or on the ointment with equal parts of glycerine spread on linen. (Al.) Poultices : Hot fomentations, to assist matura- tion and allay pain, should generally be applied. They may be sprinkled freely with Tr. Belladonna, or Tr. Opium. (W.) 80 DIGEST OF EXTERNAL THERAPEUTICS. The following is recommended to be applied to the surrounding skin during the course of the boil : #. Acid. Borici, 3J. Zinc. Oxidi, 3J. Pul. Amyli, ^iij. Vaselini, ^j. M. (Hd.) BOWELS, OBSTRUCTION OF IN- TUSSUSCEPTION F^CAL IMPACTION. The radical treatment is abdominal section, but inasmuch as non-surgical measures are often effect- ive they should be employed first. Morphine: Hypodermicalry administered is of great service for the relief of pain and spasm, render- ing the following measures more efficient. (Gn.) Gastric Lavage : Affords great relief to the inces- sant vomiting, and is often followed by reduction of the displacement ; it may be repeated at intervals of six hours. (Gn.) High Injections : If the cause is determined to be faecal impaction or if the obstruction is in the large intestine, copious injections should be tried, using for this purpose a warm saline mixture of olive oil, administered by means of a fountain syringe, while the patient is in an inverted position. The abdomen should be well kneaded, and the body well shaken. The injection should be repeated regularly. (An.) Inflation with Hydrogen Gas or Air: If injections fail, two or three gallons of the gas or air may be BOWELS. 81 carefully introduced (Semi) from a large rubber bag. Thorough manipulation of the abdomen may be combined, specially if there is intussusception. In this condition inflation, early and perseveringly ap- plied, will succeed in the majority of instances. (An.) Jonathan Hutchinson recommended inflation by warm air or water, administered while the patient is in the knee and elbow position, with thorough kneading of the abdomen. This method, says Goodno, is not without risk of causing perforation of the bowels. Enemata. Turpentine: A common domestic remedy consists of soap suds with which some turpentine has been added. The following are also employed : #. Ol. Terebinthinae, 3J. Mucil. Amyli vel Decoct. Hordei, 3 XV - M. Or,' #. Ol. Terebinthinae, 3 ss. Ol. Recini., ^iss. Ovi., No. j. Decoct. Hordei vel Aq. Fervid., 3 x iv. M. (B.) Infus. Lobelia: Half an ounce to a pint of hot water, employed for the relief of obstruction arising from intussusception, strangulation and impaction. (F.) Infus. Tobacco; Half a drachm to a pint of hot water, macerate for six hours and filter, inject one- quarter to one-half the quantity, repeating in half an hour, if necessary, carefully watching its effects. 7 82 DIGEST OF EXTERNAL THERAPEUTICS. (Sn.) Tobacco holds a secondary place as an anti- spasmodic, and care is necessary to avoid toxic effects. Effervescent Enemata : Are prepared as follows : #. Sodii Bicarb., 3J. Aquse, 3viij. M. Inject into the rectum, and immediately follow with: I*. Pulv. Acid. Tartarici, 3J. Aquse, ^viij- M. (B.) Ox Gall : Injections are useful for the relief of faecal impaction, viz.: 9 . Fellis Bovis Inspissant. , ^ ii j . Glycerini, |jij. Acid. Salicylici, gr. xv. Aquse, q. s. ad vj. M. Sig. Use in quantities of one > to 2 ounces, mixed with soap suds. (H. F.) In severe cases of tympanitis a trocar may be in- serted. (An.) Intussusception or strangulation, if not relieved within twenty-four hours, demands immediate oper- ation, longer delay is dangerous. Early operation gives much better results than late. (W.) BRAIN, CONCUSSION OF. The symptoms of concussion are those of shock with the cerebral symptoms in addition. No treat- ment is called for in the early states, unless the col- BREASTS. 83 lapse is very alarming, when stimulants will be nec- essary, but they are not indicated in cases of average severity. The tendency to death in pure concussion is from syncope and shock causing failure of the heart action. The administration of stimulants in these conditions should be such as will be least liable to provoke inflammation. The patient should be placed in a warm bed with the head at first moderately low. Heat should be applied to the axillae and extremities. Absolute quiet must be enjoined and no attempt should be made to arouse to consciousness, nor food or drink adminis- tered. If depression be prolonged mild stimulants, such as ammonia, will be called for, and in extreme cases stimulating enemata may avert impending death. Great firmness is often necessary to with- stand the urgent demands of friends for expectant measures. When reaction appears the head and shoulders should be raised a little and cold appli- cations and evaporating lotions applied. The apart- ment of the patient should be cool and carefully guarded from noise and the light modified. Conver- sation around or near him must be avoided. After recovery he must be kept under observation for two or three "weeks lest some insidious inflammation de- velop. (Rd.) BREASTS, SWOLLEN AND PAIN- FULINFLAMMATION OF. Collodion : An application covering the entire breast, will often relieve congestion and prevent sup- puration. (F.) 84 DIGEST OF EXTERNAL THERAPEUTICS. Camphorated Oil or Camphor and Lard: 3J 3J, rubbed in gentlv will sometimes abort suppuration. (Bt.) Roller Bandage: Snugly applied around the body so as to give firm support, will arrest the formation of an abscess. It should be reapplied daily. (Ga.) Massage and Evacuation : Rub gently in the di- rection of the nipple, and evacuate with breast- pump. (Sj.) Olive Oil : As soon as hardness appears rub with the oil from circumference to centre, and support the breast with a sling made of a broad handkerchief. (Ga.) Belladonna Ointment : Applied on lint and cov- ered with linseed meal poultices, if used as soon as an inflammatory blush appears, will, as a rule, cause all traces of inflammation to disappear in twenty- four hours. (T., 97.) Stramonium: The leaves as a fomentation are effective as an anodyne for engorged breasts. (Sn.) Phytolacca Dec.: The tincture sprinkled on hot flannels (Ga.), or the following ointment: I*. Pulv. Phytolaccse Rad., 3J- Camphorae, gr. x. Ext. Belladonnas, 3J- Ung. Zinc. Oxidi Benzoat., 5J- M. (Sm.) Phosphatad Oil : Applied with cloths, and gently rubbed in. Ammon. Carb.: 3-j Qj, compresses well saturated with the solution, if applied early, will prove very satisfactory. Chloroform and Glycer- ine: Equal parts. Castor Oil and Glycerine: Equal parts; very soothing. Hamamelis : Applied on compresses. (Bt.) BREASTS. 85 Spts. Vini Rect.: When the skin is tense and hard, and the veins distended, sponge the parts until quite cold, repeating as soon as heat returns. A few spongings -will afford relief. (Rd.) Heat : Applied by means of a bowl lined with flannel saturated with hot water and placed over the left breast, is one of the most effective means of relieving pain and preventing suppuration. (Rd.) The following lotions are used : Aconitine (with caution), Atropine, Pilocarpine, each in the propor- tion of 1 grain to the ounce. (Bt.) When pus has formed it must be evacuated under strict antisepsis. The part must be washed with a solution of bichloride and an incision made radiat- ing from the nipple. A director should be inserted, and any pockets of pus searched out and the walls broken through. After evacuation the abscess cavity may be irrigated with an antiseptic solution, such as Creolin 2 per cent., or Hydrogen Peroxide pure, or a weak solution of Bichloride of Mercury. After ir- rigation aseptic gauze with gentle pressure should be applied . ( Am . ) Strapping : Equal pressure applied by means of straps of adhesive plaster will prove of great benefit in old cases. If there are sinuses first inject them with an antiseptic solution. Ammon. Chloride:! ounce, with spts. of rose- mary 1 pint, kept constantly applied by means of compresses, is useful for the induration following suppurati ve mastitis . ( Al . ) 86 DIGEST OF EXTERNAL THERAPEUTICS. BREATH, OFFENSIVE. The condition of the teeth, stomach, mucous mem- brane of the throat, nose, and lungs should receive attention. The following used as mouth washes are of service (B.) (N.) (Sm.): Hydrogen Peroxide, 3), water giij. Tr. Myrrh, 3], water giij. Potass. Chlorate, 5], water 3iv. Potass. Permang.: Gr. j, rose water 3j. The following combinations will prove useful : #. Calcis Chlorat., %iij. Aquae, Alcohol., aa ^ij. Ol. Rosse, gtt. iv. M. Sig. i teaspoonful in a glass of water. (B. ) Or, #. Sod. Biborat., 3J. Tr. Myrrhae, %ss. Glycerin!, ^j. Aquae, ^iv. M. Or, #. Acid. Thymici, gr. iv. Acid. Benzoici, gr. xiv. Tr. Eucalypti, ^ss. Alcohol. Absoluti, ^iij- Ol. Gaulther., gtt. xxv. M. Sig. i or 2 teaspoonfuls in half a glass of water. (Sm.) Solutions of Boric or Salicylic Acid, Charcoal, Camphor, and Naphthol are also used. BROMIDROSIS AND HYPERHIDROSIS. 87 BROMIDROSIS AND HYPERHIDROSIS. In the former, frequent ablutions are necessary ; in the latter wash as little as is compatible with clean- liness. Applications are made in the form of pow- ders, lotions, and ointments ; as a rule powders are prefer abk. Powders. Aristol: Will restrain profuse perspiration either alone or in combination with boric acid or impure zinc carbonate. (Sm.) Boric Acid : For the feet ; soak the stockings in a saturated solution, allow them to dry, then wear thus impregnated with the acid. (F.) Chloral Hydrate: 1 drachm, with starch 1 ounce constitutes one of the best powders. (Vn.) /5-Naphthol: 15 grains, with bismuth 1 ounce or 20 grains, with boric acid 4 drachms. (Sm.) Dermatol, 20 parts. Starch, 10 parts. Talc, 70 parts. (Sm.) Salicylic Acid: The fine powder, dusted over the feet and stockings, is very effective (B.); also the fol- lowing combination : I*. Pulv. Acid. Salicylic!, Pulv. Zinc. Carbonat. Praecipitat, Pulv. Magnesii Ust. , aa ^iv. Pulv. Amyli, 3 XV - Pulv. Talci, 3 xx. M. (Vn.) Tannin: The following is a good astringent: 88 DIGEST OF EXTERNAL THERAPEUTICS. #. Acid. Tannici, 3J. Lycopodii, 3j. M. (Sm.) Tartaric Acid: Has proved efficacious in the treat- ment of fetid sweating of the feet. A pinch of the powdered acid is dusted every day in the socks and between the toes, and the erosions which may exist in these places are covered with small pieces of cotton charged with boric acid ointment. ( Rr. ) Lotions. Alum : 3J-ij, water Oj. (Sh.) Alcohol and Boroglyceride (50 per cent.): Equal parts. (Sm.) Boric Acid: Saturated solution. (Ja.) Hydrastine Muriat.: Gr. ij-vj, water 3j. (F.) Salicylic Acid: 3 per cent, solution. (Ja.) Chromic Acid: A 5 to 10 per cent, solution ap- plied once or twice in from two to four weeks is effective in bromidrosis of the feet. The same solu- tion is recommended by Prof. Richter, viz.: Applica- tions are made every five days to the palms of the hands and to the inter-digital surfaces, taking care each time to allow the parts to dry thoroughly. The yellow color of the skin disappears by washing a few times, without ill effects of any kind. Any ex- isting fissures ought to be cured by applications of a 10 per cent, salicylated soap plaster before beginning the treatment of the hyperhidrosis itself. Ten appli- cations of the chromic acid solution are generally sufficient to effect a cure. Sulphate of Copper: 1 grain, with hamamelis 1 ounce. (Sm.) Naphthol: 5 per cent, solution in alcohol for bath- BROMIDROSIS AND HYPERHIDROSIS. 89 ing the parts, or the powder of 1 per cent, with starch. (Kap.) Hydrarg. Bichlorid.: Gr. x, cologne water or tinct- ure of hamamelis ^iv. (Sh.) Lead Acetat.: ^ij iij, water Oj. (Al.) lufus. White Oak Bark. (Kp.) Infus. Quillaia: As a wash for the hands and feet once daily. (Sm.) Potass. Permang.: Gr. j v to water j, useful for sponging the feet ; afterwards dust with the powder of salicylic acid and starch. This will often correct the condition. (Sm.) Zinc: The oxide with starch. (Kp.) The oleate gr. iij, starch ss, or the compound stearate with boric acid. (Sm.) Ointments. These are not, as a rule, suited for use on the hands or feet, powders and lotions being preferable; in obstinate cases, however, they may be used with benefit. Ung. Hydrarg. Oleat.: 10 per cent, for the axillae, the skin being previously washed with alcohol. (N.) Aluminum Oleate: Diluted one-half with lard or some other fatty substance, forms the ointment of the oleate of aluminum which is very effective. (Sm.) Ung. Picis.: Equal parts with Ung. Sulphur. (Vn.) Hebra's Treatment: For obstinate and severe forms of sweating of the soles of the feet and the hands ; take equal parts of olive oil and diachylon ointment, melt the ointment, and add the oil, stir- ring until a homogeneous mass results ; cut pieces of muslin the size of the part, and spread on the oint- 90 DIGEST OF EXTERNAL THERAPEUTICS. ment thickly, and apply. Lint spread with the oint- ment should also be placed between the toes or fingers and a roller bandage firmly applied over all. These dressings should be changed twice in twenty- four hours, and the parts rubbed dry with lint and starch powder without washing. This treatment should be continued from one to several weeks, ac- cording to the severity of the disease. After the dis- continuance of the ointment the powder should be applied for several weeks. (Vn.) Pilocarpine : Small doses hypodermically have proved beneficial. (Sm.) Sea Baths or Salt Baths are sometimes of service. Carbolic, Juniper Tar, Eucalyptus and Ichthyol Soaps. Disinfection of the shoes is an indispensable pre- caution to prevent the recurrence of the bromidrosis. This is done by pouring into the shoe a mixture of 1 tablespoonful of commercial formalin to 1 litre of water, or a 3 per cent, solution of carbolic acid ; the liquid is left for a few hours, after which it can be dried rapidly. (Rr.) BRONCHITIS. ACUTE BRONCHITIS. The patient should be propped well in bed, as posi- tion influences stasis of the blood in the lungs. (Rd.) Sinapisms, or Turpentine Embrocations : Ap- plied to the anterior surface of the chest will relieve cough and oppression. (Ty.) Lin. Camphor. Comp.: Systematically and thor- CAPILLARY BRONCHITIS. 91 oughly applied with massage, is said to be very help- ful in relieving the sense of constriction and uneasi- siness. (T., 97.) Vini Ipecac.: Diluted with twice its bulk of water sprayed into the throat night and morning for about ten minutes, the patient expectorating the liquid as it accumulates, is recommended to relieve distressing cough, labored breathing and sense of constriction. (T., 97.) Inhalations of the vapor of a saturated solution Ammon. Chloride or Tr. Benzoin. Comp. poured on the surface of hot water are useful palliatives when there is decided oppression. (Ty.) CAPILLARY BRONCHITIS. Counter-irritation by sinapisms, or Turpentine, is especially useful. The former may be made with about 1 part to 5 or 6 of flaxseed meal, and, if the white of one egg and glycerine is used instead of water, it may be kept applied much longer. Turpen- tine may be applied in the combination known as St. John Long Liniment, which consists of a tea cup of vinegar and a wineglassful of turpentine beaten up with one egg. Rub on the chest and apply with flannel. This is said to be the most effective way in which to apply turpentine. (Ty.) Poultices : These are now generally condemned on account of their weight and the exposure in changing. They are, however, recommended by some writers for capillary bronchitis in children. CHRONIC BRONCHITIS. The inhalation of medicated vapors is often em- 92 DIGEST OF EXTERNAL THERAPEUTICS. ployed with satisfactory results. The following remedies are thus used : I*. Tr. Benzoin. Comp., 3J- Aq. Bullientis, Oj. M. Sig. Inhale vapor night and morning. (Sm.) ;. Acidi Carbolici, gtt. iij-vj. Aq. Bullientis, Oss. M. (Al.) Iodine : Combined with turpentine as follows, form an excellent mixture, non-irritating to the mucous membrane: Iodine 10 parts, alcohol 20 parts, mix in a flask, and add essence of terebinth 20 parts, and spirits of lavender 10 parts. Shake the mixture well. It will be found useful when ex- pectoration is profuse and fetid. (Sm. ) Ethyl Iodide: 10 to 30 minims will afford marked relief to the cough, and is the most direct method of introducing iodine into the system. (Sm.) Terebene : 5 to 40 drops to 1 ounce of water with 20 grains of carbonate of magnesia; a tea- spoonful of the mixture is added to a pint of water at a temperature of 140, and the vapor inhaled for ten minutes night and morning. (Al.) Turpentine : 5 minims of the oil to a pint of water at 150. (Al.) Creosote : 5 to 6 minims with a little carbonate of magnesia added to a pint of hot water forms an inhalation which is indicated when there is dilata- tion of the bronchi and retention of mucus. (Al.) Sulphurous Acid: In sprays, or " Pictet Liquid," the latter is a combination of sulphurous and car- bonic acid gas liquified by a pressure of three atmos- pheres. It is stored in syphons and is a very power- BRONCHIECTASIS. 93 ful agent. It must be inhaled with very great cau- tion. Carpets, furniture, hangings, bedding, etc., must be removed and nothing left in the room but a chair and a table. The slightest pressure on the valve of the syphon will permit the escape of the gas in minute quantities until the desired amount is ob- tained, the patient being the best judge. A peculiar brassy taste with a slight sense of constriction of the throat and a little cough and feeling of oppres- sion are the eifects to be obtained and kept up for an hour or two. It is claimed that if administered with due caution excellent results are to be expected. (B.) Carbolic Acid and Eucalyptus : For inhalation \vhen the expectoration is very fetid : #. Acid. Carbolici, gr. ij-iv. Ol. Eucalypti ( M ij-iv. Aquae, 3J. M. (An.) Sig. To be inhaled from a steam or hand atomizer three or four times a day. Olive Oil Inunctions to the chest are often sooth- ing and strengthening. (Rd.) BRONCHIECTASIS. Antiseptic sprays and inhalations, as mentioned in the previous article and in the article on Pulmonary Tuberculosis, are applicable. 94 DIGEST OF EXTERNAL THERAPEUTICS. BUBO. Preventive Treatment. When suffering from gonorrhoea, chancroid or any lesion liable to cause bubo, physical exertion should be avoided as much as possible. Cleansing and Dressing of Venereal Ulcerations : All sores should be thoroughly cleansed. As sprays penetrate more deeply and irritate less than washes, antiseptic lotions are better applied that way. Solu- tions of Carbolic Acid 1-100, Hydrogen Peroxide half strength, and Nitrate of Silver 1-100 in normal saline solutions, are suitable antiseptics. The lesions may first be sprayed with the peroxide, then with one of the other solutions. If there is much secretion Black Wash, or some other wet dressing may be applied and renewed after each urination. If the discharge is not copious dust- ing powders are preferable, viz.: Acetanilid, Airol, lodoform, etc. When drainage is impossible on ac- count of a contracted and elongated foreskin circum- cision should be performed. (T., 97.) Abortive Treatment. When inflammation has commenced Rest in bed and Cold Applications are of great importance. (Cl.) Collodion: Painted on the part causes contrac- tion and pressure, and is especially serviceable when it is impracticable for the patient to remain quiet. (Cl.) Pressure : A ball of cotton as large as a man's BUBO. 95 fist is placed over the gland, and bound down by a firmly applied spica bandage. A few safety pins are placed in the bandage through the ball to prevent slipping. This simple measure is often very success- ful. (T., 97.) Phytolacca Dec.: The tincture or fld. ext. on cot- ton. (Rd.) Nitrate of Silver: A 2 per cent, solution injected in the early stages. Carbolic Acid : A 2 per cent, solution by injection. (F.) The following other measures have been suggested, some of which are better adapted to hospital prac- tice: If the bubo is seen within the first twenty-four or forty-eight hours of its becoming painful, the follow- ing may be tried to prevent extension : Place the pa- tient in bed after a saline purge and apply over the bubo a compress consisting of eight or ten layers of gauze soaked in a dilute solution of acetate of lead, and a spica bandage over this. The compress should be kept wet with the lead solution for twenty-four hours ; if there is no improvement at the end of that time, the bubo should be dissected out and the inci- sion closed without drainage. To accomplish this successfully all suppurative lesions of the penis must be thoroughly cleansed and the organ enclosed in an antiseptic dressing. The skin over the bubo must be prepared as if for a major operation. (T., 97.) Mercury Benzoate: Hypodermic injections of this salt at one or two points were used for the treat- ment of threatened suppuration in thirty- three cases, thirty of which were successful. The amount injected was 7 a /2 minims of a fluid composed of a 1 per cent. 96 DIGEST OF EXTERNAL THERAPEUTICS. solution of mercury benzoate, and a MJ per cent, solu- tion of sodium chloride. It is claimed that am r mer- curial salt would accomplish the same purpose. The sodium chloride is necessary for the solution of the benzoate of mercury. (Sm.) When Suppurating: Method of Fontau: The following is recommended as most effective for suppurating bubos, reports of which give very favorable results. The skin for some eight or ten inches about the part is scrubbed with green .soap, washed with ether, and then with bi- chloride 1-1000. A narrow bistoury is then inserted into the abscess cavity, the contents of which are gently expressed. The cavity is then irrigated \vith the bichloride 1-1000, and at once filled to moderate distension with warm iodoform ointment (10 per cent, iodoform, 90 per cent, vaseline). Caution should be exercised not to use too much heat in warming the ointment lest the iodine be liberated. An ordinary cone-pointed glass syringe may be used for the introduction of the ointment ; the plunger is removed and the barrel warmed and filled by means of a spatula. Immediately on withdrawing the syringe a compress wet with a cold bichloride solu- tion is applied and the melted ointment instantly solidifies at the orifice and its escape is prevented from the cavity. A large compress of sterilized gauze is then applied by means of a firm spica bandage. The patient should report at the end of four days, when, if all is well, the dressing is reapplied, but if there is any evidence of inflammation the wound is thoroughly irrigated, cleansed and the injection re- peated. The advantages of this procedure are: 1. BUBO. 97 Simplicity and safety ; 2. Rapid cure; 3. The patient can go about when under treatment; 4. The first gland being rendered aseptic others are less likely to become affected, 5. No scar; 6. Does not interfere with another surgical procedure should any be neces- sary subsequently. The method is only applicable when there is infection by the staphylococcus and when there is an appreciable pus cavity. In diffuse phlegmon with no pus cavity the treatment has not been found available. (J. C. G., 5, 93.) Excision: The following plan has been employed with success : The overlying skin is prepared in the usual manner as for a capital operation. The in- flamed gland is cut down upon, dissected out and removed and all the surrounding necrotic tissue re- moved by a sharp curette, the removal of this tissue must be as thorough as possible. The cavity is then irrigated with hot sterilized water and packed for a few moments w r ith hot moist sterile gauze to remove loose debris and check oozing. All suspiciously necrotic looking skin should be removed ; the gauze pack is then taken out and the whole cavity is packed full with powdered boric acid ; the incision is then closed with interrupted sutures. No drainage is required except in neglected cases. When the cavity is the size of a duck's egg, the surface about the inci- sion is dusted with boric acid and very firm pressure applied by means of a well-adjusted compress of sterilized gauze ; over this a spica bandage. Cure may be expected in from four to eleven days. (T., 97.) Another method of treatment consists in incisions as described in the treatment of Fontau, and the in- troduction of a piece of Carbolized or lodoform Gauze through the incision, and allowing the pus to 8 98 DIGEST OF EXTERNAL THERAPEUTICS. drain off. If after evacuation the skin over the cavity becomes sunken and shriveled it should be removed and the bubo treated like an ulcer as the conditions indicate. (Cl.) Xeroform : After a preliminary cauterization with carbolic acid, applied as a powder will promote heal- ing and lessen suppuration. (F.) Silica Hydrate : Pack the bubo with the remecry, renewing it once or twice a day. It will check sup- puration very quickly, but should not be used too long, as it devitalizes the tissues and leads to exten- sive sloughing. ( F. ) Ammon. Chloride : 31] j in hot water useful for indolent types. (Al.) Sanoform : Less effective than iodoform, but gives good results when used as a substitute. It has the advantage of being free from odor. (F.) Nitrate of Silver: The crayon lightly applied to the surface of indolent bubos and to the cavities of sinuses is useful for stimulation. A solution of 3] j followed by iodoform gauze packing may be em- ployed for the same purpose. (Al.) Hot Fomentations : When suppuration is inevita- ble, to hasten maturation. (Cl.) BUNION. In recent cases, the sac being thin, it may be rup- tured by pressure, the contents evacuated and the condition corrected. In time the cyst becomes thick- ened and this proceeding will no longer be effective. In this case the direction of the toe must be changed BURNS AND SCALDS. 99 by -wearing properly shaped boots made with the in- ner side of the sole straight from the sole to the heel. (Rd.) If the bunion is discharging use stimulating appli- cations; if there is inflammation, poultices and soothing remedies. "Warm Foot Baths : Very serviceable for the relief of irritation of the part. (Rd.) Lotions of Tr. Arnica, gtt. xx gss, or Tr. Ruta, same strength when there is any tendency to ery- sipelas, after foot-baths. (Rd.) Verat. Vir.: Equal parts of the tincture with spirits of wine and water when there is much inflam- mation. (C.) Copper Oleate : A 10 to 20 per cent, ointment spread on as a plaster will often relieve. (Sm.) Calendula : 1 part of the succus to 10 of water when suppurating. Tr. Iodine andTr. Belladonna : Equal parts, apply twice daily. Poultices are indicated when pus has formed. (Rd.) BURNS AND SCALDS. Whatever form of dressing is employed any degree of pressure to the burned surfaces must be avoided. If the posterior surfaces of the body or limbs are in- volved the patient must lie prone. (W.) Orthoform : This local anaesthetic has proved a most effective remedy for the relief of the pain of burns. It may be dusted on the denuded surface or applied in the form of 10 to 20 per cent, ointment 100 DIGEST OF EXTERNAL THERAPEUTICS. with lanolin. It does not in any way interfere with the normal reparative process. Carbolic Acid : This is one of the first remedies; it is used mixed with olive oil. A piece of lint being soaked in the carbolized oil is applied directly to the wound. It is recommended in the proportion of 1 part of the acid to 50 of olive oil (W.) and in much stronger mixtures, such as 1 part to 12. (Ga.) The following are useful formulas for its adaptation : #. Acid. Carbolici, 3^ ss - Glycerin!, gss. Aq. Destill., ad gvj. M. (Rd.) Or, ffc. Acid. Carbolici, gr. viij. Vaselini, gij. M. Sig. Spread on lint. (Bellevue Hospital.) Or, ffc- Acid. Carbolici, gr. xv. L,iq. Calcis, Ol. Lini, aa Jij. M. Sig. Wring out cloths saturated in the mixture and apply. ( City Hospital. ) Picric Acid: A simple and satisfactory remedy for superficial burns and scalds. A solution is made as follows : Picric acid giss, alcohol 3iij ; allow the acid to dissolve, then add 2 pints of distilled water. The burned surfaces should be cleansed \vith absorbent cotton dipped in the solution and the blisters pricked ; care should be taken not to destroy the epithelial surfaces ; strips of sterilized gauze are soaked in the solution and applied so as to cover the entire injured BURNS AND SCALDS. 101 surface, and the whole kept in place by a bandage. The dressing, which soon dries, is left in place for three or four days ; it is then removed by saturating with the picric acid solution. The second dressing is applied as the first and left on for a week. The ad- vantages of this treatment are that it seems to re- lieve the pain, and limits the tendency to suppura- tion by coagulating the albuminous exudations. Healing takes place under a scab, and a smoother and more supple cicatrix results than by other methods. (T., 97.) Solution of other strengths are also employed, as 1-200, which is described as anti- septic, analgesic, and keratogenous, and free from accidents provoked by other antiseptics. Saturated solutions are also recommended. (Sj.) Carbonate of Lead: Used either pure or worked up with oil to the consistency of cream ; it should not, however, be applied to large surfaces for fear of toxic effects. This remedy was favorably regarded by the late Dr. Gross. (Al.) Sodium Carbonate: Saturated solutions for the relief of pain. (B.) Carron Oil: Made by mixing equal parts of lime water and linseed oil is an old and well-tried remedy; it was used carbolized by Dr. Gross. (T., 96.) Flour; Dusted on thickly, or flour and lard worked up together. (Ga.) Airol: A dusting powder rapid in effect and un- irritating. (Sj.) Guaiacol : Interstitial injections of a 1-10 or a 1- 20 solution, a Pravaz syringeful, affords relief. The action is slower, but more lasting than that of cocaine. (Sj.) 102 DIGEST OF EXTERNAL THERAPEUTICS. Nutgalls: 1 part of the powder and 8 parts of borated vaseline for diminishing over-abundant sup- puration, and as a deodorant. (Sj.) Ichthyol : In burns of the first and second degree, as long as the blisters are small and intact, strong solutions have been found of great benefit in reliev- ing pain and congestion, and when applied early will sometimes even prevent the formation of blisters. If, however, the surface is eroded strong solutions will cause irritation and inflammation. (F.) Equal parts with water have been used as soon as the denuded skin is removed and some of the inflammation has subsided. A 25 per cent, ointment kept continuously applied is also employed. Thiol: An excellent remedy in burns of all de- grees ; it is employed with occlusive dressings. After dusting with boric acid the entire surface may be painted with a solution of equal parts of thiol and water and oiled cotton cloths laid on over the burn. (Sj.) For burns of the first degree, the following pow- der: Zinc Oxide, 5 parts. Magnesium Carbonate, 10 parts. Ichthyol, i to 2 parts. For burns of the second degree : Zinc Oxide, 5 parts. Prepared Chalk, 10 parts. Starch, 10 parts. Linseed Oil, 10 parts. Lime Water, 16 parts. Ichthyol, i to 3 parts. Both the powders and paste are renewed daily. When inflammation is intense the two mav be em- BURNS AND SCALDS. 103 picked simultaneously, the burn being covered with a layer of the powder, and the paste applied over this" (T., 97.) Potass, Nitrate : A few teaspoonfuls in a basin of water gives excellent results in the treatment of burns of all degrees. It acts as a refrigerant ; as it dissolves it lowers the temperature of the water from 5 to 9. If a burned hand or foot is plunged in such a solution speedy relief will be obtained. When the water becomes warm the pain returns, then more of the salt must be added. Baths of this solution may be prolonged three or four days. Com- presses may also be effectively applied. The forma- tion of blisters is in a measure prevented, and cica- trization takes place rapidly. (T., 97.) Turpentine : The liniment is an old and well known remedy ; it may be applied as soon as possi- ble after the accident. The burned surfaces are dressed with cotton and gauze saturated with the liniment and so applied as to exclude the air, care being observed not to include the uninjured skin. (Rd.) The injured parts may be brushed with tur- pentine, and an ointment of turpentine and basilicon applied. This constitutes one of the most successful methods of treatment. (F.) Creolin: Gauze soaked in a 2 per cent, solution. (SJO Eucalyptus Oil: gss- j 3J of cosmoline. (Al.) Di- aphthorin : y 2 tol per cent, solution. (Sm.) Chloral Hydrate: 5 per cent, solution, antiseptic and seda- tive. (Al.) Aristol: Valuable; quickly relieves pain. (Sj.) This substance tends to form a thick crust over an ulcerating surface, and should therefore be watched 104 DIGEST OF EXTERNAL THERAPEUTICS. lest secretions and discharges be retained. It is bet- ter suited to superficial lesions. Lime Water : Combined with a ointment base, viz.: Lanolin, i part. Lard, 2 parts. Lime Water, 3 parts. (M. R., 3, 10, '96.) Continuous Warm Bath: This is advised by Hebra in cases of extensive burns. He employed a bath-tub six feet long and three feet broad, in the in- terior of which an iron frame w^as fitted, and trans- verse bands of \vebbing were attached to the frame as in an ordinary bed. The frame was suspended in the both by cords attached to each end ; it was pro- vided with a pillow and covered with a blanket ; at the head of the tub, but at a higher level, was a cop- per boiler furnishing water at any desired tempera- ture. This was connected with the tub by a pipe which entered at the bottom ; through this the water flowed continuously, escaping by a pipe at the water level. Thus a constant flow was maintained. The temperature of the water was kept at 90 to 100, and entirely changed every day. A wooden frame, over which a blanket was spread, was placed over the tub while the patient was in the bath. Hebra kept his patients in the .baths without interruption for as long as one hundred da3 7 s. (F.) When suppuration commences, strict cleanliness and antisepsis must be rigidly enforced. The dress- ings must be changed as often as the condition of the ulcerating surfaces and the rise of the temperature indicate. Little balls of absorbent cotton soaked in BURNS AND SCALDS. 105 a solution of Corrosive Sublimate 1-3000 should be used for cleansing. (W.) Chloroform : In severe cases the administration of this anaesthetic is advised at the time of dressing not only to avoid pain but to lessen shock. (T., 97.) In the stage of granulation the following: Balsam Oil : This remedy, introduced by the late Dr. W. W. Van Arsdale in 1893, forms an excellent dressing for all kinds of granulating wounds, includ- ing burns, sloughing wounds and incised accumula- tion of pus. It is prepared by mixing 20 minims of the balsam of Peru with 1 ounce of cold pressed castor oil. For ordinary use a gauze pad may be covered with the oil, which can be distributed by using a paint brush ; sufficient gauze should be used to absorb all the expected secretions, especially if the dressing is to remain on for three or four days. The whole dressing must be covered with oiled silk or rubber tissue ample enough to overlap half an inch on all sides. Layers of cotton should be applied to lend support and the whole retained in place by a bandage. (N. Y. M. J., 29, 7, 93.) Thymol: In the strength of 1-3000 has been added to ointments, such as those of boric acid or zinc oxide. It is claimed under its influence sloughs separate sooner, healthy granulations are formed and cicatrization is hastened. The scars are less irri- table than when carbolic acid is used. (Al.) Boric Acid: A very useful dressing employed in various strengths both in solution and in ointment. A method of its use is as follows : A piece of oiled silk, dipped in a saturated solution, is applied, then a piece of lint of a somewhat larger size also dipped in the solution is placed over the silk and held in place 106 DIGEST OF EXTERNAL THERAPEUTICS. by a bandage. This was the method of Lister. A saturated solution is especially recommended for the burns of the actual cautery and the acid nitrate of mercury. (B.) Bismuth Subnitrate: Mixed with glycerine to the consistency of thick cream and spread on lint then covered with oiled silk or rubber. (Al.) Salol: In the proportion of 3 parts to 100 of lanolin, allays pain and inflammation. (Al.) Salicylic Acid: 5), olive oil gviij. (B.) lodoform: Forms a useful dressing in the propor- tion of 1 part to 8 of vaseline; apply on lint and cover with rubber protective. (W.) Dermatol: Especially valuable in lesions attended with profuse secretion and therefore useful in burns. (Sm.) Copaiba: Cotton saturated with the balsam is in- dicated when the granulations are pale and flat. (Al.) Calendula: The cerate thinned with olive oil, or the following : #. Tr. Calendula;, 5j. Liq. Calcis, Ol. Lini, aa gij. M. (Rd.) Burns of a Minor Character. Cocaine: A 4 per cent, ointment, as a protective and an anodyne. Being insoluble in fatty substances, the cocaine should first be dissolved in oleic acid and afterwards added to the ointment base in small quantities. (Al.) Flexible Collodion : Greatly benefits burns of the first degree by preventing contact with the air. BURSITIS. 107 Sodium Bicarbonate, with Cosmoline, a drachm to the ounce. White of Egg mixed with Hamamelis Oil, Liquid Gutta Percha, Glycerite of Starch, Rose 'Water Ointment, Molasses. Lotions of Tr. Cantharides 1 part to 10 of water, or Tr. Urtica Urens 1 part to 4? of water. (C.) Burns of the Eyelids. For slight burns : Finely powdered Bismuth, Car- ron Oil, or Cocaine in one of the following: #. Cocain. Hydrochlorat. , gr. iij. Lanolini, gr. v. Vaselini, Aq. Destill., aa if j. M. For burns of the second degree : 9>. Cocain. Hydrochlorat., gr. xxiij. Salol., g. xlv. Vaselini, vj r - xv - M. Sig. Before applying, open blister. (T., 97.) BURSITIS. Perfect Rest \vith slight counter-irritation, with frequent application of Tr. Iodine or a Blister, will remove the swelling in most instances. If the cyst is large with thin walls the fluid may be withdrawn by Aspiration, and pressure applied with a rubber band- age, but when the walls are thick and there is evi- dence of lymph within the cavity, as denoted by a crackling sound, the most effective measure is Inci- sion, turning out the melon seed bodies or masses of 108 DIGEST OF EXTERNAL THERAPEUTICS. lymph, then inserting a drainage tube and applying aseptic dressings. When the walls are excessively thickened Excision will be necessary. (HI.) CANCER. The following are intended to meet the require- ments of the practitioner when an operation is re- fused, or to serve as palliatives in non-operative cases. The consensus of opinion is for immediate removal by the knife, not only as soon as diagnosis is made, but also in all doubtful cases. Ulcerating surfaces should first be made as clean as the condition admits by the use of antiseptic solu- tions, such as Corrosive Sublimate, Potassium Per- manganate or Hydrogen Peroxide ; then some local remedy for the relief of pain and the destruction of foetor should be applied. With this end in view the following are recommended : Salicylic Acid : Injections of 15 minims to 1 drachm of a 6 per cent, solution, repeated six to thirteen times, have been used with great relief. It is claimed that this is the best treatment for non- operative cases. (Sj.) Carbolic Acid: A mild escharotic applied directly to cancerous sores and injected beneath the aifected part, limits and retards the growth. The pure acid is used for application to the ulcerating surface and a 5 per cent, solution for injection. (B.) lodoform : Applied to the surface acts as an anal- gesic and deodorant. It may be combined with Eucalyptus as follows : CANCER. 109 fy. lodoformi, 3J- Ol. Eucalypti, j. Vaselini, Paraffin!, aa j. M. (Al). Lycoperdon : Remarkable virtue is claimed for this drug as a haemostatic, antiseptic and anodyne on cancerous ulcers. The powder of the fungus is employed. (N.) Conium: A hemlock poultice or lint saturated with the succus conii are useful anodynes on ulcerat- ing surfaces. (Wa.) Stramonium Leaves: The following effective oint- ment is used at the Middlesex Hospital, London : Fresh stramonium leaves % lb., lard 2 Ibs.; mix the leaves (bruised) with the lard, heat gently and strain. (Sm.) Calcium Carbide : The cavities of the cancer are filled with the remedy and ordinary dressings ap- plied. The action is rapid, producing a burning sen- sation which lasts for an hour or two ; at the end of that time pain, foetor and discharge have disap- peared and a clot formed as a barrier to haemor- rhage. (F.) Alcohol Injections: 30 parts of absolute alcohol are mixed with 70 of water; injections are made around the tumor and infiltrated glands twice a week. The quantity injected will vary -with the size of the tumor, sometimes amounting to 20 Pravaz syringefuls. In order to avoid injecting into a blood vessel the needle is inserted deep into the tissues, then unfastened from the syringe and left in place, if blood does not issue the injection is made, if it does the needle is removed and another locality punc- 110 DIGEST OF EXTERNAL THERAPEUTICS. tured. Under this treatment the tumor diminishes in size and becomes less painful. The injections may occasionally cause pain and intoxication. Local or general anaesthesia may be employed. (M.T., 9, 97.) Alcohol Compresses : Have a good effect for ar- resting the bloody oozing often observed. (Al.) Hydrastine Hydrochlorate : An ointment of 30 grains to 1 ounce of ointment base destro3 r s foetor. Potass. Chlorate : In a fine powder is used for dusting on malignant ulcerations. (Sm.) Pyoktanin Blue : Used in powders or solutions of 1 per cent, or in collodion 1-30, the latter is painless, easy of application and more active. (Sj.) Citric Acid: A saturated solution subcutaneously introduced at any point near the periphery of the cancer seems to possess an affinity for the diseased structures ; indurations are reduced and instant re- lief is said to be obtained from the smarting and tension. (Sj.) . Atropine : Solutions locallv for pain are effective. (F.) Orthoform : The powder sprinkled over the sur- face or an ointment of 10 to 20 per cent, is a recent remedy for the relief of pain. See Local Anaesthesia. Bscharotics. The application of these agents is limited to ulcer- ating cancers and to the removal of cancerous tumors in their earlier stages. The removal of cancers by this method is slow, painful and less certain to expose healthy tissue than the knife; nevertheless escharotics are sometimes used. Before application, if the skin is unbroken, a blister or strong ammonia should be applied. CANCER. Ill Zinc Chloride: One of the best mineral caustics ; has the advantage of not poisoning the system and limiting its action to the point of contact. The claims for its superiority over the knife are un- founded. Its action causes intense pain, notwith- standing assertions to the contrary. Some of the methods of its use are as follows : Conquin's Paste, a well known preparation, is made in various ways. The U. S. Dispensatory gives this formula : 5fc. Zinc. Chlorid., |j. Pulv. Amyl. Exsiccat., %\]-iv. Aquse, M. xxx-^j. M. Zinc oxide or anhydrous sulphate of calcium may be substituted for the amyl. (Al.) Mayet's Paste: Zinc chloride 8 parts, zinc oxide 1 part, flour dried at 212 7 parts, water 1 part ; mix the zinc oxide with the flour, dissolve the zinc chloride in water and add the mixture of zinc oxide and flour; rub the paste in a mortar ten minutes. (N.) Method of Maisonneuve : "Cauterization en Fleches." This is applied as follows : The patient is narcotized, and if it is thought necessary a knife is passed deep into the growth ; arrows of the caustic are inserted at several points which are cut close and left in. Hypodermics of morphine will to a certain extent relieve the pain, which is very severe for some hours. The skin will turn a dead white. A poultice is now applied and in a few days the mass, it is said, "shells out like a billiard ball," exposing a surface which, if healthy, will cicatrize, but if not, the treat- ment must be repeated. (HI.) 112 DIGEST OF EXTERNAL THERAPEUTICS. Potassa Cum Creta: By mixing with alcohol this substance is made into a paste ; it may be rendered nearly painless by the addition of morphine and is applied as a plaster ; at the end of fifteen minutes the skin is carbonized and if retained a slough will be formed as thick as the plaster. A clear surface will be left which heals rapidly. (Al.) Sulphuric Acid: This agent is regarded as supe- rior to other escharotics for the destruction of malig- nant growths. Michel's Paste, a form of its applica- tion, is prepared thus: 1 part by -weight of some indifferent excipient and 3 parts of fuming sulphuric acid are mixed on a glass slab forming a paste, which is applied in the following manner : If the sur- face is unbroken it should first be blistered and the epidermis removed, after which cocaine, not exceed- ing one and a half grains to the ounce, is applied, at the same time a hj'podermic of morphine is adminis- tered. After the cocaine has taken effect, the paste is applied entirely over the tumor to the depth of about half an inch. If these precautions are taken it is claimed that no pain is experienced. After the tumor is destroyed the cavity is washed out, filled with asbestos and covered with zinc ointment. It usually takes ten to twelve days for the eschar to separate ; during this time the wound should be irrigated daily. The patient should be kept on the level, otherwise the acid will gravitate to one side and a portion of the tumor will escape its action. The surrounding skin should be protected by collodion, and all oozing of any fluid carefulty mopped up. (Al.) Arsenious Acid: This agent is better adapted to epitheliomatous growths. Its application is painful CANCER. 113 and not without danger. The following are some of its preparations as an escharotic : " Poudre Caustique de Frere Cosine ou de Rousse- lot :" fy. Acid. Arsenosi, gr. x. Hydrarg. Sulphid. Nig., Qij. Pulv. Carbonis Animalis, gr. x. M. The powder is mixed with mucilage at the time of applying. (Al.) " Februre's Remedy :" Jjfc. Acid. Arsenosi, gr. x. Aq. Destill., Oj. adde Ext. Conii, 5J- Liq. Pluinbi Subacetat. , iij. Tr. Opii, 3J. M. With this the cancers is washed every morning. (U. S.) "Jusetmond's Arsenical Powder :" fy. Antinionii Sulphuret., gr. xvj. Acid. Arsenosi, gr. j. M. Melt in a crucible ; when cold, reduce the mass to powder and add 5 parts of extract of opium. "Manec's Paste: 1 ' $fc. Acid. Arsenosi, gr. xv. Hydrarg. Sulphid. Nig., gr. Ixxv. Spong. Ustae, gr. xxxv. M. This is made into a thick paste with a few drops of water. (Al.) 9 114 DIGEST OF EXTERNAL THERAPEUTICS. Method of Czerny and Trunecek: Arsenious acid 1 part in 75 each of ethylic alcohol and distilled water, paint the growth. In twenty-four hours it will be covered with an eschar, which after daily repetition of the painting will come off. (T., 98.) Sodium Ethylate : First cleanse the part with pyrozone and dry thoroughly, then anesthetize with cocaine 10 per cent, solution, and apply the remedy full strength by means of a glass rod. This strength is obtained by allowing the crystals to deliquesce. The following powder is then dusted thickly over the diseased surface : #. Acetanilidi, 5J- Aristoli, O^J-i Acid. Borici, 3J- M. Vaseline is then spread on sheet-wadding of suffi- cient size to cover the whole surface, over this ab- sorbent cotton, and bandage. The patient is seen every second day, but only the diseased points are touched afterwards. Considerable oedema follows the first application, but it soon disappears. The ethylate is very painful and cocaine does not always relieve. It should be kept in small corked bottles, care being taken that it does not touch the cork. (T., 98.) Alveloz : This drug has caustic action similar to zinc chloride and has been used with asserted suc- ces. Its application is comparatively painless. The juice of the plant is preserved for transportation by the addition of salkrvlic acid. (F.) CANCER OF LARYNX. 115 CANCER OF LARYNX. Sodium of Formate : Solutions of 5 to 20 grains to the ounce of water or glycerine as a spray or 2 parts with 8 of starch as an insufflating powder blown only on the ulcerated surface, have proved serviceable applications. (F.) Carbolic Acid : Add 20 to 40 drops to a pint of water with a small amount of glycerine, heat to 140 and inhale the vapor. (Al.) The following are for use with the atomizer : Hydrogen Peroxide. Pyoktanin, 1/2 per cent, solution. Potass. Permang., 2 percent, solution. Carbolized Alkaline Sprays as mentioned for Ca- tarrh and Rhinitis. Morphine, 2 per cent, solution. Cocaine, 5 to 10 percent, solution; more effective than morphine. Thuja, local applications have relieved. CANCER OF THE RECTUM. As in cancer of other localities, any treatment other than extirpation is simply palliative. Seda- tives of many kinds may be administered with benefit, and w r hen one ceases to be of service another may be tried. Opium: In some form this is one of the best reme- dies ; in suppositories made with 3 parts of glycerine to 1 of gelatine, it acts less like a foreign body and melts more readily. Battley's sedative or black drops in starch injections and hypodermics of mor- phine are effective . (Gt.) In administering opium or morphine the greatest care should be taken not to 116 DIGEST OF EXTERNAL THERAPEUTICS. give any more than absolutely necessary as it must be continued for months, and the mental state some- times caused by it is most distressing. Pyoktanin: The following suppository is advised : I*. Pyoktanini, gr. j. Pulv. Opii, gr, T V Ol. Theobromae, q. s. M. (T., 96.) Arsenite of Copper: A paste made by mixing the remedy with mucilage may be applied to protruding cancerous masses, an extremely rare condition. (Gt.) CANCER OF THE UTERUS. Curettage and the Actual Cautery: The applica- tion of these measures followed by antiseptic dress- ings is an old and effective method which has stood the test of time. The patient is anaesthetized and placed in the dorsal position, all readily removable tissues are gouged out with a sharp curette under continuous irrigation. The haemorrhage is stopped by packing the cavity with iodoform gauze, leaving it in place for a short time, then removing. The in- terior of the excavation is now cauterized with the round ball of the Paquelin cautery at a red heat, then irrigated with a solution of boric acid 1-20. Tampons saturated in a 50 per cent, solution of zinc chloride may also be used after curettage, as de- scribed under that remedy. (K. C.) Alcohol: When infiltration of the surrounding tis- sues is feared parenchymatous injections of absolute alcohol may be employed, using 80 minims, the injec- tions being made at several points, but not punctur- ing very deeply. Usually after ten to fifteen injec- tions the discharge lessens or disappears and the CANCER OF THE UTERUS. 117 patient improves. If the growth is too near the peritoneum to permit of this procedure, alcohol in the form of baths to the part may be administered by means of a tubular speculum. (T., 97.) Ferric Chloride: For haemorrhage saturate two or three pieces of lint with the chloride and place them in contact with the cervix, then tampon with dry cotton. To avoid excoriation of the vaginal mucous membrane, which occurs unless the chloride is very much diluted, add carbonate of soda in the proportion of 4 grains to the ounce of the chloride. (Al.) Steam : Vaporization of the uterus for cancer of the fundus has been employed for its haemostatic, anaesthetic and caustic effects. The steam is intro- duced by means of a canula attached to a rubber tube and applied for one and a half minutes ; it is followed immediately by a dark colored fluid. (F.) Compare Vaporization, under Chronic Endometritis. Chromic Acid : This is used pure and in dilutions. An effective method, which is said to be of great benefit, consists in first irrigating the uterus and vagina with a hot salt solution and then applying the acid in the strength of 1 part to 3 parts of water. Care should be observed not to permit any of the caustic to come in contact with the healthy tissue, which must be protected by a saturated solu- tion of bicarbonate of soda. Tampon with iodoform gauze after the application. (F.) Ferripyrin: Being astringent as well as anaes- thetic, is applicable for the control of haemorrhage and discharge. It may be applied directly to the dis- eased surface or mixed with charcoal placed in little bags and introduced into the vagina. (T., 97.) 118 DIGEST OF EXTERNAL THERAPEUTICS. Pyoktanin Blue : As a dusting powder with gauze packing of the same, has improved the general condition. (Sj.) Solutions of 1-300 are injected in the infiltrated tissue, a few drops at each point, using about thirty in all, at intervals of one or two days; curettage should precede the injections and the dry powder be used in the uterus. This measure will prolong life. (K. C.) A medicated crayon for introduction into the cervical canal may be made as follows : &. Pyoktanini, Acid. Tannici, aa gr. iv. Pulv. Opii, gr. j. Ol. Olivae, gtt. xv. Ol. Theobromse, gj. M. Sig Retain crayon with tampons. (T., 98.) Terebene : Tampons soaked in a solution of 116 of olive oil or used pure act well as antiseptics and deodorants. Pepsin : Good results have followed its applica- tion to cancer of the cervix ; much of the neoplastic tissue may be destroyed this way. (Sm.) Salicylic Acid : Parenchymatous injection of a 6 per cent, solution in alcohol has been employed with satisfactory results. (Sj.) A tampon thoroughly impregnated \vith the drug may be inserted twice a day to correct foetor, in conjunction with vaginal douches of a 3 per cent, solution of creolin. (Al.) Zinc Chloride : This remedy ma3' be employed after curettage and the actual cautery. Czerny used 4 parts of the chloride with 1 of zinc oxide and 3 of flour enclosed in gauze secured with a tampon by a string attached for easy removal. This was allowed CANCER OF THE UTERUS. 119 to remain about six hours, or less if there seemed any risk to the vesical or rectal septum. On its re- moval, iodoform gauze was inserted. (N.) Another method after curettage and the actual cautery consists in packing the crater of the cancer with pledgets of absorbent cotton the size of a wal- nut, which has been soaked in a 50 per cent, solution of the chloride and applying a non-absorbent cotton tampon over these. The zinc chloride produces a still further separation of the cancerous tissues, and in about a week or ten days the slough may be re- moved. In case there is haemorrhage after the sep- aration of the slough the cavity may be packed with iodoform gauze. Solutions of bicarbonate of soda should be employed to neutralize any of the chloride which may come in contact with the vagina. (K. C.) Bismuth Subnitrate, mixed with Aristol or Iodo- form, may be dusted on the interior of the cavity when curettage is not practicable on account of the disease being too far advanced. (K. C.) Calcium Carbide: A piece the size of a small wal- nut is placed in contact with the diseased part and the vagina quickly filled with iodoform gauze, which is removed in a few days and an antiseptic douche administered. (T., 97.) This remedy has been used in France with favorable results. The calcium carb- ide decomposes into calcium oxide and acetylene gas; at the end of several days the oxide is easily removed by an antiseptic douche (corrosive subli- mate). The diseased part becomes grayish and smooth, and the pain and haemorrhage are sup- pressed. (F.) Salol Gauze: May be used with good effect for packing after the curette and cautery. (T., 98.) 120 DIGEST OF EXTERNAL THERAPEUTICS. Sodium Chlorate: This remedy is advised inter- nally and locally as a palliative. Locally : I*. Sodii Chloratis, Bismuth! Subnitratis, aa ^iiss. lodoformi, 3J- M. Sig. A small quantity is applied by a tampon to the cervix. Strips of sterilized gauze six inches long and two wide impregnated \vith 1 part of iodoform, 20 parts of sodium chlorate and 20 parts of glycerine may also be used. If symptoms of iodoform poisoning appear, tampons of salolized cotton saturated in a 20 per cent, solution of chlorate of sodium should be substituted. Finally a vaginal douche of a quart of sterilized water holding in solution 150 grains of chlorate of sodium should be administered daily. (T.,98.) Nitric Acid: Recommended as an effective caus- tic ; the acid is applied to the whole diseased surface and a pad saturated with grycerine placed over it. This treatment produces a slight slough and de- stroys many of the sources of haemorrhage. It may be used every two or three months. (Al.) Hydrastis and Sanguinaria: For epitheliomatous ulcerations of the cervix, equal parts of each in pow- der have been employed with good effect. Orthoform: For the relief of pain the following: #. Orthofonni, gr. xv. Acid. Arsenosi, gr. iss. Alcoholis, M.cxx. Aquae, M.cxx. M. Sig. A tampon of absorbent cotton is saturated with this solu- tion and applied per vaginam. (R. M., 12, 5, 98.) CANCER OF THE UTERUS. 121 For the Control of Haemorrhage: Tr. Iodine (Churchill's), Persulphate of Iron in glycerine on pledgets of cotton, strong solutions of Alum and Packing the Vagina, the latter should be employed when the haemorrhage is alarming; the tampon should be made of antiseptic cotton with a string attached to each to facilitate removal. (Cp.) Tampons heavily loaded with equal parts of Ben- zoin, lodoform and Magnesia may be used in place of injections. (T., 98.) Hot Water Douches: These are valuable for the relief of pain and the control of haemorrhage, but especially for cleansing. Antiseptic Douches: #. Acid. Carbolici, gr. viij. Glycerini, 3 V "J- Ess. Thymi, ^iij. M. Sig. A teaspoonful to i or 2 quarts of water. #. Acid. Salicylici, gr. xv. Ess. Geran . Ros. , 3 i gr. xv. Alcohol, 90 per cent., 3vj. M. Sig. A tablespoonful to a pint of water. (T., 98. ) The following are for vaginal injection in the pro- portion of the amount mentioned to one pint of water : Acidum Carbolicum, sss j. Acidum Gallicum, gr. xx sj. Acidum Tannicum, gr. xx-^j. Acidum Salicylicum, sj. Alumin, 3J-iv. Aqua Chlorinii, iv. Creosotum, MX sss. 122 DIGEST OF EXTERNAL THERAPEUTICS. Cupri Sulphas, gr. x xxx. Ferri Sulphas, gr. xxx. Kino, j. Krameria, ^ss. Liquor Ferri Sulphatis, ^ij iv. Liquor Plumbi Subacetatis, 3J ij. Liquor Sodae Chlorinatae, j. Plumbi Acetas, gr. x xx. Potassii Chloras, 3j. Potassii Permanganas, gr. xx. Quercus Alba, gss. Sodii Hyposulphis, 3J ij. Tr. Ferri Chloridi, 3ss-j. Zinci Chloridum, gr. v-vij. Zinci Sulphas, sjij. (Dn.) CANCRUM ORIS. Cauterization: This is the first indication and should be immediately applied with care and thor- oughness to every portion of the diseased area. The Paquelin or the Electro-cautery are the best methods, as they can be more easily controlled. The resulting eschar should be dressed with warm boric acid solutions until it separates; then with astringent lotions. (Mus.) Other energetic caustics are Nitric Acid, Hydro- chloric Acid, Bromine, Vienna Paste and Zinc Chloride. The after treatment should include direct applications of lodoform, Pyoktanin Blue, Ichthyol, and Carbolic Acid. (Gn.) Pyoktanin Blue: Subcutaneous injection of a CARBUNCLE. 123 saturated solution promises much, according to Goodno. Potass. Permang., 1-100; Formalin, 1-15 or 30; Tr. Iodine, Fid. Ext. Eucalyptus, pure or with equal parts of glycerine, are recommended for use after the removal of the slough. (Jac.) CARBUNCLE. Compare Abscess. Carbolic Acid: This effective remedy is employed in several ways. A successful method of its applica- tion is as follows (Dr. M. O.Terry): First, apply sev- eral layers of collodion over the carbuncle extending beyond the periphery of inflammation, but leaving an uncovered area in the centre of about one-quarter of an inch. Second, make a small crucial opening. Third inject the following: Crystals of carbolic acid, 20 grains; glycerine and water, each 2 drachms. The injections should be made with a hypodermic syringe to which a lachrymal canula is attached ; push the canula well toward the periphery, injecting a few drops in several directions. Repeat daily if necessary. As a rule, not more than five injections will be required. Simple dressing of vaseline and cal- endula and iodoform may then be applied. (Hel.) Injections of 5 to 10 minims of a 2 per cent, solution (F.), or 5 drops of the pure acid at each point of the carbuncle are said to arrest the development. (T., 97.) Non-incision Treatment: The following formula 124 DIGEST OF EXTERNAL THERAPEUTICS. is highly praised by Dr. L. D. Bulkley for carbuncles as well as boils : #. Acid. Carbolici, gr. v-x. Fid. Ext. Ergotae, 3J-ij- Pulv. Amyli, Zinc. Oxidi, aa ij. Ung. Aq. Rosas, ^ij. M. Spread thickly on lint and apply. It is claimed that incision has seldom been necessary with this treatment, and that better results are obtained than with the knife, except in more malignant cases \vith gangrene. Bulkley adds : " I have applied this treat- ment to some large and formidable carbuncles, and have always found that the pus would find exit read- ily enough and healing progress satisfactorily under this dressing. On some occasions febrile and other symptoms have seemed to call for more active inter- ference with the knife ; but although urged to do it, I have adhered to the plan of treatment without in- cision, and have obtained results which have war- ranted its continued employment. I am prepared to admit, however, that possibly from neglect or other causes a very large suppurating carbunculous area might be formed, which would demand active sur- gical procedure. I may add that Sir James Paget strongly discountenances the practice of incision." (Bk.) Excision and Erasion : This procedure is indi- cated when it is not possible to isolate the disease from the surrounding tissues. Remove as much as possible with the knife, scissors and Volkmann's spoon, and in cases where a clean surface is impossi- ble swab the raw surface with a solution of chloride CARBUNCLE. 125 of zinc, gr. xl-j. A large circular wound will be left, which is painted with carbolic acid, alcohol, methyl violet, each 1 part, water 10 parts, then dust with iodoform and pack with iodoform gauze. The in- cision should be made deep around the circumference, at least half an inch from the infected part. Haem- orrhage may be guarded against by pressure forceps in the hands of an assistant. After excision great care must be taken not to infect the wound. (T., 97.) Crucial Incision with Carbolic Acid Injections: When incision is impracticable multiple crucial inci- sions may be made across the surface of the carbun- cle, then inject hypodermically carbolic acid 110. The injections should be made carefully, so as to diffuse the solution throughout the base of the in- fected part, and the puncture must be deep, drawing the needle slowly -while injecting a few drops. The incision must be carefully mopped out with the acid ; then compresses wet with a solution of bichloride, 1- 1000, applied, and an ice bag over the dressing. The injections are to be repeated every six hours until the disease is under control. (A.) Crocker recommended Glycerine of Belladonna spread on lint, followed later by Ung. Resinae until suppuration occurred; then the removal of the sloughs with the scissors when they are slow in separating, or when septic absorption is threatened. The wound is dressed antiseptically. (Hd.) Iodine Liniment : Painted freely on the part, fol- lowed by the application of a thick pad kept in place by an elastic bandage, is recommended. When the carbuncle is situated on the limb it is claimed that relief is very marked, and that the patient can be permitted to go about. (T., 97.) 126 DIGEST OF EXTERNAL THERAPEUTICS. Antiseptic irrigating solutions. See also Abscess. Hydrarg. Bichlorid., 1-2000 or 1-3000. Potass. Permang., gr. x gj. Hydrogen Peroxide. Dusting powders are indicated during the process of healing. Acetanilid, Airol, Dermatol, lodoform, Pyoktanin Blue, 1 to 2 per cent., Resorcin, Sano- form, Xeroform, etc. CARIES AND NECROSIS OF BONE. lodoform : 1 part to 10 of glycerine was used by Billroth in tuberculous caries, viz.: The abscess was first opened, the bone scraped, the cavity thorough^ cleansed and firmly rubbed with a pledget of iodo- form gauze. The wound was then stitched up, leav- ing an opening in which the iodoform emulsion was poured. Recovery by first intention may be ex- pected. Usuallv a second dressing will be required. (Sm.) Myrrh: When the discharge is very offensive this will form a useful stimulating dressing. It may be combined with potassium chlorate in the proportion of 2 drachms of each to 4 ounces of distilled water. (Al.) Turpentine: Diluted with olive or almond oil is of especial value in caries of the temporal bone. Ap- plications may be made every three or four days. (Al.) Potass. Permang.: Gr. iij-x-gj, applied with a brush or compress. (F.) Liqueur de Villate : CARIES AND NECROSIS OF BONE. 127 Tfr. Cupri Sulphatis, Zinci Sulphatis, aa gr. xv. L4q. Plumbi Subacetatis, Jss. Acid. Acetici Diluti, 3iij ss - M. A small quantity is injected into the sinus. It is claimed that only the outer portion of the bone be- comes decalcified. Acidulated Pepsin: An artificial digestive fluid has been used for the removal of dead bone from sup- purating tracts. It is employed as follows : An open- ing is made in the soft parts by the most direct route to the diseased bone, then, if possible, the sinuses are made to connect and are kept patulous by plugs of antiseptic gauze. A 3 per cent, solution of hydro- chloric acid is then injected. This may be done every two hours if the patient is confined to bed ; if not, once daily. After decalcification of the exposed bone flush the sinus with hydrogen peroxide, or bichloride of mercury 12000, and inject the following: I*. Pepsin., ^ss. Acid. Hydrochloric., M.xvj. Aq. Destill., |iv. M. Digestion of the bone and tissue detritus will take place in about two hours. The procedure may be repeated in two days. (Al.) Lactic Acid : The concentrated acid has been used on lint or absorbent cotton covered with an imper- meable tissue and bandaged in cases of fungous caries. The healthy skin should be protected with adhesive plaster; after twelve hours remove the caustic, cleanse the part and apply moist dressings for twelve to twenty-fours. The acid may be re- peated as often as necessary. (F.) 128 DIGEST OF EXTERNAL THERAPEUTICS. Nitric Acid : As a caustic to hasten suppuration, especially when there is sloughing of the soft parts. (N.) Sulphuric Acid: A swab on an aluminum appli- cator may be applied to the necrosed bone, especially when exfoliation is slow. The effect is solvent and cauterant, and tends to the removal of diseased part. (F.) Hydrochloric Acid: The dilute acid has been used as an injection in tuberculous caries. The pure acid has also been employed, a few drops being applied directly by means of a glass pipette to the diseased bone and allowed to remain on for one minute; afterwards irrigate with a saturated solu- tion of carbonate of soda and apply myrrh dress- ing. (P.) Operation : When posssible, is generally preferred to any other method. CARIES OF TEETH. See Toothache. Gum Mastiche : Often employed as a temporary filling, in solution with ether, 1 part to 4; a small piece of cotton being saturated with the solution is pressed down into the cavity, which should be pre- viously cleansed. (Al.) Myrrh : Serviceable as a mouth wash, viz.: #. Potass. Chlorat., 3U- Tr. Myrrh., 5ij. Aq. Destill., q. s. ad gvj. M. (Al.) CELLULITIS. 129 Hydronaphthol : As a mouth wash and prevent- ive of dental caries, viz : #. Hydronaphthol., gr. xvj. Alcohol., 5J- Aq. Destill., 3J. M. Sig. A tablespoonful to half a pint of water. Use freely. It should be made in small quantities, since the preparation is unstable. (Al.) Creosote Collodion: Recommended as an appli- cation to the cavities of carious teeth. (F.) Ethyl Chloride : This agent may be used as a dental anaesthetic, viz.: First, thoroughly dry the gum and cover it with vaseline, and protect the neighboring parts with wool. The patient should be instructed to breathe through the nose. The chloride may be applied to both sides of the tooth, freezing the parts. In extraction it is not necessary to spray on both sides of the tooth, the jet may be thrown near the entrance of the dental nerve in front of the ear for the upper, and behind the ramus of the in- ferior maxilla for the lower jaw. Anaesthesia of the whole jaw, it is claimed, will follow, and a tooth may be extracted without pain. During the thaw- ing, care must be observed in the use of hot water, if used too hot or too soon sloughing will follow. CELLULITIS. See Phlegmonous Erysipelas. 10 130 DIGEST OF EXTERNAL THERAPEUTICS. CERUMEN, INSPISSATED AND IM- PACTED. Vaseline, Olive Oil, or Glycerine: The latter the most effective, warmed and dropped into the ear and retained by pledgets of cotton, are useful for soften- ing the wax before syringing. The oil and glycerine should be allowed to remain twenty-four hours. (Bp.) Sodium Bicarbonate : Gr. iv j, with warm water or glycerine ; fill the ear several times a day with the solution ; allow it to remain for about fifteen min- utes, the mass will then break up and can be easily removed by injection. The auditory canal should afterwards be dried, anointed with vaseline, and protected with cotton. (Bp.) Papain: Gr. xx-j. Liquor Potassae: 10 per cent, solution. Hydrogen Peroxide: Injections of full strength are very effective. (Al.) CHAFING. See Erythema Intertrigo. CHANCRE, HARD. Strict cleanliness is of great importance. The part should be bathed frequently in tepid water or some antiseptic lotion. Usually simple dressings in the CHANCRE, HARD. 131 form of dusting powder are effective in healing the local sore. lodoform formerly headed the list, but some of the odorless dusting powders may be substi- tuted, such as Aristol, Europhen, or Bismuth Sub- nitrate. Sometimes a simple piece of lint laid on the erosion will be all that is necessary. (Cl.) Calomel: Used as a dry dressing with equal parts of zinc oxide. (B. H.) Hydrogen Peroxide : Wash the part three times a day in the pure peroxide and apply lint soaked in the same. (R.) Lotio Nigra and Lotio Flava: Old but none the less effective remedies, especially for indolent sores. (N.) Ung. Hydrarg.: If there is much induration the official ointment may be used, protecting the sur- rounding part by proper dressings ; or if this is too irritating the following : ft. Hydrarg. Prsecipitat. Alb., gr. xl. Adipis Benzoat., if j. M. Or, ft. Ung. Hydrarg., Zinc. Oxidi, Amyli, aa ^ij. Adipis Benzoat., ^j. M. (B. H.) The weight of evidence is strongly against the utility of excision and cauterization, as well as the effectiveness of antiseptic lotions and local applica- tions of mercury as preventives or abortives of constitutional symptoms. If the chancre does not heal but presents an exten- sive ulcerating surface, or appears to be of the mixed 132 DIGEST OF EXTERNAL THERAPEUTICS. variety, the same treatment as for chancroid will be indicated. CHANCROID. It has long been the custom with many surgeons to cauterize all chancroids; but modern antisepsis has modified this routine treatment. In a large majority of cases daily irrigation with a solution of Corrosive Sublimate, 1-500 or 1-1000, followed by the free application of lodoform, or an ointment of the same, in the strength of 90 grains to vaseline 1 ounce will be followed by cicatrization. If this fails, pledgets of lint soaked in Boric Acid solution or in Peroxide of Hydrogen kept continuously applied will often result in a cure. Should, however, these measures in turn prove unsuccessful and the sore deepen and extend, it should be cauterized. (A.) Cauterants. Cauterization is recommended by not a few au- thorities as the first remedial measure; but others limit its application to those cases in which anti- septic treatment has failed and to the severer forms of the lesion. Before application the sore should first be cleansed and dried. The centra-indications for the uses of cauterizing agents are when the surface involved is large and there is evidence of healthy reaction about to take place ; when there is much inflammation ; and when the sore is situated at the meatus urinarius. The objections to their use are the pain and inflamma- tory action which follows, the possible production CHANCROID. 133 of phimosis and the subsequent effusion of lymph, which is apt to cause indurations closely resembling hard chancre, and thus obscure diagnosis. (A.) Nitric Acid : The most frequently used cauterant, should be applied as follows : The chancroid is dried with absorbent cotton; then cleansed with hydro- gen peroxide and again dried. The parts are now so held as to give them as much as possible a cup-like depression looking upward. This is filled "with one drop or more of the acid by means of a glass rod ; in a few minutes the part will turn white. The acid should be allowed to overlap the original margin of the sore. The superabundant acid must now be re- moved with cotton and a drop of carbolic acid ap- plied to relieve the pain ; the ulcer is now dressed with a dusting powder. (Cl.) Sulphuric Acid : This is hardly to be preferred to nitric acid, as it penetrates more deeply and is not easily controlled. Combined with charcoal (Ricord's Paste), with asbestos (Michel's Paste), or with saffron (Velpeau's Paste), it is more manageable. (F.) It should be pressed down well into the irregu- larities of the surface, where it remains a black crust ; after a few days will come away and leave a healthy surface. (Cl.) Acid Nitrate of Mercury : One of the best caus- tics ; apply with a glass rod. (B.) Actual Cautery : This agent acts well when the lesions are small and few in number. It should burn deeply so that the surface of the sores are well charred. Apply cold water dressings until the eschar comes off. (Cl.) Radiant Heat: The thermo-cautery is brought close to the sore, but not in actual contact, and held 134 DIGEST OF EXTERNAL THERAPEUTICS. there for a few seconds. This dries up the ulcer, upon the edges of which sanguinolent strias appear. Too long application should be avoided lest blisters form. A single application will transfer the lesion into a simple ulcer, which will heal rapidly under antiseptic powders; more so than when the actual cautery is used. (D. H.) Dressing's : General indications may be summar- ized as follows: For acute inflamed and painful sores, sedative lotions, such as lead water, lead and opium wash, sulphate of zinc and opium ; for indo- lent pale ulcerations, stimulating applications, such as strong zinc solutions, nitrate of silver, etc. (A.) All dressings should be removed with great care ; if adherent, they should be softened in order to avoid tearing the sore, thus favoring re-inoculation. Moist Dressing's: Hydrogen Peroxide, Mercuric Bichloride, 1-3000 or 4000. Carbolic Acid, 1-60. The sore should be sprayed with the selected solu- tion and a pledget of lint soaked in the same kept applied and changed three times a day. (Cl.) Dry Dressings: These are indicated at any and all times. lodoform : This remedy stands first. Holmes said that the treatment of chancroid is now reduced to a simple matter in the majority of cases. There are few which will not yield to the application of iodo- form. (HI.) Europhen, Di-iodoform, Acetanilid, Aristol, Xero- form, Traumatol, etc., the last has been used with great success as a substitute for iodoform ; it has the CHANCROID. 135 advantage of being non-poisonous and non-irritat- ing. (F.) Calomel: Useful to complete the healing process. (Cl.) Guaiacol: Gently applied at first in order to anaes- thetize, then mopped on freely, for its caustic effect, is reported to have brought about a speedy cure in all but one of thirty cases. (J. de P.) Bromine: 10 minims to 1 ounce of olive oil forms a sedative dressing. (Sm.) Cocaine : 4 per cent, or stronger solutions to render cauterization painless. (Al.) Pyrogallic Acid: As a powder, 25 per cent, with starch or a 5 per cent, paste acts well. It does not attack healthy skin. Apply night and morning and cover with gutta percha. It should be continued until granulations appear, after which oxide of zinc or calomel should be dusted on. (Cl.) Alumnol : 10 per cent, dusting powders are use- ful. (F.) Pixel : 10 to 13 per cent, solutions painted on the sore will promote healing. (F.) lodoform and Glycerine: May be preferred to iodoform alone as an application to crevices. (D. H.) Hot Water: When there is extensive inflamma- tion, immersion of the part in a cup of hot water three or four times of day or a prolonged sitz bath are very beneficial. (D. H.) Charcoal Poultice and Potassium Permanganate in weak solutions are indicated when the sore is gangrenous. (Cl.) Ointments hold a secondary position and are con- demned by some observers. They may, however, 136 DIGEST OF EXTERNAL THERAPEUTICS. prove preferable in some cases. The following are recommended : #. Hydrarg. Chloridi Mitis, gr. x. Naphthalini, 3J. Ung. Camphorae, 3 v ij- M. Or, fy. Pyoktanin. (Blue), Potass. Bicarb., aa gr. xv. Aq. Destill., giij. Alcohol, gv. Reduce by heat to J iij and add Pyoktanin. (Blue), Sod. Biborat., aa gr. xv. Aq. Destill., S"J- M. Or, #. Resorcini, 3J-ij- Vaselini, ^j. M. (S. M.) Subpreputial Chancroids: Inject warm salt water every two or three hours, following with a solution of Potass. Permang. gr. j x j, or Nitrate of Silver gr. x xv sj, or a mixture of Balsam of Peru and lodoform. An offensive odor from the discharge indicates a tendency to gangrene. In this case the prepuce should be slit up, the glans penis exposed, and the appropriate treatment applied. When the fraenum has been destroyed it should be ligated or cauterized. (Cl.) PHAGED^NIC CHANCROID. See also Phage- daena. Rest in bed with antiseptic dressings, notably CHAPS AND FISSURES OF THE HANDS. 137 lodoform The Acid Cauterants as mentioned are generally indicated. Curettage is recommended by Carleton before the application of nitric acid. Potassium Permanganate : Gr. xl-lx-gj for ap- plication to the sore ; then dress with lint saturated in a solution of gr. j-ij-j. (D. H.) Menthol-Phenol: 3 per cent, in hot water for bathing the part frequently. (F.) Carbolic Acid : A few drops of the pure acid ap- plied daily. Pyrogallic Acid and Sulphuric Acid paste as mentioned. Bromine : Solution of 1-500 for continuous ap- plication. (Cl.) Hot Water: Immersion of the part in hot water, as recommended for inflammation, is also beneficial in this form. (Ga.) Actual Cautery : If milder measures fail, apply the Paquelin or galvano-cautery ; the latter is decidedly preferable as it is more easily controlled. Cases which have resisted all other measures may be ar- rested by this agent. Boric Acid: Saturated solutions are serviceable dressings after cauterization. CHAPS AND FISSURES OF THE HANDS AND LIPS. Bismuth Subnitrate, as a powder, Rose Water Ointment, Cold Cream, Glycerine with Egg Yolk or with equal parts of Bay Rum, or with equal parts of Benzoin, Glycerol of Starch, Lanolin, Mutton Suet, Nitrate of Lead gr. x gj (the last as a secret remedy 138 DIGEST OF EXTERNAL THERAPEUTICS. is much employed in Europe), all useful for the hands or lips. The following are also of service : I*. Camphorae, 5 SS - Acid. Carbolici, M.iv. Ol. Neroli, M.iij. Sevi, gij. M. Sig. Soften a small bit and apply. #. Hydrarg. Oxid. Rub., 5iij. Cerat. Benzoin., 5J- M. (Sm.) For fissured lips and cracks at the corners of the mouth, the fissure should be filled and distended with the ointment repeatedly. A cicatricial tissue will be produced which will prevent subsequent fissuring. Gutta-percha in solution, or Collodion : As pro- tectives. The following are for chapped hands : 5*. Mentholi, gr. x. Ol. Olivae, Saloli, aa M.xx. L,anolini, 3i ss - M. Sig. Apply twice daily. #. Lanolini, 5"J- Glycerini, 3^ v - Acid. Borici, Si 38 - Saloli, 3J- Mentholi, gr. xv. Ol. Citronellae, M.iij. M. (T.,98.)' Emol Keleet : Said to be the best preparation for deeply fissured skin. CHILBLAIN. 139 #. Emol. Keleet., 3^- Zinc. Oxid., 3J- Glycerini Plumb. Subacetat., q.s. Lanolini, gss. Vaselini, gss. M. (T.,98.) Use sufficient glycerine of acetate of lead to form the powder into a paste, then add the lanolin and vaseline. It should be applied at night and the hand covered with lint. Cerates of Hydrastis, Calendula, Graphites, Borax. Court Plaster will often speedily heal fissures on the hands in some persons. CHILBLAIN. General indications in the chronic form when the skin is unbroken call for stimulating and astringent applications ; in especially chronic cases galvanism is effective. When ulcers form they must be treated on general principles. The following applied by painting on the affected part are recommended when the skin is unbroken: Tr. Tamus Communis and Tr. Benzoin. Great claims are made for both these remedies. Oil of Caju- put, Tr. Capsicum, diluted, or Oil of Black Pepper and Tr. Cantharidis, equal parts, Collodion and Glycerine, equal parts, Tr. Iodine, Tr. Aconite to a\\a.y the burning and tingling. (Al., Rd., Kp., Bt.) Turpentine: In combination as follows: Venice Turpentine, 3 vj . Collodion, %ij. Castor Oil, ^iij. When there is great tenderness of the surface ; or 140 DIGEST OF EXTERNAL THERAPEUTICS. Oil of Turpentine, gss. Naphthol, gr. xv. Lanolin, 3jss. M. (Sh.) Tr. Rhus Tox., 3ss-j, Tr. Calendula, or Tr. Hamamelis, 1 part of either to 4 of water. (Rd.) Wet Compresses covered with oiled silk will afford marked relief. Fomentations of Flaxseed Meal or Marsh Mallow are also useful for relieving pains. (Bt.) Ichthyol : This is an effective remedy, and is used with equal parts of Resorcin and Tannin in 150 parts of water ; the mixture must be well shaken be- fore applying. The affected parts should be painted at night. After the first application it forms a glazed surface. Under its influence the skin shrivels and the oedema as well as the chilblains disappear. (T., 97.) Carbolic Acid: Used in various ways with good results ; a 5 per cent, solution ; or the following oint- ments : Jjfc. Acid. Carbolici, gr. xvss. Ung. Plumbi, Lanolini, aa gv. Ol. Amygdalae, 3ss. Ol. Lavandulae, gtt. xx. M. (Al.) 9. Acid. Carbolici, 3J. Tr. lodi, 3ij. Acid. Tannici, gij. Cerat. Simp., ^iv. M. (B.) ?fc. Acid. Carbolici, gr. iij. Lanolini, 3ss. Pulv. Camphor., 3ss. M. (Sh.) CHILBLAIN. 141 Plumbi Acetas, viz.: #. Plumbi Subacetat., 9ijss. Cerse flavse, 3Jss. Ol. Rapi, |j. Ovi Vitelli, No. j. M. 9;. Liq. Plumbi Subacetat., Creosoti, aa gtt. x. Ext. Opii, gr. iss. Adipis, 3j. M. (Al.) Aconite with Chloroform Liniment is one of the best applications; Sulphurous Acid, 3J-j, with a little glycerine, acts quickly (Bt.); Wardrop's Lini- ment, 2 parts of tr. cantharides with 6 parts of soap liniment; Mustard Foot Bath for the itching. (HI.) Decoction of Walnut Leaves is useful for bathing the parts, which should be then dried and rubbed with Spts. Camphor ; after this dust on Salicylate of Bismuth, 10 per cent, in powdered starch. (Sj.) Resorcin: Sometimes is very effective it may be used as follows : Resorcin, I part. Ichthyol, i part. Tannic Acid, i part. Water, 5 parts. The mixture must be shaken and painted on at night. It is not to be applied in irritable chilblain. It dries the skin and is sometimes badly borne. (T., 97.) The following ointments are of service: Ung. Bal- sam. Peru., Ung Zinci Oxidi, Ung. lodi. When ulceration appears the following : 142 DIGEST OF EXTERNAL THERAPEUTICS. J*. Balsam. Peru., 3J- Ung. Hydrarg. Nit., 3ij. Zinc. Garb., gj. Ung. Aq. Rosae, gj. M. Or, J*. Ung. Plumbi Subacetat., gss. Ext. Arnicse, 3 s8 - Ext. Cocae Erythrox., 3 SS - Ol. Anthemidis, gtt. v. Ung. Aq. Rosae, gss. M. (Sh.) CHLOASMA. See Lentigo. In selecting local applications great care should be exercised to avoid the use of agents which may cause discoloration of the skin, such as mineral acids, mus- tard or croton oil. (Sh.) Hydrarg. Bichlorid.: This remedy is much used ; the following are some of its methods of applica- tion: fy. Hydrarg. Bichlorid., gr. iij. Aq. Destill., gj. M. (Pf.) Or, Ijfc. Hydrarg. Bichlorid., gr. ij. Emulsion. Amygdal., gj. M. (Kp..) Sig. Apply night and morning. Hebra's method consists of applying a solution of the bichloride, gr. v-|j, by means of a compress, for CHLOASMA. 143 five hours. A blister will result which should be punctured and powdered with starch. The new epi- dermis will be lighter but it will not remain so. (Sh.) Bulkley recommends the following : J*. Hydrarg. Bichlorid., gr. vj. Acid. Acetici Dilut., 5^j- Boracis, 9ij. Aq. Rosse, ad 3iv. M. To be applied night and morning, at first gently brushed over the affected part, then afterwards rubbed on. If the skin becomes too scaly, suspend the application for a day or two and apply vaseline. A combination with lemon juice acts well, viz.: Jfc. Hydrarg. bichlord., gr. iv. Succi Lenionis, gij. Aq. Destill., S XV J- M. Sig. Apply a small amount with a soft cloth each morning and allow it to dry on the skin. In a few days a bran-like exfoliation of the super- ficial epidermis, containing more or less of the pig- mentation, will occur. This process may be repeated (with intervals of rest in application to prevent sore- ness from a too constant use) as long as pigmenta- tion is apparent. (M. H., 2, 99.) The following is also recommended : Jjfc. Hydrarg. Bichlorid., gr. vss. Zinc. Sulphatis, Plurnbi Subacetatis, aa 3ss. Aquae, v. M. (Vn.) Unna first washes the part with Spirits of Wine then applies a Mercurial Plaster made from the 144 DIGEST OF EXTERNAL THERAPEUTICS. White Precipitate; this is allowed to remain on over night and the following used : fy. Bismuth. Subnitratis, 5 SS - Kaolini, 3 s8 - Vaselini, SvJ'Si 98 - M. (Sh.) Copper Oleate : In oleo-palmetic acid, sufficient to make a soft ointment, is recommended by Kippax. Ung. Hydrarg. Oleate, Ung. Hydrarg. Nitrate, pure or diluted; Tr. Iodine, Veratria, gr. x-xxx-j ; Potash Soap, applied continuously for four hours or the entire day. (Sh.) Tr. Benzoin, equal parts with alcohol, applied daily until desquamation oc- curs. (Pf.) CHOLERA ASIATICA. Method ofCantani: This is indicated in the stage of serous diarrhoea and in the algid state. (An.) It consists essentially in supplying to the system the water of which it has been deprived ; this may be accomplished by intestinal injections of water, enteroclysis, and hypodermic injection, hypoder- moclysis. (Gn.) Enteroclysis : Indicated in the premonitory diar- rhoea. It may be administered by a long rectal tube. To secure retention it must be given slowly ; if ex- pelled it will serve the purpose of irrigation, but should be persisted in. The injection should consist of an infusion of chamomile containing 5 to 25 grams of tannic acid, and 20 to 30 drops of lauda- CHOLERA ASIATIC A. 145 num, and 20 to 50 grams of gum arable. The tem- perature of the fluid should be 100 to 104. The dose for an adult is from 1 to 2 quarts. The injec- tions should be repeated four times a day, and in grave cases after each movement. (Gn.) The formula of Cantani is elsewhere given with water as a base instead of infusion of chamomile and wine of opium instead of laudanum. (Sm.) Hypodemoclysis : In the later or algid stage, hy- podermic injections of artificial serum are indi- cated. This is accomplished with a fountain syringe to which a perforated needle is attached. Strict anti- sepsis should be observed in all details. The artificial serum consists of the following : Sodium Chloride, 4 grams. Sodium Carbonate, 3 grams. Sterilized Water, i litre. This amount is to be inserted at one time and re- peated subsequently as required. The temperature of the fluid should be 100 to 104 or higher if it can be tolerated . ( Gn . ) The points of injection are usually the buttocks, flank, thighs or below the pectoral muscles. Intravenous Injections of Saline or Milk: These are indicated in the algid stage, but hypodermoclysis is to be preferred. (Gn.) A formula for the saline fluid is as follows : Sodium Sulphate, 3 USS - Sodium Chloride, 3J- Distilled Water, Oij. Inject 6 ounces slowly. (T., 98.) Normal Saline Solution: This may be used for hypodermoclysis and intravenous injection in place of more complex solutions. See Appendix II. 146 DIGEST OF EXTERNAL THERAPEUTICS. Mustard Sinapisms: Large size plasters to the epigastrium and abdomen for the relief of vomiting and pain. (Gn.) Heat: Hot water bags and bottles, flannels wrung out in hot water applied to the abdomen and frequently changed are used for the relief of pain. (Gn.) Stimulation of the Surface by friction, kneading and rubbing with mustard water to relieve cramps and to stimulate the circulation should be employed. (Gn.) Methylene Violet: 15 to 45 minims of a 1 per cent, solution subcutaneously every three or four hours. (Sj.) Chloral Hydrate and Morphine: The following to be given subcutaneously in doses of 15 to 30 minims is highly recommended for the collapse : Chloral Hydrate, 5"j- Morphia Sulphate, gr. iv. Cherry Laurel Water, gj. The injection will cause burning and irritation, but according to Bartholow suppuration does not fol- low. Camphor : Subcutaneous injections of camphor dissolved in olive oil can be administered with good effect in 20 minim doses in conjunction with Can- tani's method. (Y.) Nitro-Glycerine, Atropine and Ether hypodermic- ally for stimulating the heart. (Bt.) In severe cases all medicines may be administered hypodermically for speedy action. (Bt.) After vomiting, the patient's mouth should be rinsed with a solution of Hydronaphthol, 1-5000, CHOLERA INFANTUM. 147 taking care that none is swallowed, and after each movement the buttocks, thighs and anus should be washed with soap and water. All vomited matter and discharges from the bowels should be gathered in a solution of carbolic acid 1-20, or chlorinated lime 1-10, some of which should be in the vessel when used. The water thus collected should be mixed with more of the disinfectant, stirred and al- lowed to stand twenty minutes before throwing into the closet. (Ty.) CHOLERA INFANTUM. Washing out the Stomach and Irrigation of the Colon : These are very important measures for the removal of the poison, which is one of the first indi- cations of treatment. The irrigation of the intestines should be thorough, using sterilized water, with or without Castile soap. The water may be tepid, or cold if the temperature is high, and the irrigation continued until it comes out clear. This procedure should be repeated on the return of the vomiting and purging. A flexible rubber catheter introduced six or eight inches may be used for the bowel. Objections to these methods on account of their supposed sever- ity are mostly imaginary. (Gn.) Opium: Must be used with extreme caution in young children, who are very susceptible to its in- fluence. It is valuable when there is much pain and irritability, and may be administered by enema, 2 to 5 drops in starch to an infant six to twelve months old. The effect must be carefully watched. 148 DIGEST OF EXTERNAL THERAPEUTICS. The dose may be repeated in from six to twelve hours if necessary. (A. AY.) Morphine and Atropine: These drugs must also be administered with great care to young- children. Holt gives y^- grain of morphine with ^ 7 grain of atropia for the first dose to an infant of one year. When stupor or collapse seems imminent, they are especially contra-indicated. (An.) The indications are the same as those calling for opium. These rem- edies are not often required, as others administered by the mouth render their use very infrequent ; they are nevertheless at times invaluable. Subcutaneous Saline Injection: As it is impossi- ble to supply water to the exhausted tissues by the mouth or rectum, injection into the cellular tissues of the thighs and buttocks of a solution of 4 grains of common salt to a pint of sterilized water may be practiced with good effect. One pint, and often larger quantities, may be thus administered in twenty-four hours with advantage. (An.) See Normal Saline Solution, Appendix II. Salicylic Acid: 5 grains in starch by injection has done good service. (Bt.) Hot Mustard Baths: In bad cases for the relief of intestinal congestion and cutaneous circulation. (F.) Brandy Compresses: Cloths soaked in brandy laid over the abdomen and covered with oiled silk. (Bt.) Ice Bag: May be applied to the spine for the relief of cramps of the legs (Gn.) and to the head to con- trol temperature. (An.) Cool Sponging : With gentle friction may be used frequently if there is much fever. (Gn., A. W.) Keep the abdomen and extremities covered with flannel and the child out in the open air as much as CHORDEE. 149 possible. A cool place should be selected if practi- cable, but care should be observed not to chill. CHORDEE. Cold; Its application in some form, such as ice, cold metal or immersing the penis in cold water or a cold sitz bath is usually effective. Gallobromal: Urethral injections of 1 to 2 per cent, solutions. (F.) Hop Poultice: Applied to the penis during gonor- rhoea will assist in preventing. Morphia: Subcutaneously in doses of | grain be- fore retiring. Suppositories containing Belladonna or Opium are effective, but, as a rule, cause constipation; if necessary, the following is suggested : Opium, i grain. Powd. Camphor, 3 grains. Oil of Theobroma, q. s. (A.) Leeches: In obstinate cases these will prove valuable; eight to ten ounces of blood may be ab- stracted. For the following two or three days the patient should occupy a strictly recumbent posture. (A.) CHOREA. Hydrotherapy: The wet pack is advised as effect- ive. A sheet is dipped in water at 50 to 54-, then lightly wrung out, spread on a mattress covered 150 DIGEST OF EXTERNAL THERAPEUTICS. with oiled cloth, then closely wrapped around the patient who is rubbed from head to foot and placed between woolen blankets and returned to bed. (Sj.) The spinal douche is also employed, the temperature of the water varying, according to the severity of the case, from lukewarm in the beginning to colder, lowering the temperature day by day as the patient improves. (T., 96.) Electricity: Central galvanization and general faradization act favorably. The galvanic current is preferable for vigorous children, the faradic for the anaemic and weak. (Sj.) Static electricity often gives brilliant results; some cases may be treated by the constant current and the static in combina- tion. (Bw.) Systematic Muscular Exercise : Has been success- ful in cases of long standing. (T., 98.) Rest : Put the patient in bed and keep him there according to the severity of the case, three weeks being usually necessary. The rest should be complete both mentally and physically. (Sj.) CICATRICES. Massage and Electricity: Galvanism, electro-mas- sage (faradism) and electrolysis are all employed, the latter especially, for the removal of hardened and hypertrophied new formations, and for atrophic cic- atrices when not very numerous. (F.) The following applied to granulating surfaces will prevent, it is claimed, scars appearing unsightly : COLD, EFFECTS OF. 151 #. Sod. Biboratis, giss. Sod. Salicylatis, gr. xij. Glycerin!, 3"J- Aquae Rosse, gvj. M. Sig. Apply frequently. Or, #. Ferri Chloridi, 3j. Colodii, 3ij- M. (Bt.) Thiosinamine: Cicatricial contractures have been greatly benefited by hypodermic injections of this drug in alcoholic solution, 15 per cent., or in solution with equal parts of glycerine and water ; the latter is not as painful as in alcohol and is just as active. Ectropion from lupus, talipes equinus, etc., have been much benefited by its use. The dose is V to % grain twice daily at the beginning, and gradually in- creased, rarely exceeding l^j grains. Hebra seldom gave as much as 3 grains, beginning with the smallest dose, though other observers cited by him gave as much as 4 grains, commencing with the smallest dose. Hebra suspended treatment for ten days every six weeks to two months. (F.) Excision: When the neighboring parts and the surrounding tissues admit, plastic surgery should be considered. COLD, EFFECTS OF. FROST BITE. Gradual Application of Warmth : While there is some difference of opinion as to whether warmth 152 DIGEST OF EXTERNAL THERAPEUTICS. should be gradually or suddenly applied, the ma- jority of observers favor a gradual transition from cold to heat, which may be employed in the follow- ing manner : Rub the part with snow or immerse it in iced water, the patient during the procedure being kept in a cool room, avoid even the warmth of the bed, which has been known to set up inflammation with a tendency to run on to gangrene. As soon as the bodily temperature and that of the part in- volved has be come about normal, stimulating fric- tion should be applied with Soap Liniment, Alcohol diluted with water or Spts. Camphor. (A.) Immediate Application of Warmth : The immer- sion of the affected part in a hot bath at once is ad- vocated by Shoemaker. This is contrary to general usage. The following are recommended for application after reaction has set in; the parts should after- wards be well enveloped in cotton : Tr, Benzoin Comp.: Alone or in combination with Chloroform, 3 parts to 1, painted on, acts well. (Sh.) Nitrate of Silver: Gr. v-j, applied with a brush. (W. C.) Cocaine Hydrochlorate : 1 to 10 per cent, in Pep- permint Water, useful for allaying irritation and itching. (Sh.) Aluminum Acetico-Tartaricum: A 50 per cent. solution is astringent, antiseptic and non-toxic. (Sm. ) Alcohol: In the following may be applied with old linen: V. Alcoholis, 3ij. Cocainae Hydrochloratis, gr. v. Acid. Borici, 5J- M. (F.) COLD, EFFECTS OF. 153 Ung. Acid. Carbolici: Gr. xx sj, useful for painful ulcerations of the fingers and toes. It relieves pain promptly and promotes resolution. (Al.) Thiol: In the form of a powder, viz.: #. Thioli Siccae, 3j. Zinci Oxidi, 5\j. Amyli, gj. Talci, gij. M. Or in an ointment, #. Thioli, Vaselini, aa gj. Lanolini, j. M. (Al.) Acetanilid : When the parts are raw and exposed, an ointment may be ordered. (Sj.) Phulluah : This drug is largely used as a liniment among the Hill tribes of India; it is a stimulant, emollient, anodyne, and antiseptic. (F.) Ichthyol: Has been found effective; may be used with lanolin in the proportion of 2 drachms to 6 oz. (W. C.) See also Chilblain. GENERAL DEPRESSION FROM COLD. Treatment must be regulated by the degree of de- pression. While a fair pulse and consciousness re- main, warmth should be applied very cautiously and gradually. But if there be apparent death from cold, and the patient's limbs are rigid, he should be cov- ered with snow to the depth of several inches, his mouth and nostrils only being left free. The melted snow should be replaced by fresh. If no snow be available, an iced salt bath for a few minutes may bring reaction. Where the limbs are less rigid, the 154 DIGEST OF EXTERNAL THERAPEUTICS. clothing should be removed and the whole surface of the body briskly rubbed with snow or iced water until the pallor of the skin yields to redness. The rubbing should then be continued with dry flannels, and presently the patient may be wrapped in a dry blanket and placed in a cool bed in a cool room. In- jections of tepid camphorated water will promote revival, and, as soon as the patient can swallow, camphor should be administered. Ultimately warmth may be very gradually applied. In cases of suspended breathing, artificial respiration should be resorted to. (Rd., A.) COLIC. Heat: This agent in some of the following forms is generally effective : hot \vater bags or bottles, hot plates, hot fomentations, mustard poultices, etc. Enema : A copious injection of warm water will often relieve intestinal colic. (Rd.) Turpentine Stupes: Have been used with good effect. (F.) Hot Baths: These are especially ser- viceable in renal and hepatic colic. Morphia: Sub- cutaneous injections are usually necessary in renal and hepatic forms. Chloroform : Inferior to mor- phia but superior to baths or opium. (R.) COLLAPSE. See Shock. COMA. 155 COMA. Oxygen Inhalations -.Indicated when narcotic poisoning is the cause ; if persistently employed, life may be saved. Cold Douche : For stupor of drunkenness and also for narcotic coma, should be kept up for some time if pulse and breathing continue good or become no worse. (Rd.) Blisters and Sinapisms: Applied in quick succes- sion to the chest, abdomen, thighs, and calves, are valuable in critical conditions near the end of an acute illness, "only such cases to be selected as are to be tided over a dangerous point." (F.) Blisters to back of the neck. ( Bt. ) Coma due to affections of the brain and menin- ges: The following methods of treatment are appli- cable : 1. Place the patient in a well aired room. 2. Massage entire body with alcohol and water. 3. Apply sinapisms to the legs. 4. Apply four leeches to the mastoid process or bleed from the arm. 5. Give an enema of the following : #. Sodii Sulphatis, gj. Sennae Polii, ^ss. Aquae, ad Iviij. M. Ft. Infusion. 6. Practice rhythmical tractions of the tongue by the method of Laborde. 156 DIGEST OF EXTERNAL THERAPEUTICS. 7. If deglutition is too difficult to take food, give this enema : Yolk of Eggs, 10. Peptone, Dry, 4 drachms. Milk, 8 ounces. (T., 97.) Chapman's Method of Ice to the Spine: This may be employed effectively in apoplectic coma; for the technique and indications see the subject under the head of Paralysis. Coma of infectious toxic origin : (1) Give subcutaneously every hour an injection of Ether or Caffein, viz.: I*. Caffeinse, gr. xlv. Sod. Benzoatis, gj. Aq. Bullientis, S"3- M. Sig. Dose, M.x. (2) Every four hours a tablespooniul by the mouth of the following : * I*. Ammon. Acetat., gj. Tr. Moschi, gr. xv. Ess. Menth. Pip., M.iv. Tr. Jalap., gjss. Tr. Gentian., q. s. ad gj. M. (3) Copious injections of cold water, l 1 /^ qts. to provoke diuresis. Coma of neurotic origin : The following enema : Tr. Valerian, 3J SS - Musk, gr. xv. Yolk of Egg, I. Water, . ^ * NOTE. The above formula, though outside the province of this book, has been, given to complete the method quoted. COMEDO. 157 Compress the carotid arteries, practice rhythmati- cal contraction of tongue and pass the interrupted current through different parts of the body. (T., 97.) DIABETIC COMA. Saline transfusions and intravenous injections of soda bicarbonate solutions have been administered with brilliant but temporary effect. Normal Saline Solution : In cases of coma this fluid has been injected in quantities of about 2}/2 pints. (P. M., 6, 99.) Solution of Soda Bicarbonate : 2 litres of steril- ized water containing 20 grains of the bicarbonate of soda have been follo\ved by improvement in im- pending coma. (L. M., 6, 31, 99.) Lepine recommends the following solution for intravenous injection : Sodium Chloride, i drachm. Sodium Bicarbonate, 2% drachms. Distilled Water, i quart. (P. M. J.,4, 29,99.) UR^MIC COMA. See Uraemic Poisoning. COMEDO. Compare Acne Simplex. Wash the parts freely with warm water and soap before attempting extraction. The individual comedo should be squeezed out with the fingers protected with a handkerchief; care must be taken not to bruise the skin ; after extraction one of the following may be used : 158 DIGEST OF EXTERNAL THERAPEUTICS. Sulphur Sublimate : 2 drachms with alcohol 1 ounce. Apply night and morning and allow to re- main on. (Kp.) Salicylic Acid: An alcoholic solution, gr. xv-j, will soften and aid in their removal. (Al.) Friction: Rubbing the skin with green or soft soap and water is excellent. Avoid over-stimula- tion. (Ja.) The following is useful ; it should be rubbed on at night with a piece of flannel : ffc. Saponis Olivae Praeparatse, Alcoholis, aa Jj. Aq. Rosse, ^vj. M. (Ja.) Resorcin : As a lotion or ointment. (B. H.) Zinc Oleate : With 3 per cent, of salicA^lic acid or French chalk . ( Sm . ) Thymol: As an ointment, viz.: ffc. Thymoli, gr. x. Acid. Borici, gij. Tr. Hamamelidis Virg., gj. Aq. Rosae, 5* v - Sig. Apply once or twice a day. (Sh.) Medicated soaps can be used to advantage ; those containing Sulphur, Chamomile, Ergot, Salicylic Acid, or Corrosive Sublimate should be preferred. CONDYLOMATA. Immediate removal with the scissors and cauteri- zation of the base with Nitric or Carbolic Acid may be practiced in the pedunculated variety. Broad growths should be first cocainized, then nitric acid CONDYLOMATA. 159 applied. After removal and cauterization, use some of the antiseptic dusting powders, such as Dermatol, lodoform, Bismuth Subnitrate, etc. Calomel: Dusted on with the use of moderate pressure is best for condylomata with broad flat base, especially when they are numerous. (Cl.) The parts should first be washed with chlorinated soda. Tr. Thuja : For use when the growths are situ- ated on the glans penis or scrotum accompanying gonorrhoea. (Hg.) Labarraque's Solution: Diluted, recommended for warts around the labia, followed by calomel, resor- cin, or burnt alum and savine, equal parts of each. (B. H.) Hydrarg. Bichlorid.: One of the best remedies. Bathe the part with a 1-2000 solution and dust on the following powder: powdered savine and pow- dered salicylic acid, equal parts. (Vn.) A solution of 30 grains in collodion applied with a brush will often prove effective. (Cltn.) Salicylic Acid: In combination with collodion in a saturated solution may be painted on. (Cltn.) Acetic Acid: 1 ounce, with salicylic acid, half a drachm, is a combination preferred by Unna; the mixture is applied twice daily with a camel's hair brush. (F.) Chromic Acid : 5 drachms with 1 ounce of water forms an efficacious caustic ; surrounding parts must be well protected. (B.) Calomel and Salicylic Acid: Equal parts form an especially effective powder. (Cltn.) Caustic Lead: Lead oxide, 4 grains mixed with 2 drachms of a saturated solution of caustic potash (100), forms a caustic which produces a black 160 DIGEST OF EXTERNAL THERAPEUTICS. slough, but does not penetrate deeply. (X.) Contact with the growth for five minutes will soften the mass and permit easy removal, after which apply an antiseptic dusting powder. Nitric Acid: In addition to its action as a cauter- ant, may be used in an aqueous solution, sj-Oj, for bathing the affected surfaces. Under its influence the growth will disappear. (B.) Euphoren: An excellent dusting powder. (Sh.) CONJUNCTIVA, BLENORRHCEA OF. Keep the patient quiet, allowing him to go into the open air only at stated intervals. Strictly quaran- tine, and observe great caution in regard to cleanli- ness and the prevention of contagion. (Ro.) Iced Cloths: These should be applied to the closed lids while in the recumbent position for fifteen or twenty minutes continuously, every one, two or three hours, according to indications. (Ro.) They are also advised to be kept applied continuously as long as there is marked oedema of the lids and con- junctiva. Nitrate of Silver: A solution of gr. v xx %j, should be applied to the palpebral conjunctiva once or twice a day by the surgeon while the nurse may use alum, gr. ij-sj. (Ro.) Strong solutions of the nitrate of silver should be neutralized by salt solu- tions. (Bl.) Cocaine Hydrochlorate: A solution of gr. viij-gj should be dropped into the eye according to circum- stances for the relief of pain when the iced cloths fail CONJUNCTIVITIS. 161 to relieve. When using this remedy the eye should be flooded with it, using 10 to 30 drops. (Ro.) Alum Crystal : As the swelling of the lids and other symptoms subside, this may replace the iced cloths and nitrate of silver ; the lids are inverted and the alum applied by the surgeon. (Ro.) Benzoated Lard or Vaseline should be smeared on the lids at all stages of the disease after applications. (Ro.) The absorbent cotton and old linen used in making applications, and cleansing the eye, should all be burned and the patient's clothing washed apart from others. CONJUNCTIVITIS, ACUTE CATAR- RHAL. Boric Acid : According to Noyes a 1 per cent, solution is the best local remedy. The following also have proved useful : I*. Acid. Borici, Sod. Biboratis, aa gr. x. Aq. Destill., gj. M. Or, #. Acid. Borici, gr. vj. Aq. Camphorae, Aq. Destill., aa ^j. M. (Bl.) Cocaine Hydrochlorate : A 2 per cent, solution may be dropped into the eye at intervals of ten min- utes until sensitiveness is allayed. This is recom- 12 162 DIGEST OF EXTERNAL THERAPEUTICS: mended when there is much discomfort from heat, grittiness and smarting. Since the remedy has the property of causing the blood vessels to contract, it is useful. (Ny.) Zinc Sulphate: 1 to 2 grains to the ounce of water is of service. (Ro.) When the inflammation is of traumatic origin Boyle recommends the following : #. Tr. Aconiti, gtt. x. Aq. Destill., 3J. M. Or, J*. Tr. Arnicae, gtt. x. Aq. Destill., gj. M. Or, Jfc. Tr. Hamamelidis, Tr. Arnicae, aa gtt. x. Aq. Destill., %j. M. Tr. Ledum : When there is much ecchymosis 10 drops to the ounce of water. (Bl.) Alum : Solution of gr. j-ij~3J. (Ro. ) This remedy is condemned by some oculists as injurious. (Ny.) Cold Cream or simple Cerate applied to the lids is of service. Many cases require no other treatment than the boric acid and borax prescription above. If the inflammation is more severe the following will prove useful : Lead Acetate : 1 drachm with infus. of opium, 1 pint. This should never be used when there is any tendency to ulceration of the cornea, as it forms a precipitate on it. It is only useful in the early stages and must be applied warm. CONJUNCTIVITIS GRANULOSA. 163 Liq. Plumb. Subacetatis : 2 drachms to water 6 ounces, is also employed. Nitrate of Silver: Gr. ij- 3j, dropped into the eye may be used daily when there is a large quantity of secretion or intense red- ness or effusion which calls for active interference. Tannin: Gr. v-3j, suitable when oedematous infil- tration is extensive and secretion moderate. It is sometimes also useful in old people. (Ny. ) Formalin, 1-2000 and Bichloride of Mercury, 1-10000, are used as an antiseptic lotions. (Bl.) Hydrarg. Oxid. Flav.: Gr. ss-^j, answers well when there are incrustations on the eyelids. Apply only at the root of the cilia, and do not allow any to enter the eye. (F.) Cleanliness is in all cases of the utmost import- ance. After subsidence of the symptoms examine for hypermetropia and astigmatism. CONJUNCTIVITIS GRANULOSA. See Trachoma. CONJUNCTIVITIS, CHRONIC CATARRHAL. Alum : 1 to 2 grains with 10 grains of Boric Acid is very useful in many cases. A little Morphine may sometimes be added. Nitrate of Silver: Gr. ss-j. Its long-continued use will cause an unsightly and irremovable stain; in strong solution, it may cause permanent opacity 164 DIGEST OF EXTERNAL THERAPEUTICS. of the cornea. It is nevertheless an old and well used remedy. Tannin: Gr. ij-v-j. A few drops in the eye; or evert eyelid and paint with a solution of gr. x-xxx-3-j . Zinc Sulphate: Extensively emploA^ed, gr. ss-ij-^j. The solution may be applied two or three times a day. Wine of Opium: A drop in the eye relieves pain and improves condition of the membrane. (Al.) CONJUNCTIVITIS, DIPHTHERITIC. Atropia or Scopolamine: To be used from the start. (Ro.) Papoyotin : 1 part with 5 or 10 parts of \vater and glycerine (not to be substituted by papoid) may be applied every hour. (Jac.) Ice and Cold Applications : Authorities differ. Ice should be persistently applied, according to Jacobi. On the other hand, MacBride says cold applications should not be made to any great extent because it interferes with the nourishment of the cornea. Roosa says hot or cold applications to the closed lids as may be most comfortable. Great care should be exercised in cleansing the eye, as the slightest abrasion of the cornea will allow the membrane to form on the denuded surface. Hydrogen Peroxide: 3 per cent, solution recom- mended for cleansing; too strong solutions cause haziness of cornea. The secretions should be re- moved every night with cotton dipped in a saturated solution of boric acid, and an ointment applied to the edges of the lids. (Ro.) CONJUNCTIVITIS, PHLYCTENULAR. 165 Antitoxine Serum is reported to have been used Avith success. (T., 96.) CONJUNCTIVITIS, PHLYCTENULAR. Atrophia Sulphate: Instillations of a solution of gr. ss ij 3j, should be made two or three times a day. (Ro.) Cold Douche: If there is much photophobia this is very useful ; it is often of immediate service, but is a harsh remedy. Cocaine may be substituted, but if not effectual, the douche should be employed. (Ro.) Glycerate of Tannin : Very useful for application to the nostrils for the catarrh which is usually pres- ent. (Ro.) Calomel :* By insufflation or dusted on with a fine camel's hair brush is a very valuable application ; it should not be employed when there is much ciliary irritation, as shown by photophobia, lachrymation, or contracted pupil ; these should first be controlled by atropine. (Al.) Cocaine : Should be used until the acute symp- toms, especially the photophobia, have disappeared. (Ro.) Ung. Hydrarg. Oxid. Flav.: Has been used suc- cessfully instead of calomel. A small portion is placed between the eyelids and rubbed on. (Ro.) Bismuth Loretinate: Dusted in the eye promptly relieves. (T., 97.) * NOTE. Before applying calomel to the eye first inquire if the patient has been on a course of iodides, for a chemical combination may follow which may cause great disturbance. 166 DIGEST OF EXTERNAL THERAPEUTICS. Pyoktanin: A solution of 11000 acts best in cases marked by lachrymation and great congestion of the palpebral conjunctiva. Ichthyol : 1 to 3 per cent, solution has been found very useful. Antipy- rin: 2 percent, solution. (T., 98.) CONJUNCTIVITIS, PURULENT. In the earlier stages mild antiseptic lotions and bathing the eye in hot water are indicated, but it is usually not until after this period that the patient is seen by the surgeon. (N. O.) When the stage of secretion has set in, the following remedies will be indicated : Nitrate of Silver: This remedy has more power than any other in neutralizing the poison. When the secretion and swelling are slight, solutions of 2 to 5 grains to the ounce may be used ; but when there is much swelling and secretion, the strength should vary from 10 to even 60 grains to the ounce in very severe forms. The solution is to .be applied to the everted lid with a brush and the cornea protected at the time of application. Salt solutions must be added immediately to neutralize. (Bl.) These solu- tions should be followed at once by ice cold applica- tions in order to prevent reaction. (N. O.) Formalin: 1-1000 or 2000 must be used freely for bathing the eye. Hydrarg. Bichlorid.: 1-4000, 1-5000 or 10,000. Boric Acid : Saturated solu- tions, for cleansing. (Bl.) Potass. Permang.: Gr. iij-x gj, has been highly recommended ; it should be applied thoroughly to CONJUNCTIVITIS, PURULENT. 167 the conjunctiva twice a day in severe cases and once a day in mild. (N. O.) Ice Cold Applications : Placed upon the lids are of great value in checking the inflammation. They should be kept continuously applied, being changed as soon as warm, which will be in a minute or two. (N. O.) The following is a summary of treatment recom- mended by Roosa : Early Stages. 1. Cleanse the conjunctival sac as often as the dis- charge collects, night and day, with absorbent cot- ton, saturated solution of Boric Acid or Borax in water. 2. Cold applications by Iced Cloths unless there is ulceration of the cornea. 3. Free use of Vaseline to lids and surroundings. Later Stages. 1. Daily application of Nitrate of Silver gr. v-x- 3j, or every two hours application of a solution of 4-|~<5- grain to the ounce in the form of spray until the epithelium of the cornea is coated. 2. The dropping into the eye of Antiseptics by an attendant. Atropine : Indicated if the cornea shows signs- of becoming involved. (Ro.) When only one eye is affected the other should be hermetically sealed by the Buller shield or some other such device. Prophylaxis from contagion, and isola- tion of patient when possible should be strictly en- forced. (N. O.) 168 DIGEST OF EXTERNAL THERAPEUTICS. CONSTIPATION. It should be the rule to go to the closet at a defi- nite and regular hour each day irrespective of in- clination ; the best time is immediate!)' after break- fast, as intestinal peristalsis has already been induced by that meal. Long continued and ineffect- ual straining should be avoided. Persons of sedent- ary habits should take regular exercise, especially outdoors, riding, bicycling, tennis and other sports. Hydrotherapy : The cold spinal douche adminis- tered while the patient is in a hot bath, or the alter- nate application of hot and cold water. When there is spasm, sedative applications, as flannels wrung out in hot water, placed over the abdomen at night and covered with oiled silk. (M. N., 12, 10, 98.) Cold sitz baths in the morning are also beneficial. (Rd.) Massage: General or to the abdomen; percussion, and pounding the abdomen with the inner border of the fists in the direction of the ascending and de- scending colon are effective in some cases. (Sj.) When the abdominal walls are flaccid and the in- testines atonic, a moderately firm bandage will be of benefit, but exercise of the abdominal muscles is much better ; this ma)' be performed by forcibly and rapidly retracting the abdominal muscles, repeating the movements several times a day. (Gn.) Oil Injections : From 6 to 8 ounces are injected while the patient is lying on the left side with the hips elevated ; then he lies upon the back and finally on the left side. The results are not immediate, but CONSTIPATION. 169 the effect will persist for three or four days. (M. N., 12, 10, 98.) Glycerine: Injections of a drachm or two ; or gl} r - cerine suppositories are useful. Gluten Suppositories : In mild cases and for chil- dren. (Gn.) Enemata : -When it is not expedient to give a ca- thartic, injections of Castile soap and water with olive oil may be used, especially if there are hardened masses of fecal matter. For an immediate effect the following may be injected into the rectum : Sulphate of Magnesia, ^ij. Glycerine, ^ij. Turpentine, ^ ss. Warm Water, ,?i v - Inject the entire quantity, and a movement will soon follow. This is valuable in abdominal surgery for empty- ing the bowels before operating. In cases of arterio- sclerosis and high vascular tension it will reduce the latter and relieve distressing symptoms. (Gn.) Electricity : Galvanism ; an insulated rectal elec- trode is attached to the negative pole and inserted into the rectum, the positive electrode, which should be flat and large, is placed over the abdomen. A moderate current, not sufficient to produce discom- fort, is then applied. It is very important that the rectal tube should be insulated ; it should also be hollow so that from four to eight ounces of water may be thrown into the rectum. The applications should be repeated daily or every other day. (Gn.) 170 DIGEST OF EXTERNAL THERAPEUTICS. CONTUSIONS. Rest to the part is important; this may best be secured by placing the patient in bed, by Splints, Plaster of Paris or Bandages, according to the nature and location of the injury. Contusions of the back may be advantageously treated by the applica- tion of Rubber Adhesive Plaster cut in strips two and one-half inches wide and long enough to extend well beyond the contusion. The plaster should be placed so as to run in different directions. (W. C.) The following are some of the numerous lotions recommended for bruises : Arnica: Widely employed. The tincture may be diluted with water, 1 part to 10, and saturated com- presses applied covered with oiled silk. Hamamelis: Instead of arnica, especially when there is much ecchymosis and the skin is broken, 1 part to 6 of water. (Rd.) Lead and Opium : A combination long in use and of established merit, viz.: #. Tr. Opii, Liq. Plunibi Subacetat. Dilut., aa ^j-ij. Aq. Destill., ad Oj. M. Apply with saturated compresses and cover with oiled silk and bandage. (Whar.) V. Alcohol. Dilut., ^iij. Liq. Plumbi Subacetat. Dilut., j. Morph. Acetat., gr. x. M. CONTUSIONS. 171 Apply on a layer of lint and allow to evaporate ; this is excellent for keeping down inflammation. , or even 10 to 15 grains to the ounce in severe cases where strong solutions are needed. (D. H.) Nitric Acid: A drop to the ounce in cases where the urine is ammoniacal with tendency to phos- phatic deposit and formation of calculi. (D. H.) Guaiacol: 20 per cent, solutions in olive oil; 1 to 2 grains of the injection twice daily ; 1 per cent, of iodoform added is said to increase its efficacy. This has been found of benefit in relieving pain and fre- quent micturition. (T., 97.) The following is recommended by Lutand, of Paris: When pain and inflammation have subsided, an elastic catheter, to which a syringe is attached, is introduced into the bladder and the following in- jected : J*. Acid. Borici, 3J~ij- Sod. Biborat., 5J S 1 - xv - Aq. Destill., Oj |xij. M. Of this injection one to one and a half ounces, ac- cording to the irritability of the bladder, are to be injected. This is followed by four and three-quarter ounces of warm water holding the following mixture in solution : I*. lodofornii, Glycerini, 3J~iJ- Aq. Destill., |v. Gummi Tragacanthae, gr. iv. M. (T., 96.) The following formula for an irrigating fluid is rec- ommended by Dr. Gouley : CHRONIC CYSTITIS. . 189 #. Hydrarg. Bichlorid., gr. v. Ammon. Chlorid., gr. xx. Spts. Gaulther., gss. Acid. Boric., ^j. Glycerini, Jviij. M. Sig. To one-half ounce of the solution add 7 ounces of warm water (i 10 ) and 2> ounces of hydrogen peroxide. This lo-ounce mixture should be sufficient for four washings. Nosophen: 4 per cent, solution said to clear the urine in a few days. (Sj.) Acetate of Lead : ^4 grain to the ounce in warm solutions regarded by Sir Henry Thompson as one of the best mild injections when the urine is alkaline. Acetic Acid: The following combination is recom- mended by Sir Henry Thompson for injection after the use of nitrate of silver : #. Plumb. Acetat., 9ij. Acid. Acetici Dil., vj. Acid. Carbolic., 3ss. Aq. Destill., ^iv. M. Sig. i drachm of the solution is added to 4 ounces of water and injected once or twice a day. (A.) Creolin : y 2 per cent, solution has given good re- sults in an obstinate case. (Al.) Hydrochloric Acid : When the urine is very alka- line with large amount of phosphates as is often seen in fracture of vertebras an injection of a solution containing 1/2 to 1 minim to the ounce may be used. (Al.) Curettage : Guyon's method for painful cystitis in the female (19 cures and 10 failures reported) is as follows : The patient is anaesthetized and the bladder irrigated with boric acid or sublimate solution 1 190 DIGEST OF EXTERNAL THERAPEUTICS. 10,000, and a medium sized Volkmann curette is in- troduced. While the left index finger is pressed against the vesico-vaginal septum as a guide, the in- strument is moved over the mucous membrane care- fully in the region of the trigone and neck, the usual seat of the disease ; the anterior and posterior walls and lastly the urethra are all curetted. A self- retain- ing catheter is inserted and continued for fifteen to twenty days. No accident is recorded in the above number of cases. (T., 98.) Dilatation of the Urethra in the Female: A large percentage of vesical symptoms can be relieved by this procedure. Instillations: These are made with an instrument called an instillator, which is a silver or hard rubber catheter about 18 (French) with a fine canal, to the extremity to which a hypodermic syringe of 40 minims capacity is fitted. In applying, the syringe is filled with the selected application, the catheter in- troduced until it is within the grasp of the com- pressor urethrae muscle, and the fluid injected along the membranous and prostatic urethra, and into the bladder. Larger syringes may be employed, holding 1 to 2 drachms. The solutions used in instillation are the following : Nitrate of Silver, 1 to 5 per cent., especially useful in gonorrhoeal cystitis. Bichloride of Mercury, 1-6000 to 2000. lodoform Emulsion, 10 per cent. (B. H.) Vesical Drainage: Indicated when in spite of all treatment the disease progresses and the danger of nephritis is increasing. The simplest and safest form of drainage is by the urethra ; this is attained by in- serting a soft rubber catheter of medium size, and CYSTS. 191 retaining it. The catheter should be watched to see that the flow of urine is continuous, and changed every forty -eight hours. Mild antiseptic solutions should be used twice daily for irrigating. (B.H.) The other methods for continuous drainage are by perineal and suprapubic incision. For the relative merits of these procedures, see w r orks on genito- urinary surgery. CYSTS. Paraffine : Sometimes used to distend the walls of a collapsed cyst in order to facilitate its removal. It is injected in a liquid state and allowed to cool, thus affording better facility for the dissection of the cyst walls. (Al.) DANDRUFF. See Pityriasis. DERMATITIS HERPETIFORMIS. Washes are usually more grateful than ointments for soothing the itching and irritation. The follow- ing formulae will be found convenient and useful : J*. Acid. Carbolic!, giij. Glycerini, 3jj. Aq. Destill., Oj. M. 192 DIGEST OF EXTERNAL THERAPEUTICS. Or, Jfe. Ammon. Ichthyoli, Ol. Amygdalae Dulcis, Aq. Calcis, aa ^j. M. Sig. To be rubbed in several times daily and allowed to re- main on the surface. (Vn.) Sulphur: 31] |j, according to Duhring, the most valuable of all local applications except in the ery- thematous form, when it proves irritating. It should be well rubbed in and not smeared on. Thiol: 10 per cent, solutions used twice daily have been successful. (Sm.) This drug is similar to ichthyol in action with the advantage of being less disagreeable in odor. Starch Baths with Bicarbonate of Soda can be used frequently. Other remedies recommended are Lassar's Paste, Resorcin Ointment, Liq. Carbonis Detergens, gij with water .Iviij, Calamine Lotion, Liq. Picis Alka- linus, and Tar Ointment. It is better to begin with the mildest application and use stronger as the disease advances. DERMATITIS VENENATA. Lotio Nigra: According to Van Harlingen, cloths saturated with this lotion kept constantly applied give very satisfactory results. White says the remedy should not be used over extensive surfaces for fear of absorption, or if used, should only be applied for half an hour, two or three times a day. DERMATITIS VENENATA. 193 The following is recommended by White for use on extensive surfaces in place of the black wash : #. Zinc. Oxidi, jiv. Acid. Carbolici, 3J. Aq. Calcis, Oj. M. Sig. Shake well and sop on as often as desired, or when itch- ing causes sleeplessness. (Wh.) Cypripedium: 1 part in 4 to 5 parts of water is used with success in California. (Boe.) Grindelia: A remedy which has given excellent re- sults in the proportion of 2 to 4 drachms of the fluid extract to a pint of water. Apply on cloths thor- oughly soaked with the solution and allow them to become almost dry on the skin, then renew; not keeping them, in other words, constantly wet. (Vn.) Zinc Sulphate: Solution of 3ss |j, forms one of the best applications. (F.) Apply on cloths every hour during the day. Washing Soda: Sometimes nothing is so effective as this domestic remedy in solution. (Vn.) Aq. Calcis: Applied with cotton and lint kept constantly saturated will afford prompt relief in many cases. (Ja.) Salol: 3 per cent, solutions especially recom- mended. (M. R., 5, 11, 98.) Acetate of Lead : An effective remedy, but should be used with caution, if at all, when the skin is broken, as its application is then dangerous. It may be employed as follows : J*. lyiq. Plumbi Subacetat. Dilut., gj. Aq. Destill., if iij. M. (B. H.) 14 194 DIGEST OF EXTERNAL THERAPEUTICS. Or, #. Liq. Plumbi Subacetat. Dilut., 3J-"j- Tr. Opii, 3ij-i v - Aq. Destill., Oj. M. (Al.) Burow's solution modified as follows is said to afford particularly good results : Ijfc. Plumbi Subacetatis, 3J- Aluminis, 3^J- Aquae, Oj. M. (M. R., 5, ii, 98.) Sodium Hypophosphite : Recommended by Mor- row. It may be applied in a simple solution of 6 drachms to the ounce (Sh.) or the following: I*. Sodii Hypophosphitis, gj. Glycerin!, gss. Aq. Destill., ad gviij. This may be applied by lint soaked in the solution and held in place by bandages. (Ja.) Tar; The following will be found of service for children with whom it is difficult to use compresses or bandages. It is indicated when the itching is severe and the skin is broken : #. Picis vel Ol. Cadini, 3j. Collodii, 3j. M. Gelatin : Recommended by White, viz.: #. Gelatini, 3iv. Glycerini, gj. Aquae, giv. M. When applications in the form of ointment are de- sired, the following: DIPHTHERIA. 195 I*. Acid. Tannici, gr. xv. Petrolati, 5J- M. Or, #. Acid. Carbolici, gr. x-xx. Hydrarg. Chlorid. Mitis, gr. x. Pulv. Amyli, ^j. Petrolati, |j. M. (Vn.) The latter when there is much itching. Europhen : 10 per cent, in vaseline, after washing the parts in a saturated solution of bicarbonate of soda. (Sj.) Cold Cream, Zinc Oxide Ointment, or Diachylon Ointment (half strength), also useful. (Ja.) Astringent powders will prove useful when it is not convenient to apply wet dressings, especially when the face is uncovered, viz.: fy. Pulv. Zinc. Carbon. Prsecipitati, Amyli Oryzae, aa ^j. M. Or, #. Magnesii Carbon. I^evis, Pulv. Lycopodii, aa Jj. M. (Vn.) DIPHTHERIA. Antitoxin Serum : It should be borne in mind that the antitoxin serum in the market is of varying strength, that of each sample being indicated either by the amount required to neutralize a given quan- tity of normal toxin (German method), -or by its 196 DIGEST OF EXTERNAL THERAPEUTICS. po\ver of counter-acting a unit of toxic strength. It must also be borne in mind that unfortunately the samples of serum in the market are not always either what they claim to be, nor are all the samples of the same make always uniform. Dose: 1500 to 2000 units for the first injection for a child of 2 years, in laryngeal stenosis and all severe cases, to be repeated in from eighteen to twenty-four hours; if there is no improvement, a third dose after a similar period if necessary. 1000 units for first dose for severe cases in children under two years and for mild cases over that age, repeated if necessary in from eighteen to twenty-four hours. A second dose is not usually required. The dose should always be estimated in units and not in the amount of serum. Quality: The most concentrated strength of an absolutely reliable preparation should be used. Time of Administration: It should be adminis- tered as early as possible, not waiting for confirma- tion of clinical diagnosis by bacteriological culture. If the case is seen late, injections should be made, un- less it is progressing favorably. (T., 97.) Rules of the Pasteur Institute: For the use of Roux's serum : Preventive Action: A dose of 1% drachms lasts from four to six weeks. Therapeutic Action : 1*4 to 2 a /2 drachms for benign cases at the onset ; 4 to 6 drachms in serious cases, or when they have passed several days, up to 1 ounce or even more in severe cases ; 4 to 6 drachms when breathing is embarrassed may render tracheot- omy unnecessary. If improvement is not satisfac- tory, inject 2y% to 4 drachms more. It is better to DIPHTHERIA. 197 inject at the onset a dose stronger than necessary, cutting short the malady, than to inject weak ones at intervals. For infants under one year, inject 15 minims for each month; for adults, except in extremely severe cases, it is not necessary to inject more than 4 to 6 drachms for the first time. (Sj.) Dosage According to Behring: According to se- verity of case 600 to 1000 or 1500 units; this dose may be repeated if the symptoms have not improved within a day. (Jac.) Small doses at intervals, ac- cording to Behring, are more serviceable than larger. When the infection is virulent, 600 units is a full dose. (Sj.) Dosage for Immunization. i to 3 months, 50 units. 3 to 4 " 75 " 4 to 6 " 100 '* 6 months to i year, 150 " 1 to 2 years, 175 " 2 to 4 " 200 " Adults, 400 " (T. (9 8.) Technique: The skin at the locality of puncture, the syringe, and the hand of the physician should be rendered thoroughly aseptic. The injection should be made into the loose subcutaneous tissue, and not into the muscles ; it should always be injected into a part upon which there is no pressure, and in all cases a special syringe should be used which admits of thorough sterilization each time before use. The point of injection should be covered with antiseptic gauze or iodoform collodion. 198 DIGEST OF EXTERNAL THERAPEUTICS. Local Treatment. All authorities agree that local treatment is of the greatest importance, and should be commenced im- mediately, in order to assist in checking the exuda- tion, correcting the foul odors and preventing the re- absorption of the poison. The remedies which have been recommended for this purpose are, as is well known, exceedingly numerous ; therefore, only those which have met with more general approbation are mentioned. The removal of the exudate is desirable, but all undue irritation of the pharynx by instru- ments, forcible removal of the membrane, or irritat- ing applications, have been shown to tend to the extension of the diphtheritic exudation and are to be condemned. Hydrarg. Bichlorid.: Solutions of this remedy are of great value. When used in the form of a spray, care should be taken that it is not too coarse, lest an excess be thrown on the surface, and cause in- jurious absorption, when applied for a long period. (F.) It may be employed as an irrigating solution in the strength of 1-3000 or 1-4000 (Al.); as a spray 1-5000 (Bos.) also 1-2000 to 1-10,000; for application with a swab 1-1000, in young children with caution. (Pep.) A solution of 1-20 in glycerine has been recommended, preceded by a boric acid spray, and applied two or three times a day with cotton tampons soaked in the solution. Carefully remove all excess to prevent toxic effects. Salicylic Acid, in solutions of 1-1500, or a satur- ated solution of Boric Acid may be used instead of the bichloride with very young infants. (Pep.) Hydrogen Peroxide : Of great service to cleanse DIPHTHERIA. 199 and deodorize, used in various dilutions from one- half to one-third. It is especially recommended undi- luted as a spray in the laryngeal form of diphtheria. This remedy is objected to on account of its property of coagulating the soluble albumen of the tissues, causing pseudo-membranes, which fall off and leave surfaces ready for fresh invasion. It is none the less valuable. Being non-poisonous it is harmless when swallowed, an important factor in the treatment of young children. Potass. Permang.: 1 grain triturated with 1 ounce of sugar of milk and gum acacia, blown on affected part every two or three hours. Application must be very thorough in order to be effective ; the powder should be thrown into every accessible part. Before application, the peroxide of hydrogen spray must be used, thoroughly cleansing the parts. All the froth must be carefully removed before the per- manganate is applied. This treatment is especially recommended by Goodno. It may also be used as a gargle for cleansing the mouth, gr. iij-j. Lactic Acid : One of the best solvents. Mackenzie used 3 drachms of the acid to 10 ounces of water, to be employed as a spray. It may also be used as a gargle, putting sufficient acid in the water to make it taste sour. When employed as a spray take care to protect the eyes. (B.) Applied topically it is highly recommended in 5 per cent, solution, or stronger, according to the effect. (Bos.) Slaked Lime : A saucer contained slaking lime placed in the room and the fumes allowed to impreg- nate the air is especially recommended. It is an old and effective remedy. It is claimed to be decidedly 200 DIGEST OF EXTERNAL THERAPEUTICS. better than lime water sprays to the throat, which are almost without effect. (Jac.) Thymol : After septic coagula are removed, this is useful in the proportion of 2 to 20 grains alone, or with 5 grains of carbolic acid, to the ounce of water and glycerine. It may be employed as a spray or gargle. (Al.) Toluol : Lceffler has used the following combina- tion, in which menthol seems to deaden the pain of the application : Menthol, 10 grams. Toluol, enough to make 36 c. c. Absolute Alcohol, 60 c. c. L,iq. Ferric Chloride, 4 c. c. Remove the superficial mucus and apply a swab saturated with the mixture, pressing it firmly for ten seconds over a given spot; repeat this until the whole membrane has been thus treated. This treatment, it is claimed, gives good results. (T. W.) In a series of seventy-one cases all are said to have been saved; in another series treated after the second day, out of twenty-six one only was lost. (F.) Liq. Ferri Perchloridi: 1 part to 4 of alcohol ap- plied under illumination with a probe wrapped in cotton; the whole surface of the membrane is touched gently with the remedy. Care should be observed that the solution is confined to the exuda- tion and no injury is done to the parts. This method has some strong endorsements. (Bos.) Subsul- phate of Iron or the Tr. Chloride of Iron are also used. Carbolic Acid: In proportion of 15 grains to 1 ounce of glycerine and water, as a spray ; stronger solutions may be used with a swab. (Ty.) DIPHTHERIA. 201 The following is recommended by Pepper when the bichloride cannot be used : Ijfc. Acid. Carbolici, gtt. xij. L,iq. Calcis, ^iv. M. Sig. Apply with atomizer every half hour. lodoform: Saturated solution in ether, or 5 per cent, suspended in equal parts of glycerine and water are useful preparations. Potassium Chlorate: A saturated solution as a simple wash for the mouth. (Ty.) Menthol: 1 per cent, solution in alcohol, applied by painting by means of cotton wool, three times a day, has given remarkable effects. (T., 96.) Pyoktanin Blue: Saturated solutions have been employed with encouraging results. Applications should be made with a cotton covered probe, and spray to every part of the upper respiratory track. It should be employed early if possible. (Gn.) Solutions of this drug being unstable they should be kept in dark glass bottles, and renewed every eight days. It is incompatible with corrosive subli- mate. A 3 per cent, solution has also been used. Warm Saline Solutions: Useful for cleansing pas- sages, but do not cause the bacilli to disappear as quickly as the bichloride does. Plain warm water will irritate while alkaline solutions will not. (Sj.) Papayotin: Valuable, according to Jacobi, for dis- solving the membrane. May be injected, sprayed or swabbed on. It is soluble in 20 parts of water, and is used in that strength and stronger, as 1 part to 1 or 4 of water and glycerine. It may be applied to nose and throat or through the tracheotomy tube. Trypsin : Recommended as a solvent in place of 202 DIGEST OF EXTERNAL THERAPEUTICS. the above. It acts only when neutral or alkaline. The following has been employed : 5fe. Sod. Benzoatis, 3J~ij- Sod. Bicarbonatis, 3J~"j- Trypsin., 3J. Ol. Eucalypti, 3J. Liq. Calcis, Oj. M. #. Trypsin., gr. xxx. Sod. Bicarbonatis, gr. x. Aquae, 3j. M. Sig. Make a smooth mixture and apply with a brush or spray. Another formula with bichloride of mercury is as follows : #. Trypsin., Sod. Bicarbonatis, aa 3 s8 - Aquae, 3j. Hydrarg. Bichlorid., gr. %. Glycerini, 3J- M. Warm this mixture and apply with a brush. When the membrane begins to soften, spray every hour with peroxide of hydrogen, 1 part to 6 of water. (Al.) These solvent remedies were formerly much in vogue, but have fallen into disuse. Myrrh : The undiluted tincture has been employed with success for painting the throat and tonsils ; while for the larynx mixed with glycerine it proves a useful inhalation. Nasal Injections and Irrigations: These can be used to wash the pharynx and tonsils as well as the nasal cavity, and to do away with special treatment of the throat. This is very desirable, as frequently children will not permit the throat to be treated or DIPHTHERIA. 203 even open the mouth, without force being used and consequent injurious excitement and disturbance. The following are recommended : Bichloride of Mercury, 1-3000 or 4000 (Sj.) or 1 part with 35 of salt and 5000 of water. Caution in regard to swallowing in young children. Boric Acid acts as well as the bichloride, gss-Oj (Sj.); it may be used in a saturated solution. Lime Water, pure. Carbolic Acid, 1 per cent, with caution in giving children lest it be swallowed. Solutions of Sodium Hyposulphite. (Jac.) Medicated Steam Inhalations : Are often of great service, and may be used in many instances with benefit. They may be employed as mentioned under pseudo-membranous croup. Steam Inhalations : These are very useful for soft- ening the membrane. They are more useful in tracheo-bronchial diphtheria than in that of the ton- sils. (Jac.) Dusting Powders : These are of doubtful utility, and generally contra-indicated on account of the local irritation, cough and general disturbance caused by their administration. Calomel and perhaps lodol are exceptions. (Jac.) Among the numerous other remedies are the fol- lowing : Tr. Iodine, 1-40. Liq. Sodse Chlorinatae, 1-20. Sulphurous Acid, 1-10. Condy's Fluid, 1-40. So- dium Hyposulphite, sss-gj. (Al.) Guaiacol and Menthol : The following has proved especially effective as a prophylaxis to be painted on the throat and tonsils : 204 DIGEST OF EXTERNAL THERAPEUTICS. Guaiacol, 10 parts. Menthol, i part. Sterilized Olive Oil, 10 parts. (Saj.) LARYNGEAL DIPHTHERIA. See Membranous Croup. NASAL DIPHTHERIA. This form of the disease is apt to terminate fatally unless very energetic treatment is adopted at once. The nose should be persistently and faithfully irri- gated or syringed with an antiseptic solution every hour night and day for one or two days. The child should be awakened to have the solution applied. It is a fatal kindness to permit it to sleep. Employ the solutions previously mentioned, giving preference to those which are non-poisonous, when there is danger of swallowing. Sometimes the nostrils are completely occluded by the membrane. In this case a passage must be tun- nelled with the probe and forceps; the probe may be tipped with cotton and dipped in carbolic acid. Co- caine may be used. (Gn.) A glass syringe with a soft rubber mounting in front is the best for administering the injection. When the patient cannot be raised, a nose cup or a spoon may be preferred. The manner of syringing is very important. It should be applied horizontally, and the fluid should not come out of the same nostril. Absolute quiet is very essential; all unnecessary furniture and all drapery should be removed. When possible it is well to change the patient's room to prevent reabsorption of the poison. (Jac.) DYSENTERY. 205 DYSENTERY. ACUTE DYSENTERY. Rest in bed and use of the bed pan is important, as frequent risings are injurious. (Gn.) Starch Injec- tions with 20 to 30 drops of laudanum after each stool are helpful. Mucilaginous Enemata will often allay tenesmus. Opium Suppositories for pain and tenesmus. Hot Compresses or a large Flaxseed Poultice, containing about half an ounce of mustard, often acts satisfactorily. (Bt.) Bismuth and Acacia: Half a drachm of each with an ounce of water, injected once or twice daily, ac- cording to the severity of the symptoms and retained, is of value in tropical forms. (Al.) Lysol: 1 per cent, aqueous solution as an enema. (T., 96.) Irrigation of the Rectum and Colon: This is the most rational treatment of the severer forms. The large intestine of the adult, it should be remem- bered, holds about six imperial pints, but not more than three or four should be introduced. (Pp.) The method of administering recto-colon irrigation is important ; the patient should lie on the left side without a .pillow, with the hips well elevated ; the fluid should be introduced slowly, resting when there is an inclination to reject. When pain is experienced the injections should be discontinued. The plan is entirely safe except when deep ulcers have formed. (Gn.) The following are recommended for irrigation : Sterilized Water. 206 DIGEST OF EXTERNAL THERAPEUTICS. Boric Acid, gr. x-gj. Quinine, 1-1000 or 1-5000, used by Osier in the amoebic form. Salicylic Acid, 1 to 2 per cent., or 1-300 for child- ren. Bichloride of Mercury, 1-6000. Alum, 3j Oj. Tannic Acid, 1 to 2 per cent. Nitrate of Silver, gr. ss gj. The irrigations are administered at a temperature of 100 to 110 F., though some of the older writers advocated their use cold. The Germans use iced water injections. If, on account of the irritability of the bowels, large injections cannot be tolerated, as is frequently the case, small ones may be substi- tuted, and the quantity increased gradually. Pre- vious to administration it is often advisable to allay the sensitiveness of the part by small injections of a 4 per cent, solution of cocaine or small enemata of starch and laudanum. (An.) This method of treatment is little called for in the ordinary types of the disease, it is more especially in- dicated in the severer and amoebic or tropical varie- ties. Acetate of Lead : Useful in both acute and chronic forms for the relief of tenesmus ; the following may be given by injection : Jjfc. Plumbi Subacetatis, gr. iv. Morph. Sulphatis, gr. ss. Aq. Fervid., ^j. M. (B.) DYSMENORRHCEA. 207 CHRONIC DYSENTERY. Intestinal Irrigation : The method of administra- tion and the solutions advocated for the acute form of the disease are also indicated in the chronic ; the reader is, therefore, referred to the preceding article. Before use the bowel should be well flushed with tepid water and freed from all faecal and other irri- tating matter. Nitrate of Silver : Is especially endorsed by many writers when there is ulceration of the bowels ; after the cleansing enema, inject by means of a long flexi- ble rubber tube carried up into the colon, using a so- lution of gr. x xx Oj. Care should be observed in inserting the tube so as not to wound the inflamed surfaces. (B.) Another useful solution consists of nitrate of silver gr. xx, tr. opium, gtt. xx-xxx, water Oij, repeated as required. (Sj.) Stronger solutions have been employed. Amelioration follows the third or fourth washing, but a course of sixty are said to be necessary for a cure. (An.) Sulphate of Copper: Gr. v-x-gj, an effective in- jection for ulceration and inflammation of the rec- tum. (F.) Examine the rectum for ulceration. DYSMENORRHCEA. All cases are relieved by rest in the recumbent posture. Hot applications to the abdomen and Hot Vaginal Douches. (K. C.) Scarification of the Cervix followed by Glycerine Tampons and Hot Water Injections give good results if persistently 208 DIGEST OF EXTERNAL THERAPEUTICS. employed between periods. They are indicated in the congestive variety-. (T., 97.) Galvanism : Of service in all forms, especially the neuralgic. Cleanse the vagina with hot bichloride solution, 12000, and dip the intra-uterinc electrode in a stronger solution of the same ; the intra-uterine electrode is introduced to the fundus, while the other is placed over the abdominal wall. The positive pole is used if the uterine canal is patulous and the flow too free; when the canal is contracted, the uterus small and flow scanty, the negative. The seance should last about fifteen minutes, and the strength of the current should be from 20 to 40 milliamperes. (K. C.) Spinal Ice Bag, when discharge is scanty ; if pro- fuse, Hot Water Bag; during intervals, Hot or Cold Sitz Baths. (R.) DYSPHAGIA. Cocaine : A very valuable agent for relieving this symptom. In the last stages of laryngeal tuberculo- sis, a spray a few moments before taking food will enable the patient to swallow with comparative ease. (Al.) The following is recommended by insufflation in- stead of cocaine : #. Morph. Hydrochloratis, Sac. Lactis, aa gr. xx. Gum. Arabic!, gr. xv. M. Sig. Use half a grain before meals. The effect is said to last many hours. (T., 96.) DYSPNCEA. 209 Menthol: 10 to 20 per cent, solution in vaseline as a spray is especially useful in the dysphagia of laryn- geal phthisis. (Al.) Orthoform : In laryngeal phthisis, cleanse the ulcerations and insufflate with the drug, or apply the following with the laryngeal spray : Jfc. Mentholi, 10. Ol. Atnyg. dulc., 30. Vitelli Ovi (about two yolks), 30. Orthoformi, 12.5 Aq. Destill., q. s. ad 100. M. Marked relief follows this measure. (T. P., 6, 99.) Lactic Acid: Varying from 10 to 100 per cent.; begin with a weak solution. It is one of the best topical applications for laryngeal phthisis with ulcers of the vocal cords. Dysphagia is almost always lessened and sometimes ceases after its use. Application is usually made with a brush every other day at first, then daily ; a burning sensation may be produced which will continue several hours; this may be relieved by 10 to 15 per cent, applications of cocaine. (Al.) Ice Slowly swallowing iced drinks will sometimes allay spasmodic forms. (Wa.) DYSPNOEA. Oxygen Inhalations: Used "when pulmonary and cardiac disease is the cause ; often a useful palliative. Amyl Nitrite: Inhalations when of cardiac origin with high arterial tension. (F.) Ethyl Iodide: According to See this remedy gives 15 210 DIGEST OF EXTERNAL THERAPEUTICS. prompt and satisfactory relief in the dyspnoea of phthisis. (Al.) The frequency of administration will depend upon the severity of the case, and the dura- tion upon the immediate effects. The average time is about four minutes and the frequency about six times a day. If vertigo is produced the inhalation is too long. Dry Cups: Applied to chest and back give tempor- ary relief in acute pulmonary, pleural, and cardiac diseases. Inspiration of Condensed Air: Beneficial in dysp- noea arising from many forms of disease ; namely, laryngeal and trachial stenosis and chronic disease of the bronchi and lungs in all stages, especially the earlier. (F.) EARACHE. See also Otitis. Hot fomentations of Chamomile Flowers, Hops or Poppy Heads. (F.) Cocaine : 5 to 10 per cent, solution very effective. (B.) Atropine: Gr. iij-v-gj, 1 or 2 drops in the ear is of value, especially when of rheumatic origin. (Al.) Chloroform : Insufflation of the vapor sometimes effective. (F.) The following often afford relief, a few drops on cotton inserted into the ear : Tr. of Aconite of great value, Glycerine, Ham- amelis, Arnica, Oil of Cloves, Opium in the form of ECTHYMA. 211 Laudanum, or Morphine in solution. All these rem- edies should be heated before applying. (Bt.) Syringing with hot water at short intervals is effective in some cases. (Bt.) ECCHYMOSIS. See Contusions. ECTHYMA. Local treatment consists first in getting rid of the parasites when present, after which treatment should be on general antiseptic principles. Crusts, if numer- ous, are to be removed by baths, preferably those containing Potassium Sulphuret, or by Starch Poul- tices containing Boric Acid (see Acute Eczema). The parts are then to be cleansed with Sublimate Soap or Carbolized Lotions or Bichloride of Mercury Solutions, 1-1000. The lesions are then dressed with an ointment of Boric Acid, 1 drachm, or Calo- mel, 15 grains, to Zinc Oxide Ointment, 1 ounce. (Vn.) A compress soaked in Boric Acid Solution may be applied to the lesions and covered with rubber tissue. (B.H.) Salicylic Acid: 5 to 10 grains to the ounce of oil or ointment base acts well. (Ja.) Carbolic Lotions: When ulcers show little ten- dency to heal, a weak carbolized wash may be used. (Kp.) 212 DIGEST OF EXTERNAL THERAPEUTICS. Ung. Hydrarg. Ammon.: 20 grains with zinc oxide ointment, 1 ounce (Ja.); or 5 to 10 grains with cosmoline, 1 ounce, forms an excellent anti- septic ointment. (Kp.) Aristol, Dermatol, lodoform, lodol, and remedies of that class in the form of ointments are all service- able. Cod Liver Oil: May be used externally with good results. (F.) ECZEMA. ACUTE AND SUBACUTE ECZEMA. Applications should be of a soothing, sedative character, in the more acute forms, and slightly stimulating in the subacute; dusting powders, lo- tions, and ointments are employed. When a remedy is applied for the first time in acute eczema it is better to use it over a limited area, and thus ascer- tain its effects ; for what has suited one case will not answer necessarily for another with the same ap- parent characteristics. Linen or muslin used for dressings should be disinfected before each applica- tion, and care observed that there are no creases or folds when laid on the surface. It should be of the thinnest, softest variety, and if the patient is sensi- tive to cold a fold of flannel may cover the dressing. Starch Poultice: One of the best moist applica- tions. Potato starch is preferable; it should be mixed with 5 to 10 parts of boric acid per 1000, placed in a flat bag, dipped in boiling water and allowed to cool before applying. In some cases the ECZEMA. 213 starch may be made into a paste and covered with very fine linen carefully adjusted. No form of treat- ment, according to Van Harlingen, gives more relief in acute eczema if carefully applied and changed every six hours. In mild cases, or in the later stages, the parts may be covered with a few turns of a soft linen bandage which has been impregnated with a decoction of bran or starch water. (Vn.) Dusting- Powders. These are of service for the redness, vesication, pus- tulation, and serous exudation they may be bland, astringent or sedative. Corn Starch, Arrow Root and Rice are the most soothing; Magnesium, Zinc Oxide, Bismuth, and Lead Carbonate the most astringent and sedative. Corn Starch: Should be applied at first on all large surfaces and the parts then covered with linen. Zinc Oleate: 1 drachm, with powdered arrow- root, 1 ounce, indicated when a mild astringent is desired. (Sh.) Lycopodium, Kaolin, Subnitrate of Bismuth, Der- matol and Talc, alone, or associated, are useful for isolated patches. (Vn.) When itching is very severe and obstinate : #. Camphorae, 3 s8 - Zinc. Oxidi, 3^- Amyli, 3i y - M. (Ja.) In acute vesicular or erythematous forms water, according to most writers, is irritating; it should, therefore, only be employed for the requirments of cleanliness. Olive Oil has been recommended as a 214 DIGEST OF EXTERNAL THERAPEUTICS. substitute for water. Pustular eczema requires washing with soap and water at intervals. Lotions. Lotio Nigra: The following is recommended for the acute vesicular variety, and constitutes one of the best forms of treatment for the majority of cases in the early acute stages : The affected part is bathed with the lotion, full strength or diluted with equal parts of lime water, and covered with cloths satur- ated with the same. The folio wing, which clings to the skin, may be substituted for use on the face : #. Hydrarg. Chlorid. Mitis, Mucil . Tragacanthse , L,iq. Calcis, ^xj. If. After the wash has been applied some minutes rub on oxide of zinc ointment, or this: 5fc. Pulv. Zinc. Oxidi, gr. Ixxx. Ung. Aq. Rosai, Vaselini, aa 3 iv. M. Apply gently with the fingers. The treatment is repeated at in- tervals of a few hours. (Hy. ) Lotio Flava: May be used with the same indica- tions as lotio nigra. (Sh.) Liq. Plurnbi Subacetatis Dilutus : Useful in vari- ous forms ; a pint with half an ounce of glycerine, or with laudanum, 2 ounces of each to a pint of water. When there is a good deal of inflammation, and the skin is oedematous, a bread poultice mixed with ice cold lead water has a soothing and grateful effect. (Vn.) Compound Zinc Oxide Lotion : This remedy, also ECZEMA. 215 called Startin's Lotion, has the widest range of appli- cation ; it is as follows : I*. Zinc. Oxidi, ^ss. Pulv. Calaminse Prseparatse, Qiv. Glycerini, ^j. Iviq. Calcis, Jvij- M. Grindelia Robusta : Suitable for the treatment of large surfaces, half an ounce of the fluid extract to a pint of water. Apply with cloths and allow to re- main on until quite dry. (Vn.) Carbolic Acid: One of the most effective antipruri- tics, though rarely adapted to the acute stage ; but when itching is intense and burning is not a promi- nent symptom it may be used with good effect either as a simple lotion in the strength of a drachm to a pint of water (Sh.), or in combination with black wash, as follows : #. Acid. Carbolici, 3*J~i v - Glycerini, gj. Lotio. Nigrse, Oj. M. These applications are more adapted to the erythe- matous varieties, when the skin is unbroken and there is inflammatory infiltration. (Vn.) In these conditions weaker solutions of carbolic acid will also give good results. Glycerine: Alone will prove irritating, but diluted with three parts of water will -form an agreeable ap- plication. (Vn.) Zinc Sulphate: Gr. xv xxx 3j, sometimes very useful for application on the hands. (Vn.) Cloths wrung out in Hot Water and applied very hot in quick succession will often allay the itching when other remedies have failed. 216 DIGEST OF EXTERNAL THERAPEUTICS. Alum: In the form of Burow's Liquor, is useful. When there is intense redema and loss of serum, to the extent of causing weakness, use 5 to 10 parts with 100 of \vater on compresses, renewing every three hours. (Kap.) Boric Acid, Sodium Carbonate, Sodium Hyposul- phite and Sodium Sulphite, all in the proportion of 1 drachm to a pint of water, are also used as lotions. Nitrate of Silver: Sometimes a solution of 3 to 10 grains to the ounce painted on moist patches will act satisfactorily. (Ja.) Ointments. As a rule, ointments do not agree with acute eczema as \vell as lotions, yet there are cases in which they are preferable. Cold Cream, Cucumber Cream, alone or with arrow root, and Glycerite of Starch are the most bland. Zinc Oxide: 1 drachm, with cold, cream 1 ounce, is very soothing, and better than the ordinary zinc ointment, which is apt to be too hard. (Sh.) Ung. Zinc. Benzoat.: This is one of the best reme- dies after the acute stage (Ja.), though disapproved by some \vriters. Lassar's Paste (See Appendix II): Indicated when there is much discharge, as in pustular and weeping eczema. 10 to 15 grains of salicylic acid may be added to increase its antipruritic effect. (Ja.) Diachylon Ointment : This should be prepared with great care, as improperly made it is harmful. The method of preparation, according to Duhring, is as follows : Olive oil 15 ounces, powdered litharge 3 to 4 drachms, water a sufficient quantity. The oil is ECZEMA. 217 to be mixed with 1 pint of water and heated by a steam bath to boiling, the finely powdered litharge is sifted in and stirred continually ; the boiling is to be continued until the minute particles of the lith- arge have entirely disappeared. During cooling, a few more ounces of water are to be added from time to time, and when completed water will remain in the vessel. The mixture is to be stirred until cool. When properly prepared, the ointment should be yellowish gray and of the consistency of butter. It is best applied on cloths and covered with oiled silk for cleanliness. Menthol: 5 to 20 grains in an ounce of zinc oint- ment is useful to allay itching. (Al.) lodoform : Gr. v-x-j with lard is one of the best remedies in the pustular form. (Ck.) Alumnol: 10 to 20 per cent, ointments are recom- mended by Bulkley. The following forms an excellent soothing applica- tion: I*. Zinc. Oxidi, ^ij. Acid. Salicylici, gr. x. Amyli, ^ij. Vaselini, 3>iv. M. (Kp.) Zinc Oleate : Combined with equal parts of olive oil, or with equal parts of ung. aq. rosas with a little almond oil, is often valuable. (Vn.) Bismuth Oleate : The following, known as Mc- Call Anderson's Ointment, is an elegant combina- tion: 218 DIGEST OF EXTERNAL THERAPEUTICS. I*. Bismuth. Oxidi, 3J. Acid. Oleici, 3J. Cerse Albse, ^iij. Vaselini, ix. Ol. Rosae, M.ij. M. (And.) Bismuth Subnitrate: As a mild astringent and sedative, is especially valuable in acute eczema of the scalp in children, as follows : #. Bismuth. Subnitratis, 3ss~j- Ung. Aq. Rosae, 3j. M. (Vn.) To relieve the itching the following : I*. Bismuth. Subnitratis, 3J. Glycerini, ^ij. Acid. Carbolic. Liquid., M.xij. Aq. Rosse, q. s. ad ^j. M. Sig. Shake well and apply with a camel's hair brush. (Sn.) Salicylic Acid : In strengths varying from 2 to 20 per cent., with lanolin, vaseline or water, is satisfac- tory in subacute erythematous varieties when con- fined to small areas. This remedy is also effective in weak solutions in vesiculo-pustular forms, but its best results are seen in eczema rubrum and eczema squamosum when there is considerable fissuring. (F.) Xeroform: A 10 per cent, solution will check the discharge in eczema madidum and impetiginosum. (F.) Picric Acid: Saturated solutions painted on the part have been highly praised in acute and subacute eczema. (T., 98) Potass. Permang.: 1 to 2 per cent, or stronger solutions have been recommended by Bulkley in patches of subacute forms. ECZEMA. 219 In eczema intertrigo the following will prove use- ful: &. Bismuth. Subnitratis, 3 iv. Zinc. Oxidi, 3J. Pulv. Amyli, ij. Acid. Carbolici, M.v-xv. Vaselini vel Ung. Aq. Rosse, q. s. ad ^ j. M. (B. H.) Or, #. Thymoli, g r -j- Pulv. Zinc. Oleati, 5J. M. (Ja.) Or, Jjt. Acid. Salicylici . gr. x. Pulv. Amyli, Bismuth. Subnitratis, aa 3"j- Ung. Aq. Rosa;, q. s. ad 3J- M. (B. H.) CHRONIC ECZEMA. In some cases the treatment employed for the acute form will also be applicable to this type of the dis- ease, but as a rule more stimulating remedies will be found necessary. Tar : This remedy is largely employed. It is indi- cated in the squamous form, and when the disease has become decidedly chronic with more or less infil- tration. If applied when not indicated it will irritate and retard recovery. Mild preparations should be used first and increased in strength as indicated. The two forms of tar commonly employed are Pix Liquida and Oleum Cadini. The following formulae are suggested : 220 DIGEST OF EXTERNAL THERAPEUTICS. #. Ol. Cadini, gss-j. Zinc. Oxidi, 3 ss ~j- Ung. Aq. Rosae, ^ j. M. Or, #. Ol. Cadini, 33. Ung. Zinc. Oxid. Benzoat. , ^j. M. Pix liquida may be substituted in the above for the oleum cadini in double the strength. (Ja.) Compound Tincture of Mineral Tar (Coal tar, 1 part digested -with 6 parts of tincture of quill aia, with frequent agitation for not less than eight days, preferably longer, then filtered): This is an excellent preparation in which to employ tar in a liquid form, especially in dry eczema of the scalp in adults. It should be used in the strength of 3 to 20 minims to the ounce of water. (T., 98.) Tar Baths: Are advised by Lassar for the purpose of disinfecting the skin ; after the bath the surface is dusted with Venetian talc. (T., 97.) Oleum Rusci: Effective but is difficult to obtain. It may be used in the proportion of 1 to 2 drachms to the ounce of ung. aq. rosse. (B. H.) Another ex- cellent way in which to use tar is that of the strong tincture, 2 parts to 1 of alcohol. Paint the diseased surface with about three coats, allowing each coat to dry before the other is applied ; then cover with oxide of zinc ointment, which should be changed every morning. (Ja.) The following is recommended in old patches to be rubbed in with a mop : ECZEMA. 221 #. Picis Iviquidse, Sapo. Viridis, Alcoholis, partes equales. M. (Vn.) In very chronic thickened varieties tar has been recommended to be used pure, dissolved in olive oil if the lesions are extensive. Caution must be observed lest poisonous effects be produced. Wilkinson's Ointment: Advised by Lassar in ob- stinate forms. It consists of equal parts of sulphur and oleum rusci, 1 part; prepared chalk, ^4 part; soft soap and vaseline, 2 parts. (T., 97.) Carbolic Acid: A very valuable agent, especially serviceable as an antipruritic. It will often allay itching when other remedies have failed, and may be used in the form of an ointment ; 5 to 20 grains to the ounce of base, either benzoated lard or zinc oxide ointment . ( Vn . ) Thymol : An ointment of 10 grains to the ounce and upward is used. (F.) Thioform : 10 per cent, salves are strongly recom- mended in moist forms. (T., 96.) Sulphur: A very useful remedy, especially when the surface is moist. It is indicated in pustular eczema of the hands, in chronic eczema rubrum oc- curring in patches, and when it is desired to renew the epithelium of the skin by its cornifying powers. It may be employed in the strength of 1 to 2 drachms to the ounce of vaseline or cold cream, but should be used mild at first and gradually increased in strength. It is regarded by some writers as next to tar in efficacy, forming one of the best stimulating remedies. It is not, however, as reliable, and in some persons causes considerable dermatitis. A 222 DIGEST OF EXTERNAL THERAPEUTICS. combination of sulphur and tar has good effect in old chronic cases attended with much itching and infiltration. (Vn.) Sapo Viridis: Often of the greatest service, espe- cially in eczema rubrum of the leg and other parts where there is extensive infiltration. It should be rubbed in thoroughly by means of a piece of flannel, until there is considerable smarting and copious serous discharge. The soap is then washed off with warm water, the parts well dried, and a soothing ointment, such as diachylon, applied. The procedure is repeated daily, and is effective in this form of the disease. (Vn.) Lassar's Paste (See Appendix II. for formula): May be useful in some cases but is better for the acute. Vasogene or Oxygenated Vaseline: Made by boil- ing vaseline with 4 per cent, of nitric acid, washing away the excess of acid and cooling, has given very satisfactory results in dry and weeping eczema. (T., 98.) Salicylic Acid, Salol, or Resorcin: In strength varying from 20 to 60 grains to the ounce of oint- ment base, useful when there is more infiltration than inflammation. (T., 98.) Bassorin Paste : #. Bassorini, 3 x. Dextrin! , 3vj. Glycerin!, gij. Aquae, q. s. ad jxxvss. M. (Ck.) Ichthyol: Varying strengths are used to reduce the thickening in old cases. (F.) Thiol : As a substitute for ichthyol, to which it is ECZEMA. 223 very similar but free from odor, 2 to 15 per cent, ointments, and 50 per cent, solutions. (T., 96.) Resorcin: 2 to 5 per cent, ointments are useful as mild stimulants in lotions or ointments. For ery- thematous eczema the following : #. Resorcini, gr. x-xv. Glycerini, M.x. L,iq. Calcis, 3j. M. Sig. Apply to the part three or four times daily until itching and burning cease, and the inflammation lessens. (T. , 98.) Caustic Potash: 10 to 40 grains to the ounce may be advantageously employed in old infiltrated cases and in eczema of the palms. The application should be mopped on, the parts then bathed with cold water or covered with cold water compress, and after a while with soothing ointments. This proced- ure is heroic as well as effective, and must be used with care. It should never be used more than once or twice a week, and never intrusted to the patient for application. (Vn.) A preparation introduced by Bulkley called Liq. Picis Alkalinus is the following: #. Picis L,iquidae, ^ij. Potass. Causticse, 3j. Aq. Destill., 3v. M. Sig. This is to be diluted with from 2 to 8 parts of water. (B. H.) Mercurial Ointments: Valuable when the disease is limited, but should not be used over extensive areas for fear of absorption. Some of the preparations in use are as follows : 224 DIGEST OF EXTERNAL THERAPEUTICS. $fe. Hydrarg. Chlorid. Mitis, gr. x-xxx. Ung. Zinc. Oxidi, Ung. Petrolei, aa ^ss. M. Or, 9>. Hydrarg. Oxid. Rub., gr. v-xxx. Vaselini, ^j. M.- (Vn.) Rubber Protective: For the reduction of infiltra- tion and the removal of scales, nothing is better when used for a limited period. A piece of rubber is applied to the part, and bound down with a roller bandage. It should be removed once a day, sponged with a solution of soda in water and reapplied. This plan affords great relief to the itching. As soon as infil- tration is reduced the tar remedies are indicated. (Ja.) Martin's Solid Rubber Bandage is of great service in varicose eczema rubrum. The bandage should be worn during the day only, and on remov- ing at night the limb should be bathed in hot water, dried and dusted with starch powder, and loosely covered with linen for the night. (Hy.) Ihle's Paste : A well known and useful applica- tion is the following : 5fc. Resorcini, gr. x-xx. Zinc. Oxidi, Pulv. Amyli, Lanolini, Vaselini, aa Jij- M. Plasters : The mull and salve plasters of Unna be- ing now obtained in this country can be used with good effect. They are, however, expensive and liable to become rancid. Pick's salicylated plaster, a sub- stitute is as follows : ECZEMA. 225 #. Emplastri Saponis, ^iiss. Ol. Olivse, 3v. Acid. Salicylic!, gr. xxxvij. M. Duhring recommends for a 5 per cent, plaster : Tfr. Emplastri Saponis, ^j. Ol. Olivse, Acid. Salicylici , aa gr. xxiv. M. For a 10 per cent, plaster, omit the olive oil. Hardaway uses lead plaster 61 parts, powdered soap 4 parts, and water sufficient to form a paste with the soap. Add the lead and evaporate to proper consistency. Then add vaseline 30 parts, salicylic acid 5 parts, and mix with gentle heat. The salicylic acid may be increased if necessary. These plasters are especially indicated in infiltrated varieties of eczema. After the thickening has been removed, the salicylic acid may prove injurious, in which case it should be replaced by simple ointments or pastes. Gelatin Preparations : These were recommended by Pick as a vehicle for other remedies and as a pro- tective. The following are among the best of the numerous formulas (Pick's Gelatin): fy. Gelatinse, 3 iv. Zinc. Oxidi, ^iiss. Glycerini, % ss. Aquae, ^vj. M. Heat the water, dissolve the gelatine in it, then add the gly- cerine and zinc; stir until cold. For use the liquid jelly is heated in a hot water bath and painted on. One-half per cent, of ichthyol 16 226 DIGEST OF EXTERNAL THERAPEUTICS. or any other remedy used in diseases of the skin, ex- cept lard, may be added if desired. (B. H.) Gelanthum : Introduced by Unna and modified by Skinner, is as follows : I*. Tragacanthae, 3" ss - Gelatin. Opt., 3ij. Glycerini, 3 V J- Thymoli, gr. %. Aq. Destill., q. s. M. Place the tragacanth and glycerine in a covered jar containing 10 ounces of water and add enough to make 12 ounces. (B. H.) Jamieson's Gelatin : Gelatin, 15 parts. Zinc Oxide, 10 parts. Lard, 10 parts. Glycerine, 65 parts. Heat together in a hot water bath, and add 2 per cent, salicylic acid. Apply with a brush. (Vn.) Pigments : Various remedies are added to collo- dion or liquid gutta percha, thus constituting a pig- ment. In small thickened patches of eczema Salicylic Aeid and Chrysarobin, of each 5 to 10 per cent., are valuable, and in eczemas about the mouths of chil- dren Tar similarly combined is often useful, viz.: #. Ol. Cadini, 5 j. Collodii vel Traumaticini, ^j. M. (B. H.) ECZEMA IN CHILDREN. Treatment is generally on the same lines as that for adults. When the face is the seat of the disease, it should be covered with a light linen mask held in place by being fastened to a skull cap. The oint- ECZEMA. 227 ments should be spread on cloths and the mask put on over them. Suitable openings must be made for the nose, mouth, and eyes. All parts of the skin which are in apposition should be kept separated by folds of lint. Scales should be removed as directed for eczema of the scalp, after which the selected remedy may be applied. Kaolin, Zinc Oxide, Bismuth Subnitrate are suit- able dusting powders for the erythematous variety ; Starch ma}' also be used, but boric acid must be added to prevent caking and consequent irritation. Black Wash and Dilute Lead "Water are often of service. Resorcin: For the disease when situated on the scalp and for dry scaly patches elsewhere the follow- ing is useful : Jfc. Resorcini, gr. viij-xv. Sulphur. Lotionis, 3 ss ~j- L,anolini, 3 SS "3^J SS - Adipis, q. s. ad ^iij 3ij- M. (N. Y. M. J., 4, i, 99.) Boric Acid: The powder or an ointment, 1 drachm to vaseline 1 ounce. (Vn.) For obstinate cases of the scaly type : Tar, Alcohol, Green Soap, equal parts. Or, Oil of Cade, i part. Olive Oil, i part. Lanolin, 10 parts. 228 DIGEST OF EXTERNAL THERAPEUTICS. Or, Zinc Oxide. i part. Ammonia Hydrate, i part. Oil of Almonds, i part. Tar, 10 parts, (Jac.) The following are for use in the vesicular and vesi- culo-pustular forms : &. Pulv. Zinc. Carbonatis, jj. Ung. Cucutnis, 3J. M. Or, #. Bismuth. Subnitratis, 3J. Ung. Aq. Rosae, 3j. M. (Vn.) Balsam of Peru: 1 to 30 in vaseline; apply at night (T., 96), or with boric acid as follows. 9;. Acid. Borici, gr. Ixx. Balsam. Peru., gr. v. Vaselini, 3j. M. (Sn.) Tar : In mild chronic conditions : J*. Picis Liquidae, 3 ss. Pulv. Zinc. Oxidi, 353. Ung. Aq. Rosae, |j. M. Or: $fc. Sulphur. Praecipitati, 3ss-j. Picis L/iquidse, Ung. Zinc. Oxidi, M. Or, Ol. Cadini, 3J. Collodii, 3j. ECZEMA. 229 Methylene Blue : 3 per cent, solutions in water have proved effective for eczemas of the ano-genital region. It is analgesic, soothing, antiseptic and protective. (N. Y. M. J., 4, 1, 99.) Salicylic Acid: For seborrhoeal forms the follow- ing: I*. Acid. Salicylic!, gr. iij-viij. Pulv. Zinc. Oxidi, jij gr. xv. Pulv. Amyli, giv. Tr. Benzoin. Comp., gij gr. xv. Adipis, 3iij ij. M. (N. Y. M. J., 4, i, 99-) Nitrate of Silver: 10 to 40 grains to 1 ounce gives good results in chronic cases of the squamous and crustaceous variety. (Jac.) The nails should be kept cut short in order to pre- vent scratching. ECZEMA OF REGIONS. Eczema of the Anus. The treatment is generally the same as that of the infiltrated variety in other localities. The parts should be washed with Ichthyol or mild Sublimate Soap, and the following applied : #. Acid. Borici, 3J. Cocain. Hydrochloratis, 33. Lanolini, Jj. M. ^Vn.) Tar : Ointments applied and covered with dusting powder are of especial value in adults. (Hy.) A formula for a tar ointment to be preceded by a 5 per cent, application of cocaine for the relief of the pain is as follows : 230 DIGEST OF EXTERNAL THERAPEUTICS. J*. Picis Liquidae, 33. Medullas Bovis, 3 V J- Cerge Albae, 3J. Ol. Rosae, M.v. M. (Vn. ) Salicylic Acid: A solution of 15 grains in 1 ounce of flexible collodion is often followed by good results. (Ja.) Hot "Water : Bulkley recommends the following : A soft cloth dipped in water as hot as can be borne is pressed against the anal region for a minute, re- peat the application three times, then dry and apply the following ointment : #. Zinc. Oxidi, 3J. Pulv. Amyli, ^ij. Ung. Picis L,iq., gij-iv. Ung. Vaselini Plumbici, q. s. ad J$j. M. Before using the fomentation the salve is made ready for applica- tion by spreading it on lint. Duhring uses this formula : I*. Sulphur. Praecipitati, 9ij. Naphtholi, 9j. Morph. Sulphatis, g r -ij- Zinc. Carbonatis, 3J- Ung. Aq. Rosas, j. M. Carbolic Acid : 20 per cent, in almond oil rubbed in with the fingers at night \vill give relief even when the surface is fissured and abraded. (Vn.) Rubber Sheeting or protective worn in the form of a T bandage for a few days will be useful -when there is much infiltration. (Ja.) Penciling with solutions of Nitrate of Silver, and ECZEMA. 231 applications of Potash or Coal Tar, may also be em- ployed in the same condition. Scarification is sometimes effective in exceedingly obstinate cases. (B. H.) The parts should be kept as clean as possible, and the fold of the nates separated by a layer of lint. Eczema of the Auditory Meatus. Accumulations of wax and epithelium should be re- moved by syringing with warm solutions of Borax or Carbonate of Soda as directed under the head of Impacted Cerumen. Hydrogen Peroxide : Recommended for cleansing. (T., 98.) Boric Acid, by insufflation, Tannic Acid 3J-j, or Nitrate of Silver gr. x-xx-^j applied by means of absorbent cotton on a probe, with the ear properly illuminated, are useful to allay the itching. (Bac.) Potassa : When there is much infiltration, a solu- tion of 10 grains to the ounce may be applied -with a camel's hair brush carefully stripped of all excess be- fore introduction, so that not a drop will run down to the tympanum. (Vn.) Cold Cream : Is useful after application of nitrate of silver if there is much oozing. (Bac.) Ichthyol: 25 per cent, ointments in acute and ery- sipelatous varieties. (T., 98.) Calomel : Gr. xx-xl-3-j as an ointment in dry and irritable forms. (T., 98.) The following acts well : #. Acid. Salicylic!, gr.j. Tr. Benzoini, gtt. ij Ung. Aq. Rosae, 3J- M. (Bac.) 232 DIGEST OF EXTERNAL THERAPEUTICS. Hydrarg. Oxid. Flav. or Resorcin: 2 to 5 per cent, ointments in sluggish cases. (T., 98.) Acetum Cantharidis : Applied with caution is sometimes effective. (Bac.) The following has been suggested by Van Harlin- gen for the patient to use during the intervals of treatment by the surgeon : J*. Acid. Carbolic! (crys.), Zinc. Sulphatis, aa gr. xij. Glycerini, 3^j- Aq. Rosse, ad 3 xij. M. Sig. Syringe the ear once or twice a day. Eczema of the Beard. In the acute pustular variety soothing applica- tions are indicated. Carbolized Oil, Lime "Water or Diluted Black Wash may be used for bathing the affected parts, after which Cold Cream or Vaseline may be applied. The hairs should be closely clipped, and as soon as the acute stage has passed, daily shaving should be required, or shaving at least every other day. Ung. Vaselini Plumbici : Spread on muslin should be applied after shaving. Epilation of hairs situated in the pustules should be practiced when the disease has become chronic, followed by ointments. The following is for use in the squamous form : #. Hydrarg. Ammoniat., gr. xx. Lanolini, 3J. M. (Ja.) For chronic varieties (Rosenthal's paste): ECZEMA. 233 ty. Acid. Tannici, 3J. Sulphur. Praecipitati, 3ij. Zinc. Oxidi, Amyli, aa gr. cl. Vaselini, gr. clx. M. (B. H.). Sulphur: A 1 to 2 per cent, ointment is recom- mended by Crocker. Eczema of the Breast and Nipple. Wash the nipple carefully, using as little water as possible, dry with a soft handkerchief and dress with Zinc or Diachylon Ointment. It is obvious that this must be removed before nursing. (Ja. ) Rubber nipples are useful to wear while nursing when there are cracks in the nipple. After drying, painting with Tr. Benzoin Comp. or Tr. Myrrh is often effective. (B. H.) Lister's ointment for fissures : I*. Acid. Borici, Cerse Albae, aa gr. xv. Paraffini, Ol. Amygdalae, aa gss. M. Sig. Wash the nipple with borax 1-25 and apply on muslin. Borax: Useful as an ointment as well as for cleansing. Thymol with Powdered Zinc Oleate, a grain to the ounce, for eczema under the breasts. (Ja.) Nitrate of Silver: In solution of gr. xvj %j or the crayon for touching the cracks. (B. H.) No poisonous application should be used. 234 DIGEST OF EXTERNAL THERAPEUTICS. Eczema of the Ears. When the disease is situated on the outer part of the ear, the same general line of treatment mentioned for the disease in other localities is for the most part applicable. In applying the dressing care should be observed to cover every part and furrow. A pledget of lint should be placed behind the ear, so that it will be constantry kept separated from the side of the head while sleeping. Lotio Nigra may be used first. Compound Oxide of Zinc Lotion also of service. These remedies are specially indicated in the vesicu- lar form. Zinc Oxide Ointment: According to Bacon, is usually all that is required. Diachylon Ointment: Suitable to some cases. (Bac.) Ung. Vaselini Plumbici: Containing 1 per cent, of carbolic acid, if there is much itching in subacute and chronic conditions. (B. H.) Salicylic Acid : A 5 per cent, solution when there is much infiltration will quickly reduce it. (B. H.) Sapo Viridis : When there is a deep crack of long standing behind the ears, may be rubbed in briskly and followed by tar or calomel ointment 3J j , or by equal parts of pix liquida and ung. zinc, oxidi. (Hy.) Nitrate of Silver: Gr. v x-j painted on in the moist forms. (T., 98.) The ear may be covered during the day with a linen bag made like a little ear muff. Lead and Opium Lotion: This familiar remedy or the following of a similar nature will prove useful in the acute stage : ECZEMA. 235 #. L,iq. Plumb. Subacetatis, 3*J- Bismuth. Subnitratis, gss. Morphinae, gr. ij. Glycerini, gj. Aq. Rosae, q. s. ad ^viij. M. Sig. Shake well before using. (Bn.) Eczema of the Eyelids. Weaker applications are to be employed than are used on other parts. Glycerite of Starch, Diachylon Ointment, Oxide of Zinc, or Acetate of Lead cerates, or dusting powders of Starch alone, or mixed with powdered Oxide of Zinc in the proportion of 1 of the latter to 3 or 4 of the former, should be used in the acute varieties. (N. O.) Nitrate of Mercury: The officinal ointment diluted with 3 to 6 parts of cold cream, or the Red Oxide of Mercury, 10 grains, to cold cream 1 ounce, form very useful applications for mild cases. (Vn.) Aristol: Has been highly praised. (N. O.) Anoint- ment of 5 grains to 1 drachm of cosmoline has been found effective. The following is said to be excellent : #. Acid. Salicylici, gr. x. Ung. Hydrarg. Oxid. Rub., 3J- Ung. Aq. Rosae, 3 V J- M. (Ja.) Hydrarg. Oxid. Flav.: Gr. ss-iv, vaseline sj, some- times known as Pagenstecher's ointment; it may be worked in over the eyelids. (Al.) For severe cases the eyelashes should be extracted, the edges of the lids carefully dried and touched with a camel's hair brush moistened with a solution of Caustic Potassa gr. x-|j. This application should 236 DIGEST OF EXTERNAL THERAPEUTICS. be wiped away immediately and cold water applied. Applications may be made daily until infiltration, ex- udation and itching are relieved, when a stimulating ointment such as the Yellow Oxide of Mercury as above may be used. (Vn.) Eczema of the Face. Crusts when present should be removed by soak- ing in Olive Oil or the Ung. Vaselini Plumbici ap- plied with strips of muslin. (Hd.) Black Wash and Lime Water are of decided bene- fit. (Hy.) Soothing applications should be employed such as the following, which are indicated in the erythema- tous variety : #. Zinc. Oxidi, gss. Pulv. Calaminae Praeparatae, 9iv. Glycerini, 3j. Aq. Calcis, 5 v ^j- M. Or, $fc. Zinc. Oxidi, %ss. Mucilag. Acaciae, 3J. Emul. Amygdalae, ^ij. Aq. Rosae, ad ^iv. M. (Hd.) The following ointment is described as of great general utility : I*. Zinc. Oxidi, 33. Pulv. Amyli, ij. Ung. Picis Liq., 3HJ- Ung. Vaselini Plumbici, q. s. ad 3 j. M. (B. H.) Sig. Spread on muslin and retain in position with a linen mask. ECZEMA. 237 Squires' Glycerole : This preparalion is as fol- lows: &. Glycerit. Plumbi Subacetatis, ^ss. Ung. Aq. Rosas, 3j. Cerae Albae, q. s. M. (Hd.) The following called Provan's Paste is for protect- ing the parts when the patient desires to remove the applications and go out : Jfc. Tragacanthae, Glycerin! , ati. Jss. Sod. Biboratis, ^ss. Aq. Destill., q. s. M. (Hd.) This forms a thin varnish which protects the skin from the air and which can be easily washed off. Zinc Oleate : As a dusting powder for protection after the use of pastes. ( Hd. ) Acetanilid: With cold cream, 9ij-iij-|j. (T., 98.) Carbolic Acid: Especially useful for the itching; may be used when the disease is at its height : J*. Acid. Carbolici, ^iij. Glycerini, gj. Lotio. Nigrse. Oj. M. (Vn.) Diachylon salve on mull useful for chronic eczema of the forehead. (Hd.) Liq. Carbonis Detergens: 1 part to 8 of water or stronger is excellent. (Vn.) When ointments agree well the following will be found satisfactory : Ijfc. Picis Liquidae, S 88 "^- Ung. Aq., Rosas, |j. M. (Vn.) 238 DIGEST OF EXTERNAL THERAPEUTICS. Salicylic Acid Plaster : 5 per cent, in chronic cases is of great value : (Hd.) For the healing of cracks and fissures : Ijfc. Ol. Cadini, 3J. Liq. Guttse Perchae seu Collodii, ^ j. M. Eczema of the Genitals. The parts should be kept separated by layers of linen, and in the case of males the genitalia should be wrapped in fine soft linens. In acute cases soothing remedies should be employed, such as Zinc and Cala- mine, Lead Water, Black Wash, and Lotions of Grindelia. Medicated Baths: In acute and superficial forms these \vill give relief. A bath may be prepared as fol- lows: Potass, carb., giv; sod. bicarb., ij ; pulv. bor- acis, ij. Mix, dissolve in a quart of water and add 4 to 6 ounces of dry starch ; this is to be well stirred through the water, then 6 to 8 ounces of glycerine added, and the whole mixed with 30 gallons of warm water. The patient is to remain in the bath 15 to 20 minutes; on removal dry thoroughly and dust on Bismuth Subnitrate, or apply some bland ointment. (Vn.) When the disease is chronic, and there is much infil- tration with scaling, more stimulating treatment is required, such as the following: Green Soap with friction, or Salicylic Acid in Alcohol 1 drachm to 4- ounces, afterward applying Ung. Vaselini Plumbici, or Salicylic Acid Plaster 5 per cent, strapped on, Vleminckx's Solution, pure or diluted, Wilkinson's Ointment, or painting with Caustic Potash, gr. xx-Sj. (B.H.) ECZEMA. 239 For the itching : 9<. Acid. Carbolici, ^iij. Glycerini, 3j. Aq. Destill., Oj. M. This is particularly useful in females, and is best preceded by applications of hot water. Nitrate of Silver; A solution in nitrous spirits of ether painted on is useful for itching of the scrotum. (Vn.) Lead Liniment forms a good application. (F.) For eczema of the vulva the following is com- mended: Bran Water with Boric Acid during at- tack; in the intervals Salicylic Acid Paste, or Car- bolic Acid Lotion 1 part, Balsam Peru 4 parts, oil of Sweet Almonds 400 parts; dusting powders may be freely used. Sitz Baths morning and evening. (T., 97.) Eczema of the Hands and Feet. Calamine and Zinc Lotion alone, or with Carbolic Acid, 5 to 10 drops to each ounce of lotion, affords relief to the acute vesicular variety. (B. H.) Zinc and Tar: Useful after the disappearance of the more acute symptoms, which leave the parts red and somewhat scaly, viz.: #. Ung. Picis Liq., ^ij. Zinc. Oxidi, 3J. Ung. Aq. Rosse, 3vj. M. In subacute and papular eczema : 240 DIGEST OF EXTERNAL THERAPEUTICS. ffc. Bismuth. Subnitratis, 3iv. Zinc. Oxidi, gj. Pulv. Amyli, ^ij. Acid. Carbolici, M.x-xv. Vaselini, ^j. M. (B. H.) Or, Litharge, 10 parts. Glycerine, 30 parts. Starch, 10 parts. Vinegar, 60 parts. To be reduced by boiling to 80 parts. (T., 98. ) Green Soap: In chronic cases when there is horny thickening of the palms, more vigorous treatment is required. Green soap spread on cloths covered with a rubber bandage may be applied and retained night and day until the epidermis is softened and reduced in thickness, then stimulating ointments of tar and sulphur should be used. (Vn.) Caustic Potash: Same indications as for green soap. 20 to 40 per cent, solutions applied by the physician himself; the hands should be first soaked in -water as hot as can be touched, then a mop dipped into the solution should be rubbed on the parts. If the burning is considerable, wash with cold water and apply the following : #. Hydrarg. Ammoniat., 9j. Adipis, 3 s8 - Sevi Benzoiati, 3^j Bj- Ol. Amygdalse Dulcis, M.x. Ung. Petrolei, ad vj. M. The above is to be applied on cloths and covered with wax paper. This treatment may be employed daily until the cracks and fissures heal and the skin ECZEMA. 241 assumes a healthy appearance. Then the potassa is discontinued and weak tar ointment applied, 3J Ij. (Vn.) Salicylated Plasters: For softening the horny epidermis have a very good effect ; they are moulded to the skin and allowed to remain on for from twenty-four hours to several days, when they be- come loose. The horny epidermis is scraped away and ointments applied. (Kap.) Gelanthum: For dry eczema with marked thick- ening, as a vehicle for Salicylic Acid, Ichthyol, Re- sorcin, Chrysarobin, or Tar to replace ointments. It is more agreeable. (F.) See Acute Eczema. Thymol and Zinc Oleate : These remedies, mixed in the proportion of 1 part of the former to 8 of the latter, form a powder which is more useful than oint- ments when the disease is situated between the toes. (B.H.) Eczema of the Legs. All forms of the disease may occur in this locality and should receive the treatment as suggested under the general head of this subject; the following details, however, are deserving of special attention : Green Soap : Applied with friction, this remedy gives satisfactory results in eczema rubrum; after rubbing on briskly wash off the soap "with warm \vater, dry gently and apply Ung. Vaselini Plumbic! on strips of muslin placed on evenly and carefully retained by a rubber bandage. (B. H.) Diachylon Ointment: This is excellent in moist varieties. 17 242 DIGEST OF EXTERNAL THERAPEUTICS. The following paste, recommended by Unna, gives satisfactory results : J*. Kaolini, Ol. Lini, aa 5 V J- Zinc. Oxidi, L,iq. Plumbi Subacetatis, aa ,^ss. M. Sig. To be painted and allowed to dry ; then bandage, chang- ing every twenty-four hours. Ichthyol : 2 per cent, solution in glycerine, al- mond oil, or rose water applied on lint or covered w r ith layers of cotton, followed by a 2 per cent. Zinc or Diachylon Ointment. (Vn.) Glycerole of Lead Subacetate : Dilutions of vari- ous strengths are emplo3 r ed. It is indicated in exten- sive chronic eczema rubrum of a dusky hue accom- panied by weeping, varicose veins and oedema of the subcutaneous tissues. It is also used for palmar eczema. (N.) Solutions of 15 to 30 grains to 1 ounce are recommended ; saturated strips of muslin are carefully applied, covered with waxed paper and bandaged. Rubber Bandages: When the veins are varicose apply a rubber bandage directly to the skin, remove at night, cleanse and disinfect, then dust the leg with Starch or Boric Acid. The bandage should be used w r ith caution lest it cut the surface or macerate the tissue. (Vn.) Salicylated Soap Plasters; Most useful in scaly conditions; serviceable in eczema rubrum. (B. H.) The following is recommended for general use in chronic forms: Ung. Zinci Oxidi, Ung. Hydrarg., Ung. Plumbi Subacetatis, equal parts. (T., 96.) Massage is often of service in very chronic condi- ECZEMA. 243 tions. Before employing, wash the limb with some parasiticide soap and follow with a lotion of Bi- chloride of Mercury, 1-1000, or a saturated solu- tion of Boric Acid. (Vn.) Eczema of the Lips. Cold Cream, Lanoline, inc Almond Emulsion, Ung. Vaselini Plumbici for acute types. Thymol, 5 grains, with Cold Cream, 1 ounce; Salicylic Acid Plaster, 5 per cent., in chronic forms. Tr. Benzoin Comp. or Collodion painted on serve well, giving relief and protection. (B. H.) Dilute Phosphoric Acid: May be employed as follows : I*. Acid. Phosphoric. Dil., Glycerini, Syrupi, aa ^ss. M. Sig. Apply three times a day. (Vn. ) Nitrate of Silver : The crayon may be touched to deep cracks; afterwards apply Benzoin. Ung. Hydrarg. Oxid. Rub.: A minute quantity of a strong ointment, 40 to 60 grains to the drachm, for very chronic fissures in the lips ; the fissure is torn open and the ointment applied with a little stick. (Vn.) Liq. Plumbi Subacetatis: M. xv-j, with white vaseline. (Ck.) Nasal catarrh, which is a frequent cause, should receive treatment. Eczema of the Nails. Salicylated Collodion; Painted on the infiltration around the nail, followed by Ung. Vaselini Plumbici. (B.H.) 244 DIGEST OF EXTERNAL THERAPEUTICS. Tar Ointment: A drachm to the ounce. (Vn.) Ung. Diachylon: Useful when there is much ten- derness. (Vn.) Salicylic Acid: The salicylated rubber plaster during the day, and an ointment of the acid with tar ointment, 1 drachm to the ounce, when the parts are tender. (Vn.) Eczema of the Nares. This affection is often associated with chronic rhinitis ; when such is the case the first effort should be directed to the treatment of the latter condition. All crusts should be removed by soaking in Olive Oil, which can be dropped into the nose or applied with a camel's hair brush ; when thoroughly softened they can be easily removed, after which one of the follow- ing may be used with good effect: Ung. Hydrarg. Oxidi Flav.; Ung. Plumbi and Vaseline, equal parts; Glyceritum Plumbi Subacetatis and Ung. Aq. Rosse, equal parts. (Hd.) Zinc and Red Precipitate Mull: Small rolls of paper covered with the mull and inserted up the nostril are recommended by Unna. Eczema of the Scalp. In children and men the hair should be cut short, but this is not necessary in women. If crusts are present they may be removed by Olive Oil ; saturate the scalp, cover the head with a cap and wash off in the morning; repeat if necessary, or use Starch Com- presses to the scalp, allowing them to remain on for a little while, or Starch and Boric Acid, each 1 drachm, water, 1 pint. (Vn.) ECZEMA. 24-5 Sodium Bicarbonate: Very useful in solution ap- plied in the same manner for removing crusts in in- fantile variety. The following is recommended : 9<. Sod. Bicarbonatis, , 3J. Liq. Sod. Chlorinatse, 3j. Aq. Destill., 5 x ij- M. (Al.) Liq. Potassse: 1 part to 8 to 12 of olive oil for re- moval of crusts in children. (Jac.) The above applications prepare the scalp for more active medicinal agents. Lotio Nigra : Alone or better with Aq. Calcis for acute inflammatory conditions. Apply with a sponge for ten or fifteen minutes and follow with an ointment. (Vn.) Ung. Vaselini Plumbici : Spread on strips of muslin and retained by a cap, useful when the hair is short; and in acute forms in young infants. (B. H.) Carbolic Acid: Solutions are useful. Same indi- cations as for black wash. (Vn.) The following ointments are recommended by Van Harlingen : I*. Bismuth. Subnitratis, Ung. Petrolii, partes equales. M. Or, Ijt. Hydrarg. Ammoniat., gr. x-xx. Ung. Petrolii, 3j. M. The latter is more stimulating, and indicated in subacute and chronic forms as a substitute for tar preparations : Jacobi recommends after the removal of crusts: 246 DIGEST OF EXTERNAL THERAPEUTICS. Bismuth Subnitrate, 5 parts, Vaseline, Zinc Oxide Ointment, each 20 parts, or Hebra's Diachlyon Oint- ment spread on linen and worn for days or weeks. Salicylic Acid or Sulphur: 20 to 30 grains of either to the ounce often has striking effects after subsidence of acute symptoms, or when the condition from the onset has been more of a moist exudation. (B. H.) Salicylic Sulphur Ointment: Nothing, says Hard- away, is so useful in the dry, scaly, chronic forms of the disease ; the following combination being recom- mended : #. Acid. Salicylic!, 9j-~3ss. Sulphur. Preecipitati, 3J. Vaselini, Jj. Ol. Limonis, q. s. Sig. Rub in scalp thoroughly once or twice daily. The following is recommended as the best applica- tion after the more acute symptoms have disap- peared : #. Ung. Picis Liq., 5j-ij. Zinc. Oxidi, 3j- Ung. Aq. Rosae, j. M. Sig' Spread on muslin if there is no hair; otherwise smear on gently with the fingers. (B. H.) Nitrate of Silver: 1 to 2 per cent, solutions ap- plied daily, or at longer intervals, followed by salves. (Duh.) Resorcin: 5 per cent, as a salve or lotion with glycerine or alcohol is of benefit. (B. H.) Balsam Peru: Useful in children when the healing process is slow. (Jac. ) ECZEMA. 247 Tar : Used when still stronger stimulation is nec- essary, viz.: #. Ol. Cadini, %ss. Ol. Olivse, gj. M. (B. H.) For adults when there is intense pruritus. Or, I*. Picis Liquidae, 3J. Vaselini, ^j. M. (Vn.) Tar and mercury together often act beneficially, viz.: #. Hydrarg. Ammoniat., 9j. Liq. Carbonis Deterg. , 3J. Lanolini, ^j. M. 'B. H.) Tannic Acid : When there is a tendency to greasi- ness. The following ointment is useful : 9>. Acid. Tannici, 3 S5 ~j- Acid. Carbolici, M.v-x. Cerat. Galeni, j. M, (B. H.) Calomel and White Precipitate : These remedies may be substituted for tar with the same indica- tions, when the latter is not well tolerated. They may be used alone in the strength of from 20 to 60 grains to the ounce. Calomel ointment has a stimu- lating and drying effect and is useful when there is discharge. Glycerine and Alcohol: May be substituted in the various preparations for vaseline when the hair is long. All ointments should be soft. 248 DIGEST OF EXTERNAL THERAPEUTICS. Universal Eczema. The patient should be kept in bed. The most effect- ive applications are lotions and oils, viz.: Carron Oil, Cotton Seed Oil, and Carbolic Acid, 1 part of the acid to 60 of the oil, or anoint the body with Vaseline and apply Starch Powder, or Salicylic Acid in Olive Oil, 1 part to 30. (Ja.) Bulkley recommends after drying the skin : 9. Acid. Carbolic!, 9J~3J- Amyl. Glyceriti, giv. Macintosh's cream is an excellent preparation. Its composition is as follows : #. Bismuth. Subnitratis, 3ij- Zinc. Oxidi, 3 s8 - Glycerini, o^ ss - Acid. Carbolici, M.xx-xxx. M. Sig. Apply with a brush. The carbolic acid may be omitted or reduced for universal application. (B. H.) Alkaline Baths : Followed by one of the oily ap- plications, after gently drying the skin, are effective. The bath, temperature of which should be 98, should continue for ten or fifteen minutes. The best way to dry the body is to wrap the patient in a warm sheet and pat the skin dry. After replacing the patient in bed cover him with dusting powders and wrap him in a sheet. When the skin is thick and scaly, Wilkinson's Ointment 10 per cent., pigments of Salicylic Acid or Chrysarobin in Traumaticine, Sulphate of Zinc, gij- iv Oj, and the following solution of Lead and Tar : ECZEMA. 249 #. Liq. Carbon. Deterg., 3^j- Liq. Plunibi Subacetatis, 3ij- Aq. Destill., S V "J- M. (B. H.) Solutions of Menthol and Carbolic will prove use- ful for the relief of the pruritus, see that subject. ECZEMA SEBORRHCEICUM. The principal treatment is local and most cases, even those of long standing, will be found amenable to mild measures. Sulphur : One of the best remedies for the moist variety. Among its combinations the following will prove useful : I. Sulphur, prgecipitati, Zinc. Oxidi, gr. xv-1. Lanolini, Ol. Amygdalae, aa n 'j- Ext. Violet., q. s. M. M. (Brocq.) Resorcin : One of the most effective remedies in solution and ointments. (F.) For the hairy parts a solution in alcohol and water is as follows : #. Resorcini, 3 SS ~J- Spts. Vini Rect., Aq. Destill., aa giss. M. Or, ffc. Resorcini, gr. x-xxx. Ung. Aq. Rosae, 253. M. Sig. Apply twice daily. (B. H.) 250 DIGEST OF EXTERNAL THERAPEUTICS. For irritable forms in the folds of the skin, and for the moist variety, the following may be used with good effect : #. Resorcini, gr. xij. Zinc. Oxidi, 3 SS -3J- Cerat. Simp., 3v. M. For the disease in children the following is espe- cially recommended : After removal of crusts apply compresses soaked in resorcin, 61000. At night apply an ointment of 1 part of Balsam of Peru and 30 of vaseline. (T., 96.) Sulphur and resorcin may be combined with ad- vantage. A 3 to 6 or 10 per cent, salve of the former with 1 to 3 per cent, of resorcin may be employed. The following constitutes a useful formula : #. Resorcini, gr. v-x. Sulphur. Praecipitati, gr. xv- 3 ss. Ung. Aquae Rosee, 3J. M. (B. H.) Boric Acid or Salicylic Acid may sometimes be substituted for resorcin, the former in 3 to 5 per cent, strength and the latter in 1 to 2 per cent. Calomel: The following combination is often used : #. Hydrarg. Chlorid. Mitis, gr. viij-xv. Zinc. Oxidi, 3ss-j- Petrolati, 3 v. M. (Vn. ) Chrysarobin, Anthrarobin, and Pyrogallic Acid in the strength of 2 to 10 per cent, ointments or lotions may be used in those cases marked by scaliness and incrustation (Ja.), and in those resembling psoriasis. (B.H.) EMPHYSEMA. 251 Oil of Cade and Ichthyol ointments are beneficial. Ichthyol Soap should be used for general cleansing, and Sublimate Soap for the scalp. EMPHYSEMA. Systematic long-continued practices in Expiratory Exercise are recommended. (T., 97.) Condensed Air Baths: Often afford marked relief, but are contra-indicated when there are cardiac lesions and when the age of the patient is over 50. (F.) In regard to the use of this agent Dr. J. K. Fowler -writes as follows : I have given a prolonged trial at the Brompton Hospital of the use of the compressed air bath in the treatment of emphysema associated with bronchitis, and am able to support the favorable opinions which have been expressed as to its great value. Patients almost invariably state that they breathe more freely while in the bath, and after a considerable number of baths (from twenty to thirty or more) have been taken this feeling becomes continuous, and has remained while the patients have been under treatment. In addition to the greater freedom of respiration and increased capacity for excretion, the cough becomes less frequent, and the quantity of ex- pectoration is reduced. In a healthy person the effect on the respiratory organs of submitting the bod}^ as a whole to air gradually condensed to the extent of three-sevenths or one-half an atmosphere is to cause diminished fre- 252 DIGEST OF EXTERNAL THERAPEUTICS. quency of respiration, enlargement of the lungs, in- crease of the vital capacity, and probably also an increase in the amount of the oxygen absorbed. In the subject of emplrysema, however, the effect of the bath is to cause a reduction in the size of the chest, as ascertained by measurement of the circumference ; and also in the amount of distension of the lungs, as proved by the reappearance of dulness in the pras- cordial and hepatic regions. The diaphragm is raised instead of being lowered, and epigastric pulsation may be replaced by an impulse more nearly in the normal situation of the apex beat of the heart. It appears probable that the condensed air pene- trates into parts of the lungs w r hich have been long unused in respiration, and in which air has been, so to speak, imprisoned at a high pressure ; the escape of this air is facilitated, and contraction of the lung follows. (Alb.) Ozone Inhalations : Have been used, it is said, with apparently good effect. (F.) Oxygen Inhalations: Sometimes prove useful. (Gn.) Treatment of Waldenburg: This consists of in- spiring compressed air and expiring into ratified air. It is recommended as deserving further trial. (An.) Forcible Compression of the Chest: This must usually be exercised by an attendant. An apparatus is described by Strumpell for this purpose. It con- sists of two boards fastened behind and allowed to project in front, so that the patient, taking hold of the projecting ends, can compress his own chest with each expiration. Compression should be coincident with each expiratory movement. (Ty.) EMPYEMA. 253 EMPYEMA. Local treatment is surgical. Pus must be removed by aspiration or incision. Aspiration : Adequate for the majority of cases. (L. T.) It may be employed when septic symptoms are not urgent. (W.) Anaesthesia is condemned as dangerous (Sj.), but local anaesthesia in the form of rhigoline or injections of cocaine may be advantage- ously employed. It is advisable to make an explor- atory puncture before operating. Incision and Free Drainage : The incision should be from two to three inches long, and a large sized drainage tube inserted with the end secured with a safety pin. It should be made in the eighth inter- costal space a little back of the axillary line ; the skin and muscles are gradually divided down to the pleura, which is then incised. Strict antisepsis should be observed in all details, and the patient should be anaesthetized . ( Ger . ) Exsection of the Rib: Recommended for free drainage, removing about one to two inches of the rib. It is superior to simple incision on account of the free exit which it affords, allowing the large masses of fibrinous pus to escape. (L. T.) It has also been recommended for children, on account of the smallness of the space between the ribs, which produces compression of the drainage tube. (T., 96.) Irrigation : Formerly thought to be of primary importance and absolutely essential. Many recent writers, however, are beginning to regard it in a somewhat different light. All agree that it is imper- ative when the pus is offensive. (L. T.) 254 DIGEST OF EXTERNAL THERAPEUTICS. Salicylic Acid 3 per cent, or Boric Acid saturated solution of sterilized water are recommended for irri- gation of the cavity after removal of pus. (L. T.) Hydrogen Peroxide : Diluted one-half, especially recommended for washing out the cavity. (Gn.). Pyoktanin Blue : In solution 1-1000 to 2000, is well adapted for irrigation, being non-poisonous. (Al.) Hydrarg. Bichlorid.: 1-5000 for irrigation, fol- lowed by a final flushing of the cavity of 11000 ; great care should be observed to drain off all residue of this solution by turning the patient on the side. (Ger.) This agent is recommended by many sur- geons. Tr. Iodine : The undiluted tincture, Bartholow says, may be thrown into the cavity without risk and with great benefit. The Liq. lodi Comp. in the proportion of 1 part to 15 of distilled water may also be used for wash- ing out the cavity. (B.) Styrone: For washing cavity after exsection of the rib, solutions of 1200 may be used, gradually increasing 140. ( Al. ) lodoform Gauze Packing : The careful introduc- tion, into the incision, of a roll of iodoform gauze is preferred by some to irrigation, except when the pus is offensive. A pad of oakum covered with the gauze forms an excellent dressing for old cases. (L. T.) Syphon of Revilloid: This method is recommended for intractable cases which are incurable by the so- called classical methods. Favorable results have been reported in cases of this unpromising nature. It EMPYEMA. 255 is described as follows: The syphon consists of a tube of black rubber which is inserted into the pleural cavity ; two feet from the proximal end is placed a bulb ; the tube is continued for three or four feet, and its end is placed in a receptacle containing an antiseptic solution either carbolic acid or creo- lin so as to prevent the entrance of air. The proxi- mal end is retained in position with plaster. If there is no fistula, an incision is made near the posterior axillary line. After making the incision, which should be large enough to allow the free escape of pus, the syphon is introduced, and the lips of the in- cision hermetically sealed around the tube. All that is necessary now is careful watchfulness on the part of the surgeon. (B. M. S. J., 11, 22, 94.) Estlander's Operation: Maybe considered in old and inveterate cases with or without sinuses. (Ger.) James' Method for Expansion of the Lungs: This has been practiced with success. The patient for a certain time transfers water by air pressure from one bottle to another. The bottles should hold about a gallon each, and by an arrangement of tubes the patient forces the water from one bottle to another. The strength or quantity of the transfer is increased as the patient's strength progresses. Thus the ex- pansion of the lung is systematically practiced. The abscess cavity is gradually closed, partly by expan- sion of the lung and partly by the falling in of the chest walls. (An.) 256 DIGEST OF EXTERNAL THERAPEUTICS. ENCEPHALITIS, MENINGITIS, AND CEREBRAL CONGESTION. Ice Bags and Cold Compresses should be applied to the head, and the patient kept in bed with as little physical restraint as possible. (Gn.) In cerebral congestion with much mental excite- ment, great and speedy relief may frequently be ob- tained by packing the legs from the groin to the leet inclusive in large towels which have been wrung out in hot mustard water. The towels should be covered with blankets, and after the pack the limbs should be quickly rubbed with tepid damp towels. (Rd.) ENDOCARDITIS. ACUTE ENDOCARDITIS. Ice Bag: Applied over the region of the heart aifords marked amelioration of symptoms in en- docarditis from acute infectious diseases, the pain and palpitation are relieved and the temperature lowered. A layer of flannel should be placed be- tween the bag and the skin, otherwise erythema may appear. (T., 98.) Hot Fomentations: As mustard or linseed poul- tices, for relief of pain are preferred in some cases. (Bt.) Blisters: These are often beneficial in rheumatic forms. Dr. Caton, of Edinburgh, recommends the following line of treatment to prevent the occurrence ENDOCARDITIS. 257 of valvular disease of the heart; to complete the method the internal remedies are also mentioned : Protect the patient from exposure to cold by cloth- ing with warm woolen garments next to the skin during the whole of the acute period, and insist upon prolonged absolute rest. In the way of medicines give gentle cholagogues with some of the salicylate preparations. Diet should be light and simple. When pain fails to yield to this treatment, it is quickly dis- pelled by Davies' method of treating rheumatism by the application of small blisters to the joints. Under this treatment 82 or 83 per cent, of his cases re- cover without cardiac complications. In the arrest of cardiac valvular disease, when once developed, the salicylates were found to be of little or no benefit. When the cardiac bruit is first perceptible, or there occurs a muffling of the first sound at the apex, Caton applies in the course of the third, fourth, fifth, or sixth intercostal nerves small blisters, not much larger than a shilling, in succession, one at a time. The patient is kept in bed absolutely recumbent, and as quiet as possible, for several weeks. In addition to the salicylates, 8 or 10 grain doses of sodium iodide, or potassium iodide, are given three times daily, in the hope that it may help to absorb inflam- matory products. In about five-sevenths of these cases the bruit vanishes, and the patient leaves the hospital with a sound heart. If these patients have a relapse, or a second attack of rheumatism within a few months, the endocarditis is almost sure to return. (E. M. J., 4, 99.) CHRONIC ENDOCARDITIS. See Valvular Disease of the Heart. 18 258 DIGEST OF EXTERNAL THERAPEUTICS. ENDOCERVICITIS AND CERVICITIS. ACUTE ENDOCERVICITIS AND CERVICITIS. From a clinical standpoint these conditions do not need to be considered separately from Acute Endo- metritis and Metritis. CHRONIC ENDOCERVICITIS, AND CERVICITIS AND EROSION. Remove the plug of mucus from the cervix with cotton on an applicator, and thoroughly cleanse be- fore using local remedial agents. Tepid Water Douches: For cleanliness unless the hot water douche is used. Hot Water Douches: Large quantities of very hot "water are generally employed, with good effect, but at the same time frequently abused. (Sw.) Iodine : One of the most efffcacious remedies, indi- cated in granular degenerations and in all chronic conditions ; contra-indicated in acute inflammations. Apply with a brush, inserting it well up in the canal. Churchill's iodine should be used. (Sw.) The following is recommended when there is uterine colic : Tr. Iodine and Creosote each, 3J- Glycerine, gj. To be applied on tampons. (Ch. ) Glycerine: The chief agent is local applications for relief of congestion ; used largely as a vehicle for other remedies, as well as for its local depleting effects. ENDOCERVICITIS AND CERVICITIS. 259 Ichthyol: Regarded by many as one of the most efficient remedies ; is of great benefit and wide range of application. It is used in various strengths, from 5 to 50 per cent, in glycerine, sometimes pure. (F.) lodotannin: Packed around cervix is of un- doubted value ; alterative and astringent. (B.) Carbolic Acid: As a disinfectant, in 2 to 5 per cent, solutions for douches; also as a mild caustic and a stimulant for erosions. (Sw.) Boroglyceride : One of the most valuable applica- tions in erosions with effusive leucorrhoea and itch- ing of the parts. Used diluted with twice its bulk in glycerine or in the form of a cerate. Calendula : When erosions are very red and bleed easily, this remedy may be used with good effect in varying strengths ; 2 drachms to 8 ounces of tepid water will form a useful douche. Non-alcoholic prep- arations are preferable. (M. H.) Hydrastis: Useful in powder, tincture or cerate in cases attended with profuse stringy leucorrhcea. Equal parts of the extract and boroglycerine very useful. (Bt.) Hamamelis : May be used when soothing effects are indicated, as in erosions that are sore and bleed- ing attended with venous engorgement and piles; the cerate or watery extract with equal parts of glycerine, as an application or injection. lodoform added is a useful adjuvant. (Bt.) lodoform: A very effective remedy. Its odor may be somewhat counteracted by chloral hydrate, the tampon being soaked in the following : I*. lodofornii, 3j- Chloral. Hydratis, gr. xx. Glycerini, 5J- M. 260 DIGEST OF EXTERNAL THERAPEUTICS. Sanguinaria: Equal parts with myrrh and hy- drastis mixed so as to form a fine powder, applied in the usual way with wool tampons, form a most ex- cellent and effective remedy. (Sw.) Tannin : For astringent effect when relaxation of the parts is prominent, applied on glyceriene tam- pons. (M. H.) Chromic Acid: A 50 per cent, aqueous solution in obstinate cases with glairy mucus discharge, espe- cially when a laceration exists. Application should be made only once a week in exceptional cases. (Sw.) Zinc Oleate : 1 part with iodoform 2 parts as an astringent when parts are excoriated and there is a fetid leucorrhoea. (F.) Thymol : 11000 or 3000 on glycerine tampons. (F.) Zinc Sozoiodate: The powder gives satisfactory results. (Al.) Aristol : When the consent of the patient cannot be obtained for the repair of a lacerated cervix, a pencil of 5 grains of aristol made up with gum arabic may be introduced daily and retained by a tampon. It should remain in for t\venty-four hours ; then the cervical canal should be syringed out with the following solution, using 2 tablespoonfuls to a quart of water : Salicylic Acid, 4 parts. Spts. Lavender, 30 parts. Water, 450 parts. (T., 9 8.) The aforementioned remedies are nearly all to be applied on glycerine tampons. For the use of injec- tions, see Leucorrhoea. ENDOMETRITIS AND METRITIS. 261 Lactic Acid : It is claimed that this agent is a natural antiseptic for the vaginal cavity. 3 per cent, solutions destroy the bad odor and greenish-yellow color of the leucorrhoea and diminish the amount of secretion. It is of benefit in endometritis and endo- cervicitis. Douches of 135, and the introduction of tampons, 1 part to 33 of glycerine every eight days with daily hot water douches in the intervals, is the line of treatment recommended. (N. R., 1, 8, 99.) Curettage : When other means have failed, and the cervix remains thickened and enlarged, the entire surface from the internal to the external os should be scraped with the curette. (K. C.) For details of procedure see works on Gynaecology. Schrceder's Operation : This is indicated when the disease has penetrated deeply, where superficial ap- plications will always fail. Deep acting caustics may have curative effect, but they produce cicatrical con- traction. Thorough excision and covering the ex- posed surface by a plastic operation, as recommended by Schroeder, will give the best results. (Dud.) Steam Vaporization for the treatment of endocer- vicitis has recently been employed. See Endometritis. ENDOMETRITIS AND METRITIS. ACUTE ENDOMETRITIS AND METRITIS. Mild Forms. Rest in bed and Hot Vaginal Douches, tempera- ture, 115; four quarts of water should be used every three or four hours. (K. C.) 262 DIGEST OF EXTERNAL THERAPEUTICS. Hot Fomentations : Applied over the hypogas- trium will generally control pain and render opi- ates unnecessary. (Cp.) Scarification of the Cervix : May be employed with good effect to induce rapid depletion ; after an interval of four or five hours, use hot douches fol- lowed by glycerine tampons. (K. C.) More Severe Forms. Gonorrhoeal : Dilate the cervix under anaesthesia so as to admit a small sized uterine speculum, then copiously irrigate with Bichloride of Mercury, 1- 3000, use a quart, then pack the cavity with steril- ized gauze, one end of which should be allowed to remain in the vagina to permit of easy removal. The vaginitis, which is present, should receive treat- ment. At the end of twenty-four hours this pro- cedure should be repeated. The os will remain open sufficiently to dispense with dilatation again. Creo- lin will facilitate the introduction of the gauze. (K.C.) Argentamine : Has been used with success in gon- orrhoeal forms. A hollow rubber sound is introduced into the uterus, then the solution is poured into the speculum and reaches the cavity of the uterus through the sound. After withdra wing the sound the vagina should be washed out carefully. Solu- tions of 1-3000-2000, and later 1-1000 are used. (N. M.) Ice or the Wet Pack to the Abdomen: Should be employed in conjunction with complete rest. (T., 96.) Cauterization: May be tried, if the appendages ENDOMETRITIS AND METRITIS. 263 are in good condition, in order to destroy the gono- cocci, use Phenol Alcohol, 50 per cent. Chloride of Zinc, 20 per cent., Tr. Iodine, 20 per cent., or Ni- trate of Silver, 10 per cent. (T., 96.) Septic Inflammation Folio wing Operations : When in the non-pregnant uterus prompt measures are nec- essary ; the cut surfaces of the cervix should be ex- posed and freely cauterized with pure Carbolic Acid, and the uterine cavity irrigated with Bichloride of Mercury Solution, 1-3000, then packed with Steril- ized Gauze. Curetting is rarely required in this con- dition. The wounded surfaces should be kept apart by sterilized gauze which should be retained by pack- ing the vagina with the same. If the symptoms im- prove, remove the vaginal packing at the end of two days, leaving that of the uterus in place for four or five days. It should then be withdrawn and the cavity not entered again. Vaginal douches should be employed after the removal of the vaginal pack- ing and continued until the removal of the uterine packing; then apply glycerine tampons. The cut surfaces should then receive attention, being treated by cauterants and astringents, or a new operation performed as deemed best. If unfavorable symp- toms continue, employ the treatment mentioned for the graver forms. (K. C.) Grave Forms of Inflammation Puerperal. See also Septicaemia. Curettage : The cavity of the uterus should receive prompt and energetic treatment without delay. Cleanse the vulva, vagina, cervix, and cervical canal with a copious supply of water and green soap, 264 DIGEST OF EXTERNAL THERAPEUTICS. using the finger and a wad of cotton in a pair of long handled forceps. Dilate the internal os if necessary ; then irrigate the cavity of the uterus freely with bi- chloride of mercury, 12000. After the irrigation curettage should be done, examining with the fingers from time to time to make sure that all detritus has been removed. The sharp curette, double curette for- ceps, or placental forceps are recommended. After curetting, irrigate with the same solution at a tem- perature of 115 to 120. Even if there is excessive haemorrhage, little time should be given during curet- ting to checking the bleeding, which is most always copious, as the hot irrigation soon to be applied will arrest it. After this procedure pack the uterine cavity with folds of sterilized gauze through the uterine speculum. At the end of twenty-four hours remove the packing, and if there is no fever the cavity of the uterus may be left, but if the tempera- ture is still elevated remove the packing, irrigate and apply fresh. This should be repeated at intervals as indicated. This treatment by curettage and drain- age should be persistently pursued in even the most desperate cases. (K. C.) Alcohol Gauze : Gauze soaked in alcohol and used for packing is recommended by Grandin, who says iodoform gauze is liable occasionally to produce poi- soning. (E. J.) Hydrogen Peroxide: Commended for flushing out cavity of uterus after curettage. (Al.) Lysol, Potass. Permang., and Carbolic Acid, in vaginal douches may be repeated every two or three hours; if there is no improvement wash out the uterus with mild antiseptic solutions, repeating every twelve or twenty-four hours. (T., 96.) ENDOMETRITIS AND METRITIS. 265 Camphorated Alcohol: Recommended for cauter- izing after curettage for removal of placental frag- ments. (T., 96.) Continuous Irrigation : Advocated when the tem- perature remains unaffected. Weak Carbolic, Boric Acid, or Lysol solutions are used. Irrigation is maintained continuously for twelve hours or more. Following this the inner surface of the uterus is painted with Tincture of Iodine undiluted. (T., 98.) Antistreptococci Serum : The class of cases in which the serum is of value includes those which arise from the presence of the streptococcus pyogenes the common type of septicaemia. Puerperal infection caused by the gonococcus, the bacillus coli com- munis and the staphylococcus are not 'amenable to the antistreptococci serum. For the method of ad- ministration of this agent see Septicaemia. (T., 99.) CHRONIC ENDOMETRITIS AND METRITIS. Displacements and lacerations should receive im- mediate attention. Acute and subacute metritis, inflammation of the appendages, para- and perimetritis, are contra-indi- cations to local interference in the endometrium. Cervical or vaginal catarrh if present should also re- ceive attention. The plug of mucus in the cervical canal must first be extracted before anything can be accomplished; this is sometimes difficult with ordinary forceps or applications of cotton. In this case a small syringe with a short rubber tubing attached to the nozzle may be used. The tubing is inserted into the ex- ternal os, and the mucus removed by suction. A 266 DIGEST OF EXTERNAL THERAPEUTICS. narrow piece of sponge on forceps may also be em- ployed for this purpose. If the os is contracted it must be dilated or incised in order to admit of free exit for the pent up secretions. (Sw.) The remedies mentioned for chronic endocervicitis for application to the external os and cervical canal are also indicated in this condition. The reader is, therefore, referred to that subject. Local Depletion : Will temporarily relieve, allow- ing about half an ounce of blood to escape by punct- ure or scarification. (Sw.) Hot Water Douches and Hot Sitz Baths : The systematic use of the hot douche combined with the hot sitz bath is very important. (Sw.) Glycerine Tampons: Frequently applied tend to depletion, and should follow daily the hot water douches. (K. C.) Electricity : Great benefit is sometimes afforded by a mild galvanic current applied every second or third day, negative pole in the uterus, positive over the hypogastrium. The current should be from 8 to 12 milliamperes. (Sw.) In the stage of infiltration the positive pole of the galvanic current and zinc elec- trorysis with faradization; in the stage of indura- tion, dilatation, curettage and gauze packing prove more satisfactory according to Goelet. (Sj.) Intratiterine Applications: In addition to the aforementioned remedial agents, applications di- rectly to the surface of the endometrium are em- ployed. There seems to be some divergence of opin- ion as to the utility of these measures, especially in regard to the cauterants, which are condemned by some as more harmful than productive of good. On the other hand, the most recent writers advocate ENDOMETRITIS AND METRITIS. 267 their employment. The remedies which meet with the most general approbation in utraiiterine treat- ment are Iodized Phenol, Carbolic Acid pure, and Iodine ; the best results being obtained after curet- tage. Before adopting this method the os should be dilated with laminaria tents, and no irrigation of the uterine cavity should be attempted unless the os is patulous. The external parts should be scrubbed with soap and water, antiseptic vaginal douches ad- ministered, the vagina wiped dry and swabbed with a 5 per cent, solution of Carbolic Acid, then with a 1 per cent, solution of Creolin ; slight traction is made on the cervix with the blunt hook or tenacu- lum. After the application has been made, a tampon of Ichthyol Ammoniate 1-10 in glycerine is advised, and over this a dry cotton tampon. (Dud.) Carbolic Acid : The undiluted acid is generally re- garded as the safest and most efficient remedy, since it does not burn deep enough to destroy the submu- cous tissue. (Sj.) According to Bartholow it is the best agent for the treatment of uterine catarrh. Ichthyol: Applied pure to the fundus gives relief to pain and dragging sensation and lessens leucor- rhoea. (F.) Tr. lodi Comp. (Churchill's): This remedy is much used and is very generally advised. (Sw.) Iron Sesqui chloride: In mild forms with metror- rhagia, also in bleeding from myomata, and paren- chymatous haemorrhages, injections into the uterine cavity without dilatation have been recommended. (T., 96.) Zinc Chloride: 10 per cent, solutions are used. Munde has employed 50 per cent, solutions with good results in the worst cases. The solution is to 268 DIGEST OF EXTERNAL THERAPEUTICS. be thoroughly applied and followed by the insertion of a sterilized drain through the internal os. Treat- ment by this agent has been abandoned by many because of the tendency to cicatrization of the sur- face. (Sj.) Iodized Phenol: Recommended also by Munde for use in milder cases, and for cauterization after the use of the strong zinc chloride, when a second cauter- ant application is deemed advisable. A sterilized drainage tube is to be inserted through the internal os as above. Nitric Acid : When the disease fails to respond to ordinary treatment, and the mucous follicles are the seat of cystic degeneration, or when the granula- tions have become very exuberant, this agent is use- ful. The cavity of the uterus may be touched with a cotton wrapped applicator dipped in the acid; the parts should be first thoroughly cleansed and the cervix well protected from the acid. It is well to place in the vagina beneath the cervix a pledget of cotton soaked in a solution of bicarbonate of soda to protect the vaginal mucous membrane. After the acid has been used, remove the cotton and syringe with water, after which a glycerine tampon is ap- plied and renewed daily. Nitric acid is condemned by some writers, together with other powerful caus- tics, as decidedly injurious. It is, however, recom- mended in those cases of the hasmorrhagic type which develop in connection with the menopause and membraneous exudation. A vulcanite intra- uterine speculum is recommended to prevent the acid from getting on the cervical canal. (Alb.) Actual Cautery: This agent may be employed in inveterate cases of the variety mentioned as indicat- ing the use of nitric acid. (K. C.) ENDOMETRITIS AND METRITIS. 269 Chromic Acid: Solution of 15 grains to 1 drachm. (B.) Curettage : For intractable forms, contra-indi- cated when there is inflammation of the uterine ap- pendages; anaesthesia and thorough antisepsis are essential. After thoroughly cleansing and douching with antiseptic solutions, dilate the cervix, insert a uterine cylindrical speculum, and flush the cavity of the uterus with a warm solution of bichloride of mer- cury, 12000, to the amount of one or two pints. Then follow with the curette, using a sharp instru- ment aided by the double curette or forceps of Emmet. After this introduce again the uterine spec- ulum and irrigate copiously with the bichloride solu- tion same as before. The uterus is then packed with a strip of gauze which has been previously placed in a bichloride of mercury solution 1500. This gauze should be a strip about four feet in length and folded four times. Catch an end upon a Sims tampon screw, and pass it into the uterus through the specu- lum, length by length, packing it in carefully, first at one cornu then at the other, then at the fundus, gradually withdrawing the speculum. The vagina is then packed with gauze. At the end of forty-eight hours the vaginal packing is removed ; the vagina is then douched twice daily until the uterine packing is removed, which is done on the sixth day. The vigor with which the curettage is performed will depend upon the conditions present ; haemorrhagic forms call for a more energetic application than recent subin- volution, or the endometritis of simple stenosis. The anterior and posterior walls, the fundus and the sulci and the recesses of each cornu are all to be scraped in turn. (K. C.) (Alb.) 270 DIGEST OF EXTERNAL THERAPEUTICS. The following line of treatment has been suggested for endometritis in aged women attended -with puru- lent vaginal discharge: Swab out the vagina with strong Carbolic Acid, or prescribe frequent astring- ent injections such as Zinc Chloride 5 to 10 grains to the pint. Repeat the carbolic acid applications two or three times, taking care that none goes on the vulva. If this is not successful, dilate the cervix with laminaria tents and explore the interior; if growths are discovered examine specimens of the structure microscopically ; if there are no growths scrape with the blunt curette and swab the cavity with Carbolic Acid. This is said to always remove the symptoms for a time. (T., 98.) The following are recommended for glandular forms : Sodium Solutions: To remove mucous secretions, employ sodium solutions injected daily by means of a simple catheter, followed by Carbolic Acid 2^ per cent, solution, and finally by Lysol Solution 1 per cent. Another plan of treatment for slight glandular endometritis consists of the injection of ^4 to % quart of Sodium Solution, 3 per cent., followed by (according to caue) Carbolic Acid, 2 per cent., Lysol, 1/2 per cent., Nitrate of Silver, 2 per cent., or Zinc Chloride or Cupric Sulphate or Cupric Aluminate, 5 per cent. These injections are made into the uterus through an ordinary catheter, the instrument being moved from side to side to allow the fluid to flow out. The instrument having been removed, a tampon of iodoform gauze is placed below the uterus, and the patient allowed to rest an hour to avert uterine colic. (T., 96.) Traumatol: Pencils are recommended as having produced successful results. (F.) ENDOMETRITIS AND METRITIS. 271 Vaporization: Introduction of steam into the uterine cavity has been used in hyperplastic endome- tritis with severe haemorrhage. (F.) With regard to the technique of the procedure, the use of a wooden tube for the protection of the cervix is ad- vised. This is considered preferable to gauze, which becomes too readih" saturated \vith hot vapor. The wooden tubes should be kept in a disinfectant solu- tion. If there is a tendency of the tubing for con- ducting the steam to become stopped with clots, it will be necessary to carefully empty the uterus of blood ; the vapor heated to 110 C. will arrest the haemorrhage in a short time. It is desirable to use vapor for the shortest possible time; one-quarter minute is sufficient for most cases, and one-half min- ute should be considered the maximum. The tem- perature should range between 102 and 110 C. The higher the temperature the shorter the time of application. (C. G., 8, 24, 98.) Brothers, in writing of intraliterine vaporization, says that although the treatment of haemorrhage by heat is of ancient origin, the use of steam, at a temperature of the boiling-point or above, for haemo- static purposes, is of recent origin. After describing the apparatus of Pincus, and citing twenty-one cases in his own experience, he summarizes the present uses of vaporization or vapocauterization, as fol- lows: (1) As a haemostatic it has been employed most successfully in cases of non-malignant post- climacteric uterine haemorrhages. It has proved curative in the various irregular bleedings met with in connection with catarrhal fungoid, or haemor- rhagic endometritis. It acts as a palliative measure in certain cases of fibroid tumor or inoperable car- 272 DIGEST OF EXTERNAL THERAPEUTICS. cinoma associated with haemorrhages; (2) as a caustic it can be relied on to destroy the mucous lin- ing of the uterus, even to the extent of obliterating the uterine canal ; (3) as a bactericide it may be used in cases of gonorrhoeal or septic puerperal endome- tritis. Fenomenow has repeatedly had the uterus (which was subjected to vaporization and later re- moved by hysterectomy) examined bacteriologically and proved it to be sterile ; (4) to reduce the bulk of the subinvoluted uterus, Pincus has frequently re- sorted to intrauterine vaporization with success ; (5) in chronic suppurating fistulous tracts, Feno- menow has reported successful results in cases of ab- dominal fistulas of several years' duration, which had resisted all other methods of treatment. (N. Y. M.J. 5, 13, 99.) The following general line of treatment is recom- mended in place of more conventional methods : Va- ginal douches, astringent injections, vaginal and intrauterine applications of dry powders, intra- uterine pencils, intrauterine gauze tamponing. (Dud.) Euphorbin: Intrauterine pencils are used. (F.) The following solutions are recommended by Pozzi for injections : Hydrarg. Bichlorid., 1-3000. Alum, 3SS-OJ. Tannic Acid, ^ss-Oj. Boric Acid, 3j-O. ENURESIS. 273 ENURESIS. The bladder should be emptied before retiring, and the patient should sleep on a hard mattress with light clothing, and avoid lying on the back ; this may be prevented by fastening an empty cotton spool to a belt so arranged as to cause pressure on the lum- bar region as soon as the supine position is assumed. About two hours after sleep the patient should be awakened, as it is at this time usually the discharge of urine occurs. At bedtime, a Warm Bath at 90 to 98 F., or a Warm Sitz Bath or Cold Sponging of the lumbar region is often of value. Open air Exercise and Cold Baths every morning should be enjoined. Children troubled with urinary incontinence should be taught to retain their water during the day as long as possible. (Rd.) General Massage, Sponging with alcohol and water 1-6, Friction with coarse towels, and Sea Bathing are beneficial. Nux Vomica : An ointment of 1 part of the ex- tract \vith 16 of lard. A portion the size of a coffee bean inserted into the rectum at night often acts well. (Jac.) Electricity: The interrupted current, one electrode to the perineum, the other to the epigastrium or lumbar region. (Erb.) Collodion: Applied over the meatus, sealing it, has been used, though it is scarcely to be recommended. Strychnine : Occasionally subcutaneous injections into the perineum of -^ to J grain have been effect- ive in intractable and desperate cases. (Jac.) 19 274 DIGEST OF EXTERNAL THERAPEUTICS. EPIDIDYMITIS. Rest and suspension of the scrotum is the first es- sential. When the onset of the disease is announced by pain in the perineum, dragging sensation in the inguinal region and frequent urination, a Hot Bath should be administered and the patient put to bed with the testicles properly supported. (Cn.) Aspiration or Puncture of the Tunica Vaginalis; This is indicated when the pain is intense ; in severe forms of inflammation it affords immediate relief. The sac will fill up again, requiring a repetition of the operation, to which the patient will readily as- sent, so great is the comfort afforded by this meas- ure. Antiseptic precautions are enjoined. After the puncture, and also when it has not been performed, the scrotum should be wrapped in cotton, covered with oiled silk, and placed in a shallow suspensory bandage with lacers, so that equal pressure may be maintained. (Cl.) Tobacco and Flaxseed Poultice: Applied every three hours, completely enveloping the scrotum, and covered with oiled silk and flannel, is useful. (Cl.) Hamamelis: The tincture applied hot in the same manner as the poultice affords great relief. (Cl.) Cold : The usual Ice bag or bladder will act satis, factorily for the relief of pain and inflammation. Ethyl Chloride also relieves and reduces inflamma- tion. (F.) Mercurial Ointment: Alone or mixed with equal parts of Extract of Belladonna made into a paste, EPILEPSY. 275 after the acute and painful symptoms have subsided, for the reduction of swelling. (Cl.) Ammonium Chloride: 4 drachms to the pint, for reduction of swelling in the latter stages. (Al.) Nitrate of Silver: 10 grains to the ounce in the form of an ointment is sometimes used. (Cl.) Strapping : When the pain has ceased this is indi- cated for the reduction of swelling ; pain sometimes follows its application, but it usually disappears in an hour or two ; if it continues the straps should be removed, for in this case they are too tight. The fol- lowing is the method of application: First remove the hair from the scrotum and render the parts aseptic, then cut strips of adhesive plaster an inch wide and 6 to 8 inches long. The spermatic cord about the swelling is encircled with the left hand, and the tumor pressed well down into the scrotum, rendering the walls tense and firm. A piece of muslin bandage is now carried twice around the part in- volved at the upper border and fastened at the end by a strip of adhesive plaster. The muslin prevents the adhesive straps from cutting. The straps are now applied, encircling the upper part of the scrotum, overlapping one another from above down- ward, until a little below the centre, when the direc- tion is changed and carried under the scrotum, bring- ing the pendulous parts upward. A single strap to hold the ends will complete the dressing. After which a suspensory bandage should be put on and the patient permitted to go about. (Cl.) EPILEPSY. See Convulsions. 276 DIGEST OF EXTERNAL THERAPEUTICS. EPISTAXIS. Ice should be applied to the forehead and back of the neck, and a small piece inserted up the nostril; raise the arms above the head and hold them there for a short time; press horizontally on the face bones -with the fingers just above the nostrils, and so compress the blood supply. Immerse the feet and legs in hot water- (Bt.) The patient should sit up- right, and grasp the nostrils tightly between the thumb and index finger, so as to prevent the passage of air. Compress the facial artery and resort at once to tampons if haemorrhage becomes dangerous. (Whar.) Tannic Acid or Alum : In powder hy insufflation or solution by atomizer are both very useful. (Bos.) Agaricus Chirurgorum : Used for plugging the nostrils. (F.) Antipyrin : 20 to 50 per cent, as spray or the powder by insufflation. (Bn. ) Hot "Water : Of service when atrophic rhinitis exists. (Al.) Nitrate of Silver: When a small abrasion or ulcer is the cause, which is accessible, touch the part with a strong solution. (Al.) Hydrogen Peroxide : Injections into nostril full strength, it is said to be very effective ; or a plug of cotton saturated with the remedy may be inserted into the nostril. (T., 98.) lodoform Gauze dipped in Glycerite of Tannin and used as a tampon is effective. (T., 96.) EPISTAXIS. 277 Cocaine : One of the most reliable remedies. It may be applied on pledgets of cotton carried well into the nasal cavity, or better in the following applied with the atomizer : J*. Cocain. Hydrochloratis, gr. xx. Aq. Destill., 3 SS - M. Ft. sol. et adde L,iq. Petrolati vel Ol. Olivae, ad 53. M. (Bos.) Zinc Sulphate: The powder or stronger solution of about 40 per cent. (F.) The following are also recommended for applica- tion in the form of sprays, or on little mops of cot- ton, or in more severe cases on tampons : Tr. Hamamelis; Tr. Perchloride of Iron; Liq. Ferri Sulph., 1 part, water, 8 parts; Vinegar or Acetic Acid, 1 part to 5 parts water (Rd.) (B.) (Al.) Tamponing ; The anterior and posterior nares may be tamponed at the same time, after the usual method described in all surgical works, is necessary in severe cases. A soft rubber catheter, however, is preferable to Bellocq's. Plugging with Small Sponges : This may be done in the following manner : Introduce into the interior nares a small piece of sponge tied to a short silk lig- ature, push it back along the floor of the nose to the posterior nares ; a small piece of sponge about the size of a marble, with a hole in the centre of it is then threaded on the ligature through the hole, this is pushed backward until it comes in contact \vith the first piece; then another is introduced in the same way, and so on until the cavity is completely filled up and the haemorrhage arrested. The sponges 278 DIGEST OF EXTERNAL THERAPEUTICS. should be rendered thoroughly aseptic, and should also be washed in some antiseptic solution. They may remain in from twenty-four to forty-eight hours. (Whar.) Cauterants: The galvano-cautery or chromic acid crystals on a silver probe may be used when the pa- tient is not bleeding, but has recently done so. By throwing a strong light up the nostrils the affected parts may be seen and touched. The galvano- cautery is condemned by some observers, who claim that when the bleeding points can be located a crayon of nitrate of silver or a crystal of chromic acid will usually answer the purpose, and if these fail an ordinary silver probe heated to a dull heat over a spirit lamp will take the place of the galvano- cautery, at the same time being very much more available and more easily applied. EPITHELIOMA. Extirpation by the knife is favored by most sur- geons, who advocate its performance in all cases when practicable except those of the most superficial nature, early removal being regarded as a matter of urgent necessity^ Dermatologists, on the other hand, incline decidedly to the use of caustics, reserving op- erative measures entirely for those parts where it is possible to remove a large amount of tissue without injury to the patient. Caustics they also regard as more certain of success and productive of less de- formity. From the surgeon's standpoint there are two classes of cases in which non-operative treatment is EPITHELIOMA. 279 of service ; those in which the lesion, as first men- tioned, is of a most superficial character, and where such treatment is often successful, and those in which operative measures are absolutely refused, or where from the nature of the case they are not deemed advisable. Non-operative treatment should aim at the com- plete destruction of the diseased tissues and no super- ficial caustics should ever be used, for they do more harm than good. The following are some of the most important methods suggested for the local treatment of this disease : Arsenious Acid : This agent holds the first place among escharotics and forms the basis of several well-known pastes. Arsenical pastes should have the consistency of firm butter; the strength and duration of applica- tions will vary according to the character of the cancer. Hardaway says he regulates the strength according to the case, never making it weaker than equal parts, or stronger than Marsden's. The same \vriter also says that the desired action must be ob- tained, otherwise the patient is injured. Antiseptic dressings are not necessary, as the toxines from the pus organisms are of service in destroying pathologi- cal epithelia. (B. H.) Marsden's Paste: Composed of 2 parts of arseni- ous acid to 1 of gum acacia rubbed together and made into a paste with water, which is added just before applying. It is exceedingly painful and causes oedema. It must be left on for twelve to twenty-four hours, according to the endurance of the patient. The application must be repeated if the growth is 280 DIGEST OF EXTERNAL THERAPEUTICS. not destroyed. Poultices are continually applied after the removal of the pasts until the slough sepa- rates. (Kp.) Manec's Paste: This has stood the test of time. (See Cancer, under arsenious acid, for formula.) Be- fore application, the diseased part must be thor- oughly cleansed of all crusts and detritus by the use of poultices, etc. Then the paste is to be spread on lint and closely fitted and held firmly in place by plasters. The applications must be kept up for one or two \veeks, at the end of which time the eschar falls off. For the other arsenical preparations of this nature see Cancer. Caustic Potassa : According to Van Harlingen this remedy never fails to remove superficial growths when property applied. A stick of the potassa is wrapped in a rag, leaving the point exposed. This is first passed over the surface gently, in order to dis- solve the horny epithelia ; afterwards it is bored down into every part of the growth. When apply- ing it \vill be seen that the unhealthy tissue readily gives away. The action of the caustic being always a little beyond the point of actual contact, this fact must be taken into consideration when operating near important organs. Severe pain will be caused which may be neutralized by the application of 4 to 8 per cent, solutions of cocaine. Dilute acetic acid or weak vinegar should be applied with cloths, to neu- tralize the caustic influence when it has gone far enough and also to lessen the pain. The part should be dressed with olive oil or some soothing ointment and changed daily. At the end of a week or ten days the eschar falls off. After which a rapidly granulat- EPITHELIOMA. 281 ing surface appears, which leaves only a small scar after healing. Methylene Blue: Solutions of 1-20, hypodermic- ally, when the growth is deep seated. (T., 96.) Pyrogallic Acid: This remedy is considered by many observers as the best ; it has the advantage of being almost painless ; a drachm to the ounce is the usual strength of its application, which should be continued consecutively for from two to six days. It \vill have to be reapplied from time to time and the slough scraped away. (F.) Citric Acid: A lotion for the relief of pain is made from a solution of 5 to 6 grains to 1 ounce of water. (Al.) Schwimmer's Treatment: This is adapted to su- perficial epithelioma, and to some forms of the infil- trating variety. The growth is scraped out thor- oughly with a dermal curette, the diseased tissues readily giving way. Haemorrhage should be stopped by pressure. After curetting pyrogallic acid in an ointment (1 part to 2 of base) is applied for four or six days. The ointment produces a black crust and free discharge ; at the end of the four to six days this should be softened by applications of carbolized vaseline left on for a day or two. After its removal apply mercurial plaster, under which the part will heal. (Ja.) Zinc Chloride : Though rarely indicated is some- times employed in solution, paste, or stick. It de- stroys both normal and diseased tissue, though not in equal degree. It may be used in papillomatous growths until the base is reached, then another caustic should be used. Solutions of this agent may 282 DIGEST OF EXTERNAL THERAPEUTICS. be injected into small tumors, where arsenious acid and caustic potassa cannot be used. The formula known as Bongard's Paste, which is usually employed, is as follows : #. Farinae Tritici, Atnyli, aa gj. Pulv. Acid. Arsenosi, gr. viij. Hydrarg. Sulph. Rub., ,^ij. Ammon. Chloridi, . T)ij. Hydrarg. Bichlorid., gr. iv. Zinc. Chloridi Cryst., gj. Aq. Fervid., giss. M. The first six substances are finely ground then mixed in a glass jar. The zinc chloride is dissolved in boiling water, then added to the contents of the mortar, which should be stirred until all the solution is incorporated. Cocaine (5 to 10 per cent, solution) may be added before applying. The paste is spread on muslin and left on for twenty-four hours. If the application is successful all the diseased tissues will appear necrosed. When the growths are large, several applications are necessary. (B. H.) For other preparations of this remedy see Cancer. Lactic Acid: A powerful caustic. Equal parts mixed with finely powdered silica are spread on gum paper and allowed to remain on from twelve to twenty-four hours. (Ja.) The concentrated acid has also been used applied on cotton cloths and covered with an impermeable tissue and bandage. The sur- rounding skin should be protected with adhesive plaster. After the removal of the caustic, the part should be cleansed with cold water and dressed with water dressings for from twelve to twenty-four hours. (N.) Nitric Acid: 10 parts of the fuming acid with 4 of Bichloride of Mercury, made in a syrup by the ERYSIPELAS. 283 addition of Bibulous Paper, is said to form a good caustic which will leave excellent cicatrices. (T., 96.) Chloracetic Acid: This is less suitable than stronger escharotics, but will be of service when the disease is close to some important organ, as the eye, where the influence of the caustic must be circum- scribed. Its action not being deep, applications must be repeated at intervals; a stick or a probe covered with cotton may be used. (Al.) ERYSIPELAS. A great variety of local remedies have been advised for this affection, many of which are not only unnec- essary, but of questionable utility, especially in the milder types, when only the simplest applications, if any, will be required. As the exclusion of air from the surface is grateful, the part should be covered with a light dressing, and when the face is the seat of the affection a light linen or muslin mask, saturated with the selected remedy, may be worn with benefit. Cold Water Dressings: Suitable for mild cases, forming an important and useful adjuvant; they should be changed frequently. (Gn.) After mention- ing a number of applications, Osier adds that per- haps these dressings are as good as any. Carbolized Olive Oil : 1 per cent, for facial erysip- elas. (Den.) Ichthyol: The most highly praised of all remedies. It is used in various combinations. Before applying, the affected part should be cleansed with soap and water, then washed with a solution of bichloride of 284 DIGEST OF EXTERNAL THERAPEUTICS. mercury; the ichthyol preparation should then be thickly spread on and covered with cotton batting. (Al.) A 50 per cent, ointment with lanoline is recom- mended by Unna, covering after with salicylated cotton. It is claimed that it arrests the progress of the disease. (T., 96.) With Collodion, Unna has found the following pig- ment of service : #. Ichthyoli, Etheris, aa ^ss. Collodii, 3j. M. (Al.) With Traumaticine, it is said to have aborted 60 per cent, of cases. The proportions are ichthyol 3 parts, traumaticine 10 parts; this combination, which makes a dark brown liquid, should be applied to the diseased area with a brush, and at least three- quarters of an inch beyond. (F.) The remedy is said to be indicated in all varieties of the disease. (Sj.) Lead and Opium Wash: This old fashioned rem- edy is still regarded as one of the most effective. It is useful to allay the burning. Use laudanum, 2 parts, and liq. plumbi dilutus (U. S. P. ), 4 parts. (Ty.) Trichlorphenol: 1 to 2 per cent, ointment is very effective. (F.) The following solutions are recommended applied with cloths saturated with the same : Boric Acid, saturated solution. (St.) Carbolic Acid, 1 drachm with half a pint each of alcohol and water, applied every alternate hour (Ja.), or half a drachm to a pint of milk; the latter is said to greatly relieve. (Rd.) ERYSIPELAS. 285 Borax, ^ss-Oss. (Hel.) Picric Acid, 6-1000. This remedy has been highly praised. (F.) Grindelia Robusta, 2 drachms of the fluid extract with water half a pint. ( Al.) Resorcin, 2 or 3 per cent, solutions. (F.) Hydrastis, 1 part of the tincture to 5 to 6 of water. (M. H.) Belladonna, 1 part of the tincture, 1 part of gly- cerine, 8 parts of water, recommended by Piffard. Veratrum Viride, 1 drachm of the tincture, tepid water, 2 ounces, one of the best local remedies. (Ga.) Calamine Lotion. (M. W.) Glycerite of Starch; This forms an agreeable sub- stitute for greasy preparations. (M. W.) Alcohol: Cloths kept saturated and covered with some impermeable material. Reported to have been successfully employed in thirty-two cases, when dis- ease was situated on the face and other parts. (Sj.) Vaseline: For application to the face forms a convenient dressing. (F.) Cosmoline: Preferable when an ointment is used, as it interferes less with the function of the skin. (Al.) Benzoated Collodion: Made with equal parts of the compound tincture of benzoin and collodium. (B. H.) Ferric Perchloride: 1 per cent, solution in ether is said to act quickly in aborting. (T., 96.) Salicylic Acid : Half a drachm to a drachm with cosmoline 1 ounce has been employed with satis- factory results. (Al.) Bichloride of Mercury : 1-1000 sprayed on the part at a distance of four inches, and repeated four 286 DIGEST OF EXTERNAL THERAPEUTICS. times daily, has been successfully employed. In us- ing this treatment the eyes should be protected and hair, if present, should be cut off. (Vn.) Solutions of 1-5000 as a dressing have also been employed. (St.) Method of Koch: Creolin 1 part, lodoform 4 parts, Lanolin 10 parts. Applied not only on the affected area but one inch beyond on healthy skin. (Al.) Method of Hallopeau: A mask of several thick- nesses of linen is soaked in a solution of Sodium Sali- cylate 1-20, and applied over the part. A rubber cloth is put on over this to prevent evaporation. Relief, it is said, is almost immediate and cure rapid. (An.) Method of Wcefler: A simple piece of adhesive plaster an inch in width and sufficiently long to sur- round the part is applied an inch or more from the advancing border of the disease. The firmer the pressure the greater the chance of success, which is said to be very marked. This procedure is preferable to that of the Kraske-Reidel method. (B. H.) Carbolic Acid Injections: 1 to2 percent, solutions are used for injections in the part surrounding the diseased surface. This method is painful and liable to cause abscess, at the same time it has been suc- cessful. (Os.) Pilocarpine : ^ grain doses hypodermically inject- ed in the same manner as carbolic acid, until physio- logical effects are produced, have been used. (B. H.) Kraske-Reidel Method: This consists of scarifica- tion partly in the healthy and partly in the diseased skin ; then the application of gauze wet with a solu- tion of bichloride of mercury 11000. The method ERYSIPELAS, PHLEGMONOUS-CELLULITIS. 287 is painful and causes scars and therefore is not suited for use on the face. It is to be employed only for the more grave form of the disease and is not generally commended. (B. H.) Bichloride of Mercury Injections : This procedure is only justifiable when the size of the area involved is not sufficiently great to require enough of the bi- chloride to endanger poisoning. The injections are made around the involved surface. Wyeth says he has used a solution of 1500 around an erysipelatous patch an inch in diameter without causing untoward symptoms. As the injections cause pain, local anaes- theria is necessary. (W.) This method is adapted to severe forms of the dis- ease. Antistreptococci Serum : As a remedy for ery- sipelas this agent is still within the realm of experi- mentation. Naturally it has been employed in only grave cases. The dose is 10 c.c., repeated once if necessary, but rarely more than that. Some writers urge the administration of larger doses. A number of successful cases have been reported. (P. M., 8, 99.) ERYSIPELAS, PHLEGMONOUS- CELLULITIS. Free Incision and Drainage : As soon as pus is formed, incisions should be made and drainage estab- lished. Park says that the treatment of threat- ened phlegmon consists primarily in free incision down to the deepest tissue involved, even to the 288 DIGEST OF EXTERNAL THERAPEUTICS. bone itself if necessary. (Pk.) After incision the parts should cleansed and irrigated with an anti- septic solution. Carbolic Acid and Hydrogen Peroxide: Preferable in this disease for irrigation to solutions of corrosive sublimate . ( Den . ) Antiseptic Baths: The immersion of the parts when possible in a bath of hot weak antiseptic solu- tion is beneficial. (Den.) Antiseptic Fomentations : After incision large borated or carbolized fomentations should be ap- plied. (Tre.) The following is strongly endorsed. Under its in- fluence with moist heat infiltration assumes a less threatening appearance and pus is sometimes ab- sorbed : Ichthyol, or Naphthaline, 10 parts. Resorcin, 5 parts. Mercurial Ointment, 40 parts. Lanolin, 50 parts. The proportions of the ingredients may vary. When the skin is not very sensitive the amount of ichthyol may be increased. (Pk.) ERYTHEMA SIMPLEX. Soothing and astringent lotions are indicated. The following are serviceable : I*. Acid. Hydrocyanic. Dil., 3J- Bismuth. Subnitratis. &-ij- Aq. Aurant. Flav., giv. M. ERYTHEMA INTERTRIGO. 289 Or, 1;*. Pulv. Zinc. Carb. Prsecipitati, Pulv. Zinc. Oxidi, Pulv. Amyli, Glycerini, aa $iv. Aquae, Oss. M. (Vn.) Or, J*. Acid. Carbolici, ^ss. Zinc. Oxidi, ^ij. Glycerini, 3J. Aq. Rosse vel Aq. Calcis, q. s. ad ^viij. M. (B. H.) Dilute Lead Water or Lead Water and Lauda- num, or Alcohol and water are also useful in many cases. Powders are difficult to keep in contact with the skin, and ointments, as a rule, do not agree. Alkaline Baths are sometimes serviceable. Zinc Acetate: 2 grains, rose water 1 ounce, re- commended by Tilbury Fox. Bismuth Subnitrate, Zinc Oxide, with equal parts of Starch or Lycopodium powder or Talc., as dust- ing powders. (Bt.) ERYTHEMA INTERTRIGO. Cleanliness is the most important feature of treat- ment. Wash the parts with a little Castile soap and w iter, dry with a soft towel and apply mild dusting powders such as Starch, Lycopodium or equal parts of the latter with Zinc Oxide or Buckwheat Flour, Bismuth Subnitrate or Boric Acid. 20 290 DIGEST OF EXTERNAL THERAPEUTICS. McCall Anderson's Powder: A very- useful com- pound. It is composed as follows : I*. Pulv. Camphone, 5 j-ij. Pulv. Amyli, Pulv. Zinc. Oxidi, aa ss. M. It is important that the camphor should be an impalpable pow- der, and that the bottle should be kept tightly corked. ( Al. ) Quinine Oleate : Besnier recommends the follow- ing to be rubbed on twice a da}', after which the parts are to be dusted with powdered starch : Quinine Oleate, i part. Lanolin, 30 parts. Olive Oil, 30 parts. | R. M., 6, 22, 99. i Belladonna: When the thighs and genitals are the seat of trouble, and there is some hyperhidrosis, the tincture may be painted on, followed by powdered zinc oxide. (Vn.) Lotions are suited to cases of a more obstinate character. The following will prove satisfactory : Lotio Nigra: Applied several times a day followed by dusting powders. ( Vn . ) Alum and Zinc Sulphate: Recommended by the late Dr. Tilbur}^ Fox as follows : 5fe. Zinc. Sulphatis, gr. x. Aluminis, gr. xx. Glycerini, 3J. Aq. Rosee, .^viiss. M. Bland ointments may be of service such as Zinc Oxide 1 drachm with Ung. Aq. Rosae 1 ounce. (B. H.) FAVUS. 291 Cerates or glyeeroles of Calendula, lodoform, Zinc Oxide, Hydrastine, Boric Acid, Carbolic Acid, etc. (Bt.) FAVUS. Great patience and perseverance are necessary for the successful treatment of this obstinate disease. The hair should be cut short, after \vhich all crusts may be removed with poultices and oil or hot water and soap, as in pustular eczema. Then epilation should be practiced, pulling the hair out not only from the patches, but also for about half an inch around them ; this should be repeated every week until no trace of redness exists. (Ja.) After this the scalp is ready for a parasiticide. The following are of service: Heat : The disease being sensitive to high temper- ature the following has proved successful: Com- presses wet with a bichloride of mercury solution 1- 1000, are applied to the part, and over this a series of Leiter's tubes through which hot water at a tem- perature of 140 -" to 150-' F. is run. Applications may be continued for twelve hours daily for eight days. (Sj.) Chrysarobin: 10 to 20 grains with lanoline, 1 ounce, forms one of the most effective applications. (B. H.) Tr. Iodine: Freely applied, recommended by Besnier. Resorcin: Used by Crocker, 1 drachm with 1 ounce of lanoline or oil. 292 DIGEST OF EXTERNAL THERAPEUTICS. Method of Besnier and Doyon: The following line of treatment is recommended : Cut off the hair around the patches; then cover the whole head with equal parts of soft soap and lard, allowing this to remain two or three hours; then wash off with warm water and cover the head during the night with a rubber cap. The following morning the head is washed clean and bathed with a solution of boric acid 25-1000, and covered with borated lint soaked in the following : Sodium Salicylate, 25 parts. Sodium Bicarbonat., 10 parts. Water, 1000 parts. Over this the rubber cap is placed. After a few days the scalp will be clean and the dermatitis will have disappeared. Epilation must now be practiced, the hair being extracted from the patches for an inch around them. The head to be kept covered with the rubber cap. In the evening an antiseptic ointment, such as Bal. of Peru or Oil of Cade, 2 to 5 parts. Salicylic Acid, Resorcin, each, i to 5 parts. Sulphur Precipitate, 5 to 15 parts. Lanolin, Vaseline, Lard, equal parts of each to make 100. Every morning wash the scalp with tar soap, soak each favic patch with the following : Alcohol, 90 per cent., 100 parts. Acetic Acid (Crystals), ^ to i part. Boric Acid, 2 parts. Chloroform, 5 parts. Then each patch is to be covered with mercurial plaster. (Ja.) The following other applications are recom- mended : FELON. 293 Salicylic Acid, 3 to 5 per cent.. Carbolic Acid, gtt. xv-3-sj of Olive Oil, Naphthol Oil, 1 per cent., Sodium Hyposulphite, 3ij 3j- (B. H.) Naphthol 5 percent, ointment (B.), Hydrarg. Oxid. Flav. sss gj. Ung. Sulphur, Sulphurous Acid, saturated solution (Vn.) Resorcin, Mercurial or Hydronaphthol Plasters are to be used for constant application to favus of the nails. (Ja.) When situated on non-hairy parts the disease usually 3 r ields to the application of antiparasitic ointments such as those mentioned. After apparent cure the patient should be carefully \vatched, and any red point that appears is evidence that the disease is returning, and that treatment should be at once resumed. FELON. Alkalies: A poultice of hard wood ashes, will often abort. (F.) Nitrate of Silver : A strong solution in Nitric Acid, will abort if applied early. (B.) Ichthyol : Equal parts with water, has been used with excellent results. (Al.) Leeches ; May be applied above the nail in the early stages with good effect. (Ag.) Ung. Hydrarg.: Applied for ten minutes every hour with poultices at other times. (R.) Iodine : Will often abort if applied as soon as slight pain is felt. Paint the finger freely, or dip it 294 DIGEST OF EXTERNAL THERAPEUTICS. into the fluid and allow it to dry on; repeat this three or four times a day. (Al.) Nitric Acid: Painting the affected part with the fuming acid is said to relieve the pain instantly. (Rd.) Citrine Ointment: Has been used with success. (Al.) Alcohol : Serviceable in neglected cases when poul- tices have been long used ; equal parts with water form a convenient evaporating lotion: (Al.) Heat: Fomentations and dipping the finger in hot water will afford relief of pain and hasten sup- puration. (Bt.) Lobelia: A saturated compress of the tincture kept constantly applied is said to be efficacious in arresting. (Hel.) Free Incision: Imperative when pus has formed beneath the tendons or periosteum ; its neglect will entail much pain and possibly loss of the finger. (Hel.) GALACTORRHCEA. Hot Cloths : Applied for ten minutes and repeated at intervals. (G. J.) Pressure : Cover the nipple with sterilized gauze and apply a firm binder ; the breasts will then empty themselves. ( G. J . ) Camphorated Oil: Will often control the condi- tion; the heart should be rubbed with the remedy. (F.) Conium : An ointment of the bruised leaves, may GANGLION. 295 be employed when it is desired to dry up the milk. (Sm.) GANGLION. Method of Duplay: Wash and disinfect the skin as for an operation, then inject 5 to 6 drops of Iodine into the cyst, the skin being drawn aside so as to form a valvular opening ; the contents are now evac- uated and an antiseptic dressing and pressure are applied. The pain is slight, and a cure is generally affected in from five to six days. In large cysts a second injection is sometimes necessary. The syringe should be rendered aseptic. This method is described as safe, simple and invariably successful. (T., 96.) Subcutaneous Rupture: Striking the cyst a blow is a time-honored procedure. (Pk.) Other methods are Subcutaneous Division by a small flat needle and Injections of lodoform. (Me.) Whatever method is employed pressure and the use of splints are recommended. (Pk.) GANGRENE. MOIST GANGRENE. Apply cotton batting several inches thick around the part, and cover with oiled silk or rubber protect- ive ; care should be taken that there is no pressure. Hot water bags and bottles are deprecated on ac- count of the capillary contraction these agents pro- duce. As death of the part progresses all disor- 296 DIGEST OF EXTERNAL THERAPEUTICS. ganized tissues which can be easily removed should be cut away with the scissors, and an antiseptic dressing applied, such as gauze soaked in sublimate solution 1-500. (W.) Carbolic Acid: 1 part, glycerine 4 parts; lint soaked in this solution and applied to gangrenous surfaces was used by Lister. The following has been found effective : Carbolic Acid, 752 gr. Caustic Soda, 124 gr. Water, i pint. Lint soaked in 1 part of this mixture with 4 of water and kept constantly applied and covered with oiled silk, will be found effective in relieving the pain and destroying the fetor. The solution may be made more dilute if desired. (M. H.) Hydrarg. Bichlorid.: The stronger solution may be employed for cleansing. Gauze soaked in a solu- tion of 1-1000 should be laid around the line of de- marcation as soon as formed to guard against septic absorption. (W.) Poultices: Linseed meal, charcoal, yeast or car- rots are sometimes of service in removing sloughs. (Bt.) Free Incisions : Indicated in phlegmonous or other inflammations when the tension is so great that gangrene is threatened by pressure upon the capillaries and large vessels. The incision should be made parallel with the vessels and sufficiently deep to relieve tension. (W.) lodoform and Salicylic Acid : Among the most effective of the dusting powders after the removal of sloughs to promote healthy granulations. (B.) GANGRENE. 297 Peat : Finely pulverized, sprinkled over gangren- ous surfaces has been highly praised. (F.) DRY GANGRENE. The affected part should be wrapped in cotton and placed in as comfortable a position as possible. (W.) If any local treatment is required that mentioned under the moist variety is applicable. HOSPITAL GANGRENE. As soon as attacked the wound should be immedi- ately mopped with some escharotic, the most effect- ive of which are the following : Bromine : This agent heads the list and is to be generally preferred to all others (F.); it proved to be most efficacious in the War of the Rebellion. If the disease has progressed for two days, and the wound is covered with the pulpy mould peculiar to the malady, it should be scraped first with aVolkmann's spoon and mopped with the bromine. When the skin has become undermined, free incision should be made so as to expose every part of the action of the caustic, and afterwards dressed with iodoform gauze. In the case of a gun-shot wound the entire track must be scraped out with a piece of cotton im- mersed with bromine and fastened on a holder. An- aesthesia is necessary. (W.) Nitric Acid : Ranks next to bromine. Chromic Acid: Highly effective ; it penetrates the tissues deeply, causing comparatively little pain. Zinc Chloride and the Dried Sulphate : The pow- ders are both powerful caustics, but the fact that they cause great pain should be remembered. (B.) 298 DIGEST OF EXTERNAL THERAPEUTICS. Turpentine: One of the oldest and most efficient applications; the mortified parts are first removed with the scissors and the remedy is applied directly by means of cotton cloths saturated with it. Fetor is dispelled sloughing arrested, and but little pain ensues. (B.) Citric Acid : Lemon juice dropped into gangren- ous \vounds which are then covered with lint steeped in a solution of chlorine is said to have good effect. (Pt.) Resorcin: A 2 per cent, solution is reported to have succeeded in arresting when other measures failed. (Al.) Camphor: The powder, freery sprinkled over flax- seed and charcoal poultices, has been used for the sloughing surfaces both in this form and senile or dry gangrene. (Al.) Warm Baths: For gangrenous ulcerations, the immersion of the part continuously for about eight hours in a warm water bath, temperature of 95 to 98, was introduced by Hutchinson. After two or three sittings the sores are said to assume a healthy appearance . ( Al . ) Potass. Permang.gr. iij x 3j (B.), and Labar- raque's solution (N.), both form useful dressings to correct the fetor. GASTRALGIA. Lav age : This measure has been productive of good results in cases which have resisted other ther- apeutic measures, especially those which have re- sorted to morphine; the water used warm has a soothing effect. (S. B.) GASTRITIS. 299 Warm Baths every night for ten minutes and Far- adism of the stomach should be administered in con- junction with lavage. (S. B.) GASTRITIS. Lavage : Is of service in chronic gastric catarrh with excess of mucus, and in no other condition has it done so much good. (Ew.) Several quarts of water may be used, but not more than one pint should be introduced into the stomach at once. The morning, before breakfast, is usually the best time for administration, but when the mucus collects to a large amount the stomach may be washed out again before dinner, directing the patient to take a light luncheon. (S. B.) Lavage with Nitrate of Silver: This is of value in long standing cases of catarrh with hyperacidity. .The stomach is first washed out with a weak solu- tion of bicarbonate of soda, in order to remove the excess of mucus, then with a warm solution of nitrate of silver, 20 grains to the quart. Finally the organ is douched repeatedly with a solution of chloride of sodium, 4-5 grains to the quart. Under this treat ment the digestive power of the stomach increases and the vomiting and constipation disappear. (T., 98.) Lavage in Infants: For the employment of this measure in children suffering from acute indigestion with fermentation the following directions will prove useful : Lavage of the stomach meets with difficulties in few instances only, with almost none in infants and 300 DIGEST OF EXTERNAL THERAPEUTICS. children, in whom a catheter No. 25 or 30 French is sufficient. In the adult the post-laryngeal region may offer an occasional obstacle, which, however, is overcome by patience. When the pharynx is too irri- table, or the patient refractory, the tube may be introduced through the larger, generally the right, nostril. When it does not readily pass into the oesophagus the patient should be made to swallow, when it will glide down. An aqueous Salt Solution of 7-1000 may be run through it from a funnel or a fountain syringe which is slightly raised above the level of the pharynx, and lowered when the fluid and stomach contents are to flow out. The salt water may be mixed with a disinfectant, as Thymol, 1- 3000 or 4000, or in cases of hyperacidity, with Bi- carbonate of Sodium, 1-200 or 500. The temperature should be that of the body when this is normal, somewhat or considerably cooler when there is a high elevation, or warmer when there is a reduction of the body temperature. Alcohol should not be added to the injection, because its dilution is partly absorbed by the stomach. On the other hand, when \vater is injected without salt, it causes osmosis of the body fluids into the stomach sometimes to such an extent as to visibly increase the amount return- ing from the stomach. The irrigations should amount to 100 and more c. cm. in the nursling, 200 or 300 in the child, 500 or 700 in the adult. They should be repeated until they return clear. The tube should always be withdrawn quickly so as to avoid irrita- tion of the fauces. (N. E. M. J., 5, 99.) GINGIVITIS, SIMPLE. 301 GINGIVITIS, SIMPLE. Antiseptic tooth washes should be used night and morning, or better after each meal. In infants the absence of cleanliness is often the cause of inflam- mation, hence after nursing the mouth should be washed and patient should be given a little water to drink. Nitrate of Silver: 1500 or 1000 brushed on once a day when mucous membranes are dry; recom- mended for children. (Hit.) Copper Sulphate : The powder packed down under the edge of the gums with a wooden point for sev- eral days is useful in obstinate cases ; then use as a mouth wash, viz.: &. Potass. Chloratis, gij. Sod. Biboratis, 3J. Potass. Nitratis, ss. Tr. Arnicae, ^ij. Aq. Rosae, ad ^viij. M. (T. >9 6.) Removal of Tartar: Tartar must be most care- fully scaled off; then syringe under the gums with hydrogen peroxide. (T., 96.) Zinc Chloride: If the tissues are turgid, thickened and inflamed, apply with syringe 30 per cent, solu- tion under edge of gums. (T., 96.) A useful powder : 9. Cretae Praeparatae, ^ iv. Pulv. Iridis Radicis, 3 iij . Pulv. Saponis Alb., jvj. Ol. Eucalypti, jss. Otto Rosae, Mvij. M. 302 DIGEST OF EXTERNAL THERAPEUTICS. If there is much destruction of tissue apply every four days with a brush the following : I*. Ol. Cinnamoni, Ol. Gaultheriae, aa iv. Acid. Carbolici, 3J. M. (T.,96.) GLANDERS. Excision, Curettage and Cauterization in the cuta- neous form should be practiced as early as possible, following with antiseptic dressings. (Pk.) All sus- picious wounds and all ulcers should be freely cau- terized. (Q.) As abscesses form they should be evacuated by free incision and cleansed constantly" with antiseptic in- jections of Potass. Permang. or Carbolic Acid. (Vn.) For nasal ulceration, lodoform and the allied dust- ing powders; sprays of Bichloride of Mercury, Car- bolic Acid and Hydrogen Peroxide. (Ty.) Nitrate of Silver solutions or Tincture of Iodine may be used for touching the ulcers. (Vn.) GLANDS, ENLARGED. Compare Adenitis. Iodine: Parenchymatous injections with a hypo- dermic syringe are often exceedingly valuable, a few drops of the tincture being sufficient. (F.) Carbolic Acid: 2 per cent, solution injected into the glands which threaten to suppurate will often prevent the formation of pus. (Sm.) GLOSSITIS. 303 lodoform : The officinal ointment useful in many forms of enlargement. Cadmium Iodide: The ointment, gr. x xx 3-j, in chronic enlargements. (Sm.) Ichthyol: As an ointment, 3 iij gj, was recom- mended lyy Agnew. Zinc Iodide: sj-sj, as a simple ointment. (Sm.) Mercury: The ointment of the red oxide often has striking effect in reducing simple hypertrophy of the thyroid gland, enlarged spleen, or ague cake. (B.) Calomel, sj wit hmorphia sulphate, gr. j ij gj, is use- ful in reducing swelling and arresting abscess. (Sm.) Conium: The ointment is useful in reducing scrof- ulous glands, enlarged mammary glands, enlarged liver and spleen and goitre. (Sm.) Galvanism: Often of service in reducing chronic enlargement of cervical gland ; the current may be medicated with iodine or ammonium chloride. The positive pole is placed on the back of the neck and the negative over on the gland. Rapid resolution, it is claimed, will take place. (Terry.) GLOSSITIS. SUPERFICIAL. Cleanliness is most important. All local causes of irritation, such as decayed teeth, ill-fitting artificial teeth should be removed. Ice : Will prove grateful and assist in allaying in- flammation. (Gn.) Bismuth Subnitrate: 5 grains to rose water 1 ounce, with the addition of a little glycerine, is useful and agreeable. 304 DIGEST OF EXTERNAL THERAPEUTICS. Mouth Washes containing Boric Acid, Hydrastis, Thymol, etc., are beneficial. See Aphthae. PARENCHYMA TO US. This form requires more active treatment. Deep Scarification : Indicated if the tongue be- comes alarmingly oedematous. (An.) Leeches : Applied between the hyoid arch and the angle of the jaw in conjunction with scarification > are of great service in relieving swelling. (An.) Steam Atomization: Medicated vapors, such as those of Ammonium Chloride or Compound Tinct- ure of Benzoin, favor resolution. (An.) Incision: This may be demanded even before the advent of suppuration ; the incisions should be made on the superior surface of the tongue on either side of the median line. (Gn.) When incision is followed by the vapor of hot water great relief is obtained. Tracheotomy: May be required if incision does not relieve, though it is rarely called for. (An.) For treatment of Glossitis Dessicans and Fissures, see Fissure of the Tongue. GLOTTIS, CEDEMA OF. See QEdema of the Larynx. GOITRE, SIMPLE BRONCHOCELE. Iodine : The tincture has been used with better re- sults in the cystic than in the fibrous variety ; 8 to 10 drops may be thrown into the substance of the GOITRE, SIMPLE BRONCHOCELE. 305 tumor in different parts every three to five days. Marked elevation of temperature accompanied by pain and stiffness of the neck are indications for sus- pending treatment. (Agnew.) Gosselin's use of iodine in treating cystic goitre consists of incising the skin over the gland, introducing a small trocar and evacuating the contents of the cyst, then cleans- ing the cavity with sterilized water and injecting 1 drachm of tincture of iodine ; this is permitted to re- main in five minutes; should its discharge be fol- lowed by blood a second injection is made. (Pp.) Injections of 10 to 15 drops, repeated every two or three days until ten injections have been given (L. T.), or 20 to 30 minims of a solution of 112 of alcohol injected twice a week, a new point being selected each time, care being observed not to wound any vessel, are other methods of application. lodoform: Also employed in several ways ; Mose- tig advised as a substitute for iodine the following : lodoform, 1 part ether, 5 parts, olive oil, 9, or in the proportion of 1, 7, 7. (Garre.) This is free from danger. (L. T.) It is also used hypodermically with good results in solution or sterile emulsion, a 10 per cent, solution being employed, and from two to three drops injected in the base of the growth (F.); as an ointment, a drachm and a half, with benzoated lard 1 ounce, rubbed in for fifteen or twenty minutes, night and morning, a piece of lint smeared with the same is then laid on and covered with oiled silk. (Pp.) Red Iodide of Mercury: A piece of the ointment the size of a pea is rubbed over the surface of the goitre until sensitiveness is produced ; in a few days this procedure is repeated, and continued with neces- 21 306 DIGEST OF EXTERNAL THERAPEUTICS. sary intermission for weeks and even months. The rays of the sun are said to help the action. (L. T.) Another method of application is to employ an oint- ment of the strength of 15 grains of the mercury to 1 ounce of ointment base. A small portion of this is rubbed over the goitre, which is then exposed to the rays of the sun as long as the patient can bear it. Within half an hour a smarting sensation is felt, and at the end of an hour a blister will appear which should be treated in the usual manner. The effect of the drug continues long after the blister has healed. (Al.) Yellow Iodide of Mercury, 3}, Oleic Acid, gix, rec- ommended by Lefferts for fibrous variety. Perchloride of Iron: Was used by Mackenzie in place of iodine in cystic goitre ; 1 part to 4 of water, injection of 1 to 2 drachms, according to the plan of Gosselin ; the injection is allowed to remain in three days ; if the discharge is bloody it is repeated, if pur- ulent the canula is allowed to remain for drainage. During this treatment the neck is covered with flax- seed poultices. (Pp.) Ergot: Preferable to iodine in the vascular varie- ties ; 10 to 20 drops of the fluid extract hypodermic- ally have been employed. (Pp.) Electrolysis: Effective to a certain extent, the first applications being followed by a decrease in the size of the tumor, which is less and less marked after subsequent applications. Large needles, insulated to within a short distance of the points, are intro- duced into the substance of the gland, these are at- tached to the negative pole ; the positive pole is at- tached to a large flat electrode which is applied over the gland a short distance from the needle. A current GOITRE, EXOPHTHALMIC. 307 of from 5 to 10 milliamperes may be applied for five minutes. (Gn.) Stronger currents have been advised (Dickson), being regarded as useful in the earlier stages of the disease. A current of 100 to 150 milliamperes is ap- plied for ten minutes at a time, a clay electrode is placed over the goitre and a large wire gauze elec- trode between the shoulders. When puncture of the growth is made, a current of 50 milliamperes is ap- plied for eight minutes. Another method consists of aspiration of the cyst, followed by injection of a hot solution of sodium chloride, 3J-^ij, and the applica- tion through the canula of a current of 50 to 100 milliamperes for ten minutes; the salt solution is then withdrawn. Rockwell objects to these strong currents. (Sj.) Extirpation: When all other means have failed, and the growth is large and ca.uses dangerous symp- toms, this procedure must be considered. Better re- sults are obtained from operative treatment than from medical, but the high rate of mortality contra- indicates its use until after all other measures have proved unavailing. (L. T.) See paragraph on ex- tirpation under Exophthalmic Goitre. GOITRE, EXOPHTHALMIC. Leiter's Coil: Applied over the lower part of the neck and upper part of the sternum, according to Osier, is more successful than any other treatment. It relieves the rapid heart action. Ung. Hydrarg. Oxid. Rub.: Employed as de- scribed in simple goitre or bronchocele has also been used for this affection. (L. T.) 308 DIGEST OF EXTERNAL THERAPEUTICS. Electricity: Galvanism, 25 to 75 milliamperes, is recommended by Rockwell, using sculptor's c\ay for electrode ; the positive pole is placed over the sixth cervical vertebra and the negative over the region of the solar plexus; the positive pole is shifted to the goitre during the seance ; the duration of application is from two to five minutes. (L. T.) Faradism ; positive pole on the neck over the caro- tid artery at the level of the angle of the jaw and the border of the sterno-cleido-mastoid muscle, on each side; tlie negative to the orbicularis palpebrarum muscle, thyroid gland and przecordium near the ster- num at the line of the third intercostal space ; appli- cation being made to these localities in succession. (L. T.) The seance should occupy about six to twelve minutes, and the course of treatment continued from six to twelve months. Electrical treatment should be tried for more than three or four months. Hydrotherapeutics: Act favorably in some cases; packing, needle baths, and sea baths combined with galvanism and massage, have had good effect. Cold sponge baths, tepid baths, hip baths. (An.) Mustard to the feet with cold to the thyroid gland are also methods which are worthv of consideration. (Gn.) Removal of nasal hypertrophies has cured a few cases. Change of climate and moderate elevation have beneficial effects in cases not too far advanced. Rest and freedom from excitement are essentials to successful treatment. Extirpation: Though statistics show somewhat varying results, they warrant the opinion that if medical treatment has failed and the sjonptoms are GOUT. 309 urgent an operation should be performed. It should be borne in mind that the entire extirpation of the gland is liable to be followed by myxoedema. (An.) Ligation of the Thyroid Arteries: This procedure has been employed in some cases ; its preference to extirpation is a matter to be decided by the operator according to the indications of each case. (An.) GONORRHCEA. See Acute Urethritis. GOUT. ACUTE GOUT. Local treatment is usually confined to wrapping the part in flannel or cotton batting and the applica- tion of alkaline solutions and anodynes such as the following : #. Atropiae, gr. iij. Morph. Hydrochloratis, gr. xv. Acid. Oleici, 3j. M. Sig. Paint on the painful parts with a large camel's hair brush and cover with cotton and towel bandage. (H. ) Or, V. Lin. Belladonnae, 3"j- Morph. Sulph., gr. x. M. Sig. Of this, use i tablespoonful to half an ounce of hot water and apply every two hours on lint, covering with oiled silk. (H. 310 DIGEST OF EXTERNAL THERAPEUTICS. Hot Mustard Foot Baths are of service and should be employed in retrocedent gout. (H.) The following has been reported as effective : Take half an ounce of Iodide of Potassium dissolved in 8 ounces of Rectified Spirits, add 1 ounce of Soap Lin- iment, then half a drachm each- of Oil of Cloves and Oil of Cajaput; a cloth soaked in this mixture is wrapped around the affected part and covered with protective and bandaged. This acts as a powerful counter-irritant and the inflammation, it is claimed, is subdued in from twelve to twenty-four hours. The treatment appears to have been employed in robust cases. (T., 98.) CHRONIC GOUT. See Arthritis. GUMBOIL. A roasted Fig applied as hot as can be borne to the inflamed gum will often afford relief. A small por- tion of Chamomile Flowers or a Raisin dipped in hot water, the former for convenience placed in a little lace bag, similarly applied, are also effective. When pus has formed it should be evacuated by free incision. No poultice should be placed on the face. GUMS, SPONGY AND ULCERATED. Alum : Excellent when the gums are spongy, with tendency to recede from the teeth ; it may be advan- tageously combined as follows : H^EMATEMESIS. 311 #. Aluminis, gj. Tr. Cinchon., ^ss. Tr. Myrrhae, ^ij. Mel. Rosae, jfij. Vini, Oj. M. Sig. As a mouth wash. (B.) Tannin : Same indications as for alum ; also use- ful in mercurial salivation, viz.: #. Acid. Tannici, 33. Mel. Rosae, %ij. Aquae, ^vj. M. Sig. As a mouth wash. (B. ) Tannate of glycerine applied with a brush also effective. (Sn.) Chromic Acid : One of the best applications when the gums tend to ulceration and retraction in scrofu- lous cases and after mercurial salivation. (N.) See Stomatitis for further formulas, as many of the mouth washes under that head are also applicable to this condition. H^MATEMESIS. See also Haemoptysis. The application of a broad flat Ice Bag over the epigastrium, together with the subcutaneous admin- istration of Ergotine, will generally prove effective. 312 DIGEST OF EXTERNAL THERAPEUTICS. HEMOPTYSIS. The patient should be placed in the recumbent post- ure, with head and shoulders elevated. He must be kept absolutely quiet and not allowed to speak ex- cept when necessary. Ergot or Ergotine: Subcutaneously administered is generally employed. (Gn.) Morphia: One of the most effective remedies in dangerous cases ; it must be given hypodermically in full doses, V grain two or three times in twenty-four hours for an adult. (Gn.) Liq. Ferri Subsulphatis: Sprays of a solution of 1 drachm to 8 ounces of water, caused to enter the throat with each inspiration, will often arrest, not- withstanding so little will pass the rima glottidis. (B.) Ice to the nape of the neck and chest (Rd.), also to the testicles or labia. (Sj.) Ether Spray to the spine and chest. (Bt.) HEMATURIA. Local measures can only be of service when the bladder itself is the source of the bleeding, in this case, Nitrate of Silver, ^4 gr. j> as a wash will prove valuable. ( Al. ) HEMORRHAGE. Local stringents and styptics: Alum, Agaric, Al- cohol, Antipyrin. Creolin, the latter in 2 to 3 per HAEMORRHAGE. 313 cent, solution for haemorrhage from mucous mem- branes; Ice, Oil of Turpentine for haemorrhage after removal of tonsils or extraction of teeth; Styptic Cotton, Tannic Acid, Cold Water, Hot Water, Hamamelis, Monsel's Solution, and Tr. Ferri Chloridi. Actual Cautery: Of inestimable value is arresting haemorrhage from vessels not possible to ligate. Ergot or Ergotine : Subcutaneously, the fluid ex- tract of the former, or better the following solution of the latter : ffc. Ergotinae, gr. xxx. Glycerin! (neutral), Aquae, aa ss. M. Sig. Dose, 15 minims. (T., 96.) Aqua Ammoniae: 1 to 2 drachms with an equal amount of water subcutaneously injected is advised when thrombosis of a large venous trunk tends to form, as for example in the pulmonary artery after uterine haemorrhage. (B.) Ether : Subcutaneous injection of 1 drachm into the thigh as a stimulant. (B.) Saline Injections: These are indicated in all cases when life is threatened. Simple normal saline an- swers all purposes. More complex solutions are also employed, some of which are as follows : #. Sodii Chloridi, gr. 1. Potassii Chloridi, gr. iij. Sodii Sulphatis, gr. iiss. Sodii Phosphatis, gr. ij. Sodii Carbpnatis, ^ gr. iiss. M. Sig. Add the entire powder to a pint of water and inject at a temperature of looto 120 degrees. 314 DIGEST OF EXTERNAL THERAPEUTICS. An other formula is as follows : I*. Sodii Phosphatis, Sodii Chloridi, aa gij. Aquae, Oij. M. Sig. Inject subcutaneously \y z pints into the thigh. (T., 96.) For technique and methods of administration of saline infusions see Normal Saline Solution, Appen- dix II. HEMORRHAGE FROM BONE. Yellow Wax; A convenient method of arresting bleeding from cut ends of bones after amputation consists in forcing a small bit of -wax into the can- cellated structure. (Al.) HEMORRHAGE IN DENTISTRY. Gelatin Injections: Haemostatic-anaesthetic solu- tions are of much value in dentistry to stay pain and check haemorrhage. M. A. Legrand, availing himself of recently published reports concerning the haemo- static action of gelatin, has devised the following solution : #. Gelatini, gr. xxj. Sodii Chloridi, gr. x. Acid. Carbolici, Crys., gr. iss. /9-Eucainae, gr. x. Cocain. Hydrochloratis, gr. ivss. Aq. Destill., q. s. ad ^xxv. This is injected inside the root of the tooth to be extracted. The result is not only anaesthesia but arrest of haemorrhage. It has been emplo} r ed with success in one case of haemophila in extracting two HAEMORRHAGE. 315 teeth at the same sitting. In regard to sterilization of this solution, attention is called to the fact that heat changes cocaine. A series of experiments with a 1 per cent, solution of cocaine controlled by a similar solution in boiled water were instituted; the result was as follows: The gelatin haemostatic-anaesthetic solution was heated for ten minutes in a moist heat at 100 C. and found to retain its properties. The same solution was again put through fifteen minutes of moist heat at 104 C., and again without loss of anaesthetic properties. In a third trial the solution was heated to 120 C. for twelve minutes, and re- mained anaesthetic. The same solution was decom- posed when subjected to a corresponding amount of dry heat. (N. R., 2, 24, 99.) HEMORRHAGE FROM THE LARYNX. The following should be applied by means of the laryngeal atomizer : Liq. Ferri Subsulphatis, gr. x-j. Acid. Tannicum, gr. x 3). Argenti Nitras, gr. x j. HEMORRHAGE, POST-PARTUM. Immediately pass the hand into the uterus and turn out all clots or fragments of the placenta, clear- ing the cavity of its entire contents. Grasp the fun- dus with one hand, previously dipped into ice water, if this can be done without delay, hold the uterus firmly and press it down into the iliac fossa, and as quickly as possible inject a stream of water at a tem- perature of 110 to 120 F. If delay will be caused in obtaining hot water use cold, or pass into the uterus 316 DIGEST OF EXTERNAL THERAPEUTICS. a piece of ice. While this is being done an attendant should raise the foot of the bed so that the hips will be elevated. After the hemorrhage has been suffi- ciently controlled, the lower extremities should be tied snugly, but not tight, with bands, and a com- press and binder applied over the uterus. (Ga., Ply.) Turpentine : A piece of lint saturated with the remedy carried directly into the uterus, so as to be in contact with the inner surface, will act as a stimu- lant, produce contraction, and instantly check haem- orrhage. (T., 98.) Tr. Iodine, Tr. Matico and Vinegar applied to the cavity of the uterus are effective for arresting haem- orrhage. (Ply.) The following method of applying Pressure was recommended by Playfair : Insert the fingers into the posterior cul-de-sac of the vagina and apply pressure ; then with the other hand make counter pressure over the abdomen ; thus the anterior and posterior walls of the uterus are pressed together. (Ply.) If alarming symptoms persist, Compress the Ab- dominal Aorta, to the left of the spine, on a line with the umbilicus. (Ply.) Perchloride of Iron : When everything else has failed, as a last resource inject a solution of iron into the uterine cavity, using liq. ferri perchloridi, 1 part to 6 parts of water, or 2 drachms of the perchloride in a pint of water. (Ply.) Faradism : If a battery should happen to be at hand, apply one pole to the uterine cavity and the other over the abdomen. This will produce contrac- tion. Subcutaneous injections of Ergot or Ergotine and Intravenous or Subcutaneous Saline Injections, as HAEMORRHAGE. 317 mentioned under the head of haemorrhage, are all in- dicated in this condition. See Normal Saline Solu- tion, Appendix II. HEMORRHAGE FROM THE RECTUM. The rectum should be examined by means of a spec- ulum, and the bleeding point ligated or cauterized with the Paquelin cautery. In case the point cannot be located, packing must be resorted to. Mr. Ailing- ham's method for this procedure is as follows : Take a cone-shaped sponge and pass a strong ligature through it near the apex; it is then brought back so that the apex is held in the loop ; the sponge dampened, squeezed out, and dusted with an astrin- gent powder, preferably iron, is introduced by the in- dex finger, apex first, and carried up five inches ; the ends of the ligatures should extend outside the anus ; the rectum below the sponge is now packed with cot- ton and dusted over with an astringent powder ; the ligatures are then seized and pulled down with one hand and pushed up with the other. Attention is called to the fact that when it becomes necessary to pack the rectum it should be done with great thoroughness, so that not a single point shall be ex- empt from pressure. If it is intended to leave the packing in for some time it is advisable to pass through the apex of the sponge a large stiff catheter so as to allow the escape of flatus and fluid fasces. (K.) Irrigation with very hot or cold astringent solu- tions are effective, such as Alum Water or infusion of Black Oak Bark ; simple Hot Water with com- pression is also satisfactory. 318 DIGEST OF EXTERNAL THERAPEUTICS. Local treatment for rectal haemorrhage may be summed up as consisting of Ligation, Cauterization, Torsion, Compression, Styptics, Astringents, and Hot and Cold Applications. HAEMORRHOIDS. EXTERNAL HEMORRHOIDS. Treatment is seldom sought unless there is external inflammation. Hot Baths, frequent ablution of the part with Cas- tile soap and -water, together with rest in bed and the application of the Ice Bag, will prove grateful and effectual in most cases. Hot Fomentations may be used instead of the ice bag if the latter is not agreeable. Bathing the part should precede all remedial appli- cations. The following anodyne ointments and lotions will afford relief: Ext. Belladonna and Ext. Opium: The two ex- tracts together or alone smeared over the part will afford relief. (All.) Lead and Opium Wash: Constantly applied hot or cold is very effective. (Gt.) Stramonium Ointment : Alone or with equal parts of Gallic Acid Ointment, is one of the most service- able remedies. (Al.) Hamamelis: The aqueous extract often used hot or cold according to the effect on the patient. A little may be injected into the rectum. HEMORRHOIDS. 319 After washing the parts, Mr. Allingham recom- mends one of the following : Jjfc. Bismuth. Subnitratis, gij. Hydrarg. Chloridi Mitis, 33. Cocainse, gr. iv. Vaselini, 3 j. M. Or, Ijt. Bismuth. Subnitratis, ij. Cocainse, gr. vij. Vaselini, 3j. M. Or, #. Liq. Plumbi Subacetat. Dil., |j. I,iq. Opii Ext., giv. Tr. Belladonnee, gij. M. When the piles are down and difficult to replace or retain, Mr. Allingham recommends the following ap- plications spread on lint : ty. Ung. Elemi, gss. Ung. Sambuci, ^ss. Bal. Copaibee, 3J. Ext. Belladonnee, gss. M. Or, I*. Ext. Belladonnas, 33. Ext. Hyoscyami, ^ij. Ext. Conii, ^ij. Vaselini, ^j. M. Nutgalls: The ointment alone or with 1 drachm of powdered opium to the ounce. (Sm.) Nitrate of Silver: Painting the piles daily with a 320 DIGEST OF EXTERNAL THERAPEUTICS. 2 per cent, solution is said to act very satisfactorily ; the application is painless. (T., 98.) lodoform: Suppositories containing 5 grains each will sometimes have good effect. (Sm.) The following is recommended: Wash the part with a 2 per cent, solution of carbolic acid or 1 per cent, of creolin, dry with absorbent cotton and anoint with the following : J*. Chrysarobini, gr. xij. lodoformi, gr. ivss. Ext. Belladonnse, gr. ix. Vaselini, 3 vj gr. xv. M. . (Sn.) The pain will be relieved and the tumor will almost completely shrivel within three or four months. The following also proves useful : #. Cocain. Muriatis, gr. xx. Morph. Sulphatis, gr. v. Atrop. Sulphatis, gr. iv. Pulv. Acid. Tannici, gr. xx. Vaselini, %j. Ol. Rosse, q. s. M. Sig. Apply after each evacuation of bowels. (Sn.) Or, ?fc. Acid. Gallici, gr. x. Ext. Opii, Ext. Belladonnae, aa gr. iv. Ung. Simplicis, gss. M. Sig. Apply night and morning. (H.) The following is indicated when the pile contains a hard clot : #. Morph. Sulphatis, gr. iij. Hydrarg. Chloridi Mitis, gr. xij. Vaselini, 3j. M. (Gt.) HEMORRHOIDS. 321 The following is a useful cerate : Morphia Oleate (10 per cent.), i part. Camphor, 2 parts. Oil of Sassafras, 4 parts. Resin, 8 parts. Yellow Wax, 16 parts. Benzoated Lard, 24 parts. Apply on lint; melt the wax, resin, and lard together at a gentle heat, then digest the camphor with the mixture until it is dis- solved, allow it to cool, and before it solidifies add the morphine and sassafras, and mix thoroughly. (H. F. ) Collodion : Applied on fibres of cotton and spread over the pile after defecation. (T., 98.) /Esculus Hippocastanum: Cerates or supposito- ries will often give good resalts. (Bt.) Collinsonia : The cerate, especially when asso- ciated with uterine disorder. ( Ga. ) Boric Acid: An ointment with vaseline has good effect in relieving the itching. (Ga.) After inflammation has subsided the haemorrhoids should be removed. INTERNAL HEMORRHOIDS. Hamamelis: Employed satisfactorily in various ways, viz.: Small injections of the watery extract, either hot or cold ; compresses, wet with the lotion, applied externally, or ointments or suppositories. (All.) Cold: Some patients will derive benefit from the application of ice to the inflamed part ; small injec- tions of cold water will also be found suited to some cases. (K.) Heat: May be used instead of cold in the same 22 322 DIGEST OF EXTERNAL THERAPEUTICS. manner, hot fomentations and hot sitz baths espe- cially is there is strangulation of the pile. (F.) Suppositories of the following : #. Chrysarobini, gr. i. lodoformi, gr. T %. Ext. Belladounae, gr. .V. Ol. Theobromae, gr. xxx. (Sn.) If there is severe haemorrhage, tannin may be ad- ded. It is claimed that under the above treatment, which may be combined with the ointment of the same, -when there are external haemorrhoids that pain and haemorrhage will disappear -within three or four days and the tumors shrivel completely within three or four months. The follo\ving is a useful soothing application : J*. Cocain. Hydrochloratis, gr. vij. Aq. Ext. Opii, gr. xx. Ext. Belladonnas, gr. xij. Ung. Populi, 3j. M. (Sj.) Cutol : 10 per cent, ointment. (Sj.) Hydrastis: An important remedy used in the form of suppositories ; it may be combined with good effect, each suppository to contain the following : P. Hydrastis, Hamainelidis, aa gr. iij. Cocain. Hyrochloratis, gr. %. Ol. Theobromae, q. s. M. (M. H.) Stramonium : The ointment has a soothing effect and may be combined with cocaine and hamamelis. (All.) HEMORRHOIDS. 323 A sedative ointment, recommended by Shoemaker, is as follows : ;. Ext. Opii. gr. x. Pulv. Stramonii, 3J- Pulv. Tabaci, 3 SS - Ung. Simplicis, gss. M. (Sn.) Zinc Subgallate : As an antiseptic and dessicant, pure or diluted with an inert powder, or in the form of an ointment. (F.) Ferric Sulphate: In the form of supositories, 2 grains each, when a strong astringent effect is de- sired. (F.) For small vascular tumors Mr. Ailing- ham uses : #. Ferri Sulphatis, gr. x-xx. Cocainae, gr. viij. Vaselini, 3J- M. Or, Jjt. Ferri Sulphatis, gr. ij. Theobromae, q. s. M. Tannic Acid: In various strengths in ointments and suppositories, may be employed when there is much inflammation. (F.) Conium Ointment : May be applied with benefit for the relief of pain. (M. W.) Carbolic Acid Injections: The treatment of haem- orrhoids by injections of carbolic acid, which was apparently so successful in the hands of certain itin- erants, was made known to the profession in 1876 by Andrews of Chicago. It was soon extensively adopted, but experience having shown that not in- 324 DIGEST OF EXTERNAL THERAPEUTICS. frequently it was followed by various complications and occasionally by death (13 cases out of 3304), the operation has fallen into disfavor. Recent observers, while condemning the method for general use, admit is applicability to certain selected cases. Some operators while agreeing with this view at the same time express a preference for the clamp and cautery. The disinclination or the impossibility of the pa- tient being confined to bed for a few days 'is often an important factor in the selection of the injection treatment which, if all goes well, does not require more than a few hours in the recumbant posture. If treatment by injection is decided upon, the prog- nosis should always be guarded as to pain, the time required to complete treatment, and the permanency of results. The relief obtained, according to Kelsey, does not, as a rule, last for more than two years. If it is decided to operate according to this method it should be remembered that the class of cases are limited to those in which the haemorrhoid is small, distinct, pendulous, and situated above the grasp of the sphincter muscle. When the haemorrhoid is in- flamed, strangulated, ulcerated, external, large, hypertrophied, or within the grasp of the sphincter, the injections should never be made. Great care is necessary in the selection of cases lest serious and tedious complications arise. The patient should be prepared for the operation by administering a mild cathartic the day previous, and about two hours before operating an enema of Castile soap and water should be given and the bowel emptied. A convenient position and light should be selected, and the anus and surrounding HAEMORRHOIDS. 325 parts cleansed. The amount injected should be care- fully gauged and care observed not to allow any air to enter. The injection should be made slowly and into the centre of the tumor, some say into the most pendulous portion. Although other agents have been employed, car- bolic acid has proved itself superior and should always be preferred. The strength of the solution varies all the w r ay from 3 to 50 per cent., and occa- sionally it has been injected undiluted. The weaker solutions are generally recommended. A much used preparation is 1 part of the acid with 2 parts of olive oil. Sometimes a weak solution will cause sloughing when a stronger will not. The following are some of the more complex formulas for injecting fluids : T&. Acid. Carbolici, 5J- Zinc. Chloridi, gr. viij. Ol. Olivse, |v. M. (Ad.) This is said to be the secret remedy known as the "BrinckerhoffCure." Another injection of the secret remedy class is as follows : P;. Acid. Carbolici, Glycerini, aa 3ij- Fid. Ex. Erg'otse, 3j. Aquae, 3ij. M. (Ad.) In small haemorrhoids inject from 2 to 4 drops in large from 5 to 10 drops; inject only one or two haemorrhoids at a time and allow ten days to inter- vene between operations. Let the needle remain in position until the part becomes white. Avoid 326 DIGEST OF EXTERNAL THERAPEUTICS. injecting the tissues beneath the tumor or wound- ing the rectum. As the needle is withdrawn ap- ply the finger, in order to arrest haemorrhage and to prevent the escape of the fluid. All prolapsed haemorrhoids should be returned and the external parts anointed -with vaseline to prevent irritation from oozing of the injecting fluid. After treatment the patient should remain in the recumbent posture for half an hour, and for the next few days his diet should be restricted to semi-solid food. The fluid should be made fresh for each injection and the sj'ringe carefully sterilized. For the methods of removal of haemorrhoids the reader is referred to works on surgery. HAY FEVER. Compare Acute Rhinits. Cocaine Hydrochlorate : One of the best pallia- tives for treatment of the exacerbations ; may be ap- plied in the form of a spray, by insufflation, or with a brush ; occasionally the relief obtained will last for the day, but more frequently it is transitory. For the spray a simple 4 per cent, solulion may be em- ployed, which is the usual strength, but not infre- quently weaker solutions will act quite as well. The following are recommended by Bosworth : fk. Cocain. Hydrochloratis, gr. xx. Sodii Bicarbonatis, Acid. Borici, aa gr. x. Aq. Destill., 3j. HAY FEVER. 327 #. Cocain. Hydrochloratis, gr. x. Aquae, q. s. Ft. sol. et adde Fid. Cosmolini, Jj. M. Sig. Shake well before using. lusufflations of cocaine may be used according to the following : J*. Cocain. Hydrochloratis, gr. x. Bismuth. Subcarbonatis, gj. Magnesiae Carb. Levis, jij. M. Or, P:. Morph. Tartratis, gr. j. Cocain. Hydrochloratis, gr. x. Sulphuris Flor. , 3 s8 - Sac. Lactis, ^iiss. M. (Bos.) Suprarenal Extract : Ingals and Ohls state that they have obtained much relief in hay fever by the use of an extract of suprarenal capsule prepared as follows : Adrenals, I drachm. Boric Acid, 16 grains. Cinnamon Water, 4 drachms. Camphor Water (hot), I ounce. Distilled Water (hot) to make 2 ounces. Macerate for four hours, then filter. Use as a spray to the nose four or five times a day. This solution remains stable for several weeks. (A. M. S., 99.) Good results may also be obtained from the appli- cation of an aqueous solution, which acts as a powerful vaso-constrictor and contractor of erectile tissue. 328 DIGEST OF EXTERNAL THERAPEUTICS. Menthol: Preferred to cocaine by Ball; 5 to 10 per cent, solutions in albolene or some other of the petroleum derivatives are employed with the atom- izer. The same -writer recommends the following : Rectified Spirits, with 2 or 3 parts of water. Chromic Acid, gr. T V~i"~3j- Quinine Sulphate, gr. ij xi gij. Sulphurous Acid and water, equal parts. Carbolic Acid, 1 part to 60. The following was advised by Sir Andrew Clark : #. Glyceriti Acid. Carbolici, 3J. Quininse Hydrochloratis, 3J. Hydrarg. Bichlorid., gr. . M. Sig. Paint on the floor of the nose to naso-pharynx; two or three applications will sometimes suffice to cure a parox- ysm for the season, but the immediate effects are ex- ceedingly irritating. ( Ba. ) Acetic Acid : 2 per cent, solutions as nasal washes. (T., 98.) Boric Acid and Salicylic Acid: Equal parts as an insufflating powder. (Al.) Sodium Bisulphate: Solutions of 1-5000 in water as a nasal wash. (T., 98.) HEADACHE. When congestive, Hot Foot Baths, Mustard Foot Baths or Mustard Plasters to the back of the neck are of service. ( Wa. ) Cold Water Effusions to the head or Ice Bag will sometimes relieve both congestive and bilious sick HEART DISEASE, CHRONIC. 329 headache; on the other hand Warm Applications will suit some cases better. (R.) Morphine: A Irypodermic injection of a small dose acts frequently with excellent effect and is one of the most reliable remedies, at the same time one to be avoided until other means have been tried. (Ty.) The liability of forming the drug habit must be considered. In headaches, or neuralgia occurring fre- quently, if opium in any of its forms is used this un- fortunate result is like to occur. HEART DISEASE, CHRONIC. The Schott Treatment : This consists of exercises and carbonated brine baths, and is practiced with beneficial results at Nauheim, Germany. By the use of artificial baths the treatment can be carried out at home, The following is an outline of the home treatment : Synopsis of exercises. 1. Movement of extended arms in three directions. (a) From ordinary position by the sides of the body forward and upward until they reach the tem- ples and back again. (b) From the same position, laterally outward and upward to the temples and back again. (c) From the horizontal position with the palms of the hands meeting in front of the body as far apart as possible and back. Rotation of the extended arms about their axes as fully as possible, causing prona- tion and supination. 2. For the elbo\v, wrist and finger joints the nat- 330 DIGEST OF EXTERNAL THERAPEUTICS. ural flexions and extensions ; radial and ulnar abduc- tion and adduction. 3. (a) Flexion of trunk forward from a little be- yond the erect position and back. (6) Lateral flexions of the trunk to the right, left and back. (c) Rotation of the trunk on its axis to right, left and back. 4. Movements of each extended leg forward, up- ward, outward, upward, backward, upward and back. 5. The natural flexions and extensions of the knee and ankle joints. Resistance is made by the attendant with the palm of the hand in the direction exactly opposite to the movement. In applying it to the wrist or ankles these parts should be placed in the fork formed by separating the thumb and index finger; the limb should never be grasped lest support be given. The degree of resisting force should be as much as the patient can overcome without the slightest discom- fort, and should be applied uniformly and evenly. The patient must be able to breathe quietly; the mouth and alae nasi must be watched, and on the slightest indication of shortness of breath there should be a pause. Some of the movements may be omitted, according to circumstances ; the arms above the head and the trunk exercises are the most trying. The limbs must not be allowed to fall suddenly after the completion of a movement. The clothing should be loose and easy, and a considerable interval of time be allowed between the movements. This should be prolonged if there is fatigue. The exercises are usually given for about half an HEART DISEASE, CHRONIC. 331 hour, the series being gone over twice in that time, but they are frequently employed for a shorter or longer period. A skilled attendant is necessary. (Thn.) Two new exercises, not resisted by the operator, have recently been suggested by Dr. T. E. Satter- thwaite, assisted by Dr. H. V. Barclay, which are described as follows : The patient lying on his back with the head a little elevated, the operator standing at, his side passes his two arms under the chest and then raises it slowly and gently as far as possible without lifting the patient off his bed. Then the chest is allowed to set- tle back into its normal position. This movement is of the nature of artificial respiration, and is useful in the cardiac degeneration of obese persons and in some cardiac cases, with respiratory embarrassment owing to chronic pulmonary disease. In some rare cases of chronic pulmonary disease with a cardiac complication great relief and benefit might be ob- tained without danger, if such respiratory exercises are judiciously applied. Another of these respiratory series consists in ele- vation of the shoulders. The patient sitting on a stool, the operator on another stool behind him grasps the axillae of the patient in front, he now lifts the patient's body upwards as far as it would go without leaving the stool, and then draws the body over backwards, pressing his knee against the hollow of the patient's back. The body was then allowed to settle down easily into the original position. (M. T., 4, 98.) Artificial Nauheim Baths: A scheme for a six weeks' course of baths would be about as follows : 332 DIGEST OF EXTERNAL THERAPEUTICS. First Week. ^2 per cent, warm sea salt bath (2 Ibs. to 50 gals.). Temperature 94 to 95 degrees F. Dura- tion four minutes. Intermission on third day. Second Week. % per cent, warm salt bath (3 Ibs. to 50 gals.). Temperature 93 to 94 degrees F., six minutes. Intermission on fourth day; ^4 per cent, carbonic acid gas. Third Week. 1 per cent, warm rock salt bath (4 Ibs. to 50 gals.). Temperature 92 to 93 degrees F. Carbonic acid gas, % per cent., eight minutes. Inter- mission every fourth day. Fourth Week. 1*4 per cent, bath salt, warm (5 Ibs. to 50 gals.). Temperature 91 to 92 degrees F. Nauheim concentrated brine salts, 8 ounces, ten min- utes. Carbonic acid gas, % per cent. Intermission fourth day. Fifth Week. iy 2 per cent, bath salts (7 Ibs. to 50 gals.). Temperature 90 to 91 degrees F. Xauheim concentrated salts, 10 ounces, twelve minutes. Car- bonic acid gas, % per cent. Intermission fifth day. Sixth Week. 2 per cent, bath salt (10 Ibs. to 50 gals.). Temperature 80 to 88 degrees F. Nauheim concentrated salts, 12 ounces, and carbonic acid gas. 1 per cent., fourteen minutes. Intermission every fifth day. .. It is stated in conclusion that the patient does not always feel better after a bath. There may be some praecordial oppression, but this discomfort usually passed away at the end of a week. Baths and exercises each accomplish the same re- sult, but the most rapid and brilliant results are obtained w^hen both are used together. They are, however, useful only up to a certain point ; after this has been reached they are harmful, and if at any time HEART DISEASE, CHRONIC. 333 there is a tendency to relapse, the baths should be suspended, generally, however, to be resumed again after a day or two. The final step in the treatment is two or three weeks of rest at some place of mod- erate elevation. In successful cases the improvement is gradual and sometimes does not fully show itself until the patient had resumed his ordinary mode of life. The improvement may continue for many months, in some cases for more than a year. (M. T.,4, 98.) The centra-indication in the entire range of chronic cardio-vascular affections are advanced arterio-scler- osis, decided degeneration of the cardiac muscles and aneurism. (T., 98.) Carbonic Acid Gas Inhalations: Favorable re- ports have recently been published in regard to the value of carbonic acid gas in the treatment of valvu- lar diseases of the heart. Dr. Ewart, of London, observing that inhalations of carbonic acid gas in a disguised form constitutes part of the Nauheim treatment, has employed these inhalations as a dis- tinctive therapeutic measure. In using the gas three essentials are necessary: A continuous spray abso- lutely free from all traces of the dangerous mon- oxide; sufficient means for controlling the delivery and insuring a simultaneous inhalation of air; a convenient length of rubber tubing provided \vith a mouth piece. The apparatus employed is described as follows : It consists of three bottles in a box, a small narrow wash bottle and two larger bottles, each with small necks at the bottom ; these two in- ferior necks are connected with rubber tubing con- trolled by a clip, through which hydrochloric acid travels from one bottle to the other. The hydro- 334 DIGEST OF EXTERNAL THERAPEUTICS. chloric acid supply bottle must be raised and left open while in use. The top of the other bottle is connected by a rubber tube with the wash bottle, which contains a layer of glass marbles and, above this a layer of chipped marble which is left high and dry on the glass bed. When the carbonic gas press- ure is sufficiently raised in the bottle by shutting off the tube, all the hydrochloric acid is driven back and saved by closing the clip and putting a stopper in the bottle. The inhalation is made by holding the mouth-piece between the teeth while the lips remain open. This insures the entrance of air. The effects in the healthy are as follows: A feeling of internal warmth; a strong desire to breathe, and particu- larly to breathe out ; an excited state of the circula- tion; a slight giddiness and even headache. The effects in patients with cardiac sjnnptoms, according to Ewart, have been as follows: Rapid diminution, and within a minute or two cessation of cardiac dis- tress or pain ; a feeling of increasing freedom of respi- ration ; a visible increase in the depth of breathing ; a marked improvement in the pulse ; an obvious im- provement both in the expression and in the com- plexion. It is claimed that systematic repetition of the inha- lations bring about progressive improvement in the patient's general condition. As regard to the appli- cation of the treatment, it was found that loss of compensation in any valvular disease admits of ten- tative treatment by carbonic acid gas, and will re- spond to it in varying degrees. True angina, which forbids the use of Nauheim baths, may be safely treated with the inhalation; and in the minor de- grees of angina it has never failed to give relief. In HERNIA, STRANGULATED. 335 the worst cases of mitral and aortic stenosis, aortic regurgitation, and mitral disease with angina and in mitral stenosis with pulmonary congestion, relief was very marked. In the cases reported inhalations were administered several times a day. The rate of the gas escape may be judged from the rapidity of the bubbling, which can be easily adapted to the requirements of each case by altering the aper- ture of the pressure key. For average inhalations the bubbles should be allowed to pass as fast as they can be counted. When this rate is not exceeded no possible danger can arise, even when the inhalations are continued for some time. (B. M. J., 10, 28, 99.) HEMIPLEGIA. See Paralysis. HERNIA, STRANGULATED. The patient should be placed on his back in bed, the foot of which should be elevated about twelve inches, the pelvis raised upon a pillow, the legs flexed upon the thighs, and thighs upon the abdomen, or the knee and shoulder position may be assumed. (W.) Hot Applications: Hot baths should be tried or towels dipped in hot water partly wrung out and laid on the part, and constantly renewed, will some- times assist in relieving. (W.) Ice : A bag filled with ice is also employed with effect. (F.) 336 DIGEST OF EXTERNAL THERAPEUTICS. Opium; Opium narcosis should be secured at once to relieve the pain and relax the parts. Morphia, subcutaneously, or opium suppositories may be ad- ministered. (W.) Ammonium Chloride: In the absence of ice dis- solve 5 parts of the ammonia with 5 parts of nitrate of potash in 16 parts of water; the temperature of the combined solution will fall from 50 to 10 F. This is placed in a bladder and applied to hernial tumors to promote reduction. (Al.) Chloroform Inhalation: To assist in reduction has superseded the use of tobacco and lobelia. (P.) Lobelia: The infusion may be given by enema with good effect. (F.) Tobacco: Enema of the smoke, or one containing not more than 15 grains, has proved of great value, but lobelia is generally to be preferred. (F.) Taxis: If applications do not succeed in an hour or two reduction should be attempted. All eiforts in that direction should be gentle; a trial should first be made without anaesthesia, then, if unsuccessful, with an anaesthetic. (Ger.) The neck of the tumor should be grasped between the thumb and finger of one hand and the contents gently pushed into the canal with the other. Taxis should not be continued more than five or ten minutes at a time ; it may be repeated at intervals of half an hour during the first six hours of the strangulation ; after that it is of doubtful utility, if not harmful, and after twelve hours should not be attempted. ( W.) Operation: When strangulation is not reduced herniotomy should be performed within six hours after the accident, and should never be delayed more than twelve hours. Better results, says Wyeth, are HERPES PROGENITALIS. 337 obtained if the operation is performed during the earlier period. HERPES CIRCINATUS. See Trichophytosis Corporis. HERPES LABIALIS. See Herpes Simplex. HERPES PROGENITALIS. Usually little treatment will be required. Cleanse the parts, apph r an antiseptic lotion, then dry and dust on a mild powder, such as equal parts of Bis- muth Subnitrate and Zinc Oleate (Cl.), or apply a piece of lint soaked in Lead Water or Black Wash. (Vn.) Calomel: Pure or with equal parts of Zinc Oxide sprinkled on night and morning is useful when stimu- lation is required. (Vn.) Aristol or Airol: Useful for abrasions. A solution of Menthol in alcohol 1 per cent, or a 25 per cent, aqueous solution of Carbolic Acid ap- plied at the first indication of the formation of vesi- cles will frequently act as preventives. (Cltn.) Cold Douches to the lumbar region for half a minute twice a week, extra cleanliness, and the ap- 23 338 DIGEST OF EXTERNAL THERAPEUTICS. plication of a little Alcohol as soon as eruption seems about to appear are also effective preventive measures. Astringent lotions are indicated if there is a tendency to recurrence. (Cl.) HERPES SIMPLEX. Treatment is very simple, consisting of soothing and emollient applications ; if on the lip a little Cold Cream or Oleate of Bismuth Ointment (see McCall Anderson's ointment under Acute Eczema). Care should be observed not to detach the crusts too soon. In extensive cases of herpes of the face apply Bread and Milk Poultice, Dilute Lead Water or Boric Acid in the powder, and when there are crusts some mild ointment. (Vn.) Camphor: Will often abort the vesicles, and may be applied in the form of spirits or equal parts of the powder with borax. (B. H.) Flexible Collodion: Very useful, especially for the lips. (F.) Ichthyol : 1 per cent, solution, or an ointment of Zinc Ichthyolate, 1 per cent. (B. H.) The following antiseptic and astringent lotions are recommended : Resorcin, 2 per cent.; Thymol, 3 per cent.; Men- thol, 2 per cent.; Tannin, 2 per cent., applied fre- quently. HERPES ZOSTER. 339 HERPES ZOSTER. It is important to prevent rupture of the vesicles, which leads to ulceration. To attain this end avoid ointments and apply bland astringent powders, such as Bismuth, Zinc Oxide, or Starch, or paint the part with Flexible Collodion, alone or combined with Morphine (gr. x j). A soft linen bandage should complete the dressing. (Pp.) A useful dusting powder is as follows : #. Morph. Sulphatis, gr. ij. Pulv. Amyli, Zinc. Oxidi, aa gss. M. (Vn.) Electricity : The constant current, according to Duhring, will relieve if it does not abort. The sponge electrode is placed along the course of the nerves, and directly to the seat of the eruption ; five to ten cells maybe used, and the application made for fifteen minutes twice daily. The following lotions will prove useful: Lead Water, Lead and Opium Wash, Fid. Ext. Grindelia 3ss-Oj, or Zinc Carbonate Precipitate, with Pow- dered Starch and Glycerine, each half an ounce with water half a pint. (Vn.) The following forms an effective lotion for the relief of pain; it should be applied with wadding pads, frequently renewed : #. Alcoholis, -gj. Mentholi, gr. xv. Ext. Cannabis Indicse, gr. xxv. M. (T., 98.) 340 DIGEST OF EXTERNAL THERAPEUTICS. Cerates of Calendula, Camphor, Veratrine, half strength, and Zinc Oxide Ointment are indicated. (Bt.) Cerate of Cocaine: May be used with some cau- tion, according to the extent of exposed surface in- volved. (M. W.) Ext. Belladonna or Ext. Opium: An ointment of either, in the strength of 20 grains to the ounce, may be rubbed on when the eruption occurs on the scalp. (Vn.) HICCOUGH. Whiskey, Vinegar, Hot Brandy, or Mustard Plasters over the epigastrium frequently act very speedily. Blisters to epigastrium. Cold Shower, for the physiological effect of shock on the pneumo- gastric nerve. Ice or Leeches to epigastrium, espe- cially in inflammatory forms. Hard Pressure over epigastrium, a firm bandage or belt. (Bt.) Deep Inspirations and holding the breath as long as possible is effective in mild cases. (Ta.) The following measures have been reported by Sajous as having been successfully employed in obsti- nate cases : Dry Cups over the abdomen; energetic Pressure of the soft part of the patient's thumb against the little finger of the same hand ; Morphia and Atropia, subcutaneously, in sufficient doses to induce sleep; pungent snuff or other Sternutories to produce hard sneezing have succeeded after failure of other means ; Apomorphia, subcutaneously, to produce emesis has HORDEOLUM. 341 been followed by relief; Massage; Nitrite of Amyl inhalations. Pilocarpine : Has succeeded when all other reme- dies have failed, in doses of -^ grain three times a day subcutaneously. It appears best suited to cases of nervous origin. (T., 96.) Electricity: The various forms of this agent should be tried in intractable cases. (T., 96.) HORDEOLUM. Warm Fomentations or Hot Stupes afford the most relief and hasten suppuration. (N. O.) Nitrate of Silver; Applied early will abort; a so- lution of gr. v~3J, is recommended by Bull, and one of gr. xx-xl-j by Roosa. Hydrarg. Oxidi Flavi: An ointment of gr. j-^j rubbed in is useful in the beginning of the affection. (Ro.) When the swelling points it should be punctured with a Baer or Graefe knife. (Nt O.) Errors of refraction should be investigated as they may act as a cause. HYDROCELE. Tr. Iodine: After evacuating the sac, inject one- half to 1 drachm of a tincture made with crystals of iodine 1 part to 19 parts of alcohol, 95 per cent., this is allowed to stand uncorked for a few days. In in- fants a weak solution of iodine or collodion applied externally will cause the hydrocele to disappear. (Cl.) 342 DIGEST OF EXTERNAL THERAPEUTICS. Another method for the use of iodine is the follow- ing: Puncture the sac with a trocar and allow- about one- third of the fluid to flow away, then inject about three-quarters to 1 drachm of a 1 per cent- solution of Cocaine ; after an interval of five minutes the fluid is drawn off and tincture of iodine pure or mixed with one-third water is injected, and the whole evacuated after five minutes. (Sj.) Injection of iodine causes great pain and swelling with refilling of the sac, which will require rest in bed for a few days with the use of hot fomentations and anodynes, but the results are generally satis- factory. Contra-indications to its administration are the presence of pus or blood in the effusion, and thickening or calcareous degeneration of the w^alls of the sac. (Cl.) Carbolic Acid: After evacuation, injection of 30 minims of the liquified acid (carbolic acid 8 parts, glycerine 1 part) ; sloughing never occurs unless a greater quantity is used. This procedure is compara- tively painless, the inflammatory action much less than with iodine, and the patient is not forced to rest more than a day, sometimes not at all. (Cl.) Injection of 30 minims of a freshly prepared solu- tion of equal parts of the pure acid and glycerine are also recommended. (Sj.) The contra-indications in the use of carbolic acid injections are the same as those for iodine. Treatment by Open Puncture : The sac is tapped in the usual way with a trocar and canula, but the latter is left in situ to act as a drain ; a light cotton dressing and a slightly compressing bandage is then applied. A fenestrated drainage tube may be passed through the canula, which is then removed and the HYPERTRICHOSIS. 343 tube left in its place. For two or three days the sac is irrigated with a mild antiseptic solution, and at the end of three days the tube is shortened and finally removed. (T., 96.) Another method, viz.: Introduce a trocar into the lower part of the sac and evacuate the contents, then wash out the cavity with a 3 to 5 per cent, solution of carbolic acid. The trocar is now pushed through the sac wall and brought out at its upper end, a fen- estrated drainage tube is passed through the canula and the exudations thus allowed to escape without accumulating ; antiseptic dressing should be applied and the tube removed on the eighth day. No anaes- thesia is said to be necessary. Cicatrization requires from eight to ten days. (T., 96.) After injecting iodine or carbolic acid a certain amount of manipulation of the part must be made in order to bring the injected fluid in more intimate contact with the tissues. Ammonium Chloride: Lint saturated in solutions of gr. x-3j and kept continuously applied, is used \vith advantage in congenital hydrocele. (Al.) HYPERHIDROSIS. See Bromidrosis. HYPERTRICHOSIS. Electrolysis : This is the most effective and suc- cessful method of treatment, and should be per- formed to depilation. Its action is permanent. 344 DIGEST OF EXTERNAL THERAPEUTICS. The growth of the neighboring fine hairs appears to be stimulated by the electricity, hence the opera- tion must be repeated. When carefully performed little scarring will result. (Vn.) Epilation: This consists in removing the hairs and inserting and rotating in each hair follicle a glover's needle which has been dipped in carbolic acid. (Kp.) Depilatory Powders: These agents commonly contain Arsenic Tersulphide, Barium Sulphide, Calcium Sulphide, or Quicklime. They are not to be relied upon, being temporary in effect. They cause moreover, a renewed growth of coarser hair, and redden and inflame the skin. When for any rea- son they may be required, the folio wing can be em- ployed : "Rusma of the Turks." Orpiment 1 part, quick- lime or chalk 10 parts, starch 10 parts. (F.) Delacroix's " Poudre Subtile" Orpiment 4 parts, quicklime 30 parts, powdered gum 60 parts. (F.) Reviel's Mixture : #. Calcii Sulphidi, 3v. Ess. Limonis, gtt. xx. Amyli Glyceriti, Amyli, aa ^iiss. M. Duhring recommends : Ijfc. Barii Sulphidi, ^ij. Amyli, Zinc. Oxidi, aa &iij. M. #. Sodii Sulphidi, ij. Cretae Praeparatse, ;5 V J' M. (F.) HYSTERIA. 345 The following is said to be in vogue in Turkey : #. Arsenici Trisulphureti, gij. Calcis Vivi, ^ij. Amyli, ;5ij- v - Aq. Bullientis, q. s. M. (Vn.) These powders are made into a paste and applied to the skin ; as soon as dry they are washed off. The last is allowed to remain on from five to ten min- utes, or until a tingling sensation is produced, then the skin is washed and powdered with starch. HYSTERIA. Rest Treatment : The essentials of this treatment consist of Isolation, Rest, Diet, Massage and Elec- tricity. The following is a general outline of the method : The patient should be removed from previ- ous surroundings, away from all relations and friends, even correspondence being interdicted for a time. The next essential is an intelligent and sensi- ble nurse, the selection of whom is a matter of great importance ; she must not only be agreeable and con- genial to the patient, for it must be remembered she is to be her constant and only companion for some months, but she must also possess tact, judgment, and firmness. Under the nurse's care the patient is put to bed and kept in a condition of absolute rest, even reading and self-feeding at first being prohibited. Massage is used daily at the commencement for short periods, which are gradually increased until it is continued for an hour. Faradism is also adminis- tered in association with massage ; but these meas- 346 DIGEST OF EXTERNAL THERAPEUTICS. ures are discontinued during menstruation. The diet during this period is milk, used b} r some skimmed, but unskimmed milk diluted with aerated water is preferable ; from 4 to 6 ounces are given every two hours. This diet is continued as a rule for a week or ten days, when a chop, raw oysters, with a cup of tea or coffee, are added at luncheon, later an egg and bread and butter at breakfast ; the milk is continued every two hours. The nurse should give the patient a thorough sponge bath daily. In a month or six weeks the pa- tient is allowed to sit up for a short time, after that for a longer period, increasing each da.y, until the whole day is spent out of bed. This return from the long rest in bed must be very gradual. Later, the patient is taken out for a drive, then, in time, for a short walk, then gradually for longer walks, each time increasing the distance, until long distances are covered with little fatigue. As a rule, about three months will be necessary to carry out this treat- ment, which has given most satisfactory results. (S. W. M.) For a fuller description the reader is referred to Weir Mitchell's book, "Fat and Blood," and Good- no's " Practice of Medicine." ICHTHYOSIS. Treatment, though largely palliative, must be active and continuous. The skin should be kept moist and supple by frequent warm baths with alkalis and soap, the free use of Russian baths, and by prolonged warm baths followed by inunctions of vaseline, glycerine, lanolin, or oil. ICHTHYOSIS. 347 Sapo Viridis: This maybe rubbed in twice daily for four or six days, during which period the patient should not bathe; four or five days after the last rubbing, when the epidermis begins to peel, a bath is to be administered followed by some simple oint- ment, such as oil of almonds, glycerine, pure or diluted, or the following : #. Adipis Benzoatis, ^iv. Ung. Petrolii, |j. Glycerini, 9iv. M. (Vn.) Naphthol: 5 per cent, ointment, or 2 per cent, in spirits of soap. (Kap.) Resorcin : 3 to 20 per cent, ointments well rubbed in and covered with bandages, have been successful. (Ja. ) Brocq recommends the following to be rubbed in at night and removed with soap in the morning : fy. Acid. Salicylic!, Acid. Tartarici, Resorcini, aa gj. Sulphur. Prsecipitati, ^iiss. Adipis, 3J. Lanolini, 3 u j- M. (Vn.) Ichthyol: In combination with Salicylic Acid and Sulphur may be employed as follows : I*. Ichthyoli, gij-iv. Acid. Salicylici, 3J. Sulphur. Prsecipitati, 5jij. Adipis, 3 i y - M. Sig. To be applied night and morning and washed off with ichthyol soap. 348 DIGEST OF EXTERNAL THERAPEUTICS. Potass. Iodide: The following is said to act well: Jjfc. Potass. lodidi, gr. xx. Ol. Bubuli, Adipis, aa %ss. Glycerin!, gj. M. (J. C. S.) Cod Liver Oil by inunction and Sulphur Ointment are both recommended. ICHTHYOSIS HYSTRIX. The treatment is essentially that of any warty, non-malignant growth. The patches, if not large, may be softened by poultices and then treated with Caustic Potash, Chromic Acid, or Glacial Acetic Acid, or the growths may be removed by the dermal curette or by excision. Thuja: The fluid extract painted on has had good effect. (Vn.) Salicylic Acid: A 20 percent, plaster or a satur- ated alcoholic solution is recommended after the removal of the horny covering. (B. H.) IMPETIGO. According to Duhring, this affection tends to spon- taneous recovery, and beyond the use of a mild stim- ulating ointment no treatment is required. The following line of treatment is suggested by Van Harlingen : Poultices rendered antiseptic by the addition of a little Boric Acid should be used to re- move the crusts ; the entire surface of the body should be frequently cleansed with warm water and Cor- rosive Sublimate Soap, then compresses wet with a IMPETIGO CONTAGIOSA. 349 saturated solution of Boric Acid or of Mercuric Bichloride, 1-2000, should be applied to the dis- eased points. If ulcers form beneath the crusts they should be cleansed with Hydrogen Peroxide and dusted with Dermatol, Europhen orAristol, or some antiseptic ointment may be applied. lodoform and Salicylic Ointments are also useful. IMPETIGO CONTAGIOSA. Children suffering from this disease should be kept from school and separated from other children. Hydrarg. Ammoniat.: This remedy is very gener- ally used by dermatologists, and, together with cleanliness, in most instances is all that will be re- quired. It is employed in ointments of 5 to 15 grains to the ounce. (Hd.) Bismuth Subnitrate: With vaseline or cold cream, a drachm to the ounce. (Al.) INFLUENZA. See Acute Rhinitis. INGROWING TOE NAIL. The following method, it is claimed, will result in a permanent cure : 1. Remove injurious pressure, and order careful measurement for shoes, the uppers of which should 350 DIGEST OF EXTERNAL THERAPEUTICS. be of a less unyielding nature than usual ; during actual treatment the patient should wear canvas shoes. 2. Wash the feet with warm water and soap, then soak for fifteen minutes in bichloride of mercury, 1- 4-000 ; repeat this daily for four days. 3. A small piece of antiseptic gauze is to be grad- ually and gently inserted between the nail and over- lying tissue; this must be done gently, otherwise it is very painful ; the gauze should be removed before washing. After this the tissue will become considerabh r sep- arated from the nail, which can be trimmed where in contact with the soft parts. After soaking, the gauze is to be inserted as before. Within a week, it is said, the parts will have assumed almost a normal appearance, and the patient \vill be able to go about. The gauze should be continued for some weeks. A modification of this plan has been found useful, viz.: In place of the soaking, apply a compress satur- ated in a solution of carbolic acid or perchloride of iron and cover the same with rubber tissue. After two days' application, the gauze may be used as above and the nail trimmed. (T., 98.) The following, suggested by Dr. M. O. Terry, is also said to be successful : Saturate a small piece of absorbent cotton in a solution of Liquor Potassae 1 part to 4 parts of -water ; then, with the flat end of a director, insert the cotton under, over and above the edge of the nail, allowing it to spread over the ulcerated hypertrophied tissues; next freely apply collodion over the whole, including the inflamed sur- face ; after this, with a long, narrow strip of surgical isinglass plaster, attach an end close to the nail on INGROWING TOE NAIL. 351 the swollen part and bring it around the toe two or three times, drawing the hypertrophy away as much as possible ; if the case is bad, it will require four or five dressings, which should not be changed under forty-eight hours. (Hel.) An old method, which will sometimes afford relief in the earlier stages, consists of scraping in a line from the matrix to the extremity of the nail ; the ex- ternal layer may be thus removed ; when the middle is reached there will be sensitiveness and the scraping must cease ; a deep notch is now cut in the extremity of the nail. The ingrowing parts are now to be partly raised with a probe and small bits of tinfoil inserted ; a hole should be cut in the boot to relieve pressure. This process of scraping and notching should be continued for several \veeks, when a cure will result. (Hel.) Collodion: Pack cotton firmly under the free edge of the nail with a flat probe passing between the nail and the granulations, raising the former as far as possible ; the cotton having been thus packed under and around the nail, saturate the entire mass with collodion ; after drying apply a few strips of adhesive plaster. (Al.) Nitrate of Silver: Apply a sharp-pointed crayon to the base or under the surface of the granulations, then insert a small piece of lint soaked in black wash, and envelop the toe in water dressing. (Al.) Tannic Acid: 1 part to 6 of w^ater, dissolved by gentle heat and painted on soft parts twice daily has given good results. (Al.) Calendula: Very useful for the relief of inflamma- tion ; compresses soaked in a solution of 1 part to 5 of carbolized water may be applied with good effect. (M. H.) 352 DIGEST OF EXTERNAL THERAPEUTICS. Alum: A solution of 6 drachms to 1 ounce of hot water is very effective for inflammations. (W. C.) Cocaine : This remedy is most useful for the relief of pain in dressing; also after applying a ligature around the toe, it may be given hypodermically, and thus render removal of the whole or part of the nail entirely painless. (Tre.) Antiseptic dusting powders \vill be found useful in ulceration, notably Bismuth Subnitrate. (Al.) Removal of the nail is sometimes necessa^. INSOMNIA. Warm or Tepid Baths at night, Massage or the "Wet Pack are all of value. (Gn.) Injections of Hot Milk high into the bowel is use- ful in cases of alcoholism and insanity Inhalations of a mixture of 70 per cent, of Oxygen with 30 of nitrogen gas administered before retiring are often effective in inducing sleep. IRITIS. Local or mechanical treatment is of the greatest importance to prevent adhesion of the iris to the cap- sule of the lens; this is accomplished by mydriatics. Atropine Sulphate: This is commonly used, and in most cases preferred to other mydriatics, on account of its sustained action ; a drop of the 1 per cent, solu- tion is placed on the outer surface of the conjunctiva of the lower lid, the patient holding the head back so that the outer canthus is lower than the inner. In IRITIS. 353 acute cases of plastic iritis 1 drop of a 1 per cent, solution should be dropped in the eye every two hours during the active stage. (Mac.) Scopolamine: A solution of 2 grains to the ounce of distilled water, is a better mydriatic in persons over 50 years of age and in cases where glaucoma is threatening, as atropine will precipitate an attack of the latter and will make it worse if present. This mydriatic is more active than atropine and will tear up adhesions quicker. (Boyle.) For quick action, which is necessary in plastic iritis, scopolamine hy- drobromate, in solutions of y 1 ^ of 1 per cent., is to be preferred to atropine, using 2 drops at a sitting, re- peating as necessary. (T., 98.) Cocaine Hydrochlorate : 2 per cent, solutions are used to relieve pain. (T., 98.) This remedy is fre- quently combined with atropine, not only for its anaesthetic effects, but because it assists in dilating the pupil by its action on the iris and by increasing the absorbing power of the cornea. (Al.) Duboisin Sulphate: One-half per cent, solutions may be used when atropine causes irritation of the skin or the conjunctiva. (T., 98.) Hyoscine Hydrobromate: 1 drop of a 1 per cent, solution may be instilled in cases where the adhe- sions are so strong that they resist the action of atropine. It is a very powerful remedy, and should only be used by the physician himself; the action may be kept up by atropine. (Mac.) Cold: Applicable in three ways; in the first place, tie a piece of tape around the patient's head and to it attach a square of linen which covers the inflamed eye, a basin of ice water is placed conveniently near and from it the square of linen is kept constantly 24 354 DIGEST OF EXTERNAL THERAPEUTICS. moistened. The second method consists of the appli- cation of a pad of cotton wool which has been laid upon a block of ice and which is changed as soon as it ceases to give the sensation of cold. A block of ice is placed near the bed-side and two pads kept in use, one cooling on the ice while the other is on the lids. The third plan is a modification of Letter's coil, being the same apparatus, but of much lighter construc- tion and especially adapted to this purpose. (N. O.) Heat : May be applied either in the moist or dry form. Several folds of lint are dipped in hot water, squeezed out as dry as possible, applied to the lid and covered with oiled silk. This dressing is then packed in with a thick layer of dry cotton heated by contact with a can or pail containing hot water, and bandaged in position. Another and equally effective way consists of the rapid application of a fold of linen which has been wrung in hot water and which is rapidly replaced as soon as cool. Hot infusions of Chamomile Flowers or Poppies are permissible, also Conium Lotion, a drachm of the extract to a pint of water, or Belladonna in the same propor- tions. Hot applications are useful during the early stage of the disease (Ro.), and may be ordered two or three times a day, for half hour at a time. It is advisable when the skin is sensitive to protect the lid and neighboring parts with vaseline. (N. O.) Dry heat can be applied by covering the lid with a pad of cotton which has been heated by contact with the outside of a vessel containing boiling water. (N. O.) Local Abstraction of Blood: A time-honered rem- edy, may be used if pain and vascular injection is very severe. Natural or artificial leeches may be used. (Ro.) KELOID. 355 INTERTRIGO. See Erythema Intertrigo. KELOID. Treatment is unsatisfactory. Removal by the knife is generally followed by recurrence. Electrolysis is probably the best means. (Hd.) Thiosinamine: 10 to 15 minims of a 10 per cent, solution hypodermically, have been employed with good results. (Hd.) Vidal's Method: Deep parallel incision dividing the vessels, producing obliteration, may have a bene- ficent effect, if done repeatedly. It usually relieves pain. (B. H.) Anodyne Applications may be required for the relief of pain. KERATITIS. Atropine : Renders great service by contracting vessels; it is useful in all forms according to the condition. (Ro.) Eserine: In the phlyctenular variety, a solution of one five-hundredth dropped into the eye three times a day will be found valuable in hastening the healing of the ulcers, and in relieving the photo- phobia by contracting the pupil and reducing the tension of the eyeball. As iritis is seldom a compli- cation, this remedy is generally safe. (Mac.) Pyoktanin: Solutions of 1-1000 in the parenchy- matous and sloughing forms are highly praised as well as discredited. (Al.) 356 DIGEST OF EXTERNAL THERAPEUTICS. Cocaine : Alone or in combination with atropine to relieve pain and check inflammation. (Al.) Gallicine: In superficial forms, the powder, which is very light, may be dusted on, the application being made twice a week; a smarting sensation follows, which soon passes off, or which can be relieved by cold compresses or cocaine. (F.) Hot Stupes: Of great value, especially when there is sloughing, in which case they are indispensable. They may be of service in all forms according to indi- cations. (Al.) Cauterization: The actual cautery or pure car- bolic acid is effective in the suppurative variety. (Ro.) lodoform: Dusted on or applied as an ointment (3J-gj) is favorably regarded by some when there is sloughing, but should not be relied upon to the ex- clusion of other remedies. ( Al.) Hydrarg. Oleat.: The ointment by inunction in the diffuse form may be employed for months, but with great caution. (Ro.) Aristol : The powder has been emploj^ed with suc- cess in clearing opacities of the cornea in interstitial keratitis. (Sm.) Mercury: Finely levigated Calomel as a dusting powder or the Yellow Oxide as an ointment (gr. ss- iv-3J) are recommended for chronic cases. (Al.) LARYNGISMUS STRIDULUS. Raise the child and promptly immerse it in a "Warm Bath, sponging the throat at the same time with hot water, and apply a Sinapism to the back of the neck. (Bos.) LARYNGITIS. 357 Anaesthetics will stop an attack immediately; a few drops of Ether will generally answer. Chloro- form may be used for the convulsions which may follow. Ice to the epigastrium or in the rectum sometimes will afford prompt relief. Cold "Water dashed on the face with considerable force may be tried to excite respiration. Irritation of the Pharynx with the finger or with a feather to induce vomiting will relax the spasm. (Gn.) The child should be placed in a semi-recumbent position, with free access to the air, and the tongue should be watched, lest it fall back into the pharynx and still further impede respiration. Artificial Respiration should be employed when spasm is prolonged and death seems imminent. (Gn.) Chloral Hydrate : 4 to 8 grains by rectal injection are recommended for the convulsions which not un- commonly follow an attack. (Jac.) The condition of the gums and bowels should be investigated as possible causes. LARYNGITIS. ACUTE CATARRHAL LARYNGITIS. The temperature of the room should be evenly maintained at about 70 F., and the atmosphere kept moistened with Steam. Heat: Applied to the throat increases secretion, and relieves congestion; it is useful in most cases. Flannel cloths wrung out in hot water and covered 358 DIGEST OF EXTERNAL, THERAPEUTICS. with oiled silk are the best methods of application ; poultices may be used, but they are heavy and incon- venient. A hot foot bath is often beneficial at the onset of the disease. (Ga. ) Cold: Applied by means of the ice bag, or cold wet cloths frequently changed, will often cut short an attack if undertaken early enough (Bos.); these measures are also often of service in grave forms of the disease attended with swelling of the submucous tissue. Inhalations of warm medicated vapors are of ser- vice. The following are to be used with boiling water: Tr. Benzoin Comp., 355 j Oj. Turpentine, $j, poured on the surface of a pail of boiling water. Thymol, 11000, useful in exanthematous forms with purulent exudation. Oil of Origanum, gtt. ij iv-Oj. Oil of Cubebs, indicated when there is relaxation of the mucus membrane and hypersecretion, 10 drops to 1 ounce, add a small quantity of magnesia car- bonate; of this mixture take 1 drachm to half a pint of water. Lupulin, gr. v-^j, strongly recommended if there is great pain and rapid progress of the disease. Astringent sprays may be used as follows : Liq. Ferri Persulphatis, gtt. v x $j. Argenti Nitras, gr. ij-v-.sj. Zinci Chloridum, gr. v x 3j. Dobell's Solution, or some other mild alkaline spra3', should be employed for cleansing when there is an excess of mucus. For the administration of steam inhalations em- LARYNGITIS. 359 ploy one of the special appliances constructed for this purpose, or an ordinary hot water kettle with a piece of rubber piping attached to the nozzle; for want of something better a common tin funnel placed over a cup of hot water will answer. The following measures, stated in order of the im- portance, are suggested by Bos worth for hoarseness and complete loss of voice, especially in singers and public speakers, where speedy relief is a matter of im- portance. There is no definite method, however, by which relief can be obtained in a given period : 1. Absolute and total rest of the voice ; this is literal, even whispering is to be avoided as much as possible. 2. Confinement to an apartment the temperature of which should be evenly maintained at 68" or 70, not higher. 3. Let the atmosphere be impregnated with steam from a spirit lamp. 4. Apply an ice bag to the surface of the throat. 5. By means of an atomizer, spray the larynx with a solution of nitrate of silver, gr. v-^j, repeat a second or a third time during the day, the strength of the solution and the interval of application being governed by the ap- pearance of the parts as shown by the laryngoscope. 6. Reduce turbinated bones if swollen by chromic acid. 7. If there is acute inflammation of the pharynx douche the part thoroughly with the post- nasal syringe and apply nitrate of silver, gr. xxx j. (In conjunction with these measures -^ grain of aconitine hourly for three doses, then every two hours until constitutional effects are produced, and a saline purge.) (Bos.) CHROXIC CATARRH AL LARYXGITIS. Many writers regard this disease as always sec- ondary to some other chronic affection of the upper 360 DIGEST OF EXTERNAL THERAPEUTICS. respiratory tract, as such, treatment should also be directed to the primary disease. Direct instrumental indications require the per- sonal attention of the physician. Inhalations and insufflations may be carried out by the patient or an attendant at home. Alkaline Sprays tend to increase secretion and fa- cilitate removal of adherent mucus ; for this purpose employ the following, each in the proportion of 5 grains to the ounce of water (Solis Cohen) : Am- monium Chloride, Sodium Borate, Sodium Bi- carbonate, Sodium Chloride, Potassium Chlorate. Tar Water may be used as a menstrum instead of distilled water. A few drops of some aromatic may be added to the solutions to make them more agree- able. (Pp.) Astringent Sprays are indicated when secretion is excessive. The following are to be employed with one ounce of rose water : Alumen, gr. v. Acidum Tannicum, gr. ij. Plumbi Acetas, gr. ij. Ferri Chloridum, gr. j. Argenti Nitras, gr. ss. Zinci Acetas, gr. v. Zinci Sulphas, gr. ij. Zinci Sulpho-Carbolas, gr. ij. Vegetable astringents, iodine, carbolic acid and creosote, are condemned by some -writers as in- effectual. The following in the proportion of the amount mentioned to an ounce of water, preference of selec- tion being given according to order, are recom- mended : LARYNGITIS. 361 Argenti Nitras, gr. v xx. Zinci Sulphas, gr. v xx. Zinci Chloridum, gr. ij vj. Liq. Ferri Persulphatis, M. x xxx. Cupri Sulphas, gr. iij x. Steam Inhalations : Used at home daily are ser- viceable in cases of hyperaesthesia of the mucous membrane. The patient should remain indoors for half an hour after use. The following are to be em- ployed, all in the proportion of a teaspoonful of the mixture to a pint of hot water : I. Tr. Benzoin. Conip., ^xxij. Ol. Pini Silvestris, ^ij. M. Stimulating and soothing. #. Ol. Pini Silvestris, Magnesiae Carb. Levis, aa 3J. Aq. Destill., ad ^iij. M. (L. B.) This forms a mildly stimulating and resolving ap- plication. The same formula may be employed with the addition of 5 grains of camphor. Other useful formulae used in the same proportion are as follows : I*. Ol. Eucalypti, 3J-"j- Magnesiae Carb. Levis, gr. xxx-xc. Aq. Destill.. 3 iij. M. An agreeable stimulant with sedative effect : #. Creosoti, 3 ss - Magnesiae Carb. Levis, giss. Aq. Destill., ad giij. M. 362 DIGEST OF EXTERNAL THERAPEUTICS. Useful for chronically congested conditions : &. Benzoli, ij. Ol. Cassiae, M.vj. Magnesise Carb. Levis, 3J. Aq. Destill., ad ^iij. M. (L. B.) If topical treatment of a more decided character is indicated, solutions applied with a brush, or pow- ders should be used, but only in the hands of an ex- pert, as spasm of the larynx is liable to be excited by medicinal applications when made for the first time. Remedies of this nature should not be employed until tolerance has been established. The use of cocaine will greatly assist in allaying irritation. (L. B.) Among the stronger local applications which have been suggested for intra-laryngeal treatment are the following : lodoform : Indicated in ulceration, finely pulver- ized, alone or with Bismuth equal parts, with Mor- phine gr. ij-x to the Ij of iodoform (Ty.), or in an ethereal solution. Nitrate of Silver: Gr. xxv, rose water, j, recom- mended by Solis Cohen in obstinate and protracted cases (Pp.), condemned by Lennox Brown, but re- garded by other writers as effective. Iodine: Gr. j, glycerine 3j (L. B.), or iodine, gr. v, in alcohol, 3Jviij ; applications are made daily com- mencing with the weaker solutions ; only one puff is to be applied, the patient inspiring. Holding cold water in the mouth may control spasm. The pre- vious use of a strong solution of cocaine will usually act as a preventive. (Gn.) Chloride of Iron: 388-33, with water, j, has been used in the hoarseness of professional singers; a LARYNX, (EDEMA OF. 363 single application, it is said, will often put the parts in good condition. (Al.) Faradism is of benefit in restoring the tone and power of the voice. Cold Wet Compresses at night and Iodine painted on the throat over the thyroid cartilage are useful adjuncts. (L. B.) Lactic Acid, Nitrate of Silver or Chromic Acid fused on the end of a silver probe, applied with a properly hooded porte-caustique, may be applied in some cases when there is considerable hypertrophy at the posterior insertion of the chords and anterior face of the commissure, giving rise to watery excres- cences. The use of caustics is generally condemned except for the above condition, which is occasionally observed. LARYNX, CEDEMA OF CEDEMA GLOTTIDIS. Free Scarification: Such local depletion as can be obtained by free scarification of the inflamed mem- brane is the first indication. This can be accom- plished by Tobold's concealed lancet or any other laryngeal knife convenient ; if this is not at hand use an ordinary curved bistoury with the blade wrapped in plaster or thread up to within a quarter of an inch of its point. The scarifications should be used freely three times a day both along the face of the epiglottis and the swollen venticular cords. (Bos.) Ice : Applied to the neck has been employed with good results ; the patient should also be allowed to suck ice. 364? DIGEST OF EXTERNAL THERAPEUTICS Cocaine Sprays and Steam Inhalations are ad- vised. Pilocarpine : Hypodermically administered has been successful in some cases ; in those of a sthenic type it is strongly advised. (Ty.) Tracheotomy : Should be performed if no relief is obtained. The high rate of mortality, according to Osier, is due to the fact that in many instances the operation is delayed too long. LARYNX, TUBERCULOSIS OF. See Tuberculosis. LENTIGO FRECKLES. The remedies for chloasma are also applicable. Copper Oleate: Gr. v-^-gj, with lanolin or lard is excellent. (Sh.) Salicylic Acid: Gr. iv.-j, in an ointment. (Sh.) Hydrarg. Bichlorid.: Used in strengths varying from one-half to 4 grains to the ounce of water, al- cohol or almond oil. These solutions may be left in contact with the skin several hours. (B. H.) The following are useful combinations : P. Hydrarg. Bichlorid., gr. ss. Tr. Benzoin!., 3" ss - Glycerini, 3ij- Aq. Ro.>8e, ,^vj. M. (Sm.) LEPROSY. 365 Or the following paste of Unna, which is to be ap- plied once daily : #. Hydrarg. Bichlorid., gr. iij. Zinc. Oxidi, 3ij- Bismuth. Oxychloratis, 3 SS - Dextrini, Aq. Destill., aa 3vi- Glycerini, 3"j- M. Carbolic Acid: Touch each spot with the pure acid ; as a result, the epidermis will peal off and leave a red spot which will become normal in a few days. (Sh.) Zinc Sulpho-Carbolate: A paste for application with a brush made as follows : I*. Zinc. Sulpho-Carbolatis, gr. v. Alcoholis, 3 ss. Collodii, f j. M. (Al.) Hydrarg. Ammoniat.: May be combined with Bismuth as follows : 9>. Hydrarg. Ammoniati, Bismuth. Subnitratis, aa. ^j. Ung. Aq. Rosas, 3jj. M. (Hd.) LEPROSY. For ulceration, ordinary antiseptic methods should be employed. lodoform, Aristol, Salol, Boric Acid may be dusted on after cleansing with antiseptic solutions. (B. H.) Oil of Anacardium: Used in tropical countries. As a local stimulant it may be applied pure, but is 366 DIGEST OF EXTERNAL THERAPEUTICS. better diluted with 3 parts of almond oil ; applica- tions are made to the anaesthetic spots until a blister is formed, also to tubercles until they open; the lesions are then dressed with gurjun oil. (Al.) Gurjun Oil: Recommended on good authority; the formula for its use is 1 part of the oil to 3 of lime water; churn well together so as to make a cream and apply to the ulcers. (Vn.) Equal parts of the oil and lime water are also employed. (Al.) Chaulmoogra Oil: By inunction pure or with vas- eline or lard; spread on cloths and apply to parts. Under this drug improvement may be looked for. (F.) Ichthyol: Applications varying from 10 to 60 per cent., reported by Unna to have given good results. Hydrarg. Bichlorid.: Intra-muscular injections of ^ grain were used by Crocker in two cases with re- markable improvement; it is believed to be a valu- able agent. (T., 97.) Serum Treatment: Claims have been made for the treatment of de Dios Carrasquilla, but its cura- tive power has not yet been demonstrated. (F.) Chrysarobin: Recommended by Unna in the fol- lowing combinations, to be rubbed into all the lesions except those of the hands or face : Chrysaro- bin and ichthyol of each 5 parts, acid salicylic 2 parts, simple ointment 100 parts ; on the hands and face Pyrogallic Acid is substituted for the chrysaro- bin (to counteract bad effects of the drug 30 drops of dilute hydrochloric acid are administered daily, for women and children) ; Resorcin is sometimes substi- tuted for chrysarobin. Electro-Cauterization; Has been used as a means of reducing leprous nodules ; each tubercle should be LEUCORRHCEA. 367 cauterized interstitially by single or multiple points or by electro-caustic bars when the surfaces to be destroyed are large. (T. 98.) Excision: Followed by the application of pure Carbolic Acid, is a method which has been employed with a view of relieving the disfigurements ; Tannin is applied to the surface after the carbolic acid in order to form a crust and to protect the action of the acid. The knife or scissors are used for excising. (B.M.J.,6,9,88.) LEUCORRHCEA. Compare Endocervicitis and Endometritis. Being a symptom, treatment is obviously to be directed toward the cause ; when of cervical origin, it is that of endocervicitis, endometritis and erosion. Displacements, hypertrophied cervix, lacerations, polypi, cysts and vaginitis, dyscrasia, ascarides in children are also causes which must be considered. Douches: Hot water douches are of great value in all forms and should be used daily; tepid salt water is beneficial for simple forms of catarrh. (Cp.) Hydrastis: One of the most useful remedies. The following are recommended for injection : ffc. Fid. Ext. Hydrastis, 3j. Aq. Destill., Oss. M. Or, #. Fid. Ext. Hydrastis, Sue. Calendulae, aa 5j- Glycerini, gvj. M. Sig. A tablespoonful to half a pint of water. (Cp. ) 368 DIGEST OF EXTERNAL THERAPEUTICS. #. Creolini, gtt. xxx. Fid. Ext. Hydrastis, giiss. M. Sig. 2 tablespoonfuls to half a pint of water. (T., 97.) Borax : 5 to 10 per cent, solutions, often very satisfactory in alkaline discharges. (F.) Boric Acid : The powder by insufflation or in solution with glycerine tampons ; also used in solu- tion for injection, 6 drachms to the pint. (R.) Tannin: Used in several ways; half an ounce with half a pint of claret wine forms a good astringent injection. Also the following : Creosote 3 parts, tan- nic acid 6 parts, alcohol 3 parts, water 24 parts. A tablespoonful of this mixture with 2 pints of water ; inject two or three times a day. (T., 98.) Alum: A very useful and inexpensive remedy ; use about a drachm to a pint of water for a simple in- jection. P;. Aluminis, 3J- Zinc. Sulphatis, 5 SS - Sod. Boratis, gr. jv. Aq. Rosse, ad ,^viij. M. (R.) Or, 5fc. Aluminis, Zinc. Sulphatis, aa 3J- Potass. Permang., Heliotropin., aa gr. j. M. Sig. Dissolve this powder in a pint of warm water and use a a vaginal douche. (T., 97.) Argentamine: Indicated in leucorrhoea caused by gonococcal infection, in all cases of vaginal, cervical or uterine catarrh in which there is a muco-purulent or purulent discharge, both in young girls and LEUCORRHCEA. 369 adults, and in discharges dependent upon malignant growths. The strengths of the solutions are as fol- lows : For simple vaginal irrigation, 1-5000-4000 ; for disinfection, 1-3000-2000-1000. (N. M.) The following combinations are also recom- mended : Myrrh: A drachm to an ounce of water often will have an excellent effect in simple catarrhal condi- tions. (Al.) Zinc Sozoiodate: As a dusting powder or as a 10 percent, ointment on tampons. (Al.) Grindelia: An effective remedy, may be combined with creolin as follows : #. Fid. Ext. Grindelise, gss. Creolini, 3ij- Aq. Destill., q. s. ad 5 V - M. (Sm.) Loretin: "By insufflation, after a cleansing douche this drug has many of the advantages of iodoform without its odor ; it is especially serviceable in puru- lent and offensive discharges. (T., 96.) In some chronic cases, benefit is derived from tam- pons soaked in Glycerine of Carbolic Acid 1 part and Glycerine of Tannin 4 parts, introduced through a speculum. (T., 96.) Glycerite of Tannic Acid or Gallic Acid are also used for saturating tampons. (Sw.) Other effective injections, viz.: I*. Acid. Salicylici, Acid. Thymici, aa" 3 s8 - Ess. Ambrse Griseae, gtt. xx. Alcoholis, 90, 3 V ^ SS - Aq. Coloniensis, S^ 88 - Aq. Destill. , gix. M. 25 370 DIGEST OF EXTERNAL THERAPEUTICS. Sig. A tablespoonful to a quart of water; inject three or four daily. Useful for the suppression of fetor. (Sn.) Jjfc. Zinc. Sulphatis, ' Alum. Sulphatis, aa t ^iss. Glycerini, 3 V J- M. Sig. A tablespoonful to a quart of hot water for injection. (Sn.) The following suppository may occasional!}' be of service : &. Pulv. Catechu,, Aluminis, aa. ^j. Ol. Theobromifc, q. s. M. Ft. Suppos., No. vj. Sig. One night and morning. (Sn.) The following douches are to be employed for anti- sepsis : Hydrarg. Bichlorid., 1-4000 or 2000, for occa- sional use. Carbolic Acid, 1-100 or 1-200. Izal, sJ-Qj. Condy's Fluid, Sulpho-Carbolate of Soda, Creolin, Lysol, each in the proportion of 1-200. Liq. Sodii Chlorinatse, 3j-Oj. Potass. Permang., gr. xx Oj ; inject a small quan- tity three times a day as a deodorant when dis- charge is very offensive. (Alb.) When sedative douches are desired, the following may be employed : Liq. Plumbi Subacetatis, sij-Oiij. Liq. Opii Sedativusi, 3J-OJ. Chloral Hydras, gr. xx-Oj. Sodii Boras or Sodii Bicarbonas., ^iij-Oj. (Alb.) LICHEN RUBER. 371 LICHEN RUBER. Simple ointments, such as Cold Cream or Vase- line, when there is no itching. Tar Ointment: Indicated in various forms, but must be used with discretion, as it does not always agree. Oil of Cade in an ointment containing 1 to 3 drachms to the ounce, or diluted with an equal quantity of olive oil or cosmoline, is beneficial. (B. H.) Liq. Carbonis Detergens: Preferred by Crocker as a lotion in the strength of 10 minims to 1 drachm to the ounce of water. Liq. Picis Alkalinus : Made in the following man- ner: 9>. Potass. Causticse, gr. xv. Picis Liquidse, gr. xxx. Aquse, giv. M. This should be considerably diluted when first used, as it is irritating. (Vn.) Naphthol or Thymol: Gr. x gij, with vaseline j, recommended by Crocker ; useful for the itching. Unna keeps the patient in bed between blankets, and has him rubbed night and morning with this ointment : #. Ung. Zinc. Oxid. Benzoatis, ^iv. Acid. Carbolici, 9iv. Hydrarg. Bichlorid., gr. ij-iv. M. (Ja.) 372 DIGEST OF EXTERNAL THERAPEUTICS. In chronic cases Hardaway uses the following, well rubbed in with flannel : Jfc. Sapo. diva; Praeparatae, ^i y - Ol. Rusci, Glycerin!, aa ^j. Ol. Rosinarini, giss. Alcohol is, ad ^viij. M. Hot Compresses once or twice daily will often re- lieve severe cases ; Emollient and Alkaline Baths are useful in cases when the skin is very irritable. The following was recommended by Unna : I*. Hydrarg. Bichlorid., gr. vij. Cretse Prseparatse, ^iiss. Acid. Carbolici, Ol. Olivae, aa ^v. Ung. Zinc. Oxidi, ^ xv. M. Sig. Rub in thoroughly. (Sn.) Salicylic Acid: Gr. x-xx to alcohol and water gj, or in an ointment gr. x xx gj ; a 10 to 20 per cent, plaster is effective in thickened verrucous patches. (B.H.) Menthol: Indicated especially when itching is a prominent symptom ; use in an ointment, gr. x xv Jj. (B.H.) In addition to the above, the more stimulating and stronger antipruritic remedies which have been mentioned for eczema may be employed for this affec- tion, with the view of relieving the pruritus and causing absorption of the lesions. LOCOMOTOR ATAXIA. 373 LOCOMOTOR ATAXIA. Fraenkel's Exercise Treatment: This method, it is claimed, is exceedingly helpful in keeping patients on their feet for years, and benefiting those who have not walked for a long period to such a degree that the powers of locomotion are restored sufficiently for the patient to walk about. There are two classes of exercises, those performed in bed and those performed ou't. The bed exercises consist of flexion, extension, abduction, and adduction of each leg separately, then both simultaneously. The knees and hips are likewise exercised. The patient is asked to place the heel of one foot upon the big toe of the other, then place the heel upon the knee of the other leg, then slowly travel upon the ridge of the tibia to the ankle. These exercises are made alternately, first with one leg then with the other, with the eyes open and then with the eyes closed, and should be attempted over and over again, morning and afternoon, for half an hour at a time with frequent rests; the patient should be encouraged to persist until he succeeds. The exercises performed out of bed are as follows : 1. Place the patient with back to a chair, heels to- gether ; let him seat himself slowly in the chair, then let him rise in the same careful manner. No cane is used ; if he cannot stand attendants on each side must support him. 2. Let one leg be placed at a walking step in front of the other, then placed back into the original posi- tion with great exactness. Repeat the same with the other leg. Patient may support himself if neces- sary. 374 DIGEST OF EXTERNAL THERAPEUTICS. 3. Walk three paces slowly and with precision. 4. Rest in standing position with one foot before the other with arms akimbo; flex the knees then slowly rise. 5. Patient exercises as in No. 2 ; advances one foot, then return it slowly to original position, then walks one step behind the other. This is very difficult, as it requires a great deal of balancing power. 6. Walk twenty steps, as in No. 3. 7. No. 2 performed with a cane. 8. Stand with a cane with feet together and hands on the hips. 9. Stand without cane, feet separated, and make various movements with the arms, grasping objects or forcing back outstretched hand of attendant. 10. Maintain same position as in No. 9 ; then flex the trunk forward and back, right and left. 11. No. 9, with feet together. 12. No. 10, with feet together. 13. Walk along a parallel line in the floor, patient supporting himself with a cane. 14. Same as No. 13, without a cane. Exercises with fingers and arms are recommended, based on the same principles. (Gld.) Sodium Phosphate : A hypodermic injection of a 0.1 per cent, solution has recently been used for the relief of the darting pains, which it is claimed to have considerably^ diminished. (T., 98.) Theine:^Has proved serviceable in relieving the pains, large doses hypodermically ; as much as 3 grains are said to have been given. (F.) Electricity: In the treatment of this affection this is an agent in reference to which there is a marked divergence of opinion. It is condemned by some and LOCOMOTOR ATAXIA. 375 praised by others ; in Germany it is much used, but does not appear to be so extensively endorsed in this county. It is claimed that if administered early in the course of the disease electricity is capable of ar- resting the morbid process, but if cases are not properly selected it will do harm. (Ht.) Erb's combined galvanism of the spinal cord and sympathetic cervical ganglion constitutes the best central application. The negative pole is placed over the superior cervical ganglion on one side, while the positive is applied to the lumbar region of the spine on the opposite side of the spinous processes. A cur- rent of 6 to 8 milliamperes is passed for one minute and a half. Then the electrodes are changed to the opposite sides, that is, the negative electrode is placed where the positive was applied and the pos- itive to where the negative has been. The current is again allowed to pass through the parts one minute and a half. The negative electrode is now placed over the spinous processes of the cervical vertebrae and the positive over those of the lumbar. After this the limbs and trunk are treated thoroughly with the faradic brush, with a current as strong as can be borne "without inconvenience. Applications may be made on alternate days. (Gn.) Static electricity is also employed with great relief in some cases. (F.) Hydrotherapy: Is a serviceable measure if used judiciously. Tepid baths (80 to 90) combined with gentle rubbing are beneficial. Hot and wet packs and vapor baths are used, but are claimed by some authorities to be harmful. Wet compresses on the legs at night will sometimes relieve pain. (Ty.) Among the natural springs which enjoy an especial 376 DIGEST OF EXTERNAL THERAPEUTICS. reputation for treatment of this disease are Oeyn- hausen-Rehme in Minden, Aix-la-Chapelle and Nau- heim. The mud and iron baths of Pyrmont, Driburg, Elster, Carlsbad, and Franzenbad may also be men- tioned in this conection. Massage: By its general effect upon the nutri- tion and circulation, may from time to time be em- ployed with benefit. Disturbancee of sensibility often improve under this treatment. (F.) Bonuzzi's Treatment: This is described by P. J. Mobuis, of Leipsic, as "actually barbarous." It con- sists in drawing the feet of the patient, by means of a cloth, so far above his head that the knees approach the forehead. Blondell's modification of this treatment consists in an extension en miniature, approximating the patient's bended knees to his chin, and holding them in that position for a few moments by means of a bandage passing behind the knees and about the neck. (T. C., Vol. XI.) Suspension: By means of Sayre's apparatus, first tried by Motschutkowsky, of Odessa, was much in vogue at one time, but this procedure is attended with some danger, especially in heavy patients, and those with arterio-sclerosis. Its results have not proved as satisfactory as they promised, and like many other ''cures " it has fallen into disuse. (T. C., Vol. XI.) Mercurial Inunctions: Advised in syphilitic cases and those in which there is a suspicion of specific taint ; 3 to 4 grains of blue ointment daily may be rubbed in, and a bath should be taken on the seventh day; this procedure may be repeated four or five times. The gums should be watched carefully. After .an interval of five or six weeks or several months a ' *> LUPUS ERYTHEMATOSUS. 377 second course may be administered. The baths of Nauheim and Rehme are advised by Erb during the intervals of inunctions. (T. C., Vol. XI.) LUPUS ERYTHEMATOSUS. While in external treatment we look for positive effect, it should be remembered that the disease some- times disappears spontaneously, with little or no scarring; therefore, applications which have a ten- dency to disfigure should be avoided. Sapo Viridis: This remedy has been recommended by Hebra and Kaposi, and is at times very useful ; it may be used pure or diluted in the proportion of two parts with one of alcohol (spts. sapo. kal.); this is to be rubbed in energetically once or twice daily. The sapo viridis plaster may be used when a more active method is desired. After several days the soap is to be discontinued and a soothing ointment applied. The spts. sapo. kal. may also be employed with advantage to cleanse the parts preparatory to the application of other remedial agents. (Pp.) Carbolic Acid : Applied pure, forms one of the best applications. (Kp.) Ichthyol: Useful in the following formula sug- gested by Unna : ft. . Ichthyoli, 9iv. Amyli, Qiv. Sol. Albumin. Concentrat., M.v-viij. Aquae, ad ^j. M. This preparation dries quickly, and a new coat may be added. 378 DIGEST OF EXTERNAL THERAPEUTICS. Glacial Acetic Acid: A mixture of equal parts with gh'cerine has been found serviceable in small patches and seemed to stimulate absorption of de- posits. (Pp.) Zinc Nitrate: In severe and chronic cases the fol- lowing was recommended by Tilbury Fox : #. Zinc. Nitratis, Aq. Destill., Amyli Glyceriti, Farini Tritici, aa gj. M. Make into a paste and apply; when the paste is withdrawn, apply a poultice; the raw surface left by removal of the eschar should be dusted with diachylon or zinc oxide ointment. Reapplication may be needed. ( F. ) Alcohol: Hebra has treated several cases by^ the application of alcohol with remarkably good results. In an acute case the eruption, which had spread steadily downwards as far as the lower edge of the manubrium, disappeared completely after a treat- ment of four weeks, and there was no trace of it six months later. Chronic cases were cured or at least benefited. The method is simply to moisten not to rub the patches with a pad of cotton-wool soaked in alcohol. The more often this is is done the sooner the effect appears. To increase the antiphlogistic effect in his last cases, Hebra has used the following : &. Alcoholis Absoluti, JEJtheris Sulphurici, Spts. Menthae Pip., partes equales. It is important to avoid the use of soap during treatment. (M. S. R. R., 5, 1, 99.) Pyrogallic Acid: Is serviceable when strong reme- dies are necessa^ ; being somewhat caustic in action LUPUS ERYTHEMATOSUS. 379 it must be watched; it may be employed in the strength of 40 to 90 grains to the ounce as an oint- ment ; weaker applications should be tried first. It is safer and more satisfactory when applied in flex- ible collodion, as follows : I*. Acid. Pyrogallici, 3J- Liq. Guttae Perchae, fyv. M. Sig. Apply with a brush on patches several times until con- siderable reaction takes place or a crust forms, then dis- continue. As soon as the crust is removed, repeat the application; if there is much scaling, 30 grains of sali- cylic acid may be added. (Pp.) Naphthol Sulphur Soap: Excellent for cleansing. (Kap.) The following lotion is recommended when inflam- matory symptoms are marked, and in recent and superficial forms with little infiltration and no in- volvement of the sebaceous glands : I*. Zinc. Sulphatis, Potass. Sulphured, aa 3 SS - Aquae, giij. Alcoholis, gj. M. The salts should be dissolved separately in water, and the lotion added. The parts are to be mopped twice daily for fifteen to thirty minutes; if too strong, dilute. (Pp.) Chrysarobin : A stronger application, suitable for cases mentioned in the preceding paragraph, as well as when there is more infiltration, is as follows : #. Chrysarobini, fyss- Acid. Salicylici, Pulv. Calaminae, aa 5 SS - Athens, 5j. Collodii Flex. , 3v. M. (Vn.) 380 DIGEST OF EXTERNAL THERAPEUTICS. An ointment of 40 to 90 grains to the ounce may be used in place of pyrogallic acid with the same in- dications. It is dangerous for use about the face, as it may cause violent conjunctivitis. (Pp.) Pyoktanin: Daily application of a saturated solu- tion, is of great value in torpid cases. Naphthol and Sulphur pastes promoting desquamation are useful in the same conditions. (T., 98.) Caustics : These are somtimes demanded, but weaker applications should always be tried first. Caustic Potash: 1 part to 3 to 6 water, applied by means of a charpie brush on a stick, forms one of the best caustics. (Vn.) Linear Scarification: Used in cases which are ex- tensive and much infiltrated ; better than caustics and strong applications. Use a fine scalpel or teno- tome or multiple scarifier, holding it in the hand like a pen. Make a series of parallel incisions, about one- sixteenth of an inch apart, and extending entirely through the skin; having covered the part with these parallel incisions, make another series at right angles, and even a third obliquely may be made; successive patches of an inch square may be operated upon daily. The wounds may be dressed with an an- tiseptic powder,' such as aristol or europhen. Little scar is left, and the result is more satisfactory than any other method of treatment. The skin must be frozen by ether or salt and ice before operation. (Ck.) Erasion by Curette and Scraping Spoon has been used in severe cases, but scarification is better. Paquelin Cautery: Heat barely red and run over the surface very superficially, then dress with iodo- LUPUS VULGARIS. 381 form which forms a crust. After about ten days this falls off leaving a smooth pale surface. (Vn.) Electrolysis: Multiple puncture will sometimes give brilliant results. (Ja.) Tr. Iodine: Alone or with equal parts of glycerine, painted on once or twice daily until a coating forms, is sometimes used, or it may be applied as follows : #. lodi, Potass. lodidi, aa ^iv. Glycerin!, 3J. M. (Pp.) Oil of Cade : With alcohol and green soap, equal parts ; rub in night and morning. (Pp.) Oleate of Mercury: 10 to 25 per cent, ointment rubbed in daily is of value. (Pp.) Plasters of Resorcin, Ichthyol, Hydronaphthol, and Mercury are effective, the latter is especially recommended by Kaposi. LUPUS VULGARIS TUBERCULOSIS CUTIS. External measures are absolutely essential in all cases. In the early stages stimulating applications used with a view of causing absorption are unsuc- cessful, and severer methods will have to be em- ployed. Mild applications, such as oils, ointments and plasters, namely, olive oil, soft soap, simple ointment, salicylic and mercurial plaster, will often form useful adjuvants in reducing swelling and in- flammation, macerating crusts and promoting the formation of smooth cicatrices. 382 DIGEST OF EXTERNAL THERAPEUTICS. Local treatment is either by operative procedures or by the application of caustics. Erasion by Volkmann's Spoon: This is the fore- most surgical method, though not complete, inas- much as small nodules may be left, which must be removed by other means. It is well adapted to large confluent nodules, with flabby base and depressed infiltrated tissue. (Kap.) Curettage: The whole patch or patches may be scraped with the dermal curette, then Pyrogallic Ointment, 25 to 30 per cent., should be applied for ten days, and that in turn followed by Mercurial Plaster. The acid will cause free suppuration and destroy the cells left by the curette. A second or third application may be necessary. Individual nod- ules may be bored out with Morris's double screw instrument, or with Fox's dental burrs and hooks, then pure Carbolic Acid is applied to the little ex- cavation thus produced. (Ja.) Galvano-Cautery: Has the disadvantage of burn- ing healthy as well as diseased tissue ; it is, however, serviceable in destroying recurrent nodules and those situated on the mucous membranes. (B. H.) It is preferred by some dermatologists for application after curettage. Linear Scarification: Another valuable measure and effective in non-ulcerative forms. The parts are thoroughly cross-tracked, according to Vidal's method; if bleeding is profuse, cold or hot com- presses should be applied. A five-bladed lancet, con- structed for the purpose, may be used for making the incisions. After scarification a caustic is applied, fol- lowed by antiseptic dressings. The operation may have to be repeated. LUPUS VULGARIS. 383 Besnier's Method: Employed with advantage. This consists in the use of electro-cautery knives of various shapes and sizes, applied with a view of reaching all varieties of deposits. (Vn.) Multiple Punctate Scarification: Also advised. Veiel's instrument or Pick's multiple scarificator may be used. The knives before use may be dipped in iodine, carbolic, or some other antiseptic. This procedure is of service especially for hypertrophic conditions ; also for the Irypertrophic scars which sometimes result from erosion. (B. H.) The scars -which follow the use of the curette, and linear and punctate scarification are usually less marked than those which result from the cauterants. (Pp.) Excision and Grafting after Thiersch's Method: Excision is available for patches of any size. Both the lupoid patch and the part from which the grafts are to be cut (preferably the thigh) should be thor- oughly disinfected with soap and water, ether and carbolic acid the day before operation, and a pack of gauze soaked in a solution of carbolic acid, 1-20, should be kept on the surface until the operation. The following points may be mentioned : 1. The parts are thoroughly cleansed and every precaution subsequently taken by the operator to prevent infection by the knife. 2. Before operating a line of incision is marked out beyond the disease by means of sterilized aniline dye. 3. Haemorrhage is carefully arrested before grafts are applied. 4. Dress the surface with simple layers of dry sterile gauze fastened with collodion, and allow the dressing to remain four or five days ; a second dress- 384 DIGEST OF EXTERNAL THERAPEUTICS. ing should be applied similar to the first, then a dermatol or iodoform ointment. 5. Certain cases are unsuitable by reason of impli- cation of the nasal cavity, multiplicity of areas, or the extent of the disease. Two or three sittings, at intervals, may be emploved with extensive cases. (T., 98.) Caustics: Though surgical procedures have largely superseded the use of caustics, they are none the less of service ; yet it must be remembered that certain of these agents, namely, Vienna paste, zinc chloride (the pure stick or Canquin's paste), lactic acid, and salicylic acid produce most unsightlv scars. (B. H.) Caustic Potash : When thorough and extensive destruction of tissue is desired a stick wrapped in a cloth with the point protruding, should be forced down into the diseased foci ; the effect of the caustic goes beyond the point touched; dilute vinegar should be kept near at hand to check and neutralize its action and relieve the severe pain. (Vn.) Nitrate of Silver: Is effective in some cases, and as it leaves no scars may be selected to use on the face; its action, however, is superficial. Papules and tubercles may be destroyed by boring with the solid stick, and patches may be mopped with a saturated solution. (Ck.) Liq. Antimonii Chlorati: Regarded by Unna as superior to any other remed}^. He employs it in two forms, and recommends the addition of salicylic acid, creosote, and cannabis indica. For ordinary cases : LUPUS VULGARIS. 385 #. Acid. Salicylic!, Liq. Antimonii Chlorati, Ext. Cannabis Indicse, aa gr. xvss. Creosoti Fagi, gr. xxxj. Vaselini, 3^g r - xviiss. Adipis Lanse, 3"S r - x xxv. M. This is applied to all the nodules with a glass rod, and the whole lupus region is covered with a zinc oxide plaster. The covering intensifies the action of the ointment and protects the surrounding parts. In older cases, with scattered nodules and deep forms of the disease, a stronger ointment may be used, viz.: #. Acid. Salicylici, L,iq. Antimonii Chlorati, Ext. Cannabis Indicae, Creosoti Fagi, Vaselini, aa gr. xxxj. Adipis Lanae, 3"S r - xxxv. M. The dressings are changed every day or every second day, according to the amount of suppuration. After some weeks of this treatment the nodules ulcerate and then begin to heal over, often without further treatment, leaving a smooth surface. In obstinate cases, -when the dressing is changed, the liquor anti- monii chlorati may be applied to doubful spots. Cocaine may be previously applied. (T., 97.) Salicylic Acid and Creosote : 1 part of the acid with 2 parts of creosote, made into a plaster, was regarded by Unna as the best superficial caustic until his adoption of the preparation of chloride of antimony as above. (T., 97.) Hydrarg. Bichlorid.: Unna recommends the fol- lowing : 26 386 DIGEST OF EXTERNAL THERAPEUTICS. V. Hydrarg. Bichlorid., gr. iij. Acid. Carbolic!, gr. xij. Alcoholis, 5J- M. A small sharpened stick is dipped into this solution and bored into each little lupus deposit. The pain does not last long. Pyrogallic Acid: Is one of the best remedies ; an ointment of a drachm to the ounce of vaseline, spread on cloth and renewed twice daily, is painless and efficient in many instances ; it appears to select the diseased tissues and acts but little on the healthy. (N.) A combination with Aristol is used, viz.: |fc. Pyrogalloli, gr. ix. Aristoli. gr. xviij. Lanolini, Vaselini, aa S 88 - M. (T., 97.) Zinc Chloride : According to the following for- mula : &. Zinc. Chloridi, Antimonii Terchloridi, aa 3ij- Acid. Hydrochlorici, q. s. Enough acid is added to dissolve the zinc, and the mixture is rubbed up in a mortar with sufficient powdered licorice to make a paste. This forms a powerful caustic, but it is very painful and eats through both healthy and diseased tissues. (Vn. ) Ethylate of Sodium : Applied on glass rods ; the part should be first dried as far as possible, and no water allowed to touch it while the application is being made. This agent is less painful than other caustic, and may be preferred in minor operations when an anaesthetic is not used. (N.) Cosme's Paste: As modified by Hebra is as fol- lows: LUPUS VULGARIS. 387 #. Acid. Arsenosi, gr. x. Hydrarg. Sulphuret. Rub., 5J- Ung. Simplicis, 5J. Spread on lint or linen and apply firmly; leave it on for two or three days; poultices are then applied until the slough comes away; then mild stimulating ointments. This method is very satisfactory but very painful. Lactic Acid : Has given beneficial results ; the pure acid is made into a paste with salicylic acid ; the lint saturated with the remedy or covered with a thin layer of the paste should be applied; the sur- rounding healtlry tissue must be protected by gutta percha solution. After twenty-four hours remove and dust with iodoform gauze. (Al.) At Unna's clinic, pointed matches are soaked in the following solution : Sublimate, i part. Salicylic Acid, 10 parts. Ether, 25 parts. Olive Oil, 100 parts. These are bored into each individual nodule, the ends cut off with scissors and left in situ; then covered with mercury carbolic plaster; after twenty-four hours this is removed, the part washed and the holes filled with the following powder: Sublimate, gr. iss. Cocaine, gr. viij. Salicylic Acid, gr. viij. Magnesium Carbonate, 3^j 9^j- (T., 9 6.) For other caustic applications see Epithelioma. Aristol: Has been found effective after curettage. Ethyl-Diamine Cresol: Has been favorably men- tioned; it is a colorless, nearly non-toxic liquid, with remarkable penetrating power, and a stronger disin- fectant than cresol. Solutions of 1-5000 to 3000 on compresses have been found healing in lupus of the 388 DIGEST OF EXTERNAL THERAPEUTICS. face. Continuous baths have been used for the dis- ease on the limbs. (T., 98.) Guaiacol and Thymol: Have been successful sub- cutaneously. Injections of 15 minims of the follow- ing twice a week : Thymol, ^ drachm. Guaiacol (Sterilized), Olive Oil, each, i^ drachms. Great caution is necessary, as severe pulmonary congestion is apt to occur. (T., 96.) Salicylic Acid: In addition to combination with other remedies as already mentioned, is used in other forms ; a 10 to 20 per cent, plaster, changed once or twice a day ; a saturated solution in collodion, said to be efficacious after cleansing the parts with an alkaline solution; or an ointment 3J-ij-3J, as a mild and slow acting remedy. Picric Acid: Thoroughly dusted on the parts, fol- lowed in a few days by 1 to 20 per cent, ointment, constitutes another method which has been reported successful. (T., 96.) Mono-Chlorophenol: 20 per cent, solution in alco- hol rubbed in rather hard with a pad of wadding every two days for several months has been tried with encouraging results. (T., 98.) Injections of Calomel and of Camphorated Naph- thol have also been recently employed. (T., 98.) Meragliano's Serum: Two cases have been re- ported as successfully treated ; doses of 16 and 80 minims alternately, the part being painted with the serum. (T., 97.) Tuberculin: Hopes that have been raised in re- gard to the use of this remedy have been proved to lack foundation, as the disease was found to recur LUPUS VULGARIS. 389 after the injections had been discontinued, in some cases with increased virulence. Koch, after nearly five years' silence, has an- nounced three new modifications of tuberculin, in- cluding that of tuberculin R. with immunizing and curative properties, which has led to marked im- provement by injection in lupis vulgaris. Koch's directions "were to commence with a small dose (one five-hundredth of a milligramme), which is raised as rapidily as possibly, caution being exercised not to excite constitutional reaction and not to administer a second dose until the temperature has fallen to normal or nearly so. The cure is completed when a twenty milligramme dose is reached. The remedy has also been employed by Bussenius, Worner, Seligmann, Malcolm, Morris, Whitfield, Lassar, Doutrelepont, and Van Horn with generally favorable results, but judging from the reports there were no decided cures. Doutrelepont recommends that the dose be increased more slowly than sug- gested by Koch. In brief, it may be said that the use of tuberculin for tuberculosis of the skin has scarcely yet gone beyond the stage of experimenta- tion. The preparations, moreover, are not of uniform strength and may sometimes cause unfavorable symptoms. The difficulty of obtaining it and the price are additional drawbacks to its practical use. Phototherapy: Finsen, of Copenhagen, who is known as the reviver of the mediaeval red light treat- ment for smallpox, has reported very satisfactory results from the use of the electric light in the treatment of lupus vulgaris. Dr. Valdemar Bie, Fin- sen's chief assistant, in a recent article says, 350 cases of this disease have been successfully treated by 390 DIGEST OF EXTERNAL THERAPEUTICS. this method. The less severe cases were treated by light alone, those of a more serious nature received the light treatment in conjunction with pyrogallic acid ointment to make the skin, it is said, smooth and easily penetrable by the light. While one part was being treated by the light the pyrogallic acid was applied on the other. When cauterization was healed by zinc ointment this area of skin was treated by light. All ulcerations are kept free from crusts by cataplasms of boric acid solutions. The mucous membranes are treated with a solution of iodine in iodide of potassium, or with the actual cautery. The skin, hard palate, septum nasi, tongue, and mucous membrane of the mouth are the only parts which can be reached by this method. In five cases the effect of treatment was very slow, and in none was it without result. Of the 350 suc- cessful cases, Bie says a large proportion was severe, having been unsuccessfully treated by other means. The following two cases selected from the article in question serve as examples, and at the same time present the details of treatment : "No. 192, 30 years old. Lupus vulgaris faciei et cavitatis nasi. The patient has been suffering from lupus vulgaris fifteen years. Previous treatment: (i) Cauterization of the lupus; (2) homoeo- pathic treatment; (3) scraping out and thermocauterization during three years. The disease was progressing very slowly just before the beginning of the treatment. The affected places were swollen and red. Everywhere numerous nodules, partly confluent with crusts and small ulcerations, no large ulcers. A number of dis- seminated nodules in the healthy skin. There was an extensive but almost quiescent lupus cavitatis nasi. June i, 1898. Treatment by light with a quartz apparatus and a lamp of 50 amperes one hour a day. For the mucous membrane of the nose; Compresses saturated with a solution of mercuric chloride and touching with a solution of iodine and potassium iodide (1:2:2) once a week. Sep- LUMBAGO. 391 tember 30. Steady improvement. No ulcers at present. The skin of the nose seems to be healthy. Everywhere good scar-tissue; hardly any nodules visible. October 29. No distinct nodules. Treatment discontinued. November 15. Everywhere the scar- tissue is smooth and but little visible. No distinct nodules. Janu- uarv 19, 1899. Letter from the patient's doctor. No relapse. "No. 84, 23 years old. Lupus vulgaris faciei, cavitatis nasi et maims dextrae, phthisis bulbi dextri; spina ventosa digiti iii sin- istri. The patient has been suffering from lupus for seven years. Previous treatment: (i) Ointment; (2) scraping, several times re- peated; (3) touching with iodine. There was lupus on both sides of the face and on the right hand. The extent of the disease on the left part of the face was about the same as on the right half of the face. The dorsum of the right hand was affected half of its ex- tent, including a part of the right third and fourth finger. The lupus consists of ulcers, covered with crusts, and of dissemi- nated non-ulcerated nodules. The right ala nasi was almost quiet destroyed. October 18, 1897. Light-treatment of the face, alter- nating every two days with lamps of 35 amperes and glass ap- paratus during two hours, and lamps of 50 amperes and quartz apparatus during one hour. February 19, 1899. Hardly any im- provement. March 8. A slight improvement only. April 13. Good improvement. The apex nasi is not ulcerated. The ulcers of the cheeks are less numerous, small and superficial. May 17. The affection of the face is constantly improving, no ulcers, a few disseminated nodules. June 15. Light-treatment one hour every day with a lamp of 50 amperes and a quartz apparatus. August 1 8. The affection of the face apparently cured. No distinct nodules. October 25. A fine scar-tissue everywhere on the face. Still a few doubtful patches. Treatment discontinued. November u. The scars on the face are sound, only two small solitary nodules on both cheeks. Light-treatment a few times. May 24, 1899." It will be observed from the above that a special apparatus is necessary for applying this novel and apparently successful method. (P. M. J., 10, 7, 99.) LUMBAGO. See Muscular Rheumatism. 392 DIGEST OF EXTERNAL THERAPEUTICS. MEASLES. Sponging: For hyperpyrexia, sponging with water at 90 to 95 may be employed, or if this is ineffectual a temperature of 80 may be advantage- ously substituted. As a last resort cold water baths may be employed. (Strr.) Cold Baths and Cold Pack: When there is high temperature with nervous symptoms nothing is so reliable. The temperature of the bath should be at first 100, then gradually lowered to 85 or 80 ; the body should be rubbed briskly while in the bath, and water applied to the head. After removal, dry quickly and wrap the patient in a blanket. The bath should last from five to twenty minutes. A cold pack may be applied as follows: Strip the patient and envelop him in a sheet which has been wrung out in water at a temperature of 100 ; upon the outside of the sheet rub on ice over the entire trunk, first anteriorly then posteriorly ; continue this for five minutes or more, according to indications; afterwards roll the patient in a blanket without the removal of the pack. The head should be sponged with cold water, and hot baths if necessary should be applied to the feet. (Hit.) Hot Baths: These are indicated when there is high temperature, feeble pulse and cyanosis, condi- tions which centra-indicate cold baths or cold packs. Mustard may be added ; ice should be applied to the head during the bath. (Hit.) Hot Mustard Baths: At a temperature of 100, half an ounce of mustard to the gallon, are indicated MENINGITIS. 393 in malignant types ; the patient should be immersed up to the neck for about three minutes, removed quickty, dried and placed between blankets, or wrapped in blankets and dried later. Then baths may be administered ever}' two hours. (Strr.) Hot Pack: With hot water or mustard water, 2 drachms to the gallon, may be used with the same indications mentioned for hot baths. They may be renewed every half hour. (Strr.) Simple washes of Borax, gr. x 3j, or Hot Water may sometimes be necessary for the eyes, and Do- bell's Solution for cleansing the throat. (Strr.) This discovery of the presence of pneumococci in the buccal secretions during the course of the disease point to disinfection of the mouth. (Hit.) MENINGITIS, ACUTE CEREBRAL LEPTO-MENINGITIS. Extreme quiet and avoidance of all disturbing in- fluences is of the utmost importance; a darkened room is advisable. An Ice Bag should be kept on the head, and Leeches may be applied with benefit to the back of the neck and temples. (Ty.) Blisters : Applied to the back of neck are useful, and it is claimed not as painful as appearances would indicate. (St.) Mercurial Inunctions: Are recommended when the disease is non-tubercular. (Ty.) Cold Sponging: Useful to relieve fever. (An.) Surgical Interference should be promptly resorted to when there is disease of the middle ear. 394 DIGEST OF EXTERNAL THERAPEUTICS. MENINGITIS, CEREBRO-SPINAL. Hot Baths: Have been used successralry ; the patient receiving twelve baths at a temperature of 104 in three days. (Sj.) Warm baths are highly beneficial in lessening the tendency to spasm. Aspiration of Cerebro-Spinal Fluid: In many cases a favorable course has been ascribed to punct- ure. A simple Dieulafo}^ needle may be used, or a Pavaz syringe; puncture is made between the lam- inae of the lumbar vertebrae a little to one side of the median line. (Sj.) Cold: Is generally advised ; baths are both grate- ful and valuable; ice bag to the head and long ice bag to the spine. (Bt.) Chloral Hydrate: In 1 drachm doses by the rec- tum should be administered to an adult for the con- vulsions. No other remedy, says Tj'son, equals it. Chloroform or Ether: Inhalations may be indi- cated in desperate cases. (Ty.) Morphine: Hypodermically affords relief to the intense headache, myalgia and muscular contrac- tions and tones the heart. (An.) MENORRHAGIA AND METROR- RHAGIA. As a rule, external treatment is unnecessary for menorrhagia, but when internal remedies alone have failed, they should be supplemented by these meas- ures. In such cases an examination should be made MENORRHAG1A AND METRORRHAGIA. 395 without delay. Rest is an important factor and should always constitute part of the treatment. (D.) Cold: Cloths wrung out in cold water, or better, ice bags to the hypogastrium, or small rectal injec- tions of quite cold water. (K. C.) Cold sitz bath with the feet in hot water. (Rd.) Heat : A hot water bag applied at the junction of the dorsal and lumbar regions reduces congestion, and controls metrorrhagia and menorrhagia. (F.) Vaginal douches of water at a temperature of 125 to 135 may be used in bad cases. (K. C.) Hydrastine: Is indicated for haemorrhage due to metritis, endometritis, myomata, or incomplete in- volution ; a 10 per cent, solution, hypodermically, acts favorably. (K. C.) Astringent Injections : Small injections of this nature are useful, such as Alum, gss-Oij., or a solu- tion of Tannin ; the latter is liable to stain the cloth- ing. (D.) Tepid Hip Baths: Are advised by Baruch, who claims they are superior to any internal medicine. The patient is to be placed in a hip bath at a tem- perature of 85, in which she is to remain from five to eight minutes ; constant friction is to be applied, followed by affusions, or preferably the circular bath. (S. B.) Puncture of Cervix: Followed by the application of tampons of boroglyceride is sometimes effective in cases of chronic congestion. (Alb.) Antipyrin and Salol: Equal parts heated in a test tube ; a brown liquid is obtained which may be ap- plied with absorbent cotton to the whole endonie- trium ; it is said to be painless and productive of ex- cellent results. (Sj.) 396 DIGEST OF EXTERNAL THERAPEUTICS. Cotarnine Hydrochloride (Stypticin): Is a very- useful remedy ; when haemorrhage is very profuse in- ject 30 drops of a sterilized 10 per cent solution into the gluteal muscles. (Sj.) This drug is said to be superior to ergot or hydrastis, and is indicated when there is subin volution, fungus endometritis, haemorr- hage from fibroids, and at the climacteric. Conium: Suppositories of 2 to 4 grains with glycerine 1 part, gelatin 4 parts, introduced twice daily, form an excellent anodyne when the condition is associated \vith ovarian disease. (F.) Salicylic Acid: In cases not dependent upon gross lesions, tampons moistened with a solution are valu- able. (F.) Hot Saline Enema: Used with much benefit when the patient is faint from the loss of blood; it will also tend to stop the flow. (D.) Tamponing: When haemorrhage is severe, or in cases when it is not practical to see tht patient often, use hot douches, then pack the vagina with tampons, allowing them to remain twenty-four hours; those in contact with the cervix may be saturated with glycerite of alum. If this measure fails, the cervix must be dilated, and the whole uterine cavity packed. (K. C.) MILIARIA- PRICKLY HEAT. Cold Baths or Sponging frequently in warm weather, light loose clothing and light bed clothing. (Bt.) Borax or Boric Acid may be added to the sponge bath. (Bt.) MILIUM. 397 Soothing and astringent lotions as mentioned under Acute Eczema, may be employed. Mild and astringent powders as Zinc Oxide, Bis- muth Subnitrate, Starch, Lycopodium, Kaolin, and Camphor Powder. (Ja.) Lemon Juice has a soothing effect in allaying irri- tation. (Al.) Oil of Peppermint in cosmoline is recommended (Bt.), but ointments, as a rule, are not to be com- mended. Copper Sulphate: gr. x j, much used in the West Indies. (Vn.) MILIUM. Remove the little pearl-like deposit by squeezing, and apply a drop of Iodine or Carbolic Acid ; or touch with Nitrate of Silver (Vn.); or the skin may be washed with Soap Bark water and gentry rubbed. (Kp.) MOLES. See Nsevus Pigmentosus. MUCOUS PATCHES. Cleanliness is of paramount importance ; the teeth should be cleansed at least twice daily with some antiseptic mouth wash; for this purpose solutions 398 DIGEST OF EXTERNAL THERAPEUTICS. of Boric Acid, Borax, Myrrh, Chlorate of Potash, Sodium Bicarbonate are useful. The same solutions may be also employed as gargles and sprays for the pharynx. The following is one of the best combinations for this purpose : TJe. Sod. Boratis, 3"]- Tr. Catechu., |ss. Tr. Myrrhae, ^ss. Aquae, 3 y ij- M. (Cl.) Another useful formula : #. Tr. Myrrhae, Jss. Potass. Chloratis, ^iij- Aquae, q. s. ad vj. M. (Sn.) Dobell's Solution, solutions of Alum and Hama- melis also beneficial. (Cl.) Nitrate of Silver; A few applications of the solid stick or a solution, varying from 5 to 20 grains to the ounce, will frequently cause rapid healing. Lesions of the nasal mucous membranes may be treated by sprays of 5 to 10 grains to the ounce. (B.H.) Acid Solution of Nitrate of Mercury: One of the most successful applications for all forms of syphi- litic sores of the tongue and mouth. The strength of the solution must vary according to the object in view. For ulcers of the throat 1 or 2 minims of the acid in an ounce of water may be used as a gargle or with the atomizer, care being taken that none is in- haled or swallowed. A mixture of the strength of a drachm to the ounce of water may be used for appli- cation with a mop. (N.) N^EYUS PIGMENTOSUS MOLES. 399 Glycero-Iodine (iodine gr. x, glycerine, j) : Gives quicker results than the acid nitrate of mercury. (Cl.) Potass. Chlorate: 20 grains to the ounce, is rec- ommended as a mouth wash to be used as a prevent- ive. (Al.) Sulphite of Soda: 1 drachm to the ounce. (Al.) When patches are not located on the mouth, wash with a solution of Bichloride of Mercury, 1-2000, then dust with equal parts of Calomel and Subni- trate of Bismuth. (Sn.) PIGMENTOSUS MOLES. Caustics: Are the best remedies for applying to small moles, Nitric or Acetic Acids should be pre- ferred, the surface being touched with these agents. Electrolysis: Is adopted for the removal of hairy growths and large moles. (Mor.) Removal by Excision: All large moles will require an operation for their removal ; small ones may be removed by an elliptical incision. If there is any tendency to inflammation or malig- nant proliferation, immediate removal by the knife is demanded. The employment of caustics and irri- tants under these conditions is harmful. (W.) All methods of removal, it must be remembered, will have a slight scar. VASCULARIS. Early treatment is generally advisable for the cap- illary variety and small growths. 400 DIGEST OF EXTERNAL THERAPEUTICS. The methods of treatment consist of Excision and Caustics for port wine marks, Scarification and Electrolysis for venous nsevi ; in the latter instance, when the size and location centra-indicate, Ligation may be substituted. Electrolysis: Is the best method for the majority of these growths. In the capillary variety, and in port wine marks, it is best applied by making mul- tiple punctures in parallel lines perpendicularly to the skin and entirety through it. By this method it is possible to destroy small naevi and to diminish the disfigurement of port wine marks. A scar will be left, but it is much less conspicuous than the naevus. The use of a single needle scars less than a group; the punctures should be made at least a sixteenth of an inch apart. Applications must be repeated until the naevus is destroyed; the entire point should be gone over at each application. An interval of two weeks should elapse between each treatment. (Ja. ) Parenchymatous Injections: Various agents have been used, viz.: Carbolic Acid, 2 per cent, solution, injections of 5 to 10 minims as in carbuncle; Tr. Chloride of Iron, Tr. Cantharides are recommended by some, but there is danger of producing embolism unless it is possible to isolate the growth. Alcohol: Injections of 5 to 7 minims of a 95 per cent, solution; the naevus should be encircled by a ring on which pressure is made to arrest the circula- tion, and the point of the syringe slowly \vithdrawn during injection. The tumor will gradually solidify. The injections may be repeated at intervals of sev- eral weeks, until disappearance of the growth is effected. (Al.) Carbolic Acid Tattooing: A method so termed is N/EVUS VASCULARIS. 401 said to give excellent results, leaving little or no scarring. It consists of puncturing the affected area, a portion at a time, with a number of small fine needles bound together; these are first dipped in a 50 per cent, or stronger solution of carbolic acid. The surface should be prepared by washing with alcohol. After application collodion is freely applied for pressure and protection. (F.) Ligation: Suited to some forms of vascular growths, though electrolysis is generally preferred ; venous mevi too large to permit of excision may be ligated. (T., 97.) Linear Scarification: As employed in acne rosa- cea, to which the reader is referred, gives good re- sults in small naevi and telangiectasis ; it is not suit- able for larger growths. Excision: With subsequent transplantation by the method of Thiersch, is the only reliable remedy. Nitric Acid, Glacial Acetic Acid, Trichloracetic Acid, Monochloracetic Acid are used as cauterants, but are uncertain in their effects. Collodion: Employed on account of its contractile power. It is emploj^ed for capillar}^ naevi in children and as a base combined with active agents, viz.: Bichloride of Mercury gr. viij-J, it forms a caustic useful for small naevi ; a circle of pure collodion should first be applied around the naevus, to protect the healthy integument; a single application is usually sufficient ; a dry eschar follows which separates in a few days. (Al.) Salicylic Acid and Lactic Acid, 10 parts of each, with collodion 80 parts, is also used for small growths . ( F . ) Creosote: More or less diluted, applied two or three times a day, is said to give excellent results. 27 402 DIGEST OF EXTERNAL THERAPEUTICS. Excoriation and ulceration is at first produced, which is finallv- followed by healing. (F.) Chromic Acid : Punctures with needles dipped into a 50 per cent, solution have been followed with success. (Kp.) Sodium Ethylate: Is one of the best caustics, causes little pain, should be applied on the end of a glass rod. To avoid scarring, only a small part of the naevus should be treated at one time. A crust will form which should be left undisturbed. (Kp.) NASAL POLYPUS. Destructive in situ by injection of such agents as Chromic Acid, Tincture of Iodine, or Tannic Acid, 3J-3J, may be successful, but it results in a necrotic mass which remains in the nasal cavity as an offen- sive body until it sloughs away. When the polypi are numerous, this treatment is obviously distress- ing. The best method, therefore, for the removal of these growths is by the Wire Snare. Removal by forceps, formerly much practiced and still used to some extent, is condemned. After removal by the snare the pedicle may be touched by the galvano- cautery. Sodium Ethylate: Saturate a bit of cotton with the drug and apply two or three minutes ; then with- draw ; the mass of polypi will be almost immediately destroyed. Touch the base with the same. The ap- plication causes slight burning pain and occasion- ally moderate haemorrhage. (Al.) Tannic Acid: In the small vascular variety, and in case, where the growth is soft and small, there is NASO-PHARYNGEAL CATARRH. 403 every prospect of temporary, if not permanent relief, by applications of the fine powder two or three times a day. (Wt.) Suprarenal Extract: The application of this agent preparatory to removal will prove effective for the control of haemorrhage. See Adenoid Growths of the Pharynx. NASO-PHARYNGEAL CATARRH, CHRONIC. See Chronic Rhinitis. Local treatment is similar to that of chronic rhin- itis, to which the reader is referred ; little, therefore, can be added. Important exceptions are the use of the post-nasal syringe for cleansing purposes, and the application^ of sprays through the mouth. Muco-purulent dis- charges should be removed twice daily by washes and douches. The following will prove satisfactory for this pur- pose, having a tendency to control all proliferations as well as to dislodge the mucus : 5fc. Acid. Carbolici, gr. iij. Potass. Chloratis, j. Glycerini, gj. Aquae, ad q. s. vj. M. 404 DIGEST OF EXTERNAL THERAPEUTICS. Or, ffc. Zinc. Sulpho-carbolatis, gr. iij. Acid. Salicylici, 3J- Aquse, S V 3- M. (Bos.) Sodium Bicarbonate: A solution of 10 grains to the ounce (Iv.), or the following are useful for cleans- ing purposes : ?fe. Sodii Bicarbonatis, Sodii Boratis, Sodii Chloratis, aa gr. j. Sac. Albi, gr. xxxvj. M. Sig. Dissolve in wineglassful of hot water. Another useful formula is the following : l-t. .-J-Naphtholi, gr. xlv. Alcoholis, 3 X - M. Sig. A teaspoonf itl to a quart of boiled water. (T., 98.) After cleansing, the following will also be found of service : Gallic Acid: By insufflation in the proportion of 1 grain to 2 of gum acacia forms, according to Ivins, a most grateful and beneficial application. Glycerites of Iodine or Zinc Chloride, viz.: #. lodi., gr. x. Glycerini, ^j. M. Or, 5fc. Zinc. Chloridi, gr. x. Aquae, gj. M. (Iv. ) NEURALGIA. 405 To effect a cure, radical measures and strong appli- cations are necessary, such as the following : Tr. Iodine, Glycerole of Tannin, or Nitrate of Sil- ver (gr. xx-xxx-|j), application to be made at in- tervals of three days or a week. Also Lactic Acid, 3ss-j-^j, or Monochloracetic Acid, undiluted for the hypertrophies. In making strong applications great care should be taken not to touch the palate. Chromic Acid: May be applied with good effect to the broad, flat, thickened condition of the glandu- lar structure of the pharynx. Galvano-Cautery: May be employed when other measures have failed for the reduction of the hyper- trophy. (Iv.) NEURALGIA. Dry Heat: One of the best palliatives during par- oxysms ; may be applied by means of hot water bag, hot hop bag, or Japanese fire box. (Gn.) Aconite: Is useful, especially in neuralgia of the fifth pair (R.); may be applied as an ointment, of the tincture may be painted on the affected area. It also enters into the formation of various liniments, viz.: &. Tr. Aconiti, 33. Ol. Sinapis, 3J. Glycerini, ^j. Spts. Rectificati, gvj. M. Sig. Rub in about 2 teaspoonfuls on affected part night and morning. The following is said to be still more efficacious : 406 DIGEST OF EXTERNAL THERAPEUTICS. P. Tr. Aconiti, 33. Camphorse, 3 ij . Chlorof onni , 3 i j . Ol. Cajuput., 3!]. Tr. Capsici, gij. Spts. Rectificati, ad ^vj. M. Scent with oil of origanum. (T., 98.) Aconitia : In the form of an ointment (2 grains to the drachm), or a 2 per cent, solution of the oleate in oil, will afford marked relief. Its local use being not free from danger, caution must be exercised; never apply over denuded surfaces. (F.) The following is Ludlow's formula, which is rec- ommended for "any local pain;" a portion the size of a pea is to be rubbed in over the aifected part. It is also serviceable in inflammation of joints ; #. Aconitinse, gr. iss. Atrop. Sulphatis, gr. ss. Ol.Tiglii., M.ij. Petrolati, 3J. M. (Sm.) Anodyne Colloid : The following mixture is highly recommended ; it forms a collodion which is brushed over painful parts five or six times, forming success- ive films. Absorption of the alkaloid may be facili- tated, if desired, by covering with spongo-piline : P. Amyl. Hydratis, Collodii (B. P.), aa 3j. Aconitinse, gr. j. Veratrinae, gr. vj. M. (T.,97.) Apone : A preparation specially so-called is made as follows: Capsicum, viss, aq. ammonias, liij.^ij, thymol, chloral hydrate, aa siiss, alcohol, Oij. The NEURALGIA. 407 capsicum is macerated for a month in the alcohol and the ammonia mixed ; it is then expressed and the thymol and chloral added. The preparation is then painted on the skin pure or diluted. (F.) Belladonna: The extract thinned with glycerine, and painted on, is effective (Ty.); the liniment and ointment is especially recommended in intercostal and facial forms. (R.) Capsicum: Is used in a strong infusion which is applied on lint and covered with gutta percha. (R.) A plaster may be made by incorporating the tinct- ure with gum arabic and spreading the mixture on paper. (F.) Chloral Camphor: Equal parts triturated is sometimes useful. Morphia may be added with advantage. (B.) Counter-Irritation: Will often afford relief, sina- pisms, an ammonia rubefacient, and in some cases a cantharides blister may be applied with benefit over the affected nerve. (Al.) The latter, though often of service, has, however, been superseded by more modern and less disagreeable measures. Chloroform: A deep injection of from 5 to 15 minims in the neighborhood of an affected nerve has been found extremely valuable. Long-standing neu- ralgias of the superficial division of the fifth pair have been relieved. Tyson says spirits of chloro- form should be used. This remedy must be em- ployed cautiously, as it may cause sloughing, though rarely does any local trouble ensue except tempor- ary induration. The same writer recommends it more especially for sciatica. Chloroform enters into the formation of various anodyne liniments ; a useful one is as follows : 408 DIGEST OF EXTERNAL THERAPEUTICS. $fe. Chloroformi, Tr. Aconiti, aa Jss. Lin. Saponis, ^j. M. Sig. Moisten a bit of flannel and apply covering with oiled silk. The following form effective counter-irritant lini- ments : I*. Chloroformi, Ol. Terebinthinse, aa ^j. Lin. Saponis, ^ij. M. Or, #. Chloroformi, Lin. Camphorae, aa ^j. M. (B.) Cocaine: Might be expected to constitute a useful palliative, but in order to obtain action through the skin it must be only employed in ointments or solu- tions in the strength of 10 to 15 per cent. A 20 per cent, solution dissolved in oil of cloves, 5 to 10 minims being rubbed in with the finger over the seat of pain, is recommended. Strong solutions must be used with caution on mucous surfaces. The hypo- dermic use is more effective; the dose is ^4 grain. The danger of forming the cocaine habit must always be taken into consideration. (Ty.) (Sm.) Guaiacol: Compresses wet with 15 drops to 1 drachm and placed over the part are reported to afford almost instant relief. The drug should be pure and left in contact with the skin only a short time, otherwise absorption may occur which may produce fall of temperature and symptoms of col- lapse. NEURALGIA. 409 The following solution is to be painted on two or three times a day, covering the part afterwards with cotton : #. Mentholi, Guaiacoli, aa gr. xv. Alcoholis Absoluti, 3v. M. Sig. Use little less than a drachm. (T., 97.) Ether: In 15 drop doses, subcutaneously, or mixed with alcohol and injected as near as possible to the seat of pain, has been successful in rheumatic neuralgias, sciatica, and torticollis. (Sm.) Essential Oils : These have the power to relieve the pain of sensory nerves, especially the oil of cloves, a solution of which in rhigoline is a nostrum for superficial neuralgia. The following combination may be employed : V. Ol. Caryophylli, Ol. Gaultherise, Ol. Thymi, aa 3J. Tr. Benzoini, Tr. Cinnamomi, aa %iv. M. Sig. Apply with lint and cover with oiled silk. (B.) Methyl Chloride: Is an effective analgesic in the form of a spray. Employed in this manner it is often very satisfactory in many forms of neuralgia. A large percentage of cures has been reported. (B.) Morphine By hypodermic injection affords relief in all forms, but should only be employed as a last resort because of the danger of forming the habit. (Gn.) This is especially true in chronic forms. Osmic Acid: A 1 per cent, solution in water and glycerine has been used with good effect by hypoder- 410 DIGEST OF EXTERNAL THERAPEUTICS. mic injection over the course of the nerve in sciatica. (Ty.) Peppermint Oil: May be painted along the course of the nerve, or applied with cotton, often with good effect. (Sin.) Combined as follows, it has been found of great service in neuralgic and other forms of headache : Oil of Peppermint, 5 parts. Essential Oil of Mustard, i part. Camphor, 2 parts. Ether, 10 parts. Rectified Spirit, 30 parts. Apply with a camel's hair brush. (T., 97.) Veratrine: In the following formulae; a small quantity is rubbed over the seat of pain : Veratrine, 2 parts. Oleic Acid, 98 parts. Or, Veratrine, 4 parts. Alcohol, 6 parts. Benzoated Lard, 98 parts. (H.) Actual Cautery: This may be used to great ad- vantage in the treatment of long-standing cases, especially of the larger nerve trunks, when other measures have failed. The probable occurrence of scars must be taken into consideration. (F.) Strychnine : Subcutaneously, in full doses, is of benefit when impaired nutrition is the cause. (Ty.) Electricity: Preferably in the form of galvanism, is valuable in many cases ; the positive current over sensitive points, negative over the spine at supposed origin of irritation. The strength will vary from 5 NEURASTHENIA. 411 to 35 milliamperes, according to the susceptibility of the affected part. (Gn.) While the constant current is most frequently employed, faradism may also be used. Experience has shown that the direction of the current may be ignored, though it is com- monly recommended to place the positive pole over the painful part. A sedative effect is best obtained by a weak galvanic current, just enough to produce a trembling sensation. (H.) The application of drugs by electricity has been successfully employed, the drug in solution being ap- plied with the positive pole with a specially con- structed electrode. Cocaine (10 per cent, solution) will give relief which will last about eleven hours ; 10 to 15 milliamperes should be used for from five to fifteen minutes. Morphine may be administered in the same way. (H.) Mud Baths: Such as those of St. Armand, Schwal- bach and Franzenbad are of great benefit in chronic forms dependent upon debility, neurasthenia and hysteria. (Ty.) Acupuncture and Aquapuncture : These measures are of service, the latter often remarkably beneficial. (B.) Excision: Has been used as a last resource, with success and failure. (Ty.) NEURASTHENIA. The measures recommended for hysteria are equally applicable to this condition. 412 DIGEST OF EXTERNAL THERAPEUTICS. NIPPLES, FISSURED AND SORE. Wash the nipples before each nursing, and to harden them, apply daily Green Tea, Brandy, Al- cohol, Port "Wine, Hamamelis, or Lime Water. (Bt.) For painting on the part after preliminary disin- fection the following protective preparations are efficacious: Collodion; Gutta Percha (dissolved in Chloroform), which has the advantage of not being soluble in the child's saliva; and Benzoin, which forms a protective varnish of great value. The lat- ter is also useful mixed with equal parts of glycerine. (Bt.) Glyceroles, or lotions of Hydrastis, Calendula, Arnica, Hamamelis, Phytolacca, and Borax are all used in the proportion of a drachm of the remedy to half an ounce of glycerine. Tannate of Glycerine, Cerates of Graphites, Car- bolic and Boric Acids, Hamamelis, Hydrastis, Cal- endula, and Phytolacca. (Bt.) Nitrate of Silver: The crayon touched to the nip- ple carefully and gently is sometimes very effective when the part is ulcerated. (Hpl.) Ague w advised the application of a 50 per cent. cra3^on to the bot- tom of the fissure in obstinate cases. The nipple should first be cleansed thoroughly and afterward washed with a little milk and water, a dressing of zinc oxide ointment is said to complete the cure. Nitrate of Lead: As a cicatrizing astringent is very useful dissolved in glycerine or brandy in the proportion of gr. x gj. It should be applied after NODES. 413 nursing and the child should not be allowed to take the breast until the nipple has been thoroughly washed. (N.) Rhatany: As an ointment or wash has been very successful. (Wa.) Use a watery solution of the ex- tract, or an ointment in the proportion of 1 part of the extract to 15 of cocoa butter. Iron : An effective application is composed of 2 drachms of the liq. ferri subsulphatis with 6 drachms of glycerine. This is applied with a camel's hair brush. (B.) Cocaine : 4 grains with distilled water 1 ounce may be applied ; wash off thoroughly before nursing. (Sn.) Shields of rubber or zinc may be worn. NODES. Stramonium : A leaf of the plant soaked in spirits and laid on the part will often act as a palliative. (Al.) Mercurial Plaster: One of the best applications, especially for syphilitic varieties. (F.) Iodized Vasogen: Will often prove effective after mercurial plasters fail to relieve. It should be ap- plied with caution several times a day. (F.) The following ointments will be found of service : #. lodi, Terebinth. Canadensis, aa ^iv. Colodii, ^iv. M. Sig. Apply with a brush. 414 DIGEST OF EXTERNAL THERAPEUTICS. Or, I*. Morpliinae, gr. viij. Hydrarg. Oleati (loto 20 per cent.), j. M. Sig. Apply with a brush. Or, JJe. Hydrarg. Biniodidi, gr. vij. Potas. lodidi, 9j. Adipis, gj. M. Or, #.. Cadmii lodidi, 3J- Adipis Prseparati, 3J- Lin. Aconiti, 3^j- M. (Sn.) ONYCHIA. Lead Nitrate: Has cured cases. It should be thoroughly sprinkled on the ulcerating surface. After a (lay or two the crusts which forms is removed and the sore takes on a healthy action. Pain and fetor are diminished and resolution is sometimes complete in a week. (Hel. ) When there is much pain the following : #. Hydrarg. Chloridi Mitis, Pulv. Opii, Ext. Belladonnae, aa gr. iij. Ung. Aq. Rosae, ^ss. M. (Vn.) OPHTHALMIA NEONATORUM. 415 Alumen Usta: Is useful in the following wash : $fc. Aluminis Ustse, gr. iij. Zinc. Sulphatis, gr. ij. Plumb. Acetatis, gr. ij. Aq. Destill., gj. M. (Al.) Resorcin: 10 to 20 per cent, ointment or plaster will, it is claimed, often abort the disease if seen early. (Ja.) The pustules should be evacuated, cleansed with Carbolic Acid solutions, and dusted with antiseptic powders such as Europhen, Airol, Xanoform, etc. Removal of Matrix: This is recommended for cure, cutting away the entire matrix ; simple evulsion will not answer. After removal dress with iodoform. (Hel.) OOPHORITIS. See Pelvic Inflammation. OPHTHALMIA NEONATORUM. In the first stage, strict cleanliness, constant re- moval of all secretions, and the use of antiseptic irri- gations are essential. No strong or irritating solu- tion should be applied at this period. In the second stage, and not until then, nitrate of silver is the sov- ereign remedy. If only one eye is affected the other should be protected, being securely covered in every 416 DIGEST OF EXTERNAL THERAPEUTICS. part with round lintine pads slightly larger than the orbit. These should be covered with sterilized cot- ton, the latter with gauze, and collodion should be smeared around the whole edge of the pad save at a point at the lower outer region, which should be left for ventilation. The protected eye should be in- spected every second day. The nurse should never carry the infant in her arms. Antiseptic douches should be administered as pre- ventives to women \vith vaginal discharges just be- fore confinement. For this purpose solutions of Bi- chloride of Mercury are recommended. (Mac.) Crede advised as a preventive a 2 per cent, solution of Nitrate of Silver dropped into the eyes of newly- born infants. Other measures have also been ad- vised, with the same end in view, but none are as certain in their effects as nitrate of silver. If the dis- ease is of an entirely purulent character, active and energetic measures should at once be instituted, otherwise the infant will lose its eyesight. The indi- cations are essentially the same as those of purulent conjunctivitis in adults. The general line of treatment may be summarized as follows : 1. During the earlier stages, when inflammation and oedema of the lids is severe, in addition to strict cleanliness the constant application of Cold should be maintained in the following manner : Take square compresses of lint, lay them upon a block of ice, then, when cold, place them on the swollen lids. Change the compresses as frequently as it is needful to keep up a continuous uniform impression. 2. The discharge should be constantly removed, to accomplish this proceed as follows : Gently sepa- OPHTHALMIA NEONATORUM. 417 rate the lids, wipe away the tenacious secretion with bits of moistened absorbent cotton and irrigate the conjunctival sac freely with an antiseptic solu- tion. Care should be observed not to permit the point of the pipette to come in contact with the cornea. A saturated solution of Boric Acid, or Bi- chloride of Mercury in solution not greater than 1 grain to the pint may be used for irrigation; the former is the more useful. (T., 96.) Nitrate of Silver : As soon as the discharge be- comes free and creamy the remedy should be applied as follows : Carefully evert lids and secure exposure of the inflamed tarsal cartilage. Remove all dis- charge of lymph b} r irrigation; wipe away all ad- herent particles with moistened cotton and carefully touch the areas thus prepared \vith a solution of 10 to 20 grains to the ounce by means of a cotton mop. Neutralize the excess with a solution of common salt 15 to 20 grains to a cup of water. Continue apply- ing the salt solution until a clear red surface is ob- tained, then return lids to position. The cornea should be carefully inspected before leaving. Finally apply pure vaseline to the lids, and introduce some within the conjunctival sac. (T., 96.) Protargol and Argonin: Advantages are claimed for these compounds over the older silver salts in treating the purulent ophthalmia of children. Both are silver proteid compounds, the solutions of which cannot be precipitated by albuminous fluids. Pro- targol is a yellowish powder, readily soluble in cold or hot water, and both the powder and the solution keep well. Argonin contains 4.2 per cent, of silver. It is a white powder, readih r soluble in slightly warm water, but the solution is turbid, and decomposes if 28 418 DIGEST OF EXTERNAL THERAPEUTICS. exposed to too much heat. When so decomposed, it is very irritating. Silver nitrate contains 6.35 per cent, of silver, and hence occupies a middle position in this respect between protargol and argonin. Argonin in a 2 per cent, solution will kill gonococci in a short time. It has little or no caustic proper- ties. Protargol is more powerful and should not be used in greater strength than from 1/2 to 1 per cent. Under its influence gonococci will disappear in from two to four weeks. Treatment by these remedies has the following ad- vantages : There is less ulceration of the cornea with protrusion and imprisonment of the iris, an earlier disappearance of all inflammation, a quicker eradica- tion of the gonococci, less pain to the patient, and more prompt restoration of the injured cornea and conjunctiva. In preparing solutions of argonin use 10 parts of cold water and 1 part of argonin. This is vigorously shaken in a flask until a uniform mix- ture is obtained, when sufficient boiling water is added to make a 3 per cent, solution. In preparing a solution of protargol a paste is first formed with the powder and \vater and then sufficient water is added to make it from .25 to 2 per cent., as desired. Sodium chloride, cocaine, atropine, eserine, and other allied substances used as anodynes for the eye can be administered in conjunction with protargol. Albuminous substances present in the secretions do not decompose it. It is the only silver compound known that is not affected by dilute hydrochloric acid. In suppuration of the lachrymal sac, styes, etc., the pus-formation is more quickly checked by protargol than other agents. (Fed., Vol. 7, 99.) Eserine: A solution of | to ^ gr. 3j, one drop ORCHITIS. 419 three or four times during the day according to se- verity of the case, should be used if the cornea be- comes hazy or a small ulcer forms at the border. At night instill Atropine, 2 drops of a solution of 4 grains to the ounce. Caution should be exercised lest constitutional effects of these drugs be obtained. If corneal haze continues, replace cold applications with hot, using carbolized water at 120. (T., 96.) Potass. Permang.: Flushing the conjunctival cul- de-sac with a solution of 1-5000 is recommended. A special laveur may be used and about 2 pints ap- plied in each eye twice a day. (T., 96.) Formalin : In the strength of 1-1000 or 500 may be employed with great benefit as an antiseptic dur- ing the stage of corneal complication. When the ulcer is not large or is only beginning to appear, this treatment is strongly indicated. (N. O.) Mercury Oxycyanide : This remedy, it is claimed, has antiseptic powers equal to those of the bichlor- ide, with the advantage of being less irritating and of possessing less power of coagulating albumen. Solutions of 1-500 have proved effective. (T., 98.) lodoform: Finely powdered and dusted on the conjunctival sac after cleansing, is employed ; may be applied at first even before the cord is cut. (T., 98.) ORCHITIS. Rest in bed and support of the parts as in epididi- mitis. Laudanum or Tobacco: Applied in the form of stupes, is often helpful. A piece of flannel is wrung out in hot water, then dipped in the laudanum or a 420 DIGEST OF EXTERNAL THERAPEUTICS. strong infusion of tobacco and wrapped around the testicle. Oiled silk is placed over the stupe and the parts are wrapped in cotton and lightly bandaged. (B.H.) Carbolic Acid: A 2 per cent, spray applied for fif- teen minutes daily is highly recommended. The parts are afterwards wrapped in cotton and sup- ported. This spray should not be used more fre- quently than the time mentioned, for fear of causing excoriation of the skin. (Cl.) Belladonna Ointment: Spread on cloths and wrapped around the testicles is used to subdue pain. (B. H.) Guaiacol: Applied to the groin and inner aspect of the thigh relieves pain and lowers temperature. (Sj.) Poultices : Should be used with caution. In the beginning of the attack applied for a few hours they are of service. Long applied they increase engorge- ment and pain. (B. H.) Hop poultices are indicated both in specific and simple orchitis. (Al.) Ammonium Chloride: Forms an excellent discuti- ent application in inflammatory swellings, and may be emplo} r ed in this condition when applicable in the proportion of a drachm to an ounce each of rectified spirits and water. Cloths are moistened with the solution and frequently applied. (B.) Ice: Is applied with the hope of aborting the in- flammation, and may be employed if the patient is seen at the onset of the attack. But its continued application is not desirable if the disease has pro- gressed to any extent, for the possibility of devitaliz- ing the parts and causing gangrene after effusion has occurred, must be taken into consideration. (Mor.) Puncture of the Tunica Albuginea : Employed OTITIS EXTERNA CIRCUMSCRIPTA . 421 with gratifying results ; for the relief of pain and tension, it is very generally recommended. (Mor.) Complete antisepsis should be observed. Suspensory bandages should be worn after con- valescence. (Mor.) OTITIS EXTERNA CIRCUMSCRIPTA- FURUNCLE OF THE AUDI- TORY MEATUS. The following are useful for aborting the furuncle : the Yellow Oxide of Mercury, gr.ij-gj, or the Oleate, 10 per cent., as ointments; Nitrate of Silver (the crayon application); and Menthol, 10 to 15 per cent, in oil. For a soothing effect, the following emollient oint- ments, painted on the wall of the meatus, are of benefit: Cold Cream, or White Precipitate, gr. j ij, Ung. Aq Rosae, j. (Bn.) Also irrigations with hot water, to which Laudanum may be added for relief of pain. Other applications which may be employed are : Carbolic Acid and glycerine, 1-20. Burow's Liquid, see Appendix II. Liq. Plumbi Subacetatis Dilutus, a few drops. Salicylic Acid in collodion, 5J-5J. Tr. Iodine or Pure Glycerine painted on. Belladonna Ointment. When the furuncle has formed, it should be incised by Sexton's, Buck's, or Politzer's knife. After incision the following washes should be used for irrigation, and for loosening crusts of discharge : 422 DIGEST OF EXTERNAL THERAPEUTICS. Mercuric Bichloride, 1-10,000. Sodium Bicarbonate, gr. x-xx-|j. Borax, gr. x-xx-.y. (Bl.) OTITIS EXTERNA DIFFUSA. Heat and Moisture : Applicable to simple cases. Use an irrigating douche of hot water, or frequent instillation of hot water into the upturned ear. These may be repeated as often as the patient desires. Laurel water may be substituted for plain water. . The following are useful instillations for the relief of pain: #. Morph. Sulphatis, gr. iv. Aquae, ^ij. M. Sig. 10 drops warm in the ear. I*. Atrop. Sulphatis, gr. j. Aquae, j. M. Sig. 5 drops warm in the ear. Alcohol: Pure, instilled into ear is said to abort inflammation and reduce swelling. (Bn.) Incision : May be employed when other means have failed to check the inflammation. A careful ex- amination should be made with the mirror and the most inflamed spot located. The use of the probe for this purpose is contra-indicated. A bold inci- sion, clear to the bone, is often followed by relief of pain and improvement. (Bennett.) Mild Syringing: With warm water with carbol- ized soap, boric acid, borax, salt, or bicarbonate of OTITIS EXTERN A DIFFUSA. 423 soda, should be employed when the discharge is sero- sanguinolent, for then the canal is exceedingly ten- der and intolerant of any irritant or stimulant. A cotton wool brush may be employed for cleansing; exercise care in its application, \vorking towards the outlet of the canal without undue pressure. (Bl.) Impalpable Powders or solutions of Alcohol are indicated when the discharge is sero-purulent, thick and irritating. Of .the powders, the most effective are : Boric Acid ; Borated Calendula ; Salicylate of Chinoline 1 part, with 16 of boric acid ; Resorcin 1 part, boric acid 8 parts ; Boric Acid and Oxide of Zinc, equal parts. These should all be used spar- ingly. The most effective way in \vhich to apply these powders is to insert an ordinary goose quill into one end of a flexible rubber tube, the free end of which is held in the mouth while the other is dipped into a saucer containing the powder, a little of which fills the quill, which is aimed at the desired part; a slight puff from the mouth deposits the powder. The following liquid preparations are recom- mended : Boric Acid, saturated solution. Zinc Sulphate, gr. j-j. Pyoktanin, 1-2000 or 1000. Solutions should be used warm and dropped in. Nitrate of Silver fused on the end of a silver probe or a solution on a cotton wool brush, or Alcohol as strong as the patient can bear it, are suitable agents for the reduction of redundant growths. (Bn.) 424 DIGEST OF EXTERNAL THERAPEUTICS. OTITIS MEDIA. ACUTE CATARRHAL OTITIS MEDIA. Plantago: A glycerole may be made of the fluid extract from the fresh plant mixed with glycerine, equal parts distilled and filtered. 5 drops hot in the ear for the relief of pain and local inflammation. (Ho.) In the following combination, it is said, the drug scarcely ever fails to relieve : #. Fid. Ext. Plantago Maj., 5iv. Tr. Belladonnae, gtt. xv. Tr. Aconiti Radicis, gtt. x. Sol. Morph. Sulphatis (Magendie), gtt. xx. Aq. Destill., q. s. ad gj. M. Sig. 4 or 5 drops warm in the ear at intervals of from ten minutes to two hours. ( Str. ) Another combination is the following : 9. Fl. Ext. Plantago, Maj., 5j. Fid. Ext. Belladonnae, gtt. x. Glycerini, Aq. Destill., aa 5 n j- M. Sig. A few drops in the ear for pain. (Bl. ) Morphia: 5 to 10 minims of Magendie's Solution may be dropped into the ear for the relief of pain, re- peating the doses every two hours, as indicated. (Bl.) Mullein Glycerole: Take fresh flowers (old are in- ferior), digest in Jamaica rum ten days, express the extract, and use equal parts with glycerine and dis- OTITIS MEDIA. 425 tilled water. An excellent preparation with which to follow hydrogen peroxide, which should never be used alone. (Ho.) Atropia : In the following combination may be dropped into ear for relief of pain : #. Atroph. Sulphatis, gr. ij. Acid. Borici, gr. x. Aq. Destill., j. M. (Bn.) Cocaine Hydrochlorate: 4 per cent, solution, a few drops in ear for relief of pain. Local Abstraction of Blood: Is valuable in the first stages of both acute and purulent forms. Leeches are of great value in those cases attended with intense pain and when there is great hyperae- mia, infiltration of parts and engorgement of the periosteum and mucous membrane. In many in- stances further progress of disease is arrested. Arti- ficial leeches may be used and are decidedly prefer- able. (Dch.) Hot Douche: Water poured into the meatus will frequently relieve pain at once when the artificial leech has failed; boric acid may be added, 3ss-Oj. (Bac.) Lucae's douche glass may be conveniently used. Nitrate of Silver: Applied by a mop to the pharynx is of benefit when there is hyperaemia in that locality. The strength of the solution for chil- dren should be 10 to 15 grains to the ounce, for adults 15 to 20 to the ounce. The Politzer may also be used occasionally. (Bck.) Steam : Introduced into the ear is an excellent method of applying heat; care must be exercised that it is not too hot. (Str.) 426 DIGEST OF EXTERNAL THERAPEUTICS. Carbolized Glycerine: 10 to 20 per cent, warm instillations are attended with good results. (T., 97.) Menthol Gauze : Impregnated with 10 to 15 per cent, solution in oil, and inserted into the meatus for twenty-four hours at a time, has been used with good results. (T., 97.) Inflation of the Ear Drum : May be employed in less severer cases with slight hyperaemia, using the Politzer method or the catheter. The former should be constantly employed for the purpose of relieving accumulations of mucus and fluid, for the restora- tion of the drum to its proper position, and to pre- vent formation of adhesions. (Bn.) Paracentesis : If in spite of treatment the mem- brana tympani is bulging with indications of per- foration, it should be punctured with the paracen- tesis needle and afterward douched with a solution of boric acid or bichloride of mercury, 1-4000. (Bl.) CHRONIC CATARRH AL OTITIS MEDIA. As the majority of cases arise from lesions of the nose or vault, treatment should first be directed to those localities. (Bac.) The patient should be placed in the best hygienic surroundings, guarding against changes of tempera- ture and moisture as much as possible. Inflation and Catheterization : When there is hy- pertrophy and hyperasmia of the eustachian tubes these measures are indicated, together with local treatment to the naso-pharynx. Bacon states that it is difficult to say how long the inflation treatment should be continued. In most cases nothing is gained beyond the third week, and on the other OTITIS MEDIA. 427 hand improvement may not begin until the fifth week. All manipulations should be made with the utmost gentleness. When the catheter is in position it should not cause pain. (Str.) The following are recommended for application to the pharyngeal surfaces : Nitrate of Silver: Applications should be used to the vault of the pharynx as long as hyperaemia is recognizable to any degree. The influence of the remedy is not confined to the actual areas of appli- cation. (Bac.) #. Potass. lodidi, gr. x. lodi, gr. v. Glycerini, ^j. M. Sig. Apply with brush in old cases with glandular enlarge- ments. . Acid. Tannici, Glycerini, Or, #. Aluminis, jss. Glycerini, 3 j. M. Sig. Apply with a brush in acute aggravations with a tend- ency to ulceration. Or, I*. Fid. Ext. Hydrastis, Glycerini, M. Or, #. Pini Canadensis, 3J. Glycerini. ^j. M. (Str.) 428 DIGEST OF EXTERNAL THERAPEUTICS. The following is recommended as serviceable in offensive cases : ty. lodofonni, gr. x. Acid. Tannici, gr. j. Sac. Ivactis, giss. M. Sig. Apply with a powder blower. ( Str. ) Injection of vapors or liquids into the tympanum through the eustachian tube, according to modern writers, has not been attended with satisfactory re- sults. Of the operative procedures excision of the drum head and the two larger ossicles appears to be the most satisfactory. (Bn.) Hot Air Douches: This novel treatment has re- cently been introduced by Dr. E. L. Vansant, of Phil- adelphia, who reports very successful results from its use in cases of deafness and tinnitus aurium caused by middle ear catarrh, also in persistent headache arising from catarrh of the frontal sinus. The use of this method requires an especially devised instru- ment, which, together with the technique of its appli- cation, is described by the inventor as follows: It consists of a syringe containing a small chamber, in some instances holding a piece of carbon, in other instances having in its interior several diaphragms of metal. This chamber is held over a flame, prefer- ably that of a spirit-lamp, until heated. Coming off of the chamber, anteriorly, is a nozzle with adjust- able tips. The air enters the chamber from behind and is heated while passing through. The instru- ment is small in size and is held by a handle placed at a convenient angle. The air to be heated is obtained from the usual air-condenser. The amount of heat produced may be varied at will, from a mild OTITIS MEDIA. 429 warmth to a burning degree, and depends upon how hot the chamber is heated, how swiftly the current of air is passed through, and how close the nozzle is held to the surface to be treated. In some instances vapors of chloroform, menthol, etc., have been added to the heated air; this is done by placing a small quantity of the medicament in the little cup found on one of the tips, or by placing it direct in the catheter, when one is used. In preparing the nasal chambers for treatment, the mucosa is first shrunken by applications of cocaine or eucaine, used alone or followed by watery solu- tions of the suprarenal capsule of the sheep. The hot air is directed against the openings of the sinuses, or, if necessary, a small catheter is used. When the middle ear is treated, the air is passed through a eustachian catheter. The treatment when properly carried out is said to be free from pain and rather agreeable to the patient. (P. M.J., 9, 9, 99.) ACUTE PURULENT OTITIS MEDIA. Severe cases should be confined to bed and the measures recommended for the acute catarrhal form, such as anodyne instillations, hot water douches, local depletion, and paracentesis are indicated. Heat: Dry heat affords relief of pain, especially in the first stage. It may be applied in the form of hot bran, hot salt, or hot water bag. Moist heat may be conveniently emplo3^ed by filling the upturned ear with water at a temperature of 105, and applying immediately a hot flaxseed poultice, which in turn is covered \vith flannel. Douching the ear with hot water for ten minutes at a time is another method, 430 DIGEST OF EXTERNAL THERAPEUTICS. but is not as convenient, and is no more effective than the above. (Bac.) Cold: Leiter's coil constitutes the most effective mode of applying this agent, which is especially indi- cated when symptoms of mastoid inflammation are impending. (Dch.) Artificial Leech: If the patient is seen in the early or hyperaemic stage, inflammation can frequently be arrested by the application of the artificial leech, either Burnett's, Heurteloup's, or Bacon's. These contrivances are vastly superior to the ordinary leech. They should be applied in front, and below the tragus. (Bck.) The following anodyne will also be found useful for the relief of pain in the earlier stages : #. Atrop. Sulphatis, gr. i*. Acid. Borici, gr. x. Aq. Destill. j. M. Sig. First warm and then drop into the meatus and insert a bit of cotton. Morphine, Atropine, and Cocaine, as mentioned in the acute catarrhal form, may be instilled for the relief of pain. Paracentesis: The ear should be frequently exam- ined, and soon as bulging of the ear drum is dis- covered, which usually occurs in the posterior half, the membrane should be relieved with a paracentesis needle. (Str.) After this it may be necessarj^ to force out the secretion by the Politzer method. This should be done frequently during the course of the disease, very gently when there is pain and more forcibly as the acute symptoms subside. After para- centesis, the discharge should be promoted with the ear douche as in acute catarrhal otitis media. (Br.) OTITIS MEDIA. 431 Boric Acid: A saturated solution warmed and dropped into the ear several times a day after thorough cleansing of the canal may be used with benefit after the acute symptoms have begun to abate. (Bn.) Argonin : For acute purulent inflammation of the middle ear, has recently been recommended. Its application and the advantage which it possesses over boric acid, for which it appears to be presented as a substitute, may be summarized as follows : Argonin solutions are highly antiseptic, boric acid less so ; they can be forced through a small perfora- tion in the drum-head, thus reaching every part of the t3^mpanic and eustachian tubes. In such cases boric acid lies inactive in the external audit ory canal. They can be used to flush the middle ear and tube, thus reaching every part of the inflamed tract, carry- ing out with it all products of inflammation, and especially relieving the attendant fever and pain; argonin excites a positive and decided effect upon the suppurative process. Boric acid possesses this power but feebly ; argonin stimulates the closing of the perforations in the drum-head. Boric acid has no such action. To obtain these effects it is, of course, necessary that the solution (2 to 5 per cent.) should pass through the middle ear, in order that it may be brought into contact with the whole of the mem- brana tympani. This is usually not difficult. Hav- ing cleansed the canal in the usual manner, say with carbolized water or a solution of hydrogen peroxide, the drum cavity is to be emptied by Valsalva's method, or by the Politzer bag, and the secretion thus blown out removed with the cotton carrier. 432 DIGEST OF EXTERNAL THERAPEUTICS. The auditory canal is then filled with the argonin solution, and while covering the outer end of the canal with the tragus, at the same time making strong pressure upon it, the solution is forced through the perforation into the middle ear, thence to the throat by way of the eustachian tube. The application is entirely painless. (T. C. R., 6, 98.) For antisepsis and cleanliness, solutions of Forma- lin, Bichloride of Mercury, Hydrogen of Peroxide, Carbolic Acid, Creolin, etc., as mentioned under the chronic purulent form, will be called for. Boyle uses the following with good effect : Formalin, gtt. iij. Hydrogen Peroxide, Boric Acid, Saturated Solution, aa 5jss. A few drops in the ear every two hours. Powders: Remedies in this form are of service when the perforation is large and the inflammatory symptoms have not been severe. The same pow- ders mentioned for use in the acute catarrhal form are also indicated in this variety. When the dis- charge is profuse and contains considerable mucus, remedies in this form should not be used. Astringent Injections: Are indicated in place of powders when there is profuse mucous discharge, viz.: Sulphate of Zinc, Acetate of Lead, Sulphate of Copper, all in the proportion of gr. ij-iv-3j. (Bn.) Injections of Warm Water through the catheter into the middle ear are recommended in cases when pain continues uninterruptedly after perforation of the membrana tympani in obstinate forms and in painful inflammation of the mastoid process. (Fid.) Tr. Iron Chloride on a probe, Nitrate of Silver or fused Chromic Acid used with extreme caution may OTITIS MEDIA. 433 be applied to the granulations which form on the edges of the perforation or in the middle ear. If chromic acid is used especial care must be taken to touch nothing but the granulation. (Bck.) The pharynx should receive treatment with sooth- ing sprays during the course of the disease. CHRONIC PURULENT OTITIS MEDIA OTOR- RHCEA. Antisepsis and asepsis must be maintained. Some aurists prefer using a syringe, others mop out the discharge with absorbent cotton on a cotton holder, then the whole external auditory canal and its fundus is cleansed with cotton soaked in an anti- septic fluid, which is squeezed out into the parts. The following solutions are recommended for this purpose, to be used warm : Formalin, 1-2000-1000. Carbolic Acid, 1-40. Mercuric Bichloride, 1-4000-3000. Salicylic Acid, gr. iij 5J. Creolin, 1-1000. Hydrogen Peroxide: If the discharge is very thick a solution, 12 per cent., may be slowly instilled, ap- plying a few drops at a time until effervescence ceases. This remedy, of course, cannot be heated, and therefore must be used at the temperature of the atmosphere. (Str.) When the discharge is profuse, cleanse with the peroxide every two hours and dry thoroughly with absorbent cotton. (Bl.) After cleansing, the ear should be carefully exam- ined for granulations, polypi, denuded, carious, or necrotic spots in the bony parts, which if present should receive appropriate treatment. When asepsis 29 434 DIGEST OF EXTERNAL THERAPEUTICS. has been established it should be maintained by ap- plications daily, or every other day, as the nature and quantity of the discharge indicate. For this pur- pose the antiseptic solutions mentioned may be em- ployed with a mop or in the form of one of the fol- lowing powders, the latter are generally regarded as superior, as the parts are thereby rendered aseptic more continuously. Boric Acid: Pure, or Calendulated or mixed with Plaritago; the latter is prepared thus : 1 part of sugar of milk is mixed with fluid extract of plantago, as much being added as will thoroughly moisten the sugar; triturate this in a mortar, and add equal parts of boric acid ; this, according to Houghton, gives better results than the acid alone. An effective preparation is as follows : J*. lodoformi, gr. ix. Acid. Tannici. gr. j. Sac. Lactis, gr. xc. Triturate thoroughly. (Str.) Resorcin, Aristol, Dermatol, pure or mixed^with Boric Acid and Hydrastinated Boric Acid, are rec- ommended. Airol has also been used successfully. Oil of Eucalyptus: 1 part, vaseline 8 parts, ap- plied on cotton, acts especially well in offensive cases. The patient may also use at night three or four drops applied on a piece of twisted cotton. (Str.) Various astringent solutions are also used, viz.: Zinc Sulphate, gr. ij~3J. Zinc Sulpho-Carbolate, gr. v~3J. Glycerite of Tannin. *NoTE. Both boric acid and iodoform have a tendency to cake in the ear, hence some caution is necessary in their use. PARALYSIS. 435 Nitrate of Silver, gr. j-x-|j. Acetate of Lead, gr. ij-j. Cadmium Sulphate, gr. ij-sj. More astringent at the same time more irritating than zinc. Treatment by antiseptic powders or instillations should be appled daily for a few days; then every other day, and at longer intervals as the discharge lessens. If, after a month or two, benefit is not ob- served, the mucous membrane of the drum cavity granulating or swollen, drainage defective, and the malleus or any part of the tympanic walls carious, the membrana tympani, the malleus and the incus should be removed by excision. (Burnett.) The granulations which may folio w chronic sup- puration of the middle ear usually disappear under treatment by antiseptic powders, but if such is not the case the following may be used : Alcohol alone or mixed with equal parts of Boric Acid and water, Potassium Bichromate, saturated solution, or Chromic Acid, applied by means of a probe dipped into the deliquescent crystals. The application should be made with great care and under illumina- tion. OZ^NA. See Atrophic Rhinitis. PARALYSIS. Electricity: Widely used in the various forms; in apoplectic paralysis it is often proposed, but the re- sults are not encouraging. In these conditions it should not be applied too soon after the seizure, and 436 DIGEST OF EXTERNAL THERAPEUTICS. when applied to the head at least a month should have elapsed. Electrical treatment is much the same for all forms of cerebral paralysis varying only with the seat of lesion and the muscles affected. (Rk.) Galvanism and faradism are both employed. De Watteville's method in hemiplegia is to apply a large electrode to the nape of the neck and the other, also large, on the diseased side so as to include the seat of lesion be- tween the two. In hemiplegia the constant current may be applied to the brain to improve its nutrition and the faradic to the muscles to prevent atrophy and loss of function. (B\v.) If the muscles are weak and flabb}' much improvement will follow faradiza- tion. A current just strong enough to cause contrac- tion should be used. The muscular contractions which ensue after a time, and which appear princi- pal^' in the forearm and hands, may be treated by the continuous current to the flexors and an inter- rupted or faradic current to the extensors. (B.) In lead paralysis, if the muscles fail to respond to faradization and react when stimulated by a slowly interrupted galvanic current, the interrupted gal- vanic current may be first employed followed by the faradic when the muscles have so far improved as to respond to the latter. For facial paralysis the positive pole should be placed on the pes anserinus or on the mastoid pro- cess and the negative is passed over the peripheral expansion of the nerve, so that all the enervated muscles may be stimulated to contract. A current of sufficient strength to produce muscular contraction should be employed. In paralysis of spinal origin, electricity will often PARALYSIS. 437 give excellent results, but not, however, in all forms. In the infantile variety treatment should begin early, but not until after the inflammatory symp- toms have disappeared. Good results are obtained by galvanism and faradism of the paralyzed muscles, as well as galvanization of the spinal nerves and plexus. (B.) * Chapman's System of Applying Heat and Cold to the Spine: Though applicable to other diseases this method finds an important sphere of action in paralysis. A knowledge of the anatomy and physi- ology of the vaso-motor nervous system is necessary for its successful employment. To apply heat and cold, which are the essentials of the treatment, rubber bags are used. The apparatus for hot water consists of two narrow bags 8 to 10 inches long kept parallel by cords or straps, the in- tention being to direct the heat upon the sides rather than the centre of the spine. For emergencies a yard of flannel 8 to 10 inches wide rolled from both ends nearly to the middle will answer. These parallel flannel rolls are to be dipped in hot water 115 to 120 F. and applied. Other excellent, substitutes are Edison's electro-therm, the Japanese hand-warmer, hot salt or sand, or lime while slaking in flat metal boxes. Chapman's ice bag has no open space like the hot water bag, as it must cover the spine itself as well as its sides ; it is 10 to 18 inches long and about 4 inches wide, narrower for children and wider for very large persons. Usually there are three compartments, but * Condensed by Dr. Jas. Robie Wood, from his clinics at the Metropolitan Hospital, Blackwell's Island, New York, and espe- cially prepared by him for this work. 438 DIGEST OF EXTERNAL THERAPEUTICS. they are not absolutery necessary. To prevent leak- age the bag is securely tied or clamped at the top. When such a bag cannot be procured, an ox's gullet or a section of gut from any animal can be substi- tuted. Chemical refrigerants ma3' supply the place of ice. The ideas in the application of heat and cold to the spine are simply these : To contract arteries which are controlled from certain nerve centres heat should be placed close to those spinal centres; this stimulates the vaso-constrictor nerve fibres and through them diminishes the calibre of arteries \vithin their influence. Applied upon the same region the action of cold is directly opposite ; by reducing the circulation within and near the spinal column it partly paralyzes the vaso-constrictor filaments which supply the muscu- lar walls of blood vessels, thereby permitting more or less dilatation of the arteries under their control. To make use of this knowledge it must first be as- certained whether arterial narrowing or widening is demanded in any given disease, in other words, con- ditions are the first consideration. For instance, in the same malady anaemia or hyperaemia of the brain may occur. Now in cerebral ansemia, if an ice bag be applied over the lumbar and dorsal vertebrae, that part of the spinal cord having no direct influence upon blood vessels within the cranium, the cold by causing dilatation of the small arteries of the abdo- men and legs would produce a rapid fall in blood pressure and syncope might result. On the contrary, heat upon the same locality, by inducing contraction of arteries in the legs and abdo- men, would increase the flow of blood to the brain. PARALYSIS. 439 In cerebral hypersemia cold over the same vertebras would relieve cerebral congestion, while heat would intensify that congestion. At the very onset of apo- plexy, in many cases, the dorso-lumbar application of an ice bag will control the cerebral circulation so as to prevent prolonged coma, and not infrequently consciousness will be restored within a few hours. In the cases of paralysis presented at this clinic to- day you have an opportunity of seeing the marked benefits of Chapman's system of treatment. None of these patients has had more than one hour's applica- tion of ice each day ; such chronic cases generally re- quire two or three hours' treatment daily. This old woman has had two attacks of apoplexy and has been paralyzed on one side for eight months. With- out assistance, other than a cane, she has walked down stairs to present herself at this clinic after four weeks' dorso-lumbar ice applications and an occa- sional laxative, which latter is very important dur- ing treatment at least once or twice a week. Here is a patient with both lower extremities par- alyzed and atrophied from spinal disease. Her most distressing symptom, constant involuntary dis- charge of urine and fasces, one week after the first dorso-lumbar ice application was under complete control. In other respects she has not as yet im- proved. Let me mention a few of the many maladies in which the ice bag applied upon the dorso-lumbar region will be more or less palliative, if not always curative, when the proper conditions are present. They are acute and chronic cerebral and spinal con- gestions and inflammations, cerebral and spinal apo- plexy, immediate or threatened sunstroke with cere- 440 DIGEST OF EXTERNAL THERAPEUTICS. bral congestion ; paralysis from various causes, to supply nutrition when nerve degeneration is not too far advanced ; spasmodic diseases, such as epilepsy and some forms of general convulsions ; painful spas- modic affections dependent upon irritation of some portion of the spinal cord ; spasmodic contraction of muscles ; atrophied muscles and organs ; trismus and tetanus ; angina pectoris ; locomotor ataxia ; neuralgia ; neuritis and neurasthenia ; headaches, especially those from grief, mental and physical ex- haustion and alcoholism; many hysterical condi- tions ; dysmenorrhoea, particularly when compli- cated with headache ; amenorrhoea with or without maniacal symptoms; insomnia; during chill of in- termittent fever ; cold feet ; gastric disorders ; con- stipation; sporadic and Asiatic cholera; chronic diarrhoea; obstinate nausea and vomiting, espe- cially seasickness ; eczema and some serious troubles of the eye. Heat may be applied to the dorso-lumbar region in diseases attended with cerebral anaemia; the hot stage of intermittent fevers ; congestions and inflam- mations in various abdominal diseases, such as me- tritis, peritonitis, enteritis, nephritis, and cystitis ; haemorrhages, uterine, intestinal, renal, cystic, and gastric. Heat may be applied over the middle and upper dorsal vertebrae for pulmonary haemorrhages, con- gestions and inflammations, except when its action might impede the circulation of the heart and lungs by intensifying an already existing arterial constric- tion, a condition in which amyl nitrite, sodium nitrite, or nitro-glycerine would be indicated. In such cases, heat between the shoulders would be harmful. PARALYSIS. 441 Heat may be applied to the cervical vertebrae in various congestions and inflammations of organs, glands and other tissues that are supplied by nerve filaments from the cervical S3^mpathetic. Cold may be applied to the same region where anaemia or de- generation exjsts in those organs, glands and tissues. Where to place the bags. The ice bag must not reach below the last lumbar vertebra, except in rare conditions to control the nervi-erigentes. A conve- nient rule is to place its lower end on a line with the crest of the ilia. Thence let it extend to the middle or upper dorsal vertebrae, according to the extent of the lesions. Cautions. The bag of ice must be prevented from slipping to the sides lest an annoying cold be de- veloped. It is not well to apply ice immediately after a meal or while freely perspiring. The same care is not needed with the hot water bag, which may be placed at any indicated point along the spine. Do not persist in applying ice when it be- comes disagreeable and the patient feels chilled; in such cases suspend the ice and administer laxatives, or apply heat on the same place. Where very rapid action is demanded to constrict the blood vessels in the upper part of the body or head and to dilate those of the abdomen and legs at the same time, the hot water may be placed upon the upper dorsal and cervical vertebras, while the ice bag is at the same time placed upon the lumbar and lower dorsal verte- brae. You will be better guided by keeping in mind these statements of Chapman : 1st. "By the spinal application of cold muscular tension is diminished ; sensibilitv is lessened, secre- 442 DIGEST OF EXTERNAL THERAPEUTICS. tion is lessened ; the peripheral circulation, and, con- sequently, bodily heat is increased." 2. "By the spinal application of heat muscular tension is increased, sensibility is increased, secretion is increased; the peripheral circulation, and, there- fore, animal heat, is lessened." PAROTIDITIS MUMPS. Cotton batting as a covering is all that is usually necessary in simple cases. There should be no counter-irritation. (C.) Cold Cream or Vaseline: Is often applied, and may possibly allay the sensation of tension. Belladonna or Phytolacca Ointments: May be employed in conjunction with the same remedy in- ternally. (Ha.) PEDICULOSIS. PEDICULOSIS CAPITIS. The most expeditious measure is shaving the hair, and the application of some emollient for the eczema, which is usually present. This, however, is only ad- visable in the case of children and men in hospitals, but it is generally unnecessary, for the proper use of antiparasitics will accomplish the desired end. The following will prove satisfactory : Staphisagria: Much used, and is generally effect- ive. The decoction or tincture may be applied pure, PEDICULOSIS. 443 or the fluid extract diluted with vinegar ; 1 drachm to the ounce of vinegar. (Al.) Another preparation is made by macerating an ounce of the seeds in a pint of vinegar. (F.) Kerosene Oil: A remedy suitable for dispensary practice. Saturate the scalp and allow the oil to re- main on over night, apply for two days, then wash the head thoroughly with soap and water. It will kill the pediculi but not the nits. In applying the oil avoid letting it run down over the face and neck for fear of causing excoriation. Vinegar: Will kill and loosen the nits and there- fore should supplement the application of kerosene. (F.) Cocculus Indicus: The tincture or decoction, is effective both for pediculi and nits. (F.) Startin recommended Ijfc. Sod. Hyposulphatis, 3ij- Acid. Sulphurosi Dil., iv. Aquae, q. s. ad 5 XV J- M. Sig. Apply once daily. The folio wing are useful : Hydrarg. Bichlorid., gr. iij-v-j. Carbolic Acid, gr. iij-iv, alcohol, 3j. ,5-Napthol, 5 per cent, in oil. When the hair is short, ointments may be employed advantageously, viz.: Ammoniated Mercury, gr. xx-^j-^j. Staphisagria Seeds, in powder, 3J, lard, 3j. Carbolic Acid, gr. xv xxv, ung. petrolei, 3j; this is most effective. 44-4 DIGEST OF EXTERNAL THERAPEUTICS. PEDICULOSIS CORPORIS. Administer a Hot Bath with plenty of soap and boil or bake the clothing. When this is not prac- ticable, iron the seams to destroy parasites and ova. After the bath use inunctions, viz.: Staphisagria: The powdered seed 31], lard, %j (Vn.), or the oil, 5], with Ammoniated Mercury, ^iij, lard to 3J- (T.,96.) Carbolic Acid : Useful in various combinations, viz.: I*. Acid. Carbolic!, 3J~iJ- Glycerini, gj. Aquae, Oss. M. Sn. Paraffine Oil: Said to be the most certain and speedy remedy. Sulphur; A small piece about the size of a pigeon's egg may be worn next to the skin night and day. The remedies for pediculosis capitis are also of use in this condition. PEDICULOSIS PUBIS. The parts should be washed with soap and water daily and the remedy applied for some days to in- sure the destruction of the ova. Effective applica- tions are as follows : Hydrarg. Bichlorid., gr. ij-iv, alcohol or water, j. Ung. Hydrarg. Oleati, 10 to 20 per cent. Ung. Hydrarg. Ammoniati. Naphthol, 5 to 10 per cent, solutions. (F.) The following other agents are also useful : Ointments of Veratrine, Sabadilla Seeds, ^-Naph- thol, 10 percent., Losophen, 10 to 20 per cent., Oil PELVIC INFLAMMATION. 44-5 of Rosemary, solution of Creoline, about 2 per cent. Balsam Peru with olive oil, equal parts; apply for three or four days before washing. PELVIC INFLAMMATION. ACUTE PELVIC INFLAMMATION. In view of the intimate anatomical, pathological, and clinical association of the uterine appendages, and of the similarity of the external remedial meas- ures which are employed for the relief of morbid con- ditions in these parts, salpingitis, oophoritis, pelvic cellulitis, and pelvic peritonitis will be considered col- lectively. Rest in bed, Hot Fomentations over the hypogas- trium (K. C.), careful antisepsis of the vagina, and prolonged vaginal Douches of hot water as in acute metritis. ( Pz. ) Cold: In the form of an ice bag, will be found ser- viceable in some cases. (Dud.) For the relief of pain small Blisters over iliac re- gion, followed by the application of Morphine and painting with Iodine. The administration of ano- dyne injections is useful for oophoro-salpingitis. If an external wound is the source of infection, it should be cauterized. (Dud.) Operation is advised at the moment sepsis ap- pears, viz., Free Opening into the depth of the in- flamed mass, and drainage. (K. C.) After the acute symptoms have subsided vaginal 446 DIGEST OF EXTERNAL THERAPEUTICS. tamponacle should be employed, as in chronic endo- metritis. CHRONIC PELVIC INFLAMMATION. Treatment is generally on the same lines as in chronic endometritis and metritis. Laparotomy: Pozzi says: "That whatever may be said to the contrary, a laparotomy, or even an exploratory incision, is not justifiable for the mere relief of persistent pain in the vicinity of the append- ages." Purulent forms demand surgical interference. PEMPHIGUS. The blebs are to be punctured and evacuated as soon as formed and the parts anointed with Zinc Oxide Ointment. Soothing and astringent lotions and dusting pow- ders are indicated, especially the latter. Of the lotions, Lime Water, Thymol, 1-1000, solutions of Borax, Lotio Nigra and Liq. Plumbi Subacetatis may be used as in acute eczema; of the powders, Zinc Oxide and Starch, equal parts, Bismuth, Lyco- podium, and Dermatol have proved of benefit. Tumenol : 2 to 5 per cent, solutions applied \vith compresses has been found valuable, also an oint- ment of tumenol oil containing from 5 to 10 per cent, of the oil, mingled with 5 per cent. Oxide of Bismuth and Oxide of Lead, with lard as a base. Baths containing Bran, Starch, or Gelatine, and in some cases the continuous warm bath as recom- mended bv Hebra. Corrosive Sublimate and Alka- PERICARDITIS. 447 line baths will sometimes prove of service. (Pp.) After the baths, dusting powder or ointments may be applied. Hardaway recommends Lin. Calcis, 1 ounce, with Creosote, 1 minim. Unna recommends equal parts of Linseed Oil, Lime Water, Zinc Oxide, and Chalk, both for dry- ing and for preventing the formation of bullae. Ointments: Are sometimes useful, as water does not always agree. The following may be used : Vaseline, Rose Water Ointment, Lanolin, with or without 5 to 10 per cent, of Zinc Oxide or Bismuth Subnitrate, or with 3 to 5 per cent, of Ichthyol or Sulphur (Mor.), Lassar's Paste, Zinc Oxide or Diachylon Ointment. (Ck.) ^-Naphthol: A 10 per cent, ointment is useful for the itching. Europhen : Used in the strength of 10 per cent, is also effective. (T., 98.) Ointments should be spread on cloths and bound down with bandages. Nitrate of Silver: Gr. ij-j, was employed by Erasmus Wilson after the bullas had ruptured. PERICARDITIS. Prompt treatment is of the greatest importance. Rest in bed is absolutely essential ; under no circum- stances should the patient be permitted to leave it. Hot Applications: Generally grateful. Poultices tend to relieve pain, and by dilating the superficial 448 DIGEST OF EXTERNAL THERAPEUTICS. vessels drain the deeper. Their use should be confined to the first stage of inflammation. If applied in the usual way they will be too hot, and if of the proper temperature at the time of application they will soon cool therefore, apply first over the heart a thick flannel and over this the poultice. The heat, which now will not burn, may be maintained for a much longer period. (Gn.) Morphia and Atropia: Moderate doses of these remedies associated, administered hypodermically, are very satisfactory for the relief of pain. Alorphia, VA grain ; atropia, T ^-$ grain. (Ty.) Blisters: Strongly advocated by some of the most recent authorities, to be applied as soon as diagnosis is made. A blister at least three inches square is to be applied over the praecordial space. There is no other disease, says Tyson, in which this agent gives more satisfaction. Compare paragraph on this sub- ject under Acute Endocarditis. Cold Applications: While heat is generally more grateful, the ice bag or Leiter's coil are effective in some cases affording great relief and apparently controlling inflammation. (Gn.) Cold sponging or even the cold pack may be used in cases attended with intense hyperpyrexia. (L. T.) Mercurial Ointment: This is highly praised by some writers as effective after the subsidence of acute symptoms. It is used throughout the stage of sub- acute inflammation. It may be applied on flannel under oiled silk. (H.) Paracentesis: If effusion is considerable immedi- ate 'puncture of the pericardial sac must be consid- ered. The puncture should be made in the fourth interspace one inch to the left of the sternum, first PERIOSTITIS AND OSTITIS. 449 carefully dividing with the scalpel the skin and underlying tissues, until the pericardium is reached, then puncture with a trocar. When the effusion is purulent free incision'may be made, and drainage es- tablished, with proper antiseptic precautions. (Gn.) PERIOSTITIS AND OSTITIS. See also Nodes. In the acute forms, rest in bed and elevation of the parts ; a few Leeches over the inflamed point will do much to relieve pain. This may be followed by Hot Fomentations or Goulard's Solution with Opium. (HI.) Compound Mercurial Ointment: Applied as fol- lows frequently has a beneficial effect: Spread the ointment on lint and apply it all around the limb. Then straps are firmly and evenly applied from some distance above to some distance below the seat of in- flammation ; over the whole a starch or gum band- age is placed. Thus pressure as well as the action of the mercury are obtained. (HI.) PERITONITIS. Local measures for the reduction of inflammation do not play a very important role. Heat: Most useful in allaying pain and may be applied in the form of a hot water bag, flannel wrung out in hot water and covered with oiled silk, 30 4-50 DIGEST OF EXTERNAL THERAPEUTICS. or light flaxseed poultices, frequently applied, and covered with cotton and oiled silk. As hot water bags are generally too heavy to be placed over the sensitive abdomen they can be placed at the sides and assist in keeping the light poultices warm. (Ty.) Cold: In the form of compresses is preferred bv some writers, who claim they do more good than hot applications; they are certainly preferable in some cases. (Rd.) Ice bags may also be used for the relief of pain. Turpentine : Stupes are employed for the relief of tympanites; flannels are wrung out in hot water and sprinkled with turpentine, or equal parts with sweet oil, using about 2 drachms of the mixture, which may be spread on poultices. (L. T.) Counter- Irritation: Such as blisters, ma}- be of service in some cases, but only when the disease is local and not when the inflammation is genernl. Leeches : Are generally condemned (L. T.), but in sthenic types, in plethoric persons, when the inflam- mation is localized, they are advocated by some authorities . ( Ty . ) Intravenous Saline Injection: This measure may be employed in septic peritonitis when death seems inevitable. TUBERCULOUS PERITONITIS. Simple Incision with Free Evacuation: Most suc- cessful of any of the measures employed ; the best re- sults were obtained when the abdomen was neither flushed out nor drained, but when the eifusion had been simply evacuated and the wound closed. (T., 97.) Dr. F. S. Dennis gives the following directions in PERNICIOUS MALARIAL FEVER. 451 regard to laparotomy for this disease : Certain cases, especially of the fibrous form, may occasionally re- cover without surgical intervention. The majority require laparotonvy, since the mortality of the opera- tion itself is practically nothing, and the operation rescues the patient from a general tuberculosis of which the peritoneal invasion is only a local mani- festation. Laparotomy, to be a life-saving measure, should be resorted to early in the history of the disease, since late operations show less favorable results. It is not contra-indicated when only a slight invasion exists in the lungs and pleurae, since the operation often cures the pulmonary infection. It is contra- indicated, however, when acute miliary tuberculosis is present, also when the viscera are extensively in- volved. It is called for as a further curative measure if ascites develops after the first operation. (P. M. J., 9, 30, 99.) Collodion: Several cases have been reported by French physicians in which repeated applications to the abdomen over its entire surface have been fol- lowed by recovery. (Sm.) PERNICIOUS MALARIAL FEVER. A reaction should be brought about at once. If in the cold stage, apply Heat to the surface. When there is cerebral congestion, Cold to the head. Cold is contra-indicated if the face is pale. Remissions are greatly promoted by the free and frequent use of Hot Mustard Foot Baths. (Rd.) (Ga.) 452 DIGEST OF EXTERNAL THERAPEUTICS. Quinine: tfypodermically, is advised in all varie- ties of pernicious intermittents ; the patient should be cinchonized and kept so for several days. (An.) The soluble salts should be used, such as the tan- nate, hydrobromate and hydrochlorate, in doses of 15 grains in distilled water, with 1 grain of sodium chloride, or the bisulphate in doses of 30 grains, with 5 grains of tartaric acid. The muriate of quinine and urea, in doses of from 10 to 20 grains, may also be administered. These doses may be much increased if necessary. The liability to the formation of ab- scesses after the hypodermic administration of qui- nine must be taken into consideration. (Ty. ) Amyl Nitrite: Inhalation may modify the cold stage, but has no influence on the hot. PERTUSSIS. Of the numerous agents used specially for their germicidal and antispasmodic effects, the following may be commended : Carbolic Acid: A solution of 5-1000, as a spray, seems to be valuable, and is much used. (Ty.) A form of the crude acid is sold under the name of Cresolene, the vapor of which is allowed to impreg- nate the apartment. The remedy is prepared for vaporization by heating, and it is thought to modify the disease. Resorcin: 1 per cent, solution, applied to the larynx, is very effective. (T., 98.) Hydrogen Peroxide: One of the best and least ir- ritating antiseptic applications for this disease. It PERTUSvSIS. 453 should be sprayed directly into larynx two or three times a day, in the strength of 1 part of the 30 vol- ume peroxide (hydrozone), with distilled water, 10 parts, and glycerine, l 1 /^ parts. Hydrogen peroxide is also used diluted with 2 parts of Dobell's solution. It is discountenanced by some observers. Menthol: 20 grains in liquid vaseline in an ordi- nary nasal spray, as soon as paroxysm begins, or seems impending. Diffuse a fine cloud of spray in front of the face, the spray being held about two feet away. The effect is beneficial, the paroxysm soon over, and mucus rapidly expectorated. Citric Acid: Moncorvo speaks highly of applica- tions of a 10 per cent, solution of citric acid to the pharjmx and larynx in whooping cough. These ap- plications are made every two hours b} r means of a fine brush \vith a curved handle. He claims that under this treatment the attacks rapidly diminish in frequency and intensity, and that a cure is effected in from 15 to 20 days. (J. P., 7, 8, 99.) Boric Acid: Insufflation of 3 grains into the nose every three hours. (Sn.) Nitrate of Silver: Used as a spray in 1 to 2 per cent, solution. (Jac.) It stains clothing, however, and is not applicable to young children. Chloroform or Ether Inhalations: Preferably the former, are very beneficial when convulsions have oc- curred, or are feared ; also the following -combina- tion: I*. Chloroform!, % ^j. Ether. Sulphurici, ^ij. Ess. Terebinth, Rect. , 3ijss. M. Sig. Pour a teaspoonful upon handkerchief, and hold to child's nose during paroxysm. (Sn.) 454 DIGEST OF EXTERNAL THERAPEUTICS. Hydrarg. Bichlorid.: Spraj^s of 1-4000 solution. (Ty.) Caution evidently necessary as to frequency of application and quantity applied. Rabinschek's method (B. M. P., 8, 13, 96) consisting of the in- troduction into the back of the mouth of a small tampon saturated with a solution of 11000, which is pressed against the base of the tongue, so as to enable the solution to bathe the epiglottis and neigh- boring parts, is said to be efficacious ; but, inasmuch as in a small number of cases temporary disturb- ances have been observed, such as haemorrhages of the conjunctiva and the ear, buccal ulceration, and slight fever (which were described by the author as not at all serious), this method of treatment would scarcely seem to be advisable. Thymol: Inhalations are sometimes serviceable. A good formula is as follows : #. Mentholi, Thymoli, Acid. Carbolic!, aa gr. v. Ol. Eucalypti, ^ij. Ol. Pini Sylvestris, ^iij- M. Sig. A teaspoonful to about a pint of boiling water or a few- drops on cotton, inhaled. (F. ) Sodium Sozoiodate: The powder blown into the nose in doses of 3 grains dailv is said to be effective. < F -> Ozone: The sick room may be charged with the gas in moderate quantities with benefit, improving the condition of the patient, and minimizing conta- gion. (F.) Poultices : Large enough to cover posterior sur- face of lungs ; on this the child is made to lie for one hour. Relief is almost immediate. After removal, PERTUSSIS. 455 rub in skin previousl\ r covered by poultice, sweet oil and camphor then apply cotton jacket. (Sj.) Asparol: 1 per cent, aqueous solution applied on gauze over periglotteal region. (Sj.) Carbonic Acid Gas: Inflation of rectum with this gas has been attended with success. (F.) Formaldehyde : A 1 per cent, solution is used suc- cessfully as a spray three times daily for fifteen min- utes at a time. (F.) The paroxysms are diminished, both in frequency and intensity. (Sj.) Cocaine Hydrochlorate: A 5 per cent, solution to the pharynx. (Jac.) Amber Oil: Useful as an embrocation, enters into the combination of a well known English nostrum called " Roche's Embrocation," which is composed of olive oil mixed with half its weight of oil of cloves and oil of amber. (Cool.) Sulphur Fumigations: Remove the child from the room in the morning, wash and dress in clean fumi- gated clothing ; then close the room to be fumigated for four or six hours, allowing sulphur to be freely burned in it. (Gn.) Eucalyptol: The fumes as an inhalation, or a spray as follows : 2 drachms of the oil with 2 of tere- bene, and alcohol 1% ounces, apply half an hour before each meal, and at bed time. (F.) Quinine: Insufflations have been employed, and considerable doses have been given to be swallowed slowly for their topical effect. Sprays were formerly much employed. 456 DIGEST OF EXTERNAL THERAPEUTICS. PHAGED^ENA. See also Gangrene. Nitric Acid: The foremost topical remedy, steep the effected part with the fuming acid ; if ulceration is extensive, chloroform may be administered. Bromine: In using this agent it should be remem- bered that it is one of the most powerful escharotics, and that its action is not altogether controllable. It causes widespread destruction of the tissues which are slow to heal. Its use in the pure state is mostly confmed to hospital gangrene. An aqueous, -^ per cent, solution, is employed for washing phagedaenic wounds. All disorganized tissues should be first re- moved by hydrogen peroxide irrigations, the scissors and forceps. Then irrigate with the bromine solu- tion. If gangrene is extensive, pure bromine may be used, the patient being under an anaesthetic. Com- presses wet with the bromine solution are placed over the wound, covered with oiled silk and a band- age. Dressing should be changed every twelve to twenty-four hours for the first two to four days, when the granulating surface should be clean. Then apply simple sterilized water dressings, or one con- taining 1 per cent, of sodium chloride, or 5 per cent, of boric acid. (F.) Carbolic Acid: The undiluted acid is superficial in its effects, but will be found very useful in mild cases. (N.) Potassium Chlorate: The powder thickly sprinkled over sore, proves a manageable and effective remedy. (B.) PHAGED^ENA. 457 Hydrated Silica : This substance is a jelly-like mass and is prepared by Dr. H. G. Piffard according to a process devised by Dr. C. Rice. It is said to be most effective in controlling profuse suppuration. The silica is packed closely in the part, and the dressing renewed once or twice a day. If applied too long it will devitalize the tissues and cause extensive sloughing. (F.) Pyrogallic Acid: A powder made of 1 part of the acid with 4 of starch has been found effective, (F.) Mercuric Nitrate: A useful caustic; its especial value is its speedy destruction of rapidly advancing ulceration. (F.) Zinc Chloride : This powerful caustic may be dusted, in the form of a powder, over the ulcerating surface. A superficial slough forms, which may be removed by poultices. (B.) Immersion in Hot Water: Recommended by Mr. Hutchinson. The part is placed in a bath at a tem- perature 95 to 98 and allowed to remain for eight hours at a time. After two or three baths a healthy appearance may be looked for. This method is said to have been very successful in the treatment of phagedaena of venereal sores. Cauterization: By the galvano-cautery or Paque- lin, preferably the former, will sometimes arrest the morbid process when other measures have failed. Salicylic Acid, Boric Acid, Europhen, lodoform, and Xeroform, applied to the sloughing surfaces and adjacent healthy tissues, are all effective when dust- ing powders are indicated. For cleansing and deodorizing, solutions of Hy- drarg. Bichlorid., 1-2000; Hydrogen Peroxide, pure or diluted; Carbolic Acid, in various strengths; Po- 458 DIGEST OF EXTERNAL THERAPEUTICS. tass. Permang., about 5 to 10 grains to the ounce, and Labarraque's solution. PHARYNX, ADENOID GROWTHS OF HYPERTROPHY OF THE PHAR- YNGEAL TONSIL. Mild treatment should be tried first. The follow- ing are of service: Sodium Benzoate, gr. x~3J ; Po- tassium Chlorate, gr. xx gj ; Dobell's Solution, or the following formula : #. Fid. Ext. Hamamelidis Destill., Aq Rosae, aa Jij. M. (Bn.) Tannin : One of the best applications, a solution of 40 grains to the ounce of glycerine, painted on with a suitably curved post-nasal applicator, after the use of sprays (B.); or the following combination : #. Acid. Tannici, gr. xl. Acid. Carbolici, gr. j. Sodii Boratis, gr. xx. Glycerini, %ss. Aquae, ad Jiv. M. Sig. This may be applied twice daily. (Bos.) Resorcin: 100 per cent, solution has been used successfully, one observer declares that it obviates the need of surgical measures. The time required for treatment, however, was from two to four months. (T., 98.) When milder measures fail, chromic acid, the gal- vano-cautery, the curette, or forceps should be em- ployed for the removal of the growths. (Iv.) PHARYNX, ADENOID GROWTHS OF. 459 Chromic Acid : May be applied on a probe in the form of the fused crystals or in a saturated solution, preferably the former. Applications should be guarded, and the rhinoscopic mirror used. Three or four applications may be made at weekly sittings, the saturated solution on cotton being used. Care must be exercised lest the acid flow down the throat and cause severe inflammation and spasm. (Iv.) Galvano-Cautery : Among the most efficient methods of treatment. A good practice is to burn away two or three prominent nodules at each sit- ting, repeating the operation in a week or two if nec- essary. This method, however, is not suitable for children. (Bp.) Curettage: For this purpose employ Meyer's method, an L shaped curette, a finger curette, or the finger nail; general anaesthesia and antisepsis are necessary. Some writers regard this measure as peculiarly dangerous, and only to be performed by an expert. It is not adapted for use with children. Curved cutting and crushing Forceps are used to tear away the grow r ths. The haemorrhage is quite profuse for a time, but soon subsides. Suprarenal Extract : The recent introduction of this agent for operations on the nose and throat is apparently only second in importance to that of co- caine. It is a powerful vaso-constrictor and con- tractor of erectile tissues. By its use nose and throat operations can be greatly facilitated and rendered almost bloodless. Its blanching properties are very powerful ; a drop of a 1 per cent, solution instilled into the eye will produce an ivory whiteness of lid and conjunctiva in less than one minute. It is painless, non-antiseptic, 460 DIGEST OF EXTERNAL THERAPEUTICS. and non-reactionary. A tolerance is not established by its use and there does not appear to be any danger to the tissues or the individual. The remedy may be mixed with cocaine. The method of its ap- plication is as follows : Place 5 grains of the dessi- cated suprarenals in 1 drachm of a cold boric acid solution and allow the mixture to stand ten minutes, filter and apply. The full effects will be observed in a few seconds and -will continue for one or two hours. PHARYNGITIS. ACUTE CATARRHAL PHARYNGITIS. Many simple cases disappear without treatment. Twenty-four hours in bed is about the best medicine. Local applications, when required for the comfort of the patient should be astringent and soothing. They may be administered in the form of sprays, gargles, or inhalations. Gargles are of utilitj r if used accord- ing to the method of Hagen, otherwise the fluid rarely passes beyond the pillars of the fauces. Hagen advised that the mouth be a little more than half filled with the gargle, the head bent back, the mouth open and a complete act of deglutition performed with the mouth still open ; the air is now allowed to gurgle through the solution as long as possible, and then it is expelled. (Iv.) The following are for use as gargles or sprays in solution with 1 ounce of water : Potassium Chlorate, gr. x v. Sodium Borate, gr. x. PHARYNGITIS. 461 Sodium Bicarbonate, gr. viij. Alum, gr. v. Tannic Acid, gr. v. Acetanilid, gr. iv. Tr. Capsicum, gr. iij-iv. Tannate of Glycerine, $j. Ext. Hamamelis, 3ij-iij. Rhus Glabra : Said to be one of the best remedies as a gargle ; use 2 drachms of the fld. extract to 4 ounces of water, to which 2 scruples of chlorate of potash have been added. (Al.) Fluid Petroleum Preparations: Such as Ben- zoinal, Albolene, etc., are often very soothing when applied in the form of sprays. Tannic Acid : 15 grains to 1 ounce of water, is of service when there is oedema. (Iv.) Menthol: An agreeable application, has positive value in controlling inflammation. Sprays of from 2 to 10 per cent, are agreeable and effective pallia- tives. Lozenges : Are often of service in allaying the irri- tation of the throat; the following are recom- mended, the latter being indicated when there is considerable secretion which is not easiry expec- torated (Bos.): V. Ext. Eucalypti, ^ss. Sodii Boratis, gr. x. Pulv. Pimentae, gr. vij. Ext. Glycyrrhyzae, ^iiss. M. Ft. mass, in trochisca, No. xxx. #. Ammon. Muriatis, ^ss. Pulv. Ipecacuanhae, gr. ij. Pulv. Capsici, gr. ss. Ext. Glycyrrhyzae, iiss. M. Ft. massa in trochisca, No. xxx. 462 DIGEST OF EXTERNAL THERAPEUTICS. Gallic Acid: Mixed with Tannic in proportion of 1 to 3, said to modify irritating eifects of the latter ; about 5 grains of the mixture to 1 ounce of water. Thymol: Solution of 1-1000 or 2000, is especi- ally valuable in the exanthematous variety. (Al.) Inhalents are sometimes affective in soothing the irritation ; the following are suggested : Benzoic Acid, 3 grains with 12 grains of kaolin, rub well together and add tr. tolu, 18 drops, and water, 1 ounce. Add a teaspoonful to a pint of hot water and inhale vapor. (Lefferts.) Thuja, a few drops of the essential oil in a pint of water, temperature 140. Chamomile infusion is useful for children. (Al.) Cold; Ice water compresses to the throat or small ice bags with dry towels covering; also sucking small pieces of ice. Counter- Irritation : Mustard leaves sometimes better than cold, as all throats do not bear cold equally well. (Ty.) Scarification of Uvula: When the uvula is very oedematous and elongated, it is the source of con- stant irritation and discomfort, in this condition scarification or puncture will afford prompt relief. (Pp.) CHRONIC CATARRHAL PHARYNGITIS. This condition is usually secondary to some other affection, such as naso-pharyngeal catarrh, obstruct- ive lesions of the nose, excessive use of tobacco, or chronic gastric catarrh. Treatment, therefore, should be directed toward eliminating these causes ; at the same time, local applications should be made to the pharynx every two or three days. CHRONIC FOLLICULAR PHARYNGITIS. 463 The throat should first be cleansed with some anti- septic or alkaline spray, such as Dobell's or Seller's Solution. This constitutes a very important meas- ure. After cleansing, the selected remedy may be ap- plied ; the following solutions will be found of ser- vice: Potass. Bichromate, 1 per cent.; Potass. Permang., 1 percent.; Sodium Bicarbonate, 5 per cent.; Euca- lyptus, 10 per cent. When the above have failed, one of the following, combined with 1 ounce of Glycerine, is used; Tannic Acid, 10 grains; Zinc Chloride, 5 grains; Iodine, 10 grains. (Iv.) The following are also recommended : Argent. Nit., 10 to 20 grains to the ounce; Zinc Sulphate, 10 to 20 grains to the ounce; Liq. Ferri. Persulphatis, 10 drops to the ounce. Pyoktanin Blue: T 1 /^ grs. -with 2 drachms of wa- ter; 10 minims of this solution with 1 ounce of gly- cerine ; apply with brush, especially when hypersecre- tion is a prominent symptom. (Iv.) Glycerine: Painting the throat is of value, as this agent depletes the mucous membrane. (Gn.) Cold Salt Water: As a preventive; bathe the neck and upper part of chest with cold salt water, and afterward rub with .rough towel. CHRONIC FOLLICULAR PHARYNGITIS. Galvano-Cautery: While there is some divergence of opinion in regard to the expediency of destroying the enlarged follicles by cauterization before employ- ing milder measures, it seems to be a very generally approved method for the cure of this affection. The 464 DIGEST OF EXTERNAL THERAPEUTICS. best agent to employ is the electro-cautery. Each fol- licle is touched with the needle once, and in the. case of very large follicles, the application should be made several times. The needle should be fine and brought to a red heat. It is advisable to go over the pharynx at intervals of a week until inspection shows all en- larged glands to have been eradicated. While many writers consider the above the only satisfactory treatment, other and milder measures are recommended. Some of these are employed as follows : Nitrate of Silver: Solutions of 40 to 60 grains to the ounce, have been employed after the removal of the mucus. The hypertrophied tissues are to be touched individually. Another method of applica- tion consists in splitting the follicle with a knife, and crowding in the silver. ( Ing. ) The knife and caustic may be advantageously employed when the cautery is not available. (L. B.) Hydrastine: By insufflation, is indicated in cases where the follicles are of a deep red color, where the surrounding mucous membrane is moist and the secretion, except in the naso-pharynx, is not excess- ive ; use 25 grains with 75 of acacia. At first employ small quantities only in order to ascertain suscepti- bility of patient, as remedies applied in this way sometimes cause pain. (Ing.) Astringent sprays of Alumnol, 15 to 20 grains; Cuprum Sulphate, 10 to 20 grains; Zinc Chloride, 15 to 20 grains; Zinc Sulphate, 10 to 20 grains, of either, to water 1 ounce, will occasionally prove use- ful. (Ing.) (V. H.) Pyoktanin Blue: Saturated solutions applied to each follicle are recommended. (Gn.) PHLEBITIS. 465 Iodine : A solution in glycerine. (Gn.) Curettage : Recommended by Lennox Browne in obstinate cases. Mineral Cauterants: The following may be em- ployed when the follicles are much enlarged : Nitric Acid, Chromic Acid, and London Paste applied carefully to each follicle individually. These caustic applications may be repeated in four or five days. (Ing.) Zinc Chloride, 20 to 40 grains to the ounce, is also applied to the indurated tissues. These meas- ures, for the most part, are now obsolete. Krameria: Will form a mild trochee; useful as a palliative astringent, about 3 grains to a trochee, or the following in each : #. Ext. Kratnerise, gr. j. Pulv. Cubebse, gr. J. Potass. Chloridi, gr. ij. M. (Ing.) PHLEBITIS. Rest in bed constitutes the first essential of treat- ment. The affected part should be elevated if possi- ble and enveloped in cotton. Ice : Should be applied to the parts when the tem- perature is high. (Gn.) Hamamelis: Applied on compresses acts well. (Rd.) The following anodyne preparations are recom- mended : :. Ext. Belladonnse, Ext. Hyoscyami, aa gr. xxx. Adipis Benzoatis, 3j. M. 31 466 DIGEST OF EXTERNAL THERAPEUTICS. Or, #. Chloroformi, I/in. Camphorae, aa ^ij. Glycerini, ^iv. M. Or, P:. Ichthyoli, gr. xv. Lanolini, ^j. M. (T. G., 9, 15,96.) Goulard's Lotion with Opium: A useful anodyne lotion. (HI.) Free Incision: Is indicated, if suppuration ensues; the incisions are made parallel to the veins, and free drainage established. A wet dressing should be ap- plied, and the wounds freely irrigated with sublimate solution 1-1000. (W.) PHLEGMASIA ALBA DOLENS. See Phlebitis. PITYRIASIS CAPITIS. Treatment of this affection is chiefly local. Before the application of any remedy first clean the scalp with soap and water, or if the crusts are very thick soften them with Olive Oil and then shampoo the head withSpts. Saponis Kalini. According to Hebra, this remedy is made by dissolving 2 drachms of the green soap in 1 once of alcohol; perfume if desired PITYRIASIS CAPITIS. 467 with oil of lavender, or bergamot. Apply the soap with water, a teaspoonful with a teaspoonful of water, well worked up into a lather, and quickly clean the scalp. Afterwards cleanse with cold water and apply the selected remedy. In ordinary cases where the scales are loose and dry, remedies may at once be applied, such as the preparations of resorcin, sulphur, and salicylic acid. Lotions are generally best when the hair is thick ; ointments are useful when it is thin. The following are well attested formulas : Resorcin: Gives excellent results, useful in obsti- nate case, and in those in which there is considerable effluvium capillorum, viz.: fy. Resorcini, Qiv-ij. Ol. Ricini Pur., )iv. Alcohol. Fort., gv. Balsam. Peru., git. xij. M. Sig. Rub in scalp once or twice daily. Or, fy. Resorcini, gr. x-xx. Sulphur. Prsecipitati, 5J- Ung. Aquse Rosse vel Ung. Simp., %ij. M. . Sig. Rub in scalp once or twice daily. If resorcin is used alone it should be dissolved in a bland oil. (B. H.) Salicylic Acid: Dissolved in water, forms a useful lotion for cases in which desquamation is a most marked feature. (F.) Thymol : In the following lotion, can be used freelv : 468 DIGEST OF EXTERNAL THERAPEUTICS. I*. Thymoli, 3j. Liq- Potassse, f 3J- Aq. Laurocerasi, Oj. M. Sig. Apply daily. (Vn.) An ointment of 10 per cent, and upward is also used. When one stronger than 20 per cent, is de- sired, the thvmol should first be dissolved in alcohol. (F-) Carbolic Acid: The following combination is to be preferred when the hair is thick, to be applied after washing with green soap : V. Acid. Carbolici, 9j. Alcohol, vel Aq. Coloniensis, 3J SS - t Glycerini, S^J 53 - Ol. Limonis, 5J SS - M. A few drops of this mixture are applied here and there over the surface by means of an eye dropper, and rubbed in well with a stiff brush. The mixture may be scented if desired. Apply daily. (Vn.) Oleum Rusci Crudum: Excellent as a lotion or pomade. The lotion is as follows : I*. Ol. Rusci Crudi, gtt. xv~3iiss. Ol. Ricini Puri, 3J~ij- Ol. Bergamot., Ol. Citronelli, aa gtt. xv. x-Ether. Sulphuric., Qij. Alcohol. Fort., q. s. ad ^vij. M. Sig. Apply daily with brush. The pomade : I*. Ol. Rusci Crudi, ^ivss. Vaselini Albi, 5 VSS - Paraffini, 3j. Ol. Bergamot., Ol. Citronelli, M. Sig. Rub in scalp with finger. PITYRIASIS CAPITIS. 469 These preparations will remove the scales and im- prove the functions of the glands to the extent, it is said, of restoring the hair. (B. H.) Resorcin and Salicylic Acid: May be combined advantageously in the proportions of 24 grains of each, with saponated glycerine 1 ounce. The base should be melted, the salicylic acid first incorporated, then the resorcin at a lower temperature; this is said to form an excellent application, acting both as a soap and as an ointment. (Al.) Sulphur: Unna recommends as the best line of treatment the application of an ointment made up of 1 to 3 parts of sulphur to 30 of simple ointment. The head should be first washed with Green Soap, and the ointment then applied by an attendant twice a week. When there is much falling of the hair from 2 to 10 per cent, of Tincture Cantharides may be added. Pyrogallic Acid: 1 drachm to the ounce, has been used with great benefit, applied at night and washed off in the morning with a little soap spirit. In most cases a little discoloration follows. In more chronic cases : #. Zinc. Carbonatis Puri, ^iv. Glycerin!, Ol. Cadini, aa ^j. Cerati Galeni, ad ,^viij. M. Sig. Rub firmly into surface night and morning; more fre- quently if itching is present. (And.) The following is recommended by Vigier : J*. Hydrarg. Sulphat. Flavi, gr. xlv. Vaselini, 3xv. Ess. Limonis, gtt. xx. M. Sig. Keep in porcelain jar. Apply at night and wash off in the morning. 470 DIGEST OF EXTERNAL THERAPEUTICS. Creosote: Recommended by Tilbury Fox in the following formula : J*. Creosoti, M.xxx. Gtycerini, ^iij. Aquse, ^v-viij. M. Borax: 2 drachms to the ounce of glycerine is fre- quently serviceable. (Kp.) PITYRIASIS VERSICOLOR. Tilbury Fox recommends the following measures as being effective: A hot bath should be taken for three nights in succession, the skin being vigorously scrubbed, either with cheap yellow soap, or prefer- ably Sapo Viridis, friction being maintained with a flesh brush. The affected area is then moistened with Vinegar and water, or Dilute Acetic Acid, after which it is to be well sponged with a solution of Sodium Hyposulphite 3J Ij. The eruption usually fades after the third bathing; should there be a re- crudescence, it must be attacked with solution of Corrosive Sublimate, gr. j ij j. (Hy.) Vlemingckx's Solution: Diluted from three to six times, forms an excellent application. Tr. Iodine: Painted on the part often acts well. (F.) Sulphur Baths: Combined with Mercurial Lo- tions, are used by McCall Anderson. Black Soap : Is useful for hospital practice, in scrubbing the skin, a substitute for which in private practice is the following : PITYRIASIS CAPITIS. 471 1*. Hydrarg. Bichlorid., 9j. Sapo. Viridis, ^iij. Spts. Rectificati, gij. Ol. Lavandulae, 9j. M. (And.) Scrub the skin night and morning ; caution regard- ing absorption of mercury. (And.) Leloir modifies the above formula by adding one more ounce of green soap, and twice the quantity of rectified spir- its. (T. C., Vol. V.) The following is recommended by Brocq : Salicylic Acid, 2 to 3 parts. Precipitated Sulphur, 10 to 15 parts. Lanoline, 70 parts. Vaseline, 18 parts. The following combination, according to Besnier, acts well : Ijt. Resorcini, Acid. Salicylici, aa gr. v-xlv. Sulphur. Prsecipitati, Jss. L/anolini, Vaselini, Adi pis, aa 3J- M. Sulphurous Acid (pure or dilute) ; Carbolic Acid ( l /2 to 2 per cent, solutions) ; Hydroxylamine Hydro- chloride (1 grain with an ounce each of alcohol and glycerine); Hydrargyrum Sozoiodate (a 10 per cent, solution in water); Quinine (5 per cent, ointment); Wilkinson's Ointment, and the other parasiticides which are employed in the treatment of ringworm of the body, are all well attested remedies. The underclothing should be cleansed frequently, and not worn after treatment until it has been thor- oughly boiled in hot water. 472 DIGEST OF EXTERNAL THERAPEUTICS. PLAGUE, THE BUBONIC. The following measures are recommended lay A. Mitra, L. R. C. P., L. R. C. S., Kashmir. (T., 98.) For the hyperpyrexia : Cold Sponging: When fever continues high this will be found of benefit. Cold baths are contra- indicated on account of the movements of the body which they necessitate and the great cardiac de- pression \vhich accompanies this disease. Tepid Sponging: May be found preferable to cold in some cases. Creosote Inunctions: 15 drops may be rubbed in near the axillae. Antiseptic Sponging: During the height of the fever, the entire surface of the bod} r should be sponged lightly two or three times a day with the following : #. Thymoli, gr. xl. Spts. Rectificati, Acid. Acetic. Dil., aa ^iij. Aq. Roste, o xv j- M. For the cerebral symptoms : Cold to the Head: This may be employed in the form of an Ice Cap and may be applied continuously ; Letter's Coil will also prove effective. Bathing the temples -with cold water will be found of service. Sinapisms: Mustard plasters to the upper part of the neck and over the occiput are employed for the relief of headache. Morphia and Hyoscine: These remedies are recom- PLAGUE, THE BUBONIC. 473 mended for the insomnia and may be given hypo- dermically. Morphia in doses of y& to y% grain and hyoscine in doses of ^ to -J^ grain. For the enlarged glands : Hot Fomentations: These may be employed in the form of Hot Water, or spongio-piline wrung out in hot Antiseptic Solutions, such as Corrosive Sublimate. When the glands are painful Laudanum or Belladonna ma}' be added. When suppuration occurs the gland should be in- cised and treated antiseptically. For the relief of the failing heart : Sinapisms: Should be applied over the praecordial region and to the limbs. Caffein: 5 grains dissolved by the aid of 5 grains of sodium benzoate in 20 minims of water may be in- jected three or four times a day as indicated. Ether, the Ethereal Solution of Camphor, or Strychnia may be administered hypoclermically. The latter is recommended in doses of ^ grain at first every four hours until T V grain has been given. For coma : Cold Effusions: If there is fever this measure will be indicated. Coffee: An enema of a strong infusion of coffee should be injected. For diarrhoea : Enema of Opium: This may be prepared as fol- lows : Dover's powder 2 grains, tannin 10 grains. Mix with 1 ounce of gum mucilage and from 2 to 5 ounces warm water, arrow root or starch and inject. The following other remedial measures are of im- portance: Injections of Saline Solutions; Trans- 474 DIGEST OF EXTERNAL THERAPEUTICS. .fusion of Blood; Oxygen Inhalations; Ergot or Ergotine, hypodermically, for haemorrhage. Inoculation: Haffkine has inoculated against plague on the same principle as against cholera. An attenuated virus of the plague is injected, a mild attack is produced which proves harmless, and \vhich is regarded as preventive against the more violent forms of infection. It is claimed that mor- tality has been greatly reduced by this measure. In small communities, as among physicians and attend- ants, it has proved of great value. Koch observed that while inoculation did not afford complete im- munity in those who had been subjected to the pro- cedure, if the disease was contracted, it was of a very mild type. The partial immunity is said to last for six months. The method has received the approval of the medical officers of the Indian government. (P. M., 3, 99.) Yersen's Serum: This has been .used both during the course of the disease and as a preventive, but the subject is still in a too undeveloped state to warrant definite conclusions. The experiments which were first made at Canton were successful, but those made at Bombay later failed. A stronger serum has been prepared which promises better results. (P. M., 3, 99.) PLEURISY, ACUTE. Poultices : Large, hot and frequently applied are generally grateful to the patient. (Gn.) Laudanum may be poured on the poultices. PLEURISY, ACUTE. 475 Morphine: May be administered hypodermically. when pain is severe and not otherwise relieved. Adhesive Plaster Straps: Arranged so as to re- strain the respiratory movements, as in fracture of the ribs, will, if properly applied, afford much relief. The plasters should be about 2H inches wide and the application should be made after expiration. (Gn.) Ice Bags: Advised by some, but the majority of patients find hot applications more grateful. (F.) Blisters: May be employed in the earliest stage to limit inflammation, and later, in the stage of effu- sion, to promote absorption. In the latter instance they should be applied some little distance from the seat of dulness. (F.) Sinapisms : Are often helpful ; the following is rec- ommended : #. Pulv. Sinapis, ^ss. Pulv. Lini, 3 v "j- Aq. Bullientis, q. s. M. (Sn.) Guaiacol: Useful in the stage of effusion to pro- mote absorption. I. Guaiacoli, gr. xlv. Tr. lodi, Glycerini, aa 3v. M. Sig. Paint over the posterior portion of thorax. Reaction appears in about four hours. (Sj. ) Olive Oil: A recent method for dry pleurisy and pericarditis consists of the injection of sterilized olive oil, 15 to 45 minims, over the point of friction mur- mur. It is not painful. (Sj.) In the latter stages, little is gained by external ap- plications, except for relief of pain. 476 DIGEST OF EXTERNAL THERAPEUTICS. Aspiration : When effusions are large this meas- ure should be emplo3 r ed. The indications are as fol- lows : "1. Distension and pressure dangerous to life. 2. Subsidence of fever and other active symptoms, but no decrease in the effusion. Paracentesis is sometimes rapidly curative, as well as palliative; therefore tap in delayed absorption, even if no urgent symptoms are present." (Gn.) PLEURODYNIA. See Muscular Rheumatism. PNEUMONIA, ACUTE CROUPOUS. There is considerable diversity of opinion in regard to the utility of external therapeutic measures in this disease. "Pneumonia jackets," heat and cold, in vari- ous forms, are all advocated. Goodno, who recom- mends protecting the chest with a simple layer of flannel, says: "That as good results are claimed for all, it may be concluded that none are especially val- uable." The truth or error of such a conclusion is still to a certain extent an open question. Dry Cupping : Applied to the chest is often of ser- vice in the early stages. After the application of half a dozen cups, a patient previously unable to lie down, owing to the d3 r spnoea, will assume the re- cumbent position and fall asleep. Sinapisms : Are useful for the pleuritic pains. PNEUMONIA, ACUTE CROUPOUS. 477 "Pneumonia Jackets:" These are much in use, especially in England and in this country. They may either consist of loosely quilted cotton jackets or, what is preferable, a piece of oiled silk cut out so as to fit the chest. On this a layer of cotton "batting is placed; the jacket is then applied, the cotton bat- ting next to the skin. The jacket, or more correctly the layer of cotton and oiled silk, is pinned over the shoulders and down the front of the chest with safety pins. Before applying, the cotton batting may be covered thickly with a mixture of Turpentine and Vaseline, which, acting as a mild counter-irritant, is generally grateful to the patient. Poultices: Hot flaxseed meal poultices enveloping the whole chest have, with good reason, gone out of use. Whatever good results the}^ may have had, they were more than compensated for by the evils of in- convenience of application, requiring, as they do, fre- quent changing, discomfort, disturbance and exposure of the patient. Small poultices are, however, of benefit when applied over circumscribed areas as for the relief of pleuritic pains. When the jacket is used, a small poultice over the surface of which laudanum has been poured for its anodyne effects, may be slipped under- neath the edge and placed over the painful part, which is usually on the side and convenient of access. It should not be lost sight of that if heat is too great between the shoulders it intensifies the con- striction of the arterioles. See Chapman's Spinal Ice Bag treatment under Paralysis. Cold Applications: These have lately been gaming favor. The method of Baruch is as follows : En- velop the chest in a suitably fitted linen or cotton jacket wet with cold water. The jacket should be re 478 DIGEST OF EXTERNAL THERAPEUTICS. moved and a fresh dry one substituted whenever the temperature falls to 100, and removed if it rises; in this way, it is claimed, all danger is averted. Dr. Mays, of Philadelphia, prefers to surround the af- fected area with ice bags wrapped in towels, but they are difficult to keep in position. Ice over the praecordial region is recommended as a refrigerant and cardiac stimulant in children. (Jac.) Excellent results from the use of Cold Compresses are reported by Dr. W. F. Jackson, of Brockville, Ont. He claims lowering of temperature, quieting of the circulation, relief of pain, and promotion of general bodily comfort. Dr. T. J. Mays reports a death rate of 2.7 per cent, out of 74 cases in which cold water treatment had been tried. (T., 96.) The cold compresses used for adults cover the back and front of the chest ; they are wrung out in water at a temperature of 60, and applied every half hour, according to indications. A higher temperature may be used if there is much jactitation and excitability. Cold water may be first dashed in the face if there is much delirium. Not a little of the benefit of cold compresses is due to their tonic effect upon the nerve centres, and to the relief of cerebral conges- tion which they induce by dilating the surface capil- laries. (T., 98.) Ice Cradling: The following method is described by Dr. P. B. Smith (Brit. Med. Journ., May 11, '95): The patients were placed in bed and over the body and legs two large cradles were arranged extending from the shoulders to the feet. Six or eight small pails filled with ice were attached to the arches of the cradles. A thermometer was also attached to the upper part of the cradle, which was then covered PNEUMONIA, ACUTE CROUPOUS. 479 with a blanket, then with a water proof, and lastly with the ordinary covering. The pails were kept filled with ice. The temperature under the cradles, of the -ward and of the patient was taken every four hours. The temperature of the air under the blankets was also taken before the cradles were arranged. This treatment was maintained until the patient's temperature became normal. Dr. Smith's report says that the cases upon which this method was em- ployed were those of acute sthenic pneumonia. Out of 108 cases treated by sponging and ice cradling, 10 per cent. died. The patients, as a rule, were said to feel comfortable, but one or two complained of cold feet. Dr. Smith concludes from the results of his investigations that ice cradling is suitable as a mild antipyretic treatment in sthenic cases. It is easily applied and not violent in its effects. Dry Heat: Dr. C. W. Ingraham has adoped a method of applying heat by an apparatus for the cir- culation of hot water through coils of rubber tubing, so arranged as to cover the whole chest. (N. Y. Med. Jour., May 18, 1895.) Excellent results are claimed for this method, although its application appears to have been limited. Cold Baths: In the case of children, the tub can be employed, but for adults compresses are preferable. When tubbing is administered begin with a tempera- ture of 95, and gradually lower according to indica- tions; continue for about ten minutes, and repeat every three or four hours. (S. B.) Cold Packs : Generally preferred in infantile pneu- monia, with hyperpj^rexia. Wrap the child in a wet towel, and cover with a blanket. In urgent cases this may be replaced by another every two or five 480 DIGEST OF EXTERNAL THERAPEUTICS. minutes. When frequent changes are undesirable the wet towel may remain and the surface rubbed with ice. If the temperature is reduced rapidly heat must be applied. Feeble and anaemic babies do not bear cold well. When the heart is weak and extremities chilly, cold bathing is contra-indicated. (Jac.) Hot Baths: Also used in infantile pneumonia. They are indicated in cases with high fever; when the patient is feeble or anaemic, and when the circula- tion is poor, with cold surface and high rectal tem- perature, a hot bath under these conditions will act beneficially. (Hit.) Tepid or Warm Packs: With alcohol, or a tepid bath, gradually cooled, with friction constantly ap- plied, may be employed in anaemic children. (Jac.) The general indications for the use of cold and heat in croupous pneumonia may be briefly summarized as follows : In robust persons with full strong pulse, with continued Iryperpyrexia, cold may be employed ; in patients of a less vigorous constitution and in those who are feeble and anaemic employ heat, espe- cially when the surface is cold and heart weak, con- ditions which decidedly centra-indicate cold. Thus the employment of these powerful agents call for a careful study of each case. The ' ' pneumonia j acket ' ' with small anodyne poultices for the relief of pleu- ritic pain is the method most frequently adopted and is the practice of the author. The various methods of the application of cold are presented as the obser- vations of other writers. Methyl Chloride: Has been used to relieve local- ized pain; applied along the course of the nearest nerve, is said to afford instant relief. (Sj.) POWDER STAINS. 481 Blisters : Sometimes claimed of service, especially in delayed resolution. (Ty.) Oxygen Inhalations: Are of undoubted value in relieving the dyspnoea. (Ty.) Artificial Serum: Injections have been used after the method of Galvagni, a solution of chloride and bicarbonate of sodium being employed. The report is generally favorable, though the treatment is too recent and the experiments too limited to war- rant any very definite conclusions or recommenda- tions. Subcutaneous injections are said to have ben- efited, while intravenous aggravated the condition. Serum Therapy: Remarkable clinical results are claimed by both Klemperers, Fowlinsky, and Em- merich, with anti-pneumococci serum. The serum treatment has not been more generally adopted in pneumonia on account of the difficulty of obtaining the serum from immunized rabbits. Whatever may be the value of serum therapy, it has not yet passed beyond the stage of experimentation. POWDER STAINS. Stains due to gun powder may be removed, ac- cording to Shoemaker, by first washing with equal parts of Biniodide of Mercury and Distilled Water ; this causes the spots to become red; then apply Dilute Hydrochloric Acid and the red stains will disappear. (Sh.) 32 482 DIGEST OF EXTERNAL THERAPEUTICS. PROCTITIS. The patient should be confined to bed and any scy- balse, if present, must be cleared away by injections. Cold Water Injections, and the application of Cold to the anus, will usually be sufficient for mild cases. (Gt.) Hot Water Injections : May be employed in place of cold, and are generally more grateful. (Bt.) Anodyne Injections: About 2 ounces of mucilage of starch, with a few drops of Laudanum (Tre.), or decoctions of Althea. (Al.) Suppositories of lodoform, gr. v. ; Ext. Bella- donna, gr. 1/3, are very useful. (Tre.) Antiseptic Injections: Are of great service, espe- cially if the disease is specific, viz.: Solutions of Boric Acid; Mercuric Bichloride, 1-10,000 (not stronger); Carbolic Acid, 1-100. Nitrate of Silver: If the disease does not yield, weak solutions of gr. ss-gj may be injected, increas- ing the strength later four or five times as indicated. (L. T.) A solution of gr. y-sj painted on through the speculum, is recommended in chronic forms, or as an injection in the strength of gr. iij-.lj. When the disease is extensive the latter should be followed by copious injections of warm water. Applications as injections should not be made more frequenth r than even' third day. (K.) Astringent Injections : These are useful in chronic forms. In addition to nitrate of silver, the following are employed when the discharge is very fetid : #. Liq. Bismuthi, ij. Glycerit. Amyli, ^ij. M. (Tre.) PROSTATE, HYPERTROPHY OF. 483 Or, #. Liq. Carbon. Deterg., gij. Tr. Kramerias, 3iv. Mucil. Amyli, ad 3;iv. M. Inject 3 j night and morning. (Tre. ) Other useful astringents are : Alum, sss-j-Oj ; Tan- nin, 1 to 2 per cent, solution; Zinc Sulphate, gr. xv- j ; Infus. Hydrastis, 3J-OJ. PROSTATE, HYPERTROPHY OF. Guard against exposure and sudden chilling, al- ways protect the limbs and feet when arising to uri- nate at night. A warm and equable climate is of great benefit. Over-distension of the bladder should never be permitted. Horseback riding and excesses of all kinds should be avoided. The passage every fifth day of a full-sized conical Steel Sound or the local application to the prostatic urethra of a solution of Nitrate of Silver, 1 to 3 grains to the ounce with a Keyes-Ultzman capillary of allsyringe, gives good results. (Cl.) Catheterization: Often necessary to remove resid- ual urine, especially when atony of the bladder ex- ists. It may be employed before retiring in order to give a better night's rest, and may also be required during the day. In some instances it will be neces- sary to use Mercier's catheter with one or two elbows, or an English catheter moulded to an exag- gerated curve by placing in hot water, then cooling in ice water; quickly introduced with stylet re- moved, this will frequently succeed in entering the 484 DIGEST OF EXTERNAL THERAPEUTICS. bladder. If cystitis exists the bladder should be washed out with an antiseptic solution. Catheters should receive strict antisepsis. (Cln.) Bottini's Galvano- Cautery Incision: This method consists in burning one or more grooves through the obstructing portion of the prostate by the galvano- cautery. Freundenberg's modification of Bottini's incision renders the procedure thoroughly aseptic and entirely under the control of the operator. This instrument is described as follows : " It consists of a shaft shaped like a lithotrite, provided with a platino-iridium blade, or a male shaft which is con- nected directly with a storage battery, or with a street alternating current of 104 volts by means of the cautery transformer, controlled with an ampere- meter, and concealed when the blade is closed within the female blade. The platino-iridium blade is ex- posed by turning the wheel attached to the Archi- median screw to the right, the scale on the exposed shaft behind the wheel exactly gauging the length the male blade is exposed or the length of the groove made in the prostatic tissues. The incisor is pro- vided with a cooling apparatus, which runs through the entire length of the shaft, crossing at the beak and returning on the opposite side of the instrument. The entrance and exit of the water canals are di- rected downward and inward. To one is attached a piece of rubber tubing, which supplies cold water from a reservoir and to the other a similar piece of tubing, which conveys the water to a receiver." Before operating it is very important to examine the bladder thoroughly with the cystoscope, and with Thompson's stone searcher, in order to ascer- tain whether or not a stone is present, and to deter- PROSTATITIS. 485 mine the relative size of the middle and lateral lobes of the prostate. Excellent results are obtained from the Bottini- Freundenberg method. It is not, however, free from danger, and is contra-indicated when the kidneys are involved. Sepsis from opening a pocket of pus in the prostate and pulmonary thrombosis must be con- sidered as possible dangers. When cystitis or pyelitis are present, both local and internal antiseptic medi- cation should precede the operation. (The details and technique of application are fully described by Dr. B. G. Carleton, in the N. Y. Med. Times, Dec., 1898.) Rectal Tamponade and injections of Cocaine into the parenchyma of the testicles to produce atrophy have their advocates. PROSTATITIS. ACUTE PROSTATITIS. Rest in bed, Hot Sitz or General Baths, Fomenta- tions to perineum, Rectal Douches of hot or cold water, injected against the prostate by means of a rectal psychophore, or by enemata of from two to four quarts of water, several times a day are effect- ive measures. (Cln.) Anodyne suppositories, containing Belladonna, Hyoscyamus, or Opium, such as the following: #. Ext. Opii, gr. j. Ext. Hyoscyami, gr. ss. Ol. Cocois, q. s. M. 486 DIGEST OF EXTERNAL THERAPEUTICS. Or, I*. Ext. Relladonnee, gr. #. Ol. Cocois, q. s. M. (Sn.) Leeches : Applied to the perineum are recom- mended by some authorities when there is much throbbing and pain. (Al.) Catheterization: If there is retention, the urine must be drawn, instrumentation being preceded by a douche of a 2 per cent, solution of Cocaine. Incision: When an abscess forms it must be opened in the perineum in order to avoid ischio- rectal fistula. If it becomes necessary open the ab- scess in the rectum, make a punctured incision and keep the rectum aseptic as much as possible by fre- quent Carbolic Douches. After antiseptic douching the cavity of the abscess may be distended with a warm emulsion of lodoform in vaseline in the strength of 10 per cent., which will give excellent results. If an abscess opens into the urethra, the canal should be irrigated twice a day with a satur- ated solution of Boric Acid or a solution of Nitrate of Silver, 1-2000. (Cltn.) Cold Sitz Baths: Of twenty to thirty minutes, daily at bed times. Suppositories of lodoform or Ichthyol, containing each about 2 grains, have proved beneficial. Cleanse the rectum first with a douche before inserting. (Cln.) Tannate of Glycerine : Applied to the inflamed point in the urethral canal by means of a deep ure- thral syringe is said to have good effect. (Al.) Kemp's rectal cooler is also of service for applying cold to the prostate. PROSTATITIS. 487 CHRONIC PROSTATITIS. Rest in the recumbent position and evacuation of the bowels daily by Enema are important factors of treatment. The passage of Cold Steel Sounds is very effica- cious ; a full-sized sound should be selected and passed \vith the utmost gentleness and ease, or it will be arrested by the compressor urethras, which is usually in a condition of spasmodic contraction. The sound should be passed every five or eight days. In some cases a Carleton's or Kollman's antero-posterior urethra dilator may be used. (Cln.) The Psychrophore : As some attribute the good results from the use of the sound to the cold, the passage of a hollow instrument through which cold water is caused to flow, left in position for about five minutes, is also employed. (Cl.) Nitrate of Silver: 2 to 3 drops of a solution, gr. j-x-^j, applied by means of the Keyes-Ultzman capil- lary syringe, may be used when the mucous mem- brane is seriously affected, as shown by the discharge of round masses from the lacunaa of the glands. (Cl.) In many cases the application of this remedy to the prostatic urethra will be attended with benefit. Commence with a few drops of a 1 per cent, solution and gradually increase to 2, 3, 4, and 5 per cent, as toleration is established. Unduly strong solutions will cause intense reaction. The solutions should be accurately placed in the prostatic portion of the urethra. This may be accomplished by introducing a catheter and thus ascertaining the point at which the urine begins to flow; with the length of the urethra known there will be no difficulty in making 488 DIGEST OF EXTERNAL THERAPEUTICS. the application. The applications should not be ap- plied more frequently than once in three days or once a week. (B. H.) Massage of the Prostate: The patient should be placed in the dorsal position with the limbs slightly flexed or in the knee and elbow position. The finger of the operator, protected by a long rubber tip and anointed with vaseline, is inserted into the rectum. The diseased gland is massed from right to left and the reverse. The tip of the finger should also be em- ployed to press the gland forward toward the sym- physis, and a forward and backward massage move- ment made. This procedure should be continued from two to five minutes and may be repeated every fifth day. In some cases it is advisable to introduce a full sized steel sound into the urethra, and retain it during massage. Massage by Feleke's or Swin- burne's instruments is not advised. (Cln.) Cantharidal Collodion: Is advised by some writ- ers; one side of the perineum is painted up to the raphe and the patient is kept in bed ; when the part has healed the other side is painted. The anus and scrotum must be protected. (Cl.) PRURIGO. The first aim of treatment is to improve the hygienic surroundings of the patient and to employ liberally soap, water, and clean clothing. Pilocarpine Muriate: On account of its action on the sweat glands, has a powerful effect on the gen- eral condition and may be regarded as a reliable PRURIGO. 489 remedy. It may be administered hypodermically, but in small doses, for fear of collapse. (B. H.) Baths : Plain or alkaline, are very generally em- ployed, followed by ointments or lotions, viz.: Unna's ointment acts favorably. It is composed of Zinc Oxide Ointment, 100 parts, Carbolic Acid, 5 parts, Corrosive Sublimate, Vi to 1/2 part. Wilkinson's Ointment: Hebra recommends the following modification of Wilkinson's ointment : I*. Flor. Sulphuris, Ol. Cadini., aa ^vj. Sap. Viridis, Adipis, aa Oj. Cretse, 3 i y - M. (And.) Anderson recommends Plain, Warm, Vapor, or Turkish Baths, followed by friction, and the use of the following ointment : #. Sulphuris, Glycerin!, Ol. Rusci, aa ^vj. Ung. Rumicis, 3 ij. M. Vlemingckx's Solution: Followed by hot baths, are also advised. (Hy.) The following other remedies may be mentioned as effective : Tar Ointment, Sodium Thiophene-Sulphonate, So- dium Sulphophenate, 5 to 10 per cent, ointment; Hebra's Soap Treatment, as for eczema, all consti- tute useful remedial measures. Naphthol: 2 to 5 per cent, solution, according to age, rubbed in every night in conjunction with a bath of naphthol soap every second night. (Ja.) 490 DIGEST OF EXTERNAL THERAPEUTICS. Tumenol : A 10 per cent, solution made with equal parts of alcohol, glycerine and water. (Al.) PRURITUS. External treatment, though of little effect in cur- ing, is of great benefit in relieving. When the disease covers the whole surface of the body, baths will be found of service. Linen under\vear, over which flan- nel can be worn, agrees with some, while others prefer silk. A great number of remedies, of which the following are the most important, are employed for the relief of this intractable affection : Carbolic Acid: One of the most effective applica- tions, it generally be tried first. It may be employed in strengths varying from 5 to 20 grains to the ounce or in the following combinations : Carbolic Acid, 20 parts. Glycerine, 75 parts. Alcohol, 25 parts. Distilled Water, 300 parts, i to 4 tablespoonfuls in a tumbler of hot water ; bathe parts. (T., 98.) Combined with Creoline, it will be found useful in the following proportions : Carbolic Acid, 2 parts. Creolini, 3 parts. Cologne Water, 100 parts. (T. C., Vol. V.) A solution in alcohol, 1 to 2 drachms to the ounce, is recommended. Mop the skin gently, but do not rub in. A spray the strength of half an ounce, to PRURITUS. 491 water 1 pint, and glycerine 1 ounce, with 5 to 10 minims of oil of peppermint added, is also useful. (Ja.) The fact that the skin of some persons is much more sensitive and liable to irritation than others must be taken into consideration before employing the stronger solutions. An ointment being some- times preferable, the following will be found useful : 5*. Acid. Carbolic!, gr. xv-xx. Ung. Zinc. Oxidi, j. M. Menthol: Used in various strengths; an alcoholic solution containing 10 per cent, acts well. (F.) In severe forms a solution of 50 grains to the ounce of olive oil has proved effective (Al.); or combined with cocaine, viz.: #. Mentholi, 3J. Cocain. Hydrochloratis, gr. xx. Alcoholis, gj. Aque SJ. M. Cocaine: 2 parts with 100 of flexible collodion, or a solution of 20 per cent, with 5 of glycerine. (F.) Brucine: Acts somewhat like cocaine and has been satisfactorily employed in 20 per cent, solu- tions. (F.) Chloroform: 1 drachm, olive oil, 1 ounce, will allay the itching of urticaria and pruritus (F.), or 1 drachm with 1 pint of alcohol. (B. H.) Ichthyol: Will prove useful, though it makes a disagreeable application, viz.: #. Ichthyoli, 3j. Spts. Vini, Etheris, aa gv. M. (T., 97.) 492 DIGEST OF EXTERNAL THERAPEUTICS. Bulkley recommends the following : #. Ichthyoli, 3j. Ung. Picis, gj. Zinc. Oxidi, 3^j- Ung. Aq. Rosas, 3"j- M. Or, #. Ichthyoli, Ol. Cadini, Ol. Gossypii, aa 3J. Sig. Use diluted with oil. Camphor: Useful in the form of the spirits, pow- der or ointment, or combined with Chloral by tri- turation of equal parts, forming the well known glycerine like mixture. An ointment is composed as follows : #. Camphor ae, Chloralis, aa 3J. Ung. Aq. Rosae, 3j. M. (Vn.) Camphor may be combined effectively with Borax as follows : Jfc. Spts. Camphorae, 3 ss - Sod. Boratis, gij. Glycerini, ^ij. Aquae, gvj. M. Sig. To be well shaken before applying. (A. C. S., 8, 77.) It may also be mixed with Potassium Sulphuret in the following proportions : fy. Potass. Sulphureti, 3iij. Spts. Camphorae, %ss. Glycerini, ^j. Aquse, q. s. ad ^vj. M. Sig. Apply by the medium of a saturated strip of lint. (Hy. PRURITUS. 493 These preparations should not be used on the broken skin. Opium: In the following ointment: Opium, 8 grains, creosote, 10 drops, vaseline, 2 ounces; (Ga.) or in the form of morphine in the proportion of 1 grain to the' ounce, added to the two compound camphor lotions above, may be employed when ano- dyne lotions are desired. (Hy.) Pilocarpine: Simon has successfully employed this remedy hypodermically in doses of of a grain of the muriate. (Hy.) Alkaline Lotions : Bicarbonate of Soda, 3J Oj ; Borax, saturated solution in rose water; Lime Water, pure, or in the following combination is es- pecially useful for the itching of eczema and other inflammatory conditions of the skin, also in senile pruritus : I*. Liq. Calcis, giij. Creosoti, M. x. Pulv. Zinc. Carb. (Impure), gj. Glycerin! vel Ol. Olivae, S"J- M. (Sm.) Losophen: 1 to 2 per cent, in a mixture of 3 parts of alcohol and 1 part of water, apply two or three times a day. In some cases this will prove irritat- ing; an ointment of 1 to 3 per cent, is also used. (F.) The following is recommended in dry itching in- flammatory affections of the skin : Talc, Powdered Starch, each 5 parts. Glycerine, 20 parts. L,ead Water, 100 parts. This is to be diluted with twice the volume of water, shaken and applied to the skin and allowed to dry. When the skin is broken, half the lead water may be replaced by a I per cent, solution of boric acid. The lotion is contra-indicated when there is a full discharge. (T., 98.) 494 DIGEST OF EXTERNAL THERAPEUTICS. Among some of the useful powders are the follow- ing: Talc, Oxide of Zinc, each 5 parts. Salicylate of Bismuth, 10 parts. Rice Starch, 90 parts. Borax, 2 parts. Talc, 10 parts. Oxide of Zinc, 30 parts. Rice Starch, 60 parts. (T. C., Vol. v.) Medicated Baths: These will at times afford re- lief; the following will be found of service: Sodium bicarbonate, Iviij |x, water, 30 gallons; nitric or hydrochloric acid, gj, water, 30 gallons. Starch baths, followed by sponging with aromatic vinegar 250 parts, and carbolic acid 5 parts. Sul- phur baths also are sometimes useful. After the bath the patient should be dried by wrapping in warm sheets, followed by a vigorous patting of the skin, anointing same with some bland oil and pow- dering with starch. Acid Lotions: Viz.: Vinegar, Lemon Juice, pure or diluted, and solutions of Dilute Hydrochloric Acid are said to relieve the itching of urticaria. Tannin : Squibb's formula is as follows : fy. Acid. Tannici, 9J. Glycerini, Spts. Vini Rect., aa %ss. Aq. Destill., ad 5jiv. M. Sig. Apply morning and evening. The following are among the almost endless num- ber of remedies which have been advised for this con- dition : PRURITUS. 495 I*. ,5-Naphtholi, 9j. Retinoli, Sapo. Mollis, aa gr. cc. Pulv. Crete Pneparatae, 9ij. M. ty. Ess. Gaultheriae, ^ss. Thymoli, 33. Resorcini, 3iv. Aq. Coloniensis, 3 V J3'J- M. Mercuric Bichloride: Gr. ss j. Burow's Liquor: (See Appendix II.) Resorcin: Gr. x xx j. Tumenol, a 10 per cent, alcoholic or aqueous solu- tion. Also lotions of Hamamelis, Dilute Aqua Am- moniac, Tar Water and Goulard's Solution. Liq. Picis Alkalinus: #. Picis L/iquidae, jij. Potass. Causticae. 3J. Aquae, 3 v. M. Dissolve the potash in water and gradually add to the tar with rubbing in a mortar. Dilute for use in the proportion of i to 2 drachms to a pint of water, gradually increasing the strength. PRURITUS ANL Removal of cause when it can be ascertained, such as haemorrhoids, fissure, eczema, ulcer, polypi, ascar- ides, etc., is the first essential of treatment. Many causes, however, are unattended with any discerni- ble pathological change, and palliative treatment is necessary. Applications may be made in the form of lotions or ointments, as a rule, the latter are prefer- able. Of the numerous remedies for this condition the following are worthy of mention: 496 DIGEST OF EXTERNAL THERAPEUTICS. Hot Water: Applied as hot as can be tolerated with soft cloth or by sitting over a pail of hot water and sopping the parts; dry gently by patting the skin, and dust with starch powder. Carbolic Acid: One of the most effective agents. Ijt. Acid. Carbolici, 3 ss. Glycerini, 3J. Aq. Destill., giij. M. (K.) Sig. Dilute if too strong; apply at night. Alum and Zinc Sulphate: Equal parts of each placed in an earthen vessel and heated until they be- come a hard mass ; of this half a drachm is powdered in a little water and thrown into the rectum every night ; in a few minutes it will dispel the itching, and will succeed when other drugs have failed. It is espe- cially indicated when there is engorgement of the haemorrhoidal veins. (Al.) Campho-Phenique : Equal parts with Zinc Oint- ment, is highly praised (Al.), or 3) to water j after bathing in very hot water. (Me.) Another useful formula is : Campho-Phenique, 3J. Losophen, gr. xx. Cosmoline, 3j. (T., 98.) Salicylic Acid: 3v j, will often afford great re- lief. (Al.) Cocaine and Menthol: Combinations are effective. (See Pruritus.) Nitrate of Silver: A solution of gr. xvj in Nitrous Ether (Ja.), or gr. xx, water, j, painted on will cause pain, but will afford immediate relief. (Gt.) Bulkley's Antipruritic Powder is very satisfactory ; PRURITUS. 497 it is composed of 1 drachm each of Camphor and Chloral, rubbed together until liquified, then mixed with 1 ounce of starch. Tr. Sapo. Vir.: When there is thickening of the skin from effusion this is indicated. The following combination also acts well : fy. Sapo. Viridis, Ol. Cadini, Alcoholis, partes equales. M. Sig. Apply once a day. This is effective but more disagreeable than green soap. Applications of green soap should be followed by soothing ointments. (K.) Brocq employs as a soothing ointment Zinc Oxide and Vaseline, followed by this powder: Powdered Camphor, 2 parts. Zinc Oxide, 30 parts. Bismuth Subnitrate, 30 parts. Chalk, 40 parts. (T. )9 8.) Lead Acetate : The following is used at St. Mark's Hospital, London : Solution of Lead Subacetate, i part. Fresh Milk, 7 parts. Add the milk to the lead by degrees, at the same stirring; apply on cotton and retain in place. (T. , 98.) Collodion: May be painted on as a protective when eczema and excoriations are frequent. Tar Ointments: These are generally soothing and are indicated when eczema exists. The following are suggested, Ung. Picis. painted on (T., 98), or: 33 498 DIGEST OF EXTERNAL THERAPEUTICS. #. Ung. Picis, 5iij. Ung. Belladonnae, ^ij. Tr. Aconiti Rad., jss. Zinc. Oxidi, 3J. Aq. Rosae, ^iij. M. (Me.) Tr. Iodine (Churchill's): A painful but very effect- ive remedy. (Gt.) The following is recommended, to be injected daily : #. Fid. Ext. Hamamelidis, j. Ext. Ergotae, 3ij. Ext. Hydrastis, ^ij. Tr. Benzoin. Comp., ij. Ol. Olivae Carbolat. (5 per cent. Carbolic Acid), 3J. M. Sig. Shake well before using; i to 2 drechms for injection. (B. H.) An ointment of Dr. I. V. Shoemaker's is: 5*. Sulphur. Praecipitati, J)j. ^-Naphtholi, gr. x. Morph. Sulphatis, gr. ss. Bismuth. Subnitratis, ^ss. Ung. Zinc. Oxidi, ^ss. M. Two formulae commended by Kelsej^ for use in ob- stinate cases are as follows : #. L,iq. Carbonis Deterg. (Wright's), Glycerini, aa ^j. Pulv. Zinc. Oxidi, Calamin. Prseparatae, aa ^ss. Pulv. Sulph. Prascipitati, ^ss. Aq. Destill., ad 3vj. M. Sig. To be painted on once or twice a day and allowed to dry. PRURITUS. 499 I*. Sod. Boratis, 313. Morph. Sulphatis, gr. xvj. Acid. Hydrocyanic. Dil., gss. Glycerini, ^ij. Aq. Destill., ad ^viij. M. Sig. Apply 4 or 5 times in twenty-four hours. Borax: Forms an excellent soothing application ; the powder dusted on the raw surfaces, kept sepa- rated by soft gauze, is used with good effect when moist eczema is the cause, a condition in which mild dry dressings are indicated. (Gt.) In other cases a saturated solution acts well. Dilute Sulphurous Acid: After cleansing the parts with soap suds this is said to afford quick relief in cases of eczema marginatum. (Gt.) Suppositories containing Belladonna, Cocaine, or Creosote give relief in cases when the parts are ex- coriated; when this condition exists Menthol, Pep- permint, and Chloral should not be employed. (Ja.) Forcible Divulsion: When no local cause can be detected this measure has given satisfactory results in conjunction with the removal of redundant skin by cutting and scraping ; it is recommended in cases which have resisted all other means. PRURITUS SCROTI. Many of the remedies mentioned under the general head of pruritus are applicable to the disorder in this locality. In addition the following have proved sat- isfactory : Picric Acid: 1 to 51000, has succeeded when other applications have failed. Phenol: 20 grams, glycerine 75 grams, alcohol 25 500 DIGEST OF EXTERNAL THERAPEUTICS. parts, and water, 300 grams ; 1 part of this mixture is diluted with 4 of hot "water and applied by means of saturated gauze . ( T . , 9 7 . ) Pyroligneous Acid: 1 part to 30 of water or gly- cerine, or an ointment gradually increased in strength, is recommended by Piffard. PRURITUS VULV^B. Washing the parts with soap and water, then with a Sublimate Solution, following with applications of Carbolized Vaseline, 3 to 5 per cent., often proves successful. (T., 97.) Hot Water Sponging: Using the water hot as it can be borne is excellent and should be tried in all cases. (Vn.) Nitrate of Silver: A 2 per cent, solution is highly effective. The following method is recommended: Admin- ister a vaginal injection every night of a solution of Lysol, followed by one of Boiled Water, and lastly by one of Mercuric Bichloride. Wash the vulva with care and introduce between the labia a fold of muslin wet with a solution of Tannin gss-Oj. Ex- coriations may be touched with Nitrate of Silver. (T., 96.) Cocaine Hydrochlorate: May be employed with good effect when the affection appears to start from the clitoris and is attended with nervous crisis, viz.: I*. Cocain. Hydrochloratis, $j. Acid. Borici, 3iij- M. Sig. Dust on the clitoris and underlying parts. Instant but only temporary relief will be obtained. PRURITUS. 501 Tannaform : 1 part, starch, 4 parts, for diabetic pruritus. (F.) The following are useful applied with saturated compresses : 9;. Fid. Ext. Grindeliae, |ss. Creolini, gij. Aquae, q. s. ad ^v. M. Or, |fc. Potass. Bicarbonatis, jij. Aquae, Oj. (Sm.) Veratrine: In the proportion of 3 grains to the ounce of lard. (Hy.) Hydrocyanic Acid: Used in severe cases, but with caution, and never where the skin is abraded, viz.: Tfr. Acid. Hydrocyanic. Dilut., ij. Sodii Boratis, 3J. Aq. Rosae, S v "j- M. (Sn.) I*. Bismuth. Subnitratis, ^ij. Acid. Hydrocyanic. Dilut., 3J. Mist. Amygdalae, Jiv. M. (And.) Emollient poultices, such as fresh Almond Meal, sprinkled with Boric Acid, will prove soothing; also the following lotion painted on parts : 1*. Sodii Sulphitis, 3J. Glycerini, ^j. Aquae, 3 iv. M. (B. H.) Though ointments are rarely used, the following may occasionally prove of service: jpfc. Hydrarg. Chloridi Mitis, Ext. Belladonnae, aa 3J. Ung. Aq. Rosae, j. M. 502 DIGEST OF EXTERNAL THERAPEUTICS. Injections of Zinc Sulphate, gr. v x sj and Bi- chloride of Mercury, 1iOOO, used on alternate days, with bathing of the external genitals once or twice daily with EichofFs Sublimate Soap, consti- tutes a useful adjuvant to any mode of treatment. PSORIASIS. Cleanliness of person and clothing should first re- ceive strict attention. All causes tending to depress vitality, as excesses, overwork, relaxing climate, or other drains upon the s^-stem, should, if possible, be eliminated. Local measures are of great importance ; they are of two classes ; the first, those used to re- move the scales to prepare the way for the second ; the second, those which exercise a directly curative effect upon the diseased skin, and so prevent the re- newal of the scales. For removal of the scales the following methods are efficacious : Alkaline Baths, Wet Packing, Inunctions with oil, vaseline, fat, soft soap, and even caustics, or a 6 per cent, solution of Salicylic Acid in spirits. The fats or oils require to be well rubbed in. Many cases get well with one of the above methods alone if per- severed in. Continuous Baths in tepid water have been successful. (Ck.) Daily Hot Baths and the use of soap and a nail brush should be employed in all cases, especially when the disease is wide-spread. The following alkaline bath may be resorted to and patient allowed to soak in it for twenty min- utes, after which scales may be rubbed of: PSORIASIS. 503 Bicarbonate of Soda, 3"J- Water, at temp, of 95 to 100 F., C. xxx. Much depends upon the thoroughness with which the scales are removed. Sapo Mollis (Potash Soap, Black Soap): Rubbed on night and morning and washed off as seldom as possible; highly prized by Hebra. (Hb.) Mercurial Ointments: These are useful when only mild stimulants can be tolerated, viz.: Hydrarg. Ammon. gr. x, vaseline j, or Hydrarg. Oxid. Flav. in the same strength, or these two mercurial oint- ments combined, or Ung. Hydrarg. Nitrat., more or less diluted, or Hydrarg. Biniodidi, gr. iij x |j ; the latter being a stronger stimulant. (Ck.) Chrysarobin: This is the best application, espe- cially when it is desired to remove the patches rap- idly. An ointment of half a drachm to a drachm to the ounce may be employed, though it is better in the strength of about 5 per cent. Its activity is in- creased by the addition of salicylic acid (3 per cent.). A paint which has been markedly successful is : Ijk. Chrysarobini, 3J. Acid. Salicylici, 3J. Liq. Guttae Perchae, 3j. M. (Kp.) This remedy has the great objection of staining everything with which it comes in contact, dying the hair orange yellow, and ruining all clothing. It should never be applied on the face or scalp, on ac- count of the dermatitis to which it may give rise, and the danger of violent conjunctivitis should any find its way into the eyes. The following solution avoids the smearing effect of an ointment : 504 DIGEST OF EXTERNAL THERAPEUTICS. I*. Chrysarobini, 3J. Collodii, gj. JEther. et Alcohol., aa q. s. M. Rub the chrysarobin with the alcohol and ether, and add the collodion. It will result in an emulsion, which should be shaken before using and applied with a brush after the removal of the scabs. (Ck. ) In general attacks Unna's Compound Chrysarobin Ointment (chrysarobin 5 parts, salicylic acid 2 parts, ichthyol 8 parts, and vaseline 90 parts) is effective and speedy ; it should be rubbed in after a bath. If chrysarobin produces too great a reaction it should be discontinued, and starch, vaseline, or an alkaline wash substituted. It stains the healthy skin a deep mahogany, and leaves the patches white ; it should be continued until the patches are affected in the same way. These effects may be avoided by using Auspitz's method, viz.: Dissolve gutta percha 1 drachm in 10 drachms of chloroform, to this add 1 drachm of chr\ r sarobin,, after the scales are removed the solutionis painted on and forms a film. It is renewed every two or three days. Besnier's modification of the above is to paint on a solution of chrysarobin in chloroform, and then cover it with the chloroform and gutta percha var- nish. Both methods are equally efficacious. (Ck.) Pyrogallic Acid: This remedy stands next to the preceding in importance. It stains everything black, and, on account of its poisonous action by absorp- tion, is not suited to application over extensive sur- faces. Its action is less inflammatory than that of chrysarobin. The strength of its application is a drachm to the ounce or weaker. (Vn.) The folio w- PSORIASIS. 505 ing combination has been productive of good results in cases which have resisted other treatment : Pyro- gallic acid, salicylic acid, and ichthyol, each 3 parts, olive oil and lanoline, each 10 parts. (T., 97.) Tar: Has been found useful in various forms, and acts well when there is much itching. Crocker rec- ommends Oil of Cade, half a drachm to the ounce, as an ointment, or as a lotion dissolved in spirits with or without soft soap, equal parts of each, or Liq. Carbonis Detergens, M. x ; 5] and upward. He speaks also of tar baths as being useful remedies. The following is also a convenient mode of apply- ing this remedy : #. Ol. Rusci, 315. Etheris, Alcoholis, aa gij. M. Filter and add oil of lavender, 2 parts, rub in at night, and wash off in the morning. The patient should sleep in a flannel gown. (Kap.) Thymol : Introduced some years ago by Crocker, forms a pleasant and suitable application for the face, being more cleanly and of less offensive odor than the aforementioned remedies. An ointment may be used in the strength of 15 grains to 3L drachms to the ounce, or as a lotion as follows :. #. Thymoli, 5j. Iviq, Potassse, 3j. Glycerini, 5 SS ' Aq. Sambuci, S V "J- M. (Ck.) Naphthol: This remedy is of equal efficacy with thymol. Kaposi recommends it in the strength of 80 grains to the ounce. A soap containing 2 506 DIGEST OF EXTERNAL THERAPEUTICS. drachms of the remedy to the ounce of green soap has been found to act well in cleansing the scalp, and an ointment of naphthol 5], lard sj, is useful for re- moving the scales from the body. If used over an extensive surface it may induce toxic symptoms. It may, however, be regarded as an excellent remedy when for any reason chrysarobin or pyrogallic acid cannot be used. (Al. ) Sulphur: Hebra's modification of Wilkinson's ointment often proves effective; the formula is as follows : ;. Sulphur. Sublimati, Ol. Cadini, aa ^ss. Sapo. Viridis, Adipis, aa ^j. Cretae Prseparatse, 3iss- M. The ointment of tar and sulphur may also be used combined in the proportion of a drachm of the former to an ounce of the latter. (Guy's Hospital.) An ointment of sulphur, 10 to 30 grains to the ounce, may be applied to the scalp, the strength de- pending upon the irritability of the part. (T., 98.) Vlemingckx's solution (See Acne Simplex) is also of service. Among other remedies may be mentioned Ammo- niated Mercury Ointment; Solutions of Nitrate of Silver 9ij j, recommended by Fox in chronic cases (B.); Gallacetophenone, 10 per cent.; Ichthyol, 5 to 20 per cent.; Resorcin, 5 to 20 per cent. (B. H.); Anthrarobin, the action of which is analogous to that of chrysarobin; and Turpentine. The last is a powerful, penetrating stimulant, and has been em- ployed in a large number of cases with gratifying PYORRHCEA ALVEOLARIS. 507 success. It is cleanly, but the odor is a drawback. It can be used undiluted in which case the skin is smeared with vaseline to prevent dessication, or pure, combined with olive oil in the proportion of turpentine 1 drachm to 7 drachms of olive oil, and upward. (Ck.) For a base of ointments, lard or vaseline, combined advantageously with 10 to 40 per cent, of lanoline, is most frequently employed. If a plaster is desired, use Unna's paste. India Rubber Underwear: Recommended by Crocker to be worn continuously for twelve hours or more and changed night and morning. The effect, he claims, is excellent, especially if the skin becomes moist and macerated. PUERPERAL FEVER. See Septicaemia and Puerperal Metritis. PYORRHCEA ALVEOLARIS. Carbolic Acid: The persistent application of the freely crystals will cure this affection. Hydronapthol: Gr. xvj, alcohol, sj, water, gj ; a teaspoonful to half a pint of water may be used freely with good effect as a mouth wash. (Al.) Pyrozone: 2 to 5 per cent, solution in ether, has been found a very effective stimulant and caustic ap- 508 DIGEST OF EXTERNAL THERAPEUTICS. plication, especially serviceable in checking suppura- tion. (F.) Menthol : As an anodyne and antiseptic. (F.) RABIES. Immediate measures for the elimination of the poison from the wound should be employed, viz.: Suction : The patient should immediately suck the wound ; if he is unable to do so himself, a second person may do so for him, though it is not without danger, owing to possible abrasions of the mouth. The mouth should be rinsed immediately. Cauterization: Stands next in availability. The Actual Cautery should be freely applied ; red hot iron poker, or any iron article. The Paquelin or galvanic cautery should be used if convenient, but the chances are these instruments will seldom be ac- cessible. The pain of the actual cautery is not more severe than mineral escharotics and it should always be preferred, but in its absence the Nitrate of Silver crayon thoroughly applied or Caustic Soda may be used. It is claimed that the former is especially effective. Carbolic Acid, pure, or Corrosive Subli- mate, 1500 or 1000, may be used as substitutes, but only when the cautery is not available. (Ty.) Excision of the Wound: Recommended as a para- mount necessity by some writers. (Hy.) As it is claimed that the instrument used may become in- fected by the virus from the wound, caution is neces- sary. Pasteur's Attenuated Virus: This treatment can RANULA. 509 only be carried out at a Pasteur institute, one of which is situated in New York. A careful examina- tion of the results of this method by exact and con- scientious observers show it to be an efficient agent in saving life. For the paroxysms ; Chloroform Inhalations; sub- cutaneous injections of Morphia in lull doses ; Curare, in doses of T V to | grain, or Ethyl Bromide in doses up to a drachm, both subcutaneously. Amyl Nitrite inhalations should also be tried. (B.) RANULA. Iodine: A few drops injected into the sac, usually effects a cure. (H.) Chromic Acid: After evacuation and washing out of cavity the saturated solution may be freely ap- plied. (Sm.) Nitrate of Silver: The crayon after removal of a portion of the sac. Nitric Acid: May be employed if a stronger agent is desired, but other remedies are preferable. (Bt.) Seton: An old and effective method. (HI.) RECTUM, PROLAPSUS OF THE. In recent prolapsus the immediate indication is re- placement of the bowel and relief of strangulation. Place the patient on the left side with the pubes well elevated, the shoulders and head depressed, or in the knee and elbow position, in either of which the re- 510 DIGEST OF EXTERNAL THERAPEUTICS. placement of the bowel is assisted by gravity. The fingers of the operator and the protruded mass should then be \vell lubricated and steady and gentle pressure exerted on the bowel in the direction of its narrowed position. This procedure will generally succeed. When the spasm of the sphincter is so great that reduction is impossible without injury to the bowel, and gangrene is threatened, the patient should be etherized and the sphincter dilated at once, when the prolapsed bowel can be restored. (W.) In children non-operative or palliative treatment is generally successful; the child should never be allowed to sit and strain when the bowels move, but movements should be passed lying upon side or standing, one buttock being drawn aside so as to tighten the relaxed sphincter. When the bowel has protruded it should be douched with cold water and an astringent applied. (All.) The following time-honored astringent remedies are recommended : Alum, one of the most useful agents, may be em- ployed in the strength of 2 drachms to the pint of distilled water (Gt.), or in solution with decoction of oak bark, 1 scruple to the pint, and stronger if well borne. (All.) Tannic Acid, in the form of a strong watery solution; Infus. Matico, Krameria, Hama- melis (AIL), Zinc Sulphate, gr. ij-gj, Tr. Iron gr. xx- xxx-giv (K.). All maybe applied to the protruded bowel with a sponge or bit of soft cotton, and in the case of children adhesive plaster should be applied so as to draw buttocks together ; in adults a T band- age should be employed. Ergot: The concentrated fluid extract injected into the submucous tissue in doses of 5 to 7 grains, RECTUM, PROLAPSUS OF THE. 511 repeated every second day for two weeks, is a pro- cedure which was recommended on high author- ity (Agnew and Langenbeck), but is deprecated by Allingham as uncertain and liable to produce ab- scess. Nitric Acid: Very effectual in children, recom- mended when milder measures have failed ; the pro- truded bowel should be well dried and the acid ap- plied, care being exercised to protect the anus and skin by a bland ointment. The part should be well oiled and returned to the rectum, which, by some authorities, is recommended to be packed with cot- ton. (All.) Others regard adhesive plasters binding buttocks together as sufficient. The limbs also had better be bound. Anaesthesia is necessary. In the treatment of adults nitric acid is only tem- porary in its effects; in elderly persons it must be used with caution on account of deep sloughs which may be produced in debilitated constitutions. (All.) Linear Cauterization: In adults this is undoubt- edly the best means ; the patient is etherized and placed in the Sims position ; from three to six verti- cal stripes should then be made on the mucous mem- brane with the Paquelin cautery at a dull red heat. The stripes should begin three inches up the rectum and end at the junction of the skin and mucous mem- brane. Mr. Allingham in severe cases burns through the sphincter in two places at opposite points after re- ducing the bowel, and inserts a pledget of oiled wool. He applies the cautery before reducing the bowel. Van Buren, who first recommended the procedure, replaced the bowel and applied the caute^ through a speculum. 512 DIGEST OF EXTERNAL THERAPEUTICS. In extensive cases of long standing the cautery may be applied to the whole circumference of the anus so as to produce cicatricial contraction. (K.) Clamp and Cautery: Constitute the most radical treatment of this condition, and may be resorted to -when all other means have failed ; for the technique of the operation see works on surgery. RECTUM, ULCER OF. Rest is indicated in all stages of treatment. Rest in bed with fluid diet alone will cure some cases. (K.) Local treatment varies, and -will require changing from time to time ; it. is long and tedious and will sorely try the patient, who will require much pa- tience. The first requirement of treatment is a thor- ough cleansing of the rectum ; this may be done by copious injections of sterilized water or Castile soap and water. (Gt.) Irrigation with some antiseptic solution is also employed with advantage before the application of local remedial agents. Solutions of Boric Acid; Cor- rosive Sublimate, 1-5000-10,000; Carbolic Acid, 1100, may be used for this purpose. Ointments are generally to be preferred as superior to suppositories. The rectal ointment applicator is necessary for their administration. The following are recommended : #. Bismuth. Subnitratis, ij. Hydrarg. Chloridi Mitis, gij. Morph. Acetatis, gr. ij. Glycerini, 5jij. Vaselini, 3J. M. RECTUM, ULCER OF. 513 This is very sedative and soothing. I*. lodoformi, gr. xx. Cocainse, gr. xviij. Lanolini, ^ss. M. (All.) Allays irritation and pain. Hydrastis: Useful in the proportion of about 1 drachm of the fluid extract to 1 ounce of vaseline ; lodoform may be added with advantage. Belladonna, Opium and Stramonium in the form of ointments, combined with other remedies, form useful adjuvants for the relief of .pain and spasm of the muscle. (Pt.) Balsam Peru : A mixture composed of half an ounce of the balsam, glycerine 1 ounce, water 4 ounces, will prove healing and soothing. The pure balsam will act well as a stimulant applied over the surface of the ulcer. (Gt.) Strong preparations of balsam of Peru will sometimes cause great irritation followed, however, by beneficial results. Nitrate of Silver: A solution of gr. v x-.^j brushed over surface of ulcer through the speculum is bene- ficial. (W. C.) Copious irrigation -with a solution of gr. xx-xl-Oj is effective in dysenteric ulceration. (All.) When the ulceration is high, the amount of fluid injected should be large; 3 pints may be thrown into the upper part of the rectum, sigmoid flexure, and lower part of the colon. The long flexi- ble rubber tube should be employed, and the injec- tion made slowly with the patient on the side. (K.) Cocaine: In the form of suppositories or a solu- tion, gr. x-xv-sj, is often of great service in allaying pain and irritation. 34 514 DIGEST OF EXTERNAL THERAPEUTICS. Glycerine : Injection of 4 drachms as a lubricant and evacuant. (F.) Nitric Acid : The fuming acid has been highly rec- ommended as a cauterant. (Gt.) Dusting powders introduced by an insufflator through the speculum are very useful ; the best are the following: Acetanilid, Alum, Bismuth Subni- trate, and Subiodide, Boric Acid, Calendulated Boric Acid, lodoform,' Lead Acetate, and Zinc Stearate. These remedies may be applied in the form of oint- ments with the applictator after irrigation, or in the form of suppositories, though the latter is the least desirable method of applying remedies to the rectum as their introduction is often attended with pain. They are often, however, used for the sake of conve- nience. Operative procedures are frequently necessary, viz.: Forcible Dilation of the Sphincter followed by two or three applications of nitrate of silver if the cause is traumatic; Curettage, of benefit, especially in tuberculous ulcerations; Linear Incision through the base of the ulcer; Excision; Division of the base of the ulcer, including the sphincter; Elliptical Inci- sions when the ulcer is not too large and does not extend through the mucous membrane. The edges should be brought together with catgut sutures. (Gt.) RHEUMATISM. ACUTE ARTICULAR RHEUMATISM. Local measures play a secondary part in the treat- ment of the disease. The joints, both those involved RHEUMATISM. 515 and those not, should be washed with warm water and soap, and enveloped in absorbent cotton or flannel, held in position by flannel bandages. These should be changed every two or three days, and the surface carefull}' cleansed with warm water. The entire surface of the body should also be carefully bathed at frequent intervals so that the skin is kept in good condition. Blankets, changed at suitable intervals, should be used for bed clothing, and the swollen limbs supported by pillows covered with flannel. (Gn.) Salicylates: When not tolerated by the stomach, administration by the rectum is often attended with satisfactor}^ results. First wash out the bowel with warm water, then, after an interval, inject from 20 to 40 grains of sodium salicylate in solution. This may be done every six hours. (Ty.) An ointment for application to the swollen joints is as follows: #. Acid. Salicylici, Lanolini, Ol. Terebinthinse, Adipis, aa 3"j- M. (An.) The following have also been used for application to the joints : I*. L,iq. Opii Sedativi, 3j. Potass. Bicarbonatis, ^iv. Glycerin! , ' 5V1- Aq. Bullientis, 3jix. Sig. Soak a piece of flannel in the above solution hot and wrap around painful joint. (Os. ) Fuller's lotion : #. Sodii Carbonatis, 3 V J- Tr. Opii, 3j. Glycerini, gij- Aquae, ?i x - Sig. Hot cloths saturated with this lotion may be applied to the swollen joints. (Os. ) 516 DIGEST OF EXTERNAL THERAPEUTICS. Paquelin Cautery: Applied with a light touch above and below the joint is better than blisters, and acts well for the relief of pain. Fixation of Parts : This measure is of great ser- vice ; use splints for this purpose. (Os.) Cold Baths: For hyperpyrexia the treatment must be energetic and prompt, extraordinary high temperature being inevitably fatal in a few hours. For this condition the one treatment is the applica- tion of cold. As soon as a temperature exceeds 105 the bath should be employed. If delirium or uncon- sciousness is associated with the high fever the baths are all the more indicated. If time permits the tem- perature of the baths may be gradually made cold, commencing with a temperature of 70, ice may be added if necessary. Ice Water Effusion: Rubbing the head and body with ice may be substituted for the bath, though the latter is preferable. Numerous cases are reported with temperatures ranging from 107 to 109 when this treatment was successful. (Ty. ) CHRONIC ARTICULAR RHEUMATISM. Amber Oil: As a rubefacient is useful combinated as follows : 9. Ol. Ambrae Griseae, 5 V J- Ol. Rosmarini, Ol. Bergamottae, aa 5J- Ol. Terebinthinae, 3j. Ol. Lini, ad ^iv. M. (F.) Wintergreen Oil: Fxjual parts, mixed with olive oil, applied to joints which are wrapped in cotton batting, is used for relieving pain. (F.) RHEUMATISM. 517 Massage: One of the most important measures for the relief of stiffness, pain, and contractures re- sulting from rheumatism as well as the disease in the chronic state. It should be persevered in diligently and patiently. To remove nodosities the following plan has been recommended : Apply emollient poul- tices for one or two days continuously, then ener- getic kneading under anaesthesia to crush them ; fol- low this with daily massage. (Sj.) Sulphur Fumigation: Subjecting the joint to the fumes of sulphur has proved useful. (F.) Somewhat on the same principle is the old-fashioned remedy of putting flowers of sulphur in the stockings, which is not without effect. (Rd.) Iodine: May be painted over joint with advan- tage. (Al.) Potass. Iodide: 90 grains, dissolved in water and rubbed up with an ounce of lanoline is often very beneficial; it should be well rubbed in over the affected part, (M. H.) lodoform: The following is claimed to be superior to iodide of potassium applications: lodoform 1 part, collodion or flexible collodion 8 to 15 parts, paint freely on involved joints. Make the second ap- plication over the first, only removing loosened scales of collodion. (Jac.) Fir Wool: For enveloping the joint, used espe- cially by the Germans, but does not appear to possess any advantage over ordinary cotton wool or flannel. (F.) Zinc Sulpho-Ichthyolate: Sometimes proves use- ful in the form of a soap liniment, or ointment, in the proportion of 45 grains to the ounce. (F.) Ichthyol: A 25 to 50 per cent, ointment or 518 DIGEST OF EXTERNAL THERAPEUTICS. glycerite continuously applied to joint is often effect- ive. (M. H.) Thiol: Has been used in the following combina- tion, thiol and vaseline, each 1 drachm, lanoline, 1 ounce. (Al.) Guaiacol : Equal parts, with glycerine painted over painful areas and covered with a dry imperme- able dressing will sometimes afford relief. (F.) Tr. Opium: The following is endorsed by Hughes, of London: #. Tr. Opii, Sj, Potass. Carbonatis, 3j. Aq. Bullientis, Oj. M. Sig. Apply with a soft cloth and cover with dry cotton. (Ga.) Conium: An ointment of the bruised leaves, or the following, for the relief of chronic rheumatism or gouty synovitis : #. Ext. Conii, 3j. Cocain. Hydrochlatis, gr. v. Atrop. Sulphatis, gr. j. Veratrinse, gr. xx. Ung. Aq. Rosse, j. M. (Sm.) Superheated Steam: A hot air cylinder con- structed for the purpose is used. The hand or arm is enclosed in asbestos and inserted into the cjdinder. A thermometer is inserted through a small hole in the tube; care must be exercised that it does not come in contact with the limb. The initial tempera- ture does not usually exceed 70 C., and is increased according to the endurance of the patient; most patients are able to endure a temperature of 120 C. RHEUMATISM. 519 without much discomfort. Profuse perspiration al- ways occurs and the air in the cylinder is soon sat- urated with moisture. It is believed that this must be the condition in all forms of apparatus, on ac- count of the ordinary laws of osmosis. Of course the skin does not attain anything like the temperature of the air in the cylinder, and it is probabty protected by the layer of gas formed from the evaporated per- spiration. The healing factors seem to be the per- spiration and the increased activity of the circula- tion. This diaphoretic action is not limited to the parts treated, but it may affect the whole body. The usual immediate results are relief of the pain, then increased activity of movement and loss of the feel- ing of weakness. (M. M. W., 5, 17, 98.) Liniments: Chloroform, Aconite, Belladonna, Turpentine ; also the following combinations : #. Ol. Gaultherige, Ol. Olivse, Lin. Saponis, Tr. Aconiti, Tr. Opii, aa 3ij- M. #. Ol. Cajuputi, Tr. Opii, aa 3ij- Ol. Terebinthinge, 3iv. Lin. Ammonise, ^j. M. ?fc. Lin. Aconiti (B. P.), Lin. Belladonna;, aa 3ij- Glycerinae, ad gij. M. Ifc. Chloroformi, Tr. Aconiti rad., Ol. Terebinthinse, aa Jss. Ol. Sassafras, M. v. Lin. Sapo. Camphorat., Sij ss - (Sn.) 520 DIGEST OF EXTERNAL THERAPEUTICS. Electricity: In the form of faradism, is often of positive benefit. (Bt.) Pine Needle Baths: A preparation sold in the markets ready for use, or the oil in the proportion of 1 minim to a gallon of water, forms an agreeable and useful bath. (F.) Turpentine Baths: 5 to 10 ounces to a bath tub full of water. . Alkaline Baths: May be used when the natural water of a mineral spring are not available. Hot Air Baths: This method is often productive of good results, but is contra-indicated when there are organic cardiopathies. (F.) The limb is encased in a specially prepared cylinder containing air at a temperature of 150 F. and gradually increased to 240 F. The application is continued for forty to forty-five minutes. (Sj.) Arsenical Baths: Prepared by dissolving from 15 to 45 grains of sodium arsenite and 3 ounces of sodium carbonate in a bath tub full of water. They are useful- in rheumatic arthritis, and ma^- be admin- istered daily or every other day. Thirty baths, it is said, will relieve articular pain and stiffness. Gastric disorders may appear at the beginning, and the pain at first may be aggravated, but on discontinuing the sodium carbonate these symptoms disappear. (F.) Mud Baths; Those of Schwalbach, Marienbad, St. Armand, Franzenbad are all useful. When there is cardiac disease the temperature of the bath must not be too high or the bath too long. Mineral Spring Baths: A great number are recom- mended for the treatment of the rheumatic diathesis and for chronic forms of the disease. A few of the better known are Richfield, Hot Sulphur in Virginia > RHEUMATISM. 521 Mt. Clemens, and Glenwood. Great benefit is often derived from a course of treatment at one of these resorts. Turkish, Warm Sea "Water and Sulphur Baths will prove useful in some cases. MUSCULAR RHEUMATISM. Heat; This is very effective in many forms, viz.: Hot Water Bag or Bottle, Ironing the part with hot flat iron, while protecting the skin with a piece of flannel; Hot Douche; Hot Fomentations of Flaxseed Meal and Laudanum ; Flannels wrung out in hot water'and covered with oiled silk to retain heat, and Mustard Fomentations. Cold: Sometimes useful, though heat is generally more agreeable. A Methyl-Chloride Spray is said to cure in lumbago and pleurodynia, according to Bartholow, almost immediately. Ether is also em- ployed for the same purpose, the relief being some- times permanent. (R.) Salicylic Acid: A 2 per cent, ointment freely rubbed in the skin has given good results in subacute and obstinate cases. (An.) Ether or Chloroform: A few drops subcutaneously in old cases are very beneficial. (B.) Massage: One of the most effective agents; the application of a stimulating liniment may be com- bined with advantage. Liniments : The various anodyne and stimulating liniments are all used, those most useful being tur- pentine, chloroform, and belladonna. (L. T.) The following is highly praised for muscular rheu- matism, lumbago, and sciatica: 522 DIGEST OF EXTERNAL THERAPEUTICS. 1*. Sodii Salicylatis, gss. Ol. Cajuputi., 333. Ol. Eucalypti, M. xv. L,in. Saponis, ^ss. Spts. Rectificati, 3 V J- M. (T., 97.) Also, fy. Lin. Chloroformi, ^iij. Tr. lodi, Tr. Aconiti Rad., aa sjij. Tr. Opii, gss. M. (Sn.) Iodine: The tincture painted on the affected joint until the skin becomes tender, is sometimes of ser- vice. (R.) Capsicum: Steep a handful of crushed pods in half a pint of hot water for twenty-four to thirty-six hours, then strain and bottle for use. Soak a piece of lint in this liquid and apply to the affected part, which should be covered \vith oiled silk. It does not vesicate, and will relieve in a most striking way. (R.) Anodyne Colloid.: Often affords quick relief; if pain continues a piece of absorbent cotton, -wet with warm water, should be placed over the film. (F.) See Neuralgia. M orphine : Hypodermically over the seat of pain will often cut short an attack if seen early. (An.) Belladonna: The plaster or ointment the latter preferable. (Al.) The following also is used : I*. Ung. Belladonnae, Ung. lodi. Comp., aa ,^ss. Sig. Rub in twice a day and apply heat. (Sn. ) Theine : Hypodermically, in doses of i grain has been used with success. (F.) RHINITIS. 523 Osmic Acid : Hypodermicalty in closes of 8 to 10 drops of a 1 per cent, solution, deep in the muscle. (P.) Strapping: This will be found of service in pleuro- dynia ; the involved muscles may be treated by com- plete rest by strapping the side as in fracture of the rib. (Ty.) Aquapuncture : Has been successfully employed. Braunscheidtismus: An old remedy, will some- times afford instant relief. (B.) Paquelin Cautery: Applied gently and rapidly over large surfaces, is said to "act like magic." (L. T.) The practical application of such a remedy would seem doubtful. Hydrotherapy: Warm or cold pack, Turkish baths, hot air baths, sulphur and other mineral springs as advised in chronic rheumatism. Electricity: Either in the form of galvanism or faradism, is useful in chronic cases. RHINITIS. ACUTE RHINITIS. Menthol: One of the most frequently employed remedies for this condition. It is given first import- ance by Lennox Browne, being preferred by him to cocaine. He advises its administration by any one of the following methods : (1) A 10 per cent, solution in almond oil, in liquid vaseline, or in one of the many odorless paraffine compounds, to be sprayed into the nose or about the room. 524 DIGEST OF EXTERNAL THERAPEUTICS. (2) By placing 1 to 2 drachms of the oily solution in a Lee's steam draft inhaler or a bronchitis kettle. (3) To carry a Cushman's pocket menthol inhaler. The vapor of the following combination, inhaled from a wide-mouthed bottle or pocket inhaler, will add to the comfort of the patient : Oil of menthol, 1 drachm, with carbonate of ammonia, half an ounce ; or oil of menthol, 1 drachm, with 2 drachms each of camphor and carbonate of ammonia. Menthol Chloroform: In the strength of 10 per cent., for the purpose of aborting. Place a few drops on a handkerchief, and take about five deep inhalations. The secretions are at first increased, but afterwards diminished. (T., 97.) Carbolic Acid: A popular German remedy, called Hager's, is as follows : J*. Acid. Carbolici, 3J. Alcohol . Fort . , 3 ii j . Aq. Atnmonise Fort., 3J. Aq. Destill., ^ij. M. Sig. To be used as an inhalation from an open-mouthed bottle. Half an ounce of a 1-20 solution to a pint of water is useful in washing out the nose. (T., 96.) Steam Inhalations : Always grateful ; following may be added to boiling water in about the propor- tion of a teaspoonful of the mixture to half a pint : fy. Tr. Lupulini, .3J. Tr. Benzoini Comp , ^vij. M. Or, Jfr. Caniphorse, sjss. Ol. Eucalypti, M.x. Terebinthinae, M.xij. Alcoholis, ad ^ij. M. (Bn.) RHINITIS. 525 Camphor: An old and well-tried remedy; the spirits may be inhaled from a bottle, or when added to boiling water m some of the combinations as mentioned. Chloroform: 1 drachm may be added to the ben- zoin inhalation above mentioned, to increase its sed- ative action. (Al.) The following are to be employed with the atom- izer: Calendula: Very useful after operations about the nose, viz.: #. Succi Calendulae, ^iss. L,iq. Alboleni, gij. M. (Tn.) Cocaine: Is used for controlling the venous tur- gescence. It is claimed that it has more than a palli- ative action. Applied every three or four hours it may arrest or control the attack ; the following for- mulae are recommended : #. Cocain. Hydrochloratis, gr. xx. Morphinse, gr. it. Aquae, 3J. Ft. Sol. et adde, Cosmolin. Liquid., 2;j. M. Sig. Apply with a Burgess atomizer. ( Bos. ) #. Cocain. Hydrochloratis, gr. v. Ol. Eucalypti, M.xx-gj. Vaselini vel Lanolini, ad ^j. M. Mackenzie recommended the following effective combination : Jjfc. Mentholi, gr. v. Pinoli, M.v. Benzoinoli, ^j. M. 526 DIGEST OF EXTERNAL THERAPEUTICS. Snuff Powders: Are very often used, but are not as effective as sprays. Moreover, to some very sen- sitive mucous membranes the effect of a powder is not as agreeable as a spray. The following are recommended : Tfc. Morph. Hydrochloratis, gr. ij. Pulv. Acacias, 3^j- Bismuth. Subnitratis, 5 V J- M. This is known as " Ferrier's Snuff." In using prep- arations of morphine it must be remembered that the drug can readily be absorbed by the nasal mucous membrane. #. Antipyrini, gr. xij. Camphorae, gr. x. Sac. Lactis, ad 3 u 'j- M. (Bn.) 9?. Cocain. Hydrochloratis, gr. iss. Mentholi, gr. iiss. Acid. Salicylici, gr. viij. Acid. Borici, 3J. Amyli, 5 iss - M. Sig. A pinch every two hours after blowing the nose. I-fc. Cocain. Hydrochloratis, gr. f. Bismuth. Salicylatis, gss. Pulv. Camphorae, 3J- M. (T.,96.) Eucalyptus: Infusion of the leaves for washing out nostrils, or the oil, a few drops on cotton inserted into the nostrils for the relief of the sensation of fullness. Chamomile: Infusions with a little alum intro- duced into the nostrils, is very useful for the coryza of infants. (T., 97.) RHINITIS. 527 Boric Acid: An ointment made with vaseline in the strength of 10 per cent, for application to the nose when there is irritation. (T., 96.) Lemon Juice: The hands are rubbed with some drops of the liquid, and are then held in front of the mouth or nose, while deep inspirations are taken. The sneezing is said to cease after the first few in- halations. (T., 96.) Hot Foot Bath; At bed time, in conjunction with copious draughts of cold water during and after bath to induce free perspiration, when promptly car- ried out will often avert a cold in its incipient stages. (Rd.) To Diminish Excessive Sensitiveness to Cold: 1. Free exposure to the open air daily. 2. The morn- ing cold bath. Cold sponging over the entire sur- face of the body, the plunge bath, or the shower bath are invaluable methods of protecting the body against injury from exposure to changes of tempera- ture. Taken regularly in the morning, the cold bath inures the surface of the body to a greater degree of cold than it will probably encounter during the day ; at the same time it promotes a vigorous capillary circulation, \vhich is essential to the harmonious and healtlvy working of the system. 3. Breathing through the nostrils. Infants should be taught to breathe through the nostrils, especiallv during sleep. (Rd.) SIMPLE CHRONIC RHINITIS. Cleanliness is the first essential ; the nasal cavities should be thoroughly and carefully cleansed of all mucous accumulations before local remedial agents 528 DIGEST OF EXTERNAL THERAPEUTICS. are applied. The following are effective for this pur- pose, using the compessed air apparatus, the nasal atomizer being employed by the patient at home: Seller's Antiseptic Tablets; De-bell's Solution; and Benzoic Acid, gr. x, with 2 drachms each of Chlor- ide of Sodium and Bicarbonate of Soda; half of this powder being added to a glass of water; or Borax, 2 grains to the ounce of water, together with a little glycerine, may be used. (Bp.) After the nasal cavities have been cleansed altera- tive or astringent applications should be employed, according to the indications ; these, generally speak- ing, are of two varieties, liquids, including oleagi- nous preparations and solutions, and insufflating powders ; the former should be applied in the form of a spray by means of the compressed air apparatus. Liquid Applications. The petroleum oils form the menstrum for the oleaginous compounds, viz.: Albolene, Benzoinol, Cosmoline, liquid Vaseline, etc. In these some me- dicinal agent is dissolved, usually in proportion of 1 to 10 per cent. Camphor- Menthol: 10 per cent, in lanolin is a serviceable remedy; it relieves stenosis and conges- tion, and prepares the body for the two succeeding formulae : Calendula: 4 parts, hamamelis 8 parts, pinus strotus 8 parts, lanolin 80 parts. (Bp.) Hydrastis; 1 drachm of tincture to the ounce of water is useful when there is a tenacious, stringy mucous dropping from the posterior nares. Menthol Crystals: Gr. v x, albolene, a;j. (Ty.) RHINITIS. 529 Terebene: Gtt. x, albolene, 3J, applied twice daily, is one of the most effective applications. (Bp.) Cocaine: A 4 per cent, solution will relieve when there is considerable temporary swelling of the mucous membrane. (Iv.) The following solutions are also serviceable for application with the atomizer : V. Ext. Pini Canaden., gtt. xx. Glycerini, ^ij. Aquae, gj. M. (Qy.) Or, I*. Thymoli, gr. x. Eucalyptoli, gr. xx. Mentholi, gr. xxx. Ol. Cubebae, gr. xl. Ol. Rosse, q. s. Benzoinoli, 3 i y - M. Or, Tjk. Thymoli, gr. ss-v. Alcohol! , 3ss. Glycerini, 3iss- Aquae, 3j. M. (F.) Or, #. Acid. Carbolici, gr. ij-v. Aquae, 3j. M. (Al.) Insufflating Powders. Aristol: Alone, or in combination with Boric or Tannic Acid, forms a very astringent powder. Cerium Oxalate: 20 grains to the ounce of acacia, for catarrh in children. 35 530 DIGEST OF EXTERNAL THERAPEUTICS Europhen: For catarrh of children, and for reduc- ing hypersecretion following surgical operations. Salicylic Acid: Mixed with some indifferent me- dium in equal proportions. Potass. Sozoiodol: Equal parts with talc, or in proportion of 1 to 2, is highly commended. Sodium Sozoiodol: In the proportion of 1 to 2 with talc, especially when discharge is muco-puru- lent. (Al.) Gallic Acid: 4 grains, with acacia, 2 grains, after cleansing with a solution of bicarbonate of soda, one of the best applications. (Iv.) Tannic Acid: 2 parts, lodoform, 1 part, carefully triturated. (F.) Cauterization: When engorgement of the turbi- nated bodies produces swelling of these structures and consequent constriction of the nasal passages, the cautery is indicated. The galvano-cautery should be used touching the sensitive areas as practiced in hay fever. (Ing.) In absence of the galvano-cautery, mineral cauter- ants may be used, as mentioned for the treatment of hypertrophic rhinitis. ( Bp. ) Ethyl Chloride : 5 to 20 drops on a handkerchief, inhaled, has good effect. (B.) Bougies are of service ; they act in two ways, namely, by retaining the medicinal agent in contact longer, and by exerting pressure; a small piece of cotton should be placed in the nostrils to prevent flow of mucus. (Al.) Sea bathing and sea water are often ver\- bene- ficial. (Iv.) RHINITIS. 531 ATROPHIC RHIXITIS. Thorough cleansing is the first requirement. This is best accomplished by detergent alkaline sprays, as Dobell's Solution, Seller's Antiseptic Tablets, solutions of Boric Acid, or Borax. Crusts not re- moved by these agents may be brought away by means of a probe wrapped in cotton and dipped in A'aseline. Hydrogen Peroxide: When the crusts of inspis- sated mucus are difficult to dislodge, they may be softened by pledgets of lint soaked in the peroxide and inserted into the nostrils. (Bl.) Formalin: After removing crusts with a weak alkaline solution apply cocaine, and then wash out thenares with the following douche, which will cause the crusts to diminish and the odor to cease : V. Formalin! . gtt. v-x. Aquae, ,~> vn j- M. (L., 4, 98.) Galvano-Cautery Electrode: Used for the re- moval of the crusts. The electrode is introduced cold, put in contact with the crusts, which, \vhen the current is turned on, adhere with great tenacity to the heated electrode and are then removed with ease. (Bn.) After cleansing, the mucous membrane is ready for the application of some alterative or astringent agent, which will vary in strength according to the sensitiveness of the parts. The following cleansing deodorant, antiseptic and alterative remedies are for application by the atom- izer or compressed air spray apparatus. Thymol: Is a useful deodorizer and cleanser, but 532 DIGEST OF EXTERNAL THERAPEUTICS. does not have any great influence on the course of the disease. The following is grateful : I*. Tliymoli, gr. x. Eucalyptoli, gr. xx. Mentholi, gr. xxx. Ol. Cubebae, gr. xl. Ol. Rosae, q. s. Benzoinoli, iv. M. The solution may be used stronger or weaker as the condition requires. A solution stronger than 5 per cent, is seldom, if ever, required. (F.) Citric Acid: This agent has been used with satis- factory results. It acts as a powerful deodorizer and possesses marked healing properties. The mode of employment is as follows : Every morning the nose should be rinsed out and freed from pus and crusts. Then by means of an insufflator, citric acid mixed with equal parts of sugar of milk is intro- duced three times a day. Deodorization can be noticed at once, and lasts for several days, even if the process is not repeated. The secretion is also speedily considerably reduced. (M.M. W., 4, 11, 99.) Ichthyol: Gtt. xx-xxx, albolene, 3-j Mercuric Bichloride: Gr. ss, albolene, sj. Potass. Permang: Gr. ss, aque, j ; especially when discharge is persistent is a good deodorizer, but not as lasting as some others. (F.) Camphor Menthol: 10 per cent, solution in lano- line when odor is very foul. (Bp.) Thiol: In the following combination, by means of oil atomizer, three or four times a day : I*. Pulv. Thioli, gr. x. Mentholi, gr. v. Liq. Blancolini, gj. M. (T.,98.) RHINITIS. 533 Pheno-Salyl.: Sol. 1-1000, with a little salt. Creoline: Sol. 1-1000. (Al.) Hydrastis: Fid. ext., 33, aq. destill., Oj. (B.) Labarraque's Solution: In strength of 15 to 20 drops to the ounce is most useful for correcting odor. (Al.) Zinc Sulphate: Weak solutions have been used to cleanse. (F.) Iodine : In solutions of varying strengths is of great service. One of 4- per cent, in lanolin, and also the following may be mentioned : &. lodi, " gr. v. Potass. lodidi, gr. x. Glycerini, gj. M. Dilute with water as condition demands. Alcohol: Diluted according to the susceptibility of the patient, forms one of the simplest and best ap- plications. (Bn.) Nasal Douche : In addition to the spray, the pa- tient should use once a day, by means of the nasal douche, 1 or 2 quarts of hot water with salt, a half ounce to the quart ; the water should be used as hot as can be borne. (Bos.) The following powders may be given by insuffla- tion: Aristol with Zinc Stearate Compound; Euro- phen, especially in scrofulous children; Nosophen; lodo-Tannin ; Calomel, gr. v, with Sac. Alb., gss; Zinc Zozoiodate, 1 part, with talc., 10 parts, when an excitant action is desired. Nitrate of Silver: Of great benefit. Solutions vary according to the sensitiveness of the mucous mem- brane; 10 to 40 grains to the ounce are recom- mended, applied with cotton applicator every second 534 DIGEST OF EXTERNAL THERAPEUTICS. or third day with lengthening intervals. (Ty.) At home the patient should use in the morning the fol- lowing spray : #. Hydrarg. Bichloridi, gr. j. Aq. Ivaurocerasi, ^iij. Aq. Destill., Oss. M. In the evening; the same followed by this oint- ment : 9?. Hydrarg. Oxidi Flavi, gr. vj-x. Ol. Bergamottse, gr. vj. Vaselini, 3j. M. Susceptibility of some patients to mercury, espe- cia,lly in the nose, renders caution necessary. The applications, therefore, may be weaker. (Bn.) lodoform: In the form of bougies or wafers con- taining 2 to 5 grains, or 1 grain by insufflation. (Al.) Trichloracetic Acid: 10 to 15 per cent, aqueous solution applied two or three times a week by means of cotton covered silver probe, and rubbed on points. (Sm.) Balsam Pine : Cotton tampon, soaked with the remedy and carried into nasal chambers. (Al.) The following ointments are commended : Europhen : 10 per cent, ointment on cotton tam- pons, left in place half an hour. Hydrarg. Oxidi Flavi: 10 grains to fresh lard, 1 ounce, applied on septum when there is bleeding or ulceration. Calendula or Hamamelis Cerates : For bleeding ulcerations of the septum. Creosote: With oil of anise, each 10 drops, vase- RHINITIS. 535 line, 1 ounce ; a small portion in the nostril forms a useful application. (Sm.) Cupric Electrolysis: This method has recently been employed by Dr. McBride, of Edinburgh, who reports eight cases. After cleansing the nostrils an- aesthetize with cocaine and apply the electricity as follows: A copper needle attached to the positive pole is inserted into the tissue lining of the middle meatus and a platinum needle is passed into the septum; a current of from 3 to 10 milliamperes, rarely the latter, is used. Each sitting lasts about ten minutes. Of the eight cases reported four were practically cured for long periods extending to eigh- teen months; in one there was marked improve- ment, in one apparent cure lasting some months with recurrence, while in two there was improve- ment for a few weeks only. This method is believed by its author to be one of the most valuable for the treatment of ozaena. (E. M. J., 4, 99.) Galvanism: Dr. Delevan recommends the follow- ing : The positive electrode is placed on the nape of the neck, and the negative, wrapped in absorbent cotton, is applied directly to the nasal mucous mem- brane; the strength of the current is four to seven milliamperes, and the duration seven to fifteen min- utes, or until a watery secretion is induced ; excellent results are claimed. Galvano - Cautery : Recommended by Lennox Browne, and others. The electrode is applied at various sittings to successive portions of the mu- cous membrane so as to produce as many small eschars as possible ; insufflation of iodoform or iodol may follow the applications. The use of the galvano- cautery is regarded by other writers as a measure to 536 DIGEST OF EXTERNAL THERAPEUTICS. be employed only with great caution, as it is capable of doing much harm. As a stimulating agent it is re- garded as productive of good results in the earlier stage if applied with great care. Vibratory Massage; Applied as follows: A piece of absorbent cotton, loosely torn from a roll, is in- serted into the inferior meatus, completely filling it and the space between the middle of the inferior turbinated bone and septum. The dry cotton is held on a holder, and vibratory movements are carried over the mucous membrane of the inferior, middle and superior tubinated bodies, pharynx, septum and floor of nose. From 3 to 6 pledgets of cotton are necessary in each nostril in order to cleanse. The mucous membrane after the massage looks pink and clean, and there is a feeling of relief. Immediately afterward some such application as 10 per cent, lodoglycerine may be made. Applications are to be made daily. (Bp.) Electrolysis: Claims have been asserted for a large percentage of cures with bi-polar electrolysis. 20 milliamperes for 20 minutes at each sitting, cop- per needles being inserted into the submucous tis- sues. (T., 98.) Sea bathing is often of great benefit, both from its local and constitutional effect; residence by sea is also beneficial. HYPERTROPHIC RHINITIS. In the earlier stages spray applications will be found of great benefit, and will often arrest the prog- ress of the disease ; they must be applied with care and thoroughness under the fullest illumination and RHINITIS. 537 inspection. A large number of formulae have been suggested, of which the following may be mentioned : #. Fid. Ext. Hamamelidis Destill., Aq. Rosse, aa gij. M. (Bn.) ty. Acid. Carbolic!, gr. iij. Sod. Bicarbonatis, gr. xij. Sod. Boratis, gr. xxx. Glycerini, 5 s8 - Aquae, ad gvj. M. (Bos.) Acid. Borici: Gr. x-3j. Zinc. Sulpho-Carbolate: Gr. ij j. Resorcin: Gr. v 3J. Petroleum preparations, such as Albolene, Ben- zoninal, Glycolene, etc., may be substituted for aqueous solutions when there is great irritability. Various remedies may be combined with these oils with good effect, the most useful being Oil of Euca- lyptus, Oil of Sassafras, Oil of 'Pine Needles, and especialty Menthol, the strength being from 2 to 6 grains to the ounce of the petroleum base. (Bn.) Iodine: In cases of moderate fibrous thickening applications to the turbinated bones are valuable. Solutions of the crystals, 10 grains, with potassium iodide, 40 grains, to glycerine, 1 ounce or from 2 to 5 drachms of the tincture, with enough glycerine to make 1 ounce. An applicator covered with cotton should be used. (Bn.) When the above line of treatment, combined with proper hygiene and internal remedies, has proved ineffective and more energetic measures are required, the following should receive consideration : Chromic Acid: Soft and vascular enlargements 538 DIGEST OF EXTERNAL THERAPEUTICS. are best removed by this agent, not used as a general escharotic, but according to the following manner : First apply cocaine, 5 per cent, solution, to con- tract and anaesthetize the parts to be operated upon. This may be done by inserting small pledgets of cot- ton, saturated with the cocaine, between the septum and turbinates, allowing them to remain five to ten minutes ; the chromic acid is now to be applied, us- ing it on the end of a small probe in the form of a iused bead or a few crystals on a tightly wound strip of moistened cotton. The application is made to the point of greatest hypertrophy, and should be kept applied about fifteen or twenty seconds. After this the mass should be sprayed with an alkaline solution, such as Dobell's. The cauterizations should be repeated at intervals of seven to twelve days until physiological respiration is attained. In the inter- vals sedative sprays should be applied. (Bn.) Another method of applying chromic acid is to in- cise the mucosa, separate it from the erectile tissue by means of a flat probe or spatula, and then insert a probe with the fused acid on its tip. (T., 98.) Trichloracetic Acid: Has been strongly advised. An aluminum rod, with a hollow in its distal ex- tremity in which a few dry crystals are placed, is used. Applications are made in the same manner as with chromic acid. It is claimed there is little or no inflammationy, reaction, and the eschar is dry and aseptic. (Bn.) Galvano -Cautery: When decided fibro-elastic changes have taken place, more energetic treatment is required ; for these conditions the galvano-cautery is the best method ; with it there is no reaction, and no difficulty in limiting the amount of destruction. RHINITIS. 539 The application may be repeated every three or four days, or as soon as the eschar has disappeared. (Bos.) The Snare or Electric Trephine (Whiting) are methods to be preferred for the reduction of hyper- trophy of the turbinated bones. Septal hypertrophies are best treated with the Saw, Dull Chisel, or Knife. (Iv.) When fibro-elastic changes have progressed so far that much of the turbinated tissue has become tendi- nous in structure the outlook for cure is unfavorable, though much can be accomplished in securing com- fort and arresting the progress of disease. The use of alterative sprays, such as those agents mentioned under Chronic Rhinitis, especially solutions of Thy- mol, Zinc Iodide, and Zinc Sulpho-Carbolate, are of great value. The} 1 " must be applied at first daily and toward the end of four to fourteen months' treat- ment once a fortnight. The Snare or Curette should be used in this stage to remove myxomatous and papillomatous tissue. (Bn.) Faradism : Valuable in the advanced stages, us- ing a straight nasal electrode, long enough to reach the pharyngeal wall when introduced through the nostril. The current should be carefully applied. General hygienic measures are of great importance. Riding, bicycling, regular and frequent bathing, daily sponging face, neck, and chest with cold water will be found of benefit. Forcible efforts to clear the nos- trils are to be avoided, as they increase the general irritation. The matter of clothing should receive attention, care being observed that it is sufficiently warm for 540 DIGEST OF EXTERNAL THERAPEUTICS. the season. "Catching cold" should be carefully guarded against. RING WORM. See Trichophytosis. SCABIES. Before attempting any of the various methods of treatment, the condition of the patient's skin must be considered. If highly irritated or covered with an inflamed eruption, it must be treated with Bran Baths, soothing ointments, such as Zinc Oxide or Bismuth Subnitrate, in the proportion of 1 drachm to 1 ounce of Ung. Aq. Rosse. A soon as the skin is in condition one of the following methods may be employed (B. H.): Sulphur; A time-honored and effective remedy is used in various forms and combinations. An oint- ment of 2 drachms to the ounce is recommended by Kippax, applied in the following manner: The pa- tient first takes a hot bath with plenty of soap, then the ointment is rubbed in thoroughly over the whole body, and allowed to remain on over night; in the morning another hot soap and water bath should be taken ; the same programme is followed every night until every trace of itching has disappeared. In the majoritv of instances three davs will effect a cure. (Kp.) SCABIES. 541 Fournier recommends for private practice a prelim- inary rubbing with good toilet soap ; then the appli- cation of Bourguignon's ointment, "which is as fol- lows: Glycerine, 200 parts. Gum Tragacanth, 5 parts. Sublimated Sulphur, 100 parts. Carbonate of Potassium, 35 parts. Oil of Lavender, ^ Oil of Peppermint, Oil of Cloves, each '# P arts " Oil of Cinnamon, This is followed by baths and powders of corn starch. It is contra-indicated in adults when much excoriation is present, and should never be applied in the case of children. The following method is that of Bazin and Hardy ; it is recommended as highly effective if the patient is an adult and the skin is not over-sensitive ; it is di- vided into three stages : 1. Patient scrubs and washes himself in lukewarm water with green soap all over, except face and head, for twenty minutes. 2. Patient then soakes in a lukewarm bath for twenty minutes. 3. Rub all over body for twenty minutes, except head and face, paying special attention to the part covered with the eruption, the following ointment known as Hardy's modification of Helmerich's pomade : $fc. Potass. Carbonatis, 3J. Sulphur. Praecipitati, sjij. Adipis, 3 i ss - M. 542 DIGEST OF EXTERNAL THERAPEUTICS. The ointment is allowed to remain on the surface for twenty-four hours. It should be so prepared as not to contain any undissolved particles of the pot- ash. A bath is now given, and the skin, \vhere ex- coriated, is dressed with zinc oxide, 1 drachm, ben- zoin ointment, 1 ounce, and a little starch dusted on. This, it is said, rarely fails to eradicate the disease. The application may be repeated once or twice if necessary. If any irritation of the skin remains, ad- minister bran baths for a week or so. (B. H.) Wilkinson's ointment, modified as follows : #. Sulphur. Sublimati, Ol. Cadini, aa %ss. Cretse Praeparatatse, giiss. Sapo. Viridis, Adipis. aa ^j. M. This is only fit for hospital use, as it is most dis- agreeable, though effective. (Ja.) ,3-Naphthol: Recommended in 10 per cent, oint- ments, or in the following combination : #. y3-Naphtholi, gr. Ixxx. Saponis Viridis, 3 s 8 - Pulv. Cretae Albae, gr. j. Adipis,, 3J. Sig. Apply every morning for five or six days and adminis- ter a bath every second day. (Kap. ) M. It is well adapted to cure the eczemas which often accompany this affection. Van Harlingen says that he has used for years one or the other of the follow- ing formulae exclusively for this affection, viz.: #. Pulv. Naphtholi, 3J. Ung. Adipis, gj. M. SCABIES. 543 I*. Pulv. Naphtholi, Saponis Viridis, 3\ r . Pulv. Cretse Albse, 3 j. Axungise, J5 X - M. The latter is adapted for coarse skins : Balsam Peru :* Is recommended for young chil- dren and infants, and for feeble patients with second- ary eruptions. For children : fy. Balsam. Peruvian!, ^iij. Ichthyoli, sjss. Lanolini, ^ij. Ung. Aq. Rosse, 3iv. Albolini (Liq.), ^ij. M. (T.,98.) J*. Balsam. Peruviani, Sulpliuris, aa 3J. Adipis, gj. M. (B. H.) For adults : 1*. Balsam. Peruviani, jv. ^-Naphtholi, 3J. Adipis, ^vj. M. (T., 97.) The patient is rubbed at night for fifteen to twenty minutes, and sleeps in a nightshirt impregnated with the balsam. The next morning a warm bath, with plenty of soap, is given. It is claimed the vapor of the balsam kills the parasite. Styrax : The use of this remedy within the last * NOTE. The use of balsam of Peru is not wholly without dan- ger, as this agent has been known to cause nephritis. It should not, therefore, be used when there is any kidney lesion present or any tendency in that direction. When applied the urine should be examined at frequent intervals. 544 DIGEST OF EXTERNAL THERAPEUTICS. few years has been revived. The following formulae are recommended as efficient : I*. Liq. Styracis, Jj. Adipis, ^ij. M. Or, #. Styracis, ^j. Spts. Vini Rectificati, ^ij. Ol. Olivse, 3J. M. Sig. Rub the parts thoroughly, and repeat in twenty-four hours. ( And. ) A warm bath should precede the application of the remedy. In one hundred and twenty-four cases thus treated by Unna, albumen appeared in the urine in nine. The treatment, however, was generally suc- cessful. (N.) The following combination with Sulphur is recom- mended as being efficient in six rubbings : &. Sulphur. Sublimati, 3J. Sapo. Viridis, jij. Styracis Liquid. , 3 iss. Cretse Prseparatse , 3 j . Ung. Aq. Rosae, q. s. ad ^j. M. (T.,98.) Oxynaphthoic Acid, powdered chalk and green soap, each 80 grains, with lard to 1 ounce, or Creo- lin 30 grains with lard 1 ounce are said to act very quickly without irritating the skin. All underclothing and bedding must be burned or disinfected. SCARLET FEVER. 545 SCARLET FEVER. High temperature does not require very active treatment unless organic or functional disturbances of the heart or brain are threatened ; as long as these two organs perform their functions naturally, the temperature may be let alone. Baths: For high temperature and non-appearance of eruption : If in thirty-six hours the eruption does not de- velop, place the patient in a water bath at 100 for ten minutes. If there is no appearace of eruption, repeat it three or four hours. If the second bath has no effect, and especially if the temperature remains high (above 104.5), and the patient is becoming drowsy, a cool bath at a temperature of 80 must be administered, cooling the water gradually down to 65. The low temperature is indicated if the fever does not fall. If the cool bath fails, or if in spite of reducing the temperature the cerebral symptoms re- main, dash the face and upper part of trunk with water at 50 to 60. For this purpose the patient may be placed upon a rubber sheet, and, if conveni- ent, a small hose, with attachments to both the hot and cold water spigots, so that the temperature can be regulated, may be played upon the patient. The value of this treatment is not alone for the reduction of temperature, but for its stimulating effects upon the depressed nerve centres. It must be administered with judgment and care, and not employed unless the temperature is 105, and so persists, with increas- ing severity of cerebral symptoms. (Gn.) 36 546 DIGEST OF EXTERNAL THERAPEUTICS. In malignant scarlet fever with hyperpyrexia, cold baths must be used freely, for unless the temperature goes down the patient may die in a few hours. Cold Packs: Are invaluable, especially at the onset of the disease, when the eruption does not appear and the temperature is high (Rd.) ; they are also in- dicated in septic forms and those marked by per- manent cerebral symptoms. (Hit.) The packs may be repeated several times at intervals of an hour as long as the fever remains high. They may take the place of cold baths, which are not approved of by some writers. Holt regards cold packs as superior to medicinal antipyretics, and as almost as effective as the bath ; they are also much easier to administer and less likely to excite opposi- tion on the part of the friends. Mustard Baths: Of great service when there is retrocession of the eruption. Use a drachm to the gallon. (Al.) Sponging: With cool or tepid water is useful in many cases when the temperature is high, and the pulse frequent and feeble. (Jac. ) Hot Baths: Indicated when the surface and ex- tremities are cold, pulse frequent and filiform. Strong friction should be applied in conjunction with the baths. (Jac.) Warm Baths: At a temperature of 95 were ad- ministered in 110 cases twice a day. Nephritis did not occur and desquamation was mild. (T., 98.) Hot Water Enemata: May be employed in the same conditions calling for hot baths. (Jac.) Cold to the Throat: Often very comforting and effective in allying glandular inflammation. Little SCARLET FEVER. 547 rubber bags of ice, or ice wrapped in dry cloths, may be used. (Ty.) Anointing the Body with Oils : This constitutes a useful adjuvant in allaying irritation of the skin, and in preventing the scales from flying about during the stage of desquamation. Suet, sweet oil, vaseline, or cocoa butter may be used for this purpose, the latter being preferable. Oil of Eucalyptus: Remarkable results are re- ported from the use of this remedy; the body was carefully rubbed all over with the oil three times a day for three days ; then a bath was administered, followed by another anointing with the oil. Euca- lyptus was also sprayed into the patient's mouth, nose and throat, and into the atmosphere of the room. (Sj.) The following is also commended for smearing on the skin after a warm bath : Jjfc. Acid. Carbolici, 3J. Ol. Eucalypti, gij-iv. Ol. Amygdalae, Ol. Olivse, aa ^viij. M. (T.,96.) Ichthyol : A 5 per cent, lanolin ointment is useful, when simple oily applications have failed, for severe irritation of the skin which appears to cause restless- ness and high temperature. (T., 96.) For the cleansing and disinfection of mouth, pharynx, and nares, the following solutions are used, of which the first is preferred : Hydrogen Peroxide, 1-3. Mercuric Bichloride, 1-10,000. Carbolic Acid, 1-60. Liq. Sod. Chlorinatae, 1-10. 548 DIGEST OF EXTERNAL THERAPEUTICS. Boric Acid, 1-15. Potass. Permang., 1-250. Sulphurous Acid, 1-10. Cleansing the nares and naso-pharynx may, it is said, prevent extension of suppuration to the eusta- chian tube. The nostrils should be sprayed with an alkaline solution and then with the following : P. Mentholi, gr. xx. Eucalyptoli, M.x. Fid. Paraffini, ad ^j. M. Sig. Apply every 3 or 4 hours. (T., 97.) Hydrogen Peroxide : Should constitute the sole local treatment for the otitis during the stage of in- flammation . ( Gn . ) Caustics may be required if there is much slough- ing of tonsils. First cleanse the parts, then apply such agents as Nitrate of Silver or Chinoline, 2 to 5 per cent, in alcohol. (A. W.) SCIATICA. The remedies mentioned for Neuralgia, Lumbago and Chronic Rheumatism, are applicable to this con- dition. SCORBUTUS. Antiseptic and astringent mouth washes, as found under Stomatitis, are applicable to this condition. Nitrate of Silver: One of the best applications for the ulcers. (Ty.) SEBORRHCEA. 549 Hydrochloric Acid: For applications to the gums, viz.: #. Acid. Hydrochloric., Dilut., 3J. Mellis, Aq. Rosae, aa ^j. M. Sig. Apply to gums three or four times a day. (Sn.) Compresses saturated with Aromatic Vinegar or Spirits of Camphor are very useful for the ecchymosis and infiltration. (Rd.) Turpentine: The undiluted oil painted on the gums hourly will cause the buccal haemorrhage to cease. (F.) SEBORRHCEA. When located on the scalp the scales must be first removed ; this may be accomplished if the scales are hard by soaking the scalp over night in Oil, and re- moving the softened scabs with hot water and Cas- tile soap, or by shampooing with Spirits of Green Soap, using about a drachm with a sponge and con- siderable water ; after rubbing vigorously for a few minutes, cleanse with clear warm water, and dry with a soft towel. If the scalp is sensitive a good toilet soap should be used. After the preliminary cleansing the remedy may be applied, viz.: Captol: Strongly recommended by Eichoff, who employs it in 1 to 2 per cent, alcoholic solutions and in the following combination : 550 DIGEST OF EXTERNAL THERAPEUTICS. #. Captol., Chloral. Hydratis, Acid. Tartarici, aa gr. xvss. Ol. Ricini, gtt. viiss. Spts. Vini (65 per cent.), 3 XXV M.xv. Ess. Flor. Aurant., 3^j M.xlvij. M. Under the influence of this remedy in from eight to fourteen days the scabs and hypersecretion disap- pear and the falling out of the hair ceases. (T., 99.) Carbolic Acid: Most efficient; employ in the fol- lowing combination : #. Acid. Carbolici, 3J-3i ss - Ol. Ricini, 9ij. Ol. Limonis, 3J- Aq. Coloniensis, t ^ij. M. (Vn.) Resorcin: In oil or vaseline, 5 per cent., or, 5fc. Resorcini, gr. xx. Alcoholis, 3ij- Vaselini, 3 V 3- M. (T..97-) Sulphur: Regarded as one of the most satisfac- tory remedies ; a solution of 1 ounce to water, 1 quart, is used applied to the head daily (T., 97.); a solution of 1 drachm in sweet oil 1 ounce, rubbed in the scalp thouroughly nightly for a week, wrapping the head in a towel or wearing a night cap. During the second week the applications are made every other night, and after that reduced in frequency. (Ja.) Vlemingckx's solution, as described in the treatment of Acne Simplex, is suitable for the disease when located on the face. Zinc Sulphide: Duhring recommends the salt ob- SEBORRHCEA. 551 tained by double decomposition in the following lotion : #. Zinc. Sulphatis, Potassii Sulphidi, aa 3 SS - Aq. Rosae, ^iij. Alcoholis, 3"J~ V J- M. (F.) Mercurial Ointments: The following is for use upon the scalp : #. Ung. Hydrarg. Nitratis, 3J-i v - Ol. Cadini, 3J. Ol. Olivse, 3ij. Lanolini, 3iv. M. Well rubbed in at night, and washed off in morning with borax, Jjij, water, Oj; then rub in a little almond oil. The ung. hydrarg. flav. may be used instead of the nitrate, with or without ths oil of cade. (Ck.) An ointment of White Precipitate and Tar is as follows : #. Hydrarg. Ainmoniati, Picis Liquidae, gss. Ung. Petrolii, gj. M. (And.) Bronson recommends for private practice, as a sub- stitute for sulphur, the following : #. Hydrarg. Ammoniati, 9j-ij- Hydrarg. Chloridi Mitis, 9ij-iv. Vaselini, ^j. M. Hydrarg. Bichlorid.: A useful ointment is as fol- lows: 552 DIGEST OF EXTERNAL THERAPEUTICS. ty. Hydrarg. Bichloridi, gr. xij. Spts. Vini Rectificati, 55 j. Glycerin! (Price's), gij. Aq. Destill., ^v. M. (And.) For the face and scalp : #. Hydrarg. Bichloridi, gr. ij. Aq. Rosse, gj. M. (Sh.) Hydrastine: An ointment of this remedy, recom- mended by Shoemaker, as follows : *. Hydrastinae Hydrochloratis, gr. v-xx. Naphtholi, gss. Tr. Quaillaise, ^ss. Tr. Hamamelidis, q. s. ad %iv. M. (Sm.) Salicylic Acid, 3 per cent, in Castor Oil, Solution of Chloral, a drachm to the ounce, Tannic Acid, a drachm to the ounce of rice powder for the face, are other useful applications. (Ja.) (Kp.) For irritation after removal of the scales, a plain dusting powder, viz.: J*. Acid. Salicylici, gr. x. Zinc. Oxidi, Amyli Oryzse vel Maydis, aa 3j j. M. (B. H.) Sig. Used for a few days. For Seborrhoea of the Genitals, absolute cleanli- ness, dusting powders and antiseptic lotions, such as those of Ichthyol and Bichloride of Mercury, are generally indicated. For Seborrhoea Oleosa use Sulphur, which is the most effective, Oil of Cade, Ichthyol or Resorcin in some penetrating medium. Tannic Acid in the pro- SEPTICAEMIA. 553 portion of half a drachm or a drachm to the ounce of vaseline is useful for the disease on the body and scalp. SEPTICAEMIA- PYAEMIA SEPTICO- PY^MIA. In all cases the primary seat of infection should be ascertained, and the most rigid antisepsis applied according to the nature of the lesion. Septic wounds should be laid open by free incisions, scraped with the sharp curette, freely irrigated with hydrogen per- oxide or mercuric bichloride, 1-1000 or 2000, and in some instances cauterized with pure carbolic acid. Free drainage should be established by means of tubes or iodoform gauze. Dressings should be fre- quently changed so that the cavity of the wound can be irrigated. Bichloride gauze may be used for dress- ing until sloughing appears, when antiseptic fomen- tations will be indicated. Punctured wounds must be laid open their entire depth, scraped, cauterized with carbolic acid and packed with iodoform gauze. Inflamed glands may be painted with iodine, and afterwards coated with ichthyol; if suppurating, they should be incised and treated antiseptically. Cellulitis demands multiple incisions, septic cystitis bladder irrigation, and in grave forms suprapubic or perineal section. Puerperal infection calls for irriga- tion with bichloride solutions of 1-2000, and curet- tage of the uterine cavity followed by irrigations of the same solution. In septic peritonitis the chances of recovery will be enhanced by laparotomy and copious irrigations with normal saline solution. In 554 DIGEST OF EXTERNAL THERAPEUTICS. short, pus, wherever located, must be evacuated, and septic infection, wherever seated, must be eradicated. In conjunction with these measures the following have given results which command attention, the cases in which they have been employed were those of the gravest nature where other remedial agents, both local and constitutional, had failed: Antistreptococci Serum: The reports of the re- sults of administration of this remedy in severe cases of septic infection are favorable. Attention is called to the statement of Marmorek, that the action of the serum is limited to those forms of sepsis which arise from the presence of the streptococcus pyogenes, the most common form of septicaemia ; infections due to the staphylococcus, the bacillus coli communis, the gonococcus, and the Talamon-Fraenkel coccus are not amenable to the action of the serum. The rem- edy is given by subcutaneous injection into the are- olar tissue of the lateral abdominal wall. The syringe and skin should previously receive the most thorough sterilization and antisepsis, respectively. The surface should be prepared by washing with an ethereal solution of soap, then washed with bi- chloride, 1-1000, and sprinkled with boric acid. The dose ranges from 30 to 45 c.c. in twenty-four hours. The usual dose is first 15 c.c., and after twelve hours, 10 c.c.; in severe cases 25 c.c. for the first dose, repeated at the end of twenty-four hours. The British Institute of Preventive Medicine recommends 20 c. c. for the initial dose, followed by the same quantity if the temperature does not fall. At present the practitioner must rely upon the instructions which accompany each article of serum. (T., 99.) (B. M.J., 10,31, 96.) SEPTICAEMIA. 555 Collargolum: This is a non-poisonous allotropic silver which is permanently soluble in water and al- buminous fluids, and is an effective general anti- septic which can be introduced into the system with- out causing either local reaction or general poison- ous effects. It remains metallic silver in sterile blood or lymph ; but in the presence of pathogenic bacteria or their toxins it enters into combination, and acts as an antitoxic agent. Introduced into the system by inunction of the ointment, or hypodermically, or by the mouth in capsules, or in solution, or applied locally to wounds, it enters the lymphatics, and cir- culates dissolved in the blood. The faeces frequently become brownish-black, but argyria never occurs. Collargolum is usually best employed in the form of the Unguentum Crede, as an inunction; any sur- face of the body may be selected, preferably the back, buttocks and loins. The single dose for adults is 3 grams (45 grains); for adolescents 2 grams (30 grains); and for children 1 gram (15 grains); to be thoroughly rubbed into the cleansed skin for from twenty to thirty minutes, and not washed off. Three inunctions upon three successive days are re- quired in all cases, and the ointment is to be used subsequently as indicated. The remedy has been successfully employed in pure and mixed forms of infections of staphylococcus and streptococcus and other bacilli. In recent cases it is said to exert a rapid curative action ,and in those of a more chronic nature it is also effective provided it is used before secondary changes in the vital organs have occurred. Very favorable reports of the effects of this agent have been published. It has been em- ployed in conjunction with injections of antistrepto- 556 DIGEST OF EXTERNAL THERAPEUTICS. cocci serum. (N. Y. M. J., 6, 17, 99, a.) (D. M. W., 3, 9, 99.) Saline Solution; Intravenous or subcutaneous in- jections of normal saline have given favorable results in grave forms of infections of all varieties. As it is not likely that the small amount of saline fluid which is introduced into the circulation can produce destruction of the toxins, it is probable that a re- newal of physiological action is induced. Whatever the action, this agent has proved to be a means of saving life. (F.) Strychnia: Hypodermic doses of ^ to 4^ grain every two to four hours will be found one of the most reliable remedies to sustain the heart's action in septic conditions when indications point to reme- dies of this class. (J. C. W.) SHOCK COLLAPSE. Heat: In the form of hot water bags and bottles should always be applied to the extremities and sides. Strychnia: Indicated in all forms of shock. It should be given subcutaneously in full doses, ^ to T V grain. Larger doses have recently been advocated. Dr. J. B. Hall (British Medical Journal, Nov. 25, 1899) reports two cases of severe shock during operation, with impending death, in which Vi grain was injected with successful results. The same writer, while not advocating this amount for routine practice, regards not less than T \, grain as the proper dose when the remedy is indicated. Whiskey or Brandy: May be injected hypodermi- SHOCK COLLAPSE. 557 cally, the latter every ten minutes in half drachm doses until reaction. (A.) Digitalis: 15 minims every fifteen minutes hypo- dermically. Atropine T ^ T grain may be given with the first dose of Digitalis. (A.) Aqua Ammoniac: 10 to 60 drops diluted with from 1 to 8 drachms of sterilized water, injected into a vein, is of great benefit. (F.) Turpentine Enema: Half an ounce rubbed up with raw egg in the form of an emulsion is a power- ful stimulant. (A.) Camphorated Oil: 1 part of camphor to 9 parts of aseptic sweet oil in doses of 15 minims, hypo- dermically, is a prompt and powerful stimulant in cases of sudden prostration. (F.) The following line of treatment is for collapse after a prolonged operation, extensive loss of blood, and shock folio wing severe injuries : Place the patient in such a position that the head will be lower than the body, apply around him hot water bottles and bags, and rub actively; administer hypodermics of Ether or Caffeine. Brandy will be found beneficial; like- wise Champagne by the rectum. For the purpose of stimulating the heart a momentary whiff of Nitrite of Amyl, and for stimulating the respiration, slap the face with a wet towel, also use Laborde's rhyth- matic tractions of the tongue, inhalations of Oxy- gen and Silvester's method of Artificial Respiration. (T., 97.) Normal Saline Solution: By transfusion or sub- cutaneous injection will be found of the greatest ser- vice when haemorrhage is the cause and should be employed in severe cases. Beef Extract: In large doses by enema with hot water acts rapidly. (P.) 558 DIGEST OF EXTERNAL THERAPEUTICS. SIGMOID FLEXURE AND UPPER RECTUM, DISEASES OF. The employment of the Protoscope and Sigmoido- scope is of invaluable service. The ability to recog- nize various lesions in their incipiency, establishing the diagnosis beyond doubt, enables one by the prompt administration of appropriate treatment to attain excellent results. The pictures, as viewed through the proctoscope, are characteristic of neo- plasms, including carcinomata and fibrous and ade- noid polypi, and such non-surgical diseases as simple acute catarrh, hypertrophic catarrh, and atrophic catarrh. In the latter conditions the treatment con- sists chiefly in copious Irrigation with saline or mild antiseptic solutions ; in cases of atrophic catarrh a 5 to 10 per cent, solution of Argonin has been found to be particularly efficient, while in cases of hyper- trophic catarrh the aqueous fluid extract of Kra- meria is regarded as almost a specific. (N. Y. M. J., 2, 7, 98.) SPERMATORRHOEA CHRONIC SEM- INAL VESICULITIS AND AM- PULLITIS.* Sleeping in the dorsal position should, if possible, be avoided, as it is apt to induce pollutions. A *NoTE. This entire article, with the exception of the paragraph on " Stripping of the Seminal Vesicles," is an abstract, by permis- sion, of the treatment of this disorder, as described by Dr. Bukk G. Carleton, in his work on the subject. See Cln. in Reference Key. SIGMOID FLEXURE AND UPPER RECTUM. 559 knotted towel tied around the waist, or a block of wood held in position by tapes and placed in the small of the back, will cause the patient to awaken when he turns. Cold Baths : A general cold bath, preceded by light calisthenics or massage, is often beneficial in hyperaesthesic cases with frequent pollutions. In the later periods, with anaesthesia of the parts, cold sitz baths, cold sprays to the genitals, or cold shower baths, will give good results. Hot Sitz Baths : In the hyperaemic stage baths at a temperature of 105 for ten minutes at bed time are indicated ; after the bath the part should be care- fully dried with a soft towel, avoiding all friction. Steel Sounds: If there is much prostatic irrita- bility the passage of a full-sized steel sound every third day or once a "week is of benefit. It must not, how r ever, be allowed to remain in the canal as ad- vised for urethral dilatation, as unpleasant symp- toms may be caused. Stripping the Seminal Vesicles: This method is intended to reestablish the natural expulsive power of the seminal vesicles and ampullae by the removal of inflammatory deposits. Fuller, who originated this plan of treatment, described it as follows : " The patient, whose bladder must be full, is directed, while standing with the knees straight, to bend the body forward at right angles; the operator now intro- duces the forefinger of one hand into the rectum, while with the other firm counter pressure is made over the pubes. The end of the forefinger will, in all ordinary cases, reach beyond the posterior margin of the prostate, and the bodies of the vesicles can be de- tected, one on each side of the posterior border of the 560 DIGEST OF EXTERNAL THERAPEUTICS. gland. Only the lower half can be felt in ordinary in- stances. Firm pressure is made by the tip of the index finger, reaching as far back as possible. The finger tip should be slowly and firmly drawn along the line of the vesicle, the manoeuvre being aided at the same time by counter-pressure over the pubes. The procedure may be performed several times on each vesicle. In this manner if the sac is distended some of the contents can be pressed into the pros- tatic sinus. After the manipulation, the urine should be voided in order to ascertain how much has been expressed. This treatment should not be repeated more frequently than once in four days. If applied too often, or with too firm pressure, active symp- toms may be induced, even causing acute epididy- mitis. (Ful.) The finger of the operator should be protected by a rubber tip. Evidence of inflamma- tion, the presence of pus in the urine voided after manipulation or increase of tenderness are contra- indications. Rectal Psychophore: Excellent results are ob- tained in the same class of cases that call for the pre- ceding method. Ice water, or alternating hot and cold water, should be used by means of Carleton's psychophore. The psychophore, alternated every fifth day with Fuller's method, will give very satis- factory results. Intra-Vesical Douches: These are indicated for hyperasmia or catarrh of the posterior urethra or when the bladder is involved to any extent. Valen- tine's modification of Janet's method may be used, or preferably a No. 12 F. catheter, sterilized, may be introduced into the bladder after the urine is evacu- ated, and 4- to 6 ounces of an antiseptic fluid injected SPERMATORRHOEA. 561 with Janet's antiseptic syringe. As soon as there is a sensation of fullness the catheter should be with- drawn and the bladder emptied. The antiseptic solu- tions which act favorably, are Formalin, 1-1000- 10,000; Bichloride of Mercury, 1-12,000-20,000; Nitrate of Silver, 1-2000-8000; Potass. Permang., 1-2000-10,000. Bladder irrigations should be ad- ministered after manipulations of the ampullae, never before. Deep Urethral Douches: Are of service for pos- terior urethral irritation. Janet's antiseptic vesical syringe, or an ordinary fountain syringe, attached to a catheter, may be used, injecting from a few ounces to a pint of the selected solution every one to four days. The solutions for this purpose are : Nitrate of Silver, 1-500-1000. Formalin, 1-1000. Thalline Sulphate, 1-40-100. lodoform Emulsion, 5 per cent. Instillations: Often of advantage; they sometimes act best when the applications are made through a soft rubber catheter, cut to 8}4 inches in length, so that the eye of the catheter when fully introduced will be located in the centre of the prostatic urethra ; then with a Taylor's minim syringe from 10 minims to a drachm of the selected solution can be intro- duced without pain or injury. The action of the compressor urethra muscle will prevent the flow of the solution from and into the urethra and tend to cause it to pass backward into the bladder. The Keyes-Ultzmann syringe should be employed for stronger instillations. The bladder should be quite full at the time in order to subsequently dilute the 37 562 DIGEST OF EXTERNAL THERAPEUTICS. solution by the passage of the urine through the urethra. The following strong solutions are recommended : Nitrate of Silver, 1 to 10 per cent.; Sulphate of Cop- per, 10 per cent.; Tr. Iodine, Carbolic Acid, Borogly- ceride, equal parts. When these are employed commence with one of one-tenth the strength of that which it is intended to finally administer ; at the first application apply 10 minims and gradually increase the strength at each sitting, repeating the application every fourth day until the desired strength or satisfactory results have been obtained. In making instillations of weak solutions the blad- der should be emptied and the solution placed in the posterior portion of the urethra, allowed to flow back into the bladder and then voided, thus afford- ing a double application. The weaker solution for instillations are those which may be also employed for irrigation, viz.: Nitrate of Silver, 1-2000-8000. Potass. Permang., 1-1000-10,000. Mercuric Bichloride, 1-10,000. Zinc Sulpho-Carbolate, 1-1000-3000. Carbolic Acid, 1-100-500. If urethral instillations cause too much reaction they must be reduced in strength, preceded by Co- caine, or discontinued. When nitrate of silver solu- tions cause pain it may be relieved by douches of sodium chloride. Urethral Psychophore : With water at 40 to 50, may be applied for five or ten minutes everyday, or every third day. This is indicated when there is hyperaesthesia of the posterior urethra, with or SPERMATORRHOEA. 563 without impotence, especially when the urethral dis- charge is free from pus. When there is anaesthesia and loss of tone hot water at a temperature of 105 to 110 ma3 r be employed with good effect. A psy- chophore of sufficient size to fill the urethra should be used and placed in such a position that its three distal inches come in exact relation -with the local lesion, the remainder of the instrument not trans- mitting either heat or cold. Dilatation of the Prostatic Urethra: Diseased con- ditions in this part may necessitate this procedure in order to empty the follicles of the prostate. A pros- tatic dilator should be used. Carleton's instrument for this purpose will afford very satisfactory results. When it is desired to dilate the bulbous urethra at the same time Kollmann's antero-posterior dilators will answer well. Prostatic dilatations should al- ways be preceded by urethral irrigation and fol- lowed by douching of the bladder. It should not be repeated more frequently than once in ten days. Ichthyol Suppositories: Recommended for the absorption of inflammatory products in the pros- tatic and periprostatic tissues. Electricity : Faradism has good effects ; the brush may be applied to the genitalia, or King's rectal elec- trode may be employed. Galvanism may be used by applying the positive pole to the lumbar or sacral region and the negative to the parts by means of the ordinary electrode ap- plied externally, or the conical steel sound. In hy- perasmic conditions of the urethra the ordinary sound forms an excellent electrode. A current of one or two milliamperes may be administered for not longer than one or two minutes. Newman's sound 564 DIGEST OF EXTERNAL THERAPEUTICS. will be required when the general condition of the urethra is relieved, but hyperaesthesic spots remain; under these conditions three milliamperes may be given. Outdoor exercises and sports are generally advis- able. Bicj^cling, however, should be under medical supervision ; a properly constructed saddle, that is, one which does not permit pressure on the perineum, is essential. Over-fatigue must be avoided and the erect posture maintained in riding. Horseback rid- ing is not to be permitted. General massage will often be found of benefit. SPRAINS. Heat and Cold: In regard to the use of these agents, in which there appears to be some diversity of opinion, the following indications are given by Mr. Tubby (Practitioner, April, 1897) : If the injury is seen within the first two or three hours apply cold vigorously by pouring on cold water or by the use of ice or spirit lotions ; this should be kept up for ten or fifteen minutes; then wrap the limb in lint soaked in cold water or spirit lotion, place it in a proper position and firmly band- age. If seen later hot applications should be fre- quently made, either hot water or hot vinegar and salt. Keep the joint at rest and maintain steady pressure with bandages. Before this, especially if there is much swelling, use friction, the object of which is to empty the lymphatics of a certain amount of coagulated lymph. In rubbing it is al- ways advisable to commence at the part most dis- SPRAINS. 565 tant from the joint, thus emptying the lymphatics in that locality first. Not a few writers advocate the immediate use of hot applications as soon as the in- jury is seen. Rubber Bandage and Hot Water: The following plan is recommended for .the relief of pain : Immerse the part in hot water, increasing the temperature until the patient becomes accustomed to the heat and the pain becomes less. The next step is the ap- plication of a rubber bandage, which is to be applied immediately after the discontinuance of the hot water. If there is laceration of ligaments, or contu- sion of the parts, a wet compress may be applied, over which the bandage is placed. This may be left on for twenty-four hours. In injuries of the knee it may be kept applied for several days. It should be put on hot and changed several times a day. If the skin becomes thickened or white as from a poultice omit the compress. The bandage, however, must be worn constantly, and the compress reapplied should pain follow its removal. (Hel.) Aspiration: In severe injuries when there is much enlargement, and a great amount of blood has poured into the joint; it should be removed with the aspirating needle under careful antisepsis. (A.) Strapping The method of Gibney and Cotterell is recommended both in early and late stages, viz.: For sprain of tarsus and ankle, take strips of plaster one and a half inches wide, and eighteen long; the first strip starts at the juncture of the middle and upper third of the leg, outer or inner side; apply close to the tend o- Achilles, carrying it across the sole of the foot to the base of the great or little toe ; several strips are applied, covering the 566 DIGEST OF EXTERNAL THERAPEUTICS. inner or outer side of the ankle. A strip is then ap- plied with its middle at the point of the heel. The ends come to a point on the foot at the junction of the metatarsal bone and tarsus. A number of these ascending strips are applied in an imbricating manner until the entire joint is covered. These strips should be applied so as to meet in front of the ankle and make circular constriction. After strapping apply a bandage, and the patient is allowed to walk. (W. C.) This method is now much used, being highly en- dorsed. Splints and Plaster of Paris : In severe sprains re- duce misplaced tendons, apply hot or cold water, and later apply splints or plaster of Paris as in frac- tures. After wearing these for a time they should be removed and massage employed. (W. C.) Bandaging : Should be used in all forms unless plaster or splints are employed. Usually sufficient in mild cases after applying compresses or lotions. (W. C.) Compression: Wrapping the joint in plenty of cotton and bandaging somewhat firmly, -will often prove effective. ( A. ) Arnica: Very useful ; the tincture of the root is to be preferred, 1 part to about 5 of water; apply with compress and bandage. Lead and Opium Wash: A remedy of great effi- cacy. The formula is as follows : #. Tinct. Opii, I/iq. Plumbi Subacetat. Dil., aa ij. Aquae, q. s. ad Oj. M. Sig. Saturate a compress, squeeze out excess, and apply over all a roller bandage. SPRAINS. 567 Massage: Excellent results have been obtained in all forms of sprains and contusions, and in the in- juries of the soft parts consequent upon dislocations. Applications may be made immediately or very soon after the injury. Dr. J. Robie Wood recommends that in sprains of the ankle the part be placed in hot water, and at the same time massed with an up- ward movement ; then adhesive strips, according to the method of Gibney and Cotterell, are to be ap- plied. Massage is also of great efficacy after the subsidence of acute symptoms, when much stiffness, pain and loss of power remain, constituting in this condition the most important measure for the restoration of the limb. Ammonia: The following combinations form use- ful liniments : #. Aq. Ammoniae, Fid. Ext. Arnicae, Lin. Saponis, Ol. Terebinthinae, aa ^ij- M. Sig. Rub in several times a day. I*. Lin. Ammoniae, gij. Spts. Chloroformi, gj. Lin. Mentholi, ij. Tr. Opii, gj. M. Sig. Rub well over the surface. (Sm. ) Hamamelis: The aqueous extract, somewhat di- luted with water, forms a most useful remedy ; apply with compresses, and cover with rubber protectors. Ichthyol: Applied with friction and massage is said to sometimes give satisfactory results. (Sm.) Alcohol: Equal parts with water, forms a useful evaporating lotion. (N.) 568 DIGEST OF EXTERNAL THERAPEUTICS. Tr. Rhus Tox. or Tr. Rutta, diluted, may be used with good effect after hot \vater applications. (Rd.) The various liniments, viz.: Aconite, Belladonna, Camphor, Chloroform, Soap, and Turpentine are all of use. STRANGURY. Electro-Static Current to the spine and hypogas- trium has been very effective. Warm Sitz Baths, Hot Fomentations to the perineum. Suppositories containing Opium, Belladonna or Hyoscyamus. (Cl.) STRICTURE, SPASMODIC. Hot Sitz Baths and Hot Fomentations, if not re- lieved, use the Catheter. When this is not possible, anaesthetize and use catheter, or Aspirate to give im- mediate relief, assuring the patient that the next urination will be normal. (Cl.) Morphia, hypo- dermically, may be necessary. STOMATITIS. The treatment of the different varieties of this dis- ease resemble each other so closely that they will be considered collectively. Particular attention should be directed toward securing an aseptic condition of all which comes in contact with the mucous mem- STOMATITIS. 569 brane of the mouth. Every means should be em- ployed to prevent infection. Nurses should exercise care in cleansing the infant's mouth, and avoid wounding the mucous membrane. In health anti- septic mouth washes are not necessary, but steril- ized water should be used for cleansing. Gentle fric- tion with a soft cloth is advised in thrush for the removal of the exudate in order to permit of the more perfect action of local remedies ; alkaline solu- tions effect this purpose also. (Gn.) Boric Acid or Borax: 1 to 3 per cent., or stronger solutions, constitute the most frequently employed and generally effective remedies in cases of the ca- tarrhal, aphthous, and membranous (Thrush) variety. (Hit.) Borax with honey or glycerine is used. (Rd.) Potass. Chlorate: 33, to water, giv, is one of the best local remedies for general use. (B.) In the fol- licular and ulcerous variety its topical effect may be obtained by giving it internally, and not allowing the patient to swallow any water for some little time after. The dose is a drachm hourly of a solu- tion of 8 grains to 5 ounces of glycerine and water. (Jac.) Nitrate of Silver : 1-1000 or 500, may be brushed on in the catarrhal forms when the tongue and mucous membrane are dry. In the aphthous va- riety, when there is a tendency to superficial ulcera- tion, a solution of 1-50 may be applied gently. Weaker solutions, as 1-500, applied daily are ser- viceable in Bednar's aphthae and thrush. (Jac.) Potass. Permang.: When a stronger disinfectant is required, solutions of 1-250 or 500 four or five applications daily. (Jac.) 570 DIGEST OF EXTERNAL THERAPEUTICS. Alum : Local applications of solutions constitute one of the most reliable remedies in relaxed condi- tions of the mucous membrane. The use should not be prolonged on account of destructive action on teeth. (Al.) The powders or a solution 3ss, water, ^j, are used. (Ty.) Sulphurous Acid: Strong or diluted, as a spray. Bismuth Subnitrate : As a dusting powder di- rectly to the ulcers, or 3] to glycerine j. Tr. Hydrastis: 31], glycerine 31). Carbolic Acid; 1 per cent, solution, as a mouth wash, or the pure acid to ulcers as an anaesthetic and cauterant. Naphthalin: 5 to 10 per cent, as a dusting pow- der. Labarraque's Solution in the following: #. Liq. Sodii Chlorinatae, Tinct. Myrrh.se, aa 5 s8 - Aq. Rosas, 3j. Aq. Destill., ^vj. M. (Al.) Pyoktanin Blue: 1-500. Sodium Salicylate : ^iss, rose water 3y. Tannin: Especially when the gums are spongy, 3J, with aq. rosae gij, aq. destill. 3vj. Sodium Sulphite: 3], water sj. Tr. Iron and Glycerine: Equal parts, painted on ulcerations forms a good application. Myrrh : 3J, water gvj, a little boric acid, borax, or a few drops of carbolic acid or thymol may be added with good effect. Lemon Juice: Properly diluted, forms an agree- able mouth wash. Resorcin: As a dusting powder. SUNSTROKE. 571 Copper Sulphate: Gr. x, water j in chronic re- current forms; the ulcers may be touched with the pure crystals. Hydrochloric Acid: Gtt. v., glycerine gss. Baptisia: The decoction as a mouth wash. MERCURIAL STOMATITIS. The local treatment of this condition does not ma- terially differ from that of other forms. The reader is, therefore, referred to the previous article. The remedies to which preference should be given are Chlorate of Potassium, Alum, Myrrh, Tannin and Labarraque's Solution. SUNSTROKE PROSTRATION BY HEAT. Cold Baths and Affusions: Severe cases with high temperature should be treated with ice baths, plac- ing the patient in a tub of water \vith ice floating in it, the bath being at a temperature of about 44. When baths are not convenient or deemed expedient, strip the patient, place ice on his head, and pour cold water over body. Care should be taken not to re- duce temperature too fast or too low ; a temperature of 102 should be a signal for the withdrawal of cold. After the bath or cold affusion the patient should be dried, removed to a cot, an ice cap placed on the head and the body lightly covered. He should be allowed to rest until exacerbation indicates the need for a renewal of cold applications. (An.) 572 DIGEST OF EXTERNAL THERAPEUTICS. Cold Water Enteroclysis: Useful in extreme cases when temperature remains very high; administer about 2 quarts as often as required. (Sj.) Quinine: It is claimed by physicians residing in the East Indies that the mortality from heat apo- plexy has been reduced more than 50 per cent, by the administration of this remedy. The sulphate may be given hypodermically in several injections of 1^ grains each. (N.) A formula for hypodermic use is as follows : fy. Quin. Sulphatis, 9iv. Acid. Sulphuric. Dilut., 3" ss - Acid. Carbolici Pur., gr. ij. Aq. Destill., q. s. ad ,^j. M. Sig. Dose M. x-xxx=gr. iij-x. Another form for hypodermic injection is the double salt of quinine and urea, Quiniae Hydro- chloras Carbamidata, a formula for which for sub- cutaneous administration is as follows : #. Quin. Hydrochlorat. Carbamidatae, 3ij- Div. in chart. No. xxiv. Sig. Dose i or 2 powders=gr. v-x in 30 minims of distilled water. (Sm.) Counter- Irritation: To the nape of the neck when there is evidence of meningeal irritability. (Sj.) Morphia: Subcutaneously, is of benefit in cases characterized by pallor of the face and weakness of the heart, that is, heat exhaustion. (B.) Ether first, then CafFein, hypodermically, for col- lapse. (Sj.) Venesection : May be indicated in apoplectical cases. (An.) SYCOSIS COCCOGENICA. 573 Hot Baths: If after reduction of the fever diapho- resis does not occur a bath may be administered, and possibly a hypodermic of Pilocarpine in urgent cases. (An.) ' Artificial Respiration: Should be employed when there is collapse, and kept up until other measures have had time to act. (An.) SYCOSIS COCCOGENICA. Treatment \vill vary according to the stage of the disease. When acute, emollient and soothing appli- cations will be indicated, together with cutting the hair as short as possible and the removal of scales and crusts by means of oils and fomentations. Ammoniated Mercury: When papules are begin- ning to appear 2 parts of the ointment with 1 of vaseline are sometimes effective in arresting the progress of the disease. (Ck.) Shaving : There is some divergence of opinion in regard to the utility of this measure ; some writers, while admitting that it enables the remedy to reach the skin with greater ease, claim that it tends to spread the infection ; it is moreover painful to many. On the other hand, some dermatologists insist that it is essential to successful treatment, advising it every second or third day. When done for the first time, the hair should be clipped close and a poultice applied to soften the crusts. The lather from a car- bolic shaving stick applied and left on skin over night, is, according to Crocker, a useful adjunct. Poultices: If there is much oedema and severe in- 574- DIGEST OF EXTERNAL THERAPEUTICS. flammation, warm fomentations will prove of bene- fit; in some cases, however, cold starch poultices give better results. Qa.) A poultice made with bread and dilute lead water, applied cold, is recom- mended in preparing the face for shaving. Epilation: When there are pustulations and the beard can not be shaved, each affected hair must be pulled out and the follicles cleansed with a \veak antiseptic lotion, and an ointment of resorcin or sublimate applied. This measure should only be used when the roots of the hair are loosened. (Ck.) Lotio Nigra : Of service when the disease is acute, and there is much pain and swelling. It may be ap- plied every two or three hours, followed each time by Oxide of Zinc Ointment, applied by means of the finger, or spread upon pieces of linen, and bound upon the parts. (Sh.) Bichloride of Mercury: A lotion of 2 grains to the ounce of water after epilati on . ( Rd . ) Lead Water and Laudanum, weak solutions of Witch Hazel, Zinc, and Lead Acetate form useful, sedative and astringent lotions for the reduction of swelling and inflammation. (Sh.) The following wash is also of service in the acute stage : fy. Pulv. Zinc. Carb. Psecipitati, Pulv. Zinc. Oxidi, Glycerini, Liq. Plumbi Subacetat. Dil., aa ^ij. Aq. Rosae, ^viiss. M. (Vn.) Oils: When there is a good deal of crusting, these preparations are indicated, viz.: Oil of Ergot, Olive Oil with fluid Mercury Oleate, or Cod Liver Oil alone SYCOSIS COCCOGENICA. 575 or combined with Arrowroot, Zinc or Lead Carbon- ate, Opium, Arnica, or Belladonna lightly penciled over the surface. (Sh.) Salicylic Acid: 2 per cent, solutions in olive oil excellent for softening the crusts ; apply for a day and a night, then wash with soap and water. This may also be applied at night to prevent drying when lotions are used during the day. An ointment of 10 to 15 grains to the ounce of Lassar's paste forms a stimulating application indicated when there is pus- tulation. (B. H.) Lassar's Paste, Zinc Ointment, or Cold Cream, preceded by Hot Water, sopped on for five or ten minutes twice a day, constitute excellent soothing remedies for the acute stage, especially when the face is shaved. The following are also useful applica- tions after shaving : P. Zinc. Oxidi, Zinc. Carbonatis, aa 3J. Ung. Aq. Rosae, ad gj. M. Or, 1*. Zinc. Oxidi, 3J. 01. Lini, gj. M. (Ja.) Ointments: Among the most serviceable in earlier stages are : Zinc, Lead, and Bismuth Oleates (alone or combined with other agents) ; Calomel, 10 grains to the ounce of cold cream or rose ointment. Resorcin, Ichthyol, or Boric Acid may also be brought into requisition. (Sh.) Diachylon Ointment: Is excellent in the acute forms ; a few grains of Camphor may be added. (Sh.) 576 DIGEST OF EXTERNAL THERAPEUTICS. It may also be advantageously combined with other remedies, as Oil of Cade, half a drachm to the ounce, when the disease has become chronic and requires stimulation. (B. H.) Provan's Tragacanth Paste: Recommended by McCall Anderson, is as follows : fy. Tragacanthse, 3 ss. Glycerini, 533. Sodii Boratis, 3 SS - Aq. Destill., q. s. M. The following combinations are useful : #. Pulv. Phytolaccae Rad., 3j. Mentholi, gr. x. I/anolini, Ung. Zinc. Oxidi, aa ^ss. M. (Sh.) Also: #. Acid. Carbolic!, gr. v. Bismuth. Subnitratis, 333. Ung. Hydrarg. Ammoniati, gij. Ung. Aq. Rosse, 3v. M. (T. C., Vol. V.) Mercurial Ointments: Suitable when stronger preparations are demanded. They may be used when the eruption is confined to one or two points, and in subacute and chronic cases. Combined, as in the following, with Sulphur, they are effective: #. Hydrarg. Sulph. Rub., ^ss. Sulphur. Sublimati, ^iss. Adipis, ^ iv 3 vss. M. (Ja.) Sulphur: Useful when disease becomes more SYCOSIS COCCOGENICA. 577 chronic, and inflammation is less. The following wash is for subacute cases, and sometimes succeeds when other remedies fail : I*. Sulphur. Praecipitati, gij. Pulv. Camphorge, gr. x. Pulv. Tragacanthse, J}j. Aq. Calcis, ^iv. M. (Vn.) Pyrogallol : A 2 per cent, solution in alcohol painted on the affected part twice a day and the ap- plication at night of the following ointment is rec- ommended by Viell : 5fc. Sulphur. L,actis, Alcoholis, Aq. Rosae, aa ^j. Mucil. Gum. Acaciae, M. xx-xxx. M. /5-Naphthol: Kaposi recommends the following combination to which sulphur may be added as fol- lows: #. ,3-Naphtholi, 3J. Spts. Sapo. Viridis, ^iij 3J- Alcoholis, 3 V J 3ij- Balsam. Peruvian!, gij. Sulphur. Loti, gx. M. (Kap.) Green Soap: When the affection is of long stand- ing, and there is much infiltration, a small portion, rubbed on with a little water, and then washed off, followed by diachylon ointment, is a valuable method of treatment. (Vn.) In addition to the employment of these remedies, it is often of the utmost importance to open the various lesions that may be present, and to puncture 38 578 DIGEST OF EXTERNAL THERAPEUTICS. the surface thoroughly, thus relieving the enlarged and congested blood vessels, allowing stagnated blood to circulate, the effused serum to escape, and preventing the formation of pus. If there is much thickening of skin depletion is followed by decidedly beneficial results. Massage and Static Electricity: Serviceably em- ployed when debility is marked. (Sh.) The rhinitis, which is often present, should be treated with antiseptic douches. After a cure has been effected, the patient should be kept under obser- vation for some time. He should be instructed to bathe the face daily in hot water, and apply some protective ointment. Ointments, when used, should be bound on tightly. SYNOVITIS. ACUTE SYNOVITIS. Rest in the position of greatest comfort; Mild Ex- tension ; Cold application by means of Ice Bags or Leiter's Coil (Tre.); Heat may be substituted for cold if the latter is not agreeable to the patient ; use the hot water bag, or immerse the parts in hot water. (W.) The following is an anodyne ointment; apply twice daily with a brush : j*. Morph. Sulphatis, gr. viij. Ung. Hydrarg. Oleati, 5 per cent., j. M. Lead and Opium "Wash: Applied hot, forms one of the best applications. (Tre.) Alcohol: Diluted with water, equal parts, forms an excellent evaporating lotion. SYNOVITIS. 579 Splints: To keep the parts at rest, should be used in cases arising from traumatism. (Tre.) Aspiration : If there is much tension, with ex- treme pain, and the capsule and ligaments are in danger of being overstretched, to prevent perma- nent damage the joint should be aspirated under complete antisepsis. (W.) Compression: Equal pressure as firm as can be borne, covering the joint with cotton and bandag- ing, is useful after the more acute symptoms have subsided. (A.) Carbolic Acid: In subacute cases, when aspira- tion has failed to relieve, a permanent cure can ordi- narily be effected by injecting through a trocar 2 to 3 drachms of a 5 per cent, solution. (Pk.) Hamamelis or Vinegar are both useful. CHRONIC SYNOVITIS. Compare Chronic Rheuma- tism. Rest of the part is essential. Iodine: The tincture, painted on the joint, has long been used. After its application Ashhurst rec- ommended : fy. Ung. Hydrargyri, Ung. Belladonnse, aa ^j. M. The following is also for painting on the part : I*. lodi, 3 SS - Potass. lodidi, 3J. Aquae, 3 V J- M. (Sn.) Ichthyol; 20 to 50 per cent., in lanolin, rubbed on the joint, which is bound in cloths covered -with the same ointment, is sometimes attended with good results. (M. H.) 580 DIGEST OF EXTERNAL THERAPEUTICS. Mercurial Ointment: Was used by Dupuytren in the form of inuntions, viz.: 5fc. Ung. Hydrargyri, gij. Pulv. Ammon. Chloridi, 5jj. M. (Sn.) Carbolic Acid: An injection of 10 minims of a so- lution of gr. viij, distilled water %j, is used, repeating every third day. (Sn.) Pressure by an Elastic Bandage, Friction, Mass- age, are all of service. (Pk.) Aspiration and Irrigation of the Capsule and Joint: Are most effectual methods. Strict antisepsis should be followed, shave the joint and wash it thoroughh r with ether, then sublimate 13000, and apply an antiseptic rubber bandage around the parts, leaving a small space exposed for the insertion of the needle. An aspirator should be used for the withdrawal of the fluid, after which the capsule should be filled to distension \vith a sublimate solu- tion of 1-10,000 ; then the same is withdrawn, and an antiseptic dressing applied, followed by plaster of Paris splints or some fixed apparatus. (W.) Opening the -joint and removal of hypertrophied tissue is followed by excellent results. (Tre.) SYPHILIS. Mercury: The methods of administration other than by the mouth of the cardinal remedy for this disease are by Inunction, Subcutaneous Injection, Fumigation, and Calomel in Traumaticin. SYPHILIS. 581 Inunction : This should be restricted to those cases where there is faulty digestion, such as catar- rhal conditions of any part of the alimentary canal, where the internal administration of the mercurial preparations has not been attended with results, and where the conditions demand immediate and direct action ; in the latter instance it will be found invaluable. Ung. Hydrargyri: The ordinary ointment of the U. S. P. is genenerally used. It is very important that it should be freshly prepared ; about 4-0 grains consti- tute the dose for one application. The body is usually anointed at six sittings, as follows: The back and neck, chest and abdomen, right arm and left arm, right leg and left leg, avoiding the scrotum. Hairy parts should be avoided. If it is not possible, they should be shaved. Should that be objectionable the Ung. Hydrarg. Ammoniati may be substituted. The inunctions are best administered by a profes- sional masseur. The region should be first washed with soap and carbolized water. (Cl.) Between the first and second applications there should be an interval of about five days or less ; be- tween the second and third, five to ten days ; between the others, about two weeks. Hot baths should be given during these intervals. This method of admin- istering mercury is not always well borne ; some are easily salivated, while others may suffer from eczema and erythema. Patient should be carefully watched to see if any untoward effects are produced requiring a decrease of dose or discontinuance. (Cl.) A 20 per cent, ointment of the Oleate of Mercury may be used ; it has the advantage of being less dis- agreeable than the ordinary mercurial ointment, but 582 DIGEST OF EXTERNAL THERAPEUTICS. being more easily absorbed it should be applied with a brush and not rubbed in, at least no so vigorously. (N.) Hyrgolum: This preparation of mercury finds its most important use as an inunction in syphilis. It is a quicksilver in a new allotropic form. The ordinary form is that of a fluid metal entirely insoluble in water. Hyrgolum, on the other hand, has the follow- ing properties : It is a solid body of a dark, almost black color, fairly soluble in cold water and insoluble in alcohol and ether. As now prepared for the market, there remains a small insoluble residue. The aqueous solution is neutral and entirely free from all caustic properties. It is dark in color, transparent to trans- mitted light, but strongly fluorescent and hence opaque to incident light. The advantages claimed for it over blue ointment are its freedom from un- pleasant effects, stomatitis being very rare; the clothing is not soiled and the skin is free from irrita- tion. The technique of application is also easier. Six inunctions a week in the usual locations are used. The quantity for a single application varies with the susceptibilty of the patient and intensity of the symptoms. The average dose for an adult is 30 grains. In most instances it is not necessary to ex- ceed this. Severe eases may require 45 to 60 grains. In -weak or anaemic patients and those in whom there is an idosyncrasy for mercury, the dose should be 15 grains daily or every other day. The following is a suitable formula for composing an ointment for inunction : SYPHILIS. 583 P;. Hydrarg. Colloidalis, 10 grams. Aq. Destill., 10 grams. Adipis Suilli, 80 grams, -, ?5 grams Cerae Albae, 20 grams, j Ether. Sulphurici, 1.5 grams. Ether. Benzoatis, 3.5 grams. M. Ft. Ung. The colloidal mercury should be dissolved in an abundance of cold distilled water before incorporation, since a too vigorous rub- bing of the substance with the menstruum changes it into in- soluble mercury of the ordinary form. The aqueous solution is then added in small quantities at a time to the lard and wax, with constant stirring, until the salve has an even greyish-black color. The ethers are then added; these are of the greatest importance in facilitating the intimate mixture of the fats with the colloidal mercury, in favoring the stability of the salve and its absorption by the skin, and, finally, in improving the odor of the preparation. The average time required for application is about eight and a half minutes. No especial exertion is necessary and when the inunction is finished the skin resumes its normal color. No black material comes off afterwards as -with the use of blue ointment. A slight redness occurs which soon disappears. (B. K. W., 98, No. 42.) Subcutaneous Injection: There a is divergence of opinion among writers in regard to the advantage of the hypodermic administration of mercury. Ac- cording to Martineau, its action is more rapid, more effective, and more energetic than by any other method. Carleton recommends it as beneficial for many cases, but not suitable for routine practice. The syringe used for mercurial hypodermic dosage should have rubber mountings ; both needles and the point of injection should be rendered thoroughly aseptic. The subcutaneous areolar tissue of the back is the best point for injection. Irritation may be 584 DIGEST OF EXTERNAL THERAPEUTICS. caused, and in some instances, when given improp- erly, abscesses may be produced. Of the mercurials recommended for this form of administration the fol- 1 owing have been selected : Hydrarg. Bichlorid.: A simple solution in distilled \vater, 4 grains to the ounce; 10 minims daily, in- creased, minim by minim, until 50 have been given, or until the physiological effects have been produced. The moment the least mercurial impression is made the dose must be reduced. In place of small doses, Shoemaker, of Philadel- phia, has used injections of V to Vs grain in the gluteal region two or three times a week. This method he regards as especially adapted to subjects with broken-down constitutions, where it affords the most positive way of limiting or curing the dis- ease in long standing cases. The following solution is also employed : fy. Hydrarg. Bichlorid., gr. -sv. Sodii Chloridi, ^ss. Aq. Destill., l^ij- M. Sig. Inject x to xv minims every second day. (Sm.) Albuminate of Mercury : Prepare as follows : Corrosive sublimate 15 grains, distilled water 5 drachms ; to this solution add 5 drachms of white of egg, shake thoroughly, and incorporate % drachm of sodium chloride and 2 ounces of distilled water. This mixture is again well shaken, then filtered and sufficient water added to make 4 ounces. The dose is 15 to 30 minims. (B.) Amidopropionate or Alaninate of Mercury: An eligible mercurial for subcutaneous use, as it does not cause irritation at the site of injection. The dose in syphilis is T V to \ grains daily. (F.) SYPHILIS. 585 Asparagin Hydrargyrate : Used recently with ex- cellent results ; dose | grain. (F.) Biniodide of Mercury and Guaiacol: It has been found that guaiacol will render painless intramuscu- lar injections of gray oil, oil with calomel, and espe- cially oily solutions of the biniodide of mercury. (S. M., 4, 22, 99.) The following is a formula (Legrange): Sterilized Olive Oil, 20 drachms. Mercury Biniodide, 6 grains. Synthetic Guaiacol, 36 grains. 30 minims of the solution will represent ^ grain of mercury biniodide. The injections may be made in the thigh. It is a well known fact the cocaine can- not be combined with mercurial preparations with- out the former being precipitated. (M. A., 6, 99.) Fumigation: One of the earliest methods of ad- ministration, is somewhat less reliable than inunc- tions, and more easily productive of salivation. It is useful in secondary and tertiary cases with ulcera- tions, when the eruptions are diffuse, or when the in- ternal administration of mercury is not well borne or the patient is unwilling to submit to inunctions. It is not adapted to continuous use. Various mercurials are employed, the Sulphuret, Iodide, and Calomel ; the latter is best, and is gener- ally selected. From 20 to 40 grains are put in a cup of water and placed over a spirit lamp, the patient is wrapped in a blanket, and so arranged that the vapor of the mercury will fall upon the skin under the blanket; or a special apparatus may be em- ployed. Commence with 20 grains and gradually in- crease, 5 grains at a time, administering every second 586 DIGEST OF EXTERNAL THERAPEUTICS. day, watching the gums for any sign of salivation. After the fumigation, the patient should retire to bed to avoid taking cold. Never give the fumigations after a meal or con- tinue their use for more than a month or two, (Cl.) Calomel and Traumaticin : Favorable results have been reported from the following : A bath is given, then a 25 per cent, mixture of calomel and traumati- cin is painted on the patient's back, or if there are syphilitic manifestations on the skin, it is applied over those surfaces. This method is peculiarly well adapted to cases when the internal administration of the drug is not well tolerated, and to hereditary syphilis in children. It has the double advantage of producing both local and general effects as well as being neat and cleanly. (F.) SYPHILIS OF THE LARYNX. The local treatment of simple chronic laryngitis is generally applicable to this condition. In erythe- matous forms of inflammation, if serious, the same treatment as recommended for acute catarrhal laryngitis should be employed. (L. B.) Mucous patches in the larynx do not appear to have the same tendency to spread as when situated on the soft palate and pharynx. If there is any indication for local treatment it should be by cauterization in the same manner as for lesion when located else- where. Cleansing sprays of Dobell's Solution or Boric Acid are of the first importance ; these should gener- ally be made daily. Iodine gr. v, to grycerine or fluid cosmoline, sj, or Zinc Chloride in the same proportion ; the iodine is SYPHILIS. 587 useful when there is increase of tissue, erosion and ulcerations, otherwise the chloride is better. When ulceration is deep increase the iodine to 15 grains. Guaiac: Gtt. j 5J, as a spray or vapor for ulcera- tion and oedema. (Iv.) Europhen and lodoform: Excellent applications for superficial ulcerations. (Bos.) Calomel: By insufflation, for ulceration. (F.) Carbolic Acid: Gr. xx-xl-Oj, as an inhalant to correct fetor. (Al.) Nitrate of Silver: 3J-s*j, for superficial ulceration. (Bos.) As a spray, gr. v-xxx-3j. (Cl.) Bichloride of Mercury: Solutions of 1-1000-500, as a spray are employed in all forms of deep ulcera- tion and gummata. (Bos.) Chromic Acid: Gr. x-3j. (Ba.) Galvano-Cautery: The best means for arresting ulcerations of the epiglottis. (L. B.) When a thick secretion coats the ulcer it should be removed with a cotton covered prove. SYPHILIS OF THE NOSE AND NASO-PHARYNX. Cleanliness is one of the most important features of treatment. Each time the patient is seen the nose should be thoroughly cleansed with cotton pledgets under illumination, and at home by the patient with the douche two or three times daily. If the secre- tions are dry and hard, spraying the nasal chambers with warm liquid vaseline before employing the cleansing wash will facilitate removal of hardened mass. The following are suitable for cleansing purposes : 588 DIGEST OF EXTERNAL THERAPEUTICS. 5fc. Sod. Bicarbonatis, Sod. Boratis, aa gj. Acid. Carbolici (Cal vert's No. i), ^j. Aq. Calidae, ^xx. M. #. Potass. Chloratis, ^ss. Sod. Bicarbonatis, Sod. Boratis, aa -5J. Aq. Calidse, 3 XX - M. (Bn.) Sodium Bicarbonate, Sodium Borate, Sodium Chloride, equal parts, of this about 10 grains to water, 1 ounce; for cleansing in mild forms of specific coryza. Sodium Salicylate (1 per cent.), Acid Salicylate (2 per cent.), Carbolic Acid (1 to 2 percent.) are solutions useful when there is much discharge with tendency to decomposition and desi- cation. These may be used in the nasal douche when there is ample room for escape ; otherwise the nasal bath may be preferred. Tar Water: An excellent wash for frequent use. It is a good deodorizer and does not disorder the stomach as salicylic acid and salicylate of soda may do. (T., 97.) Hydrogen Peroxide: Forms a valuable applica- tion ; it both cleanses and deodorizes in a marked de- gree (Marchand, 15 vol.); 1 part to 8 of water. (Bn.) After cleansing, a stronger detergent may be used, such as the following : Aluminum Aceto-Tartrate: 1 to 2 drachms of a 50 per cent, solution to a pint of water, especially when there is ulceration and fetor. (T., 97.) Liq. Potass. Permang.: 1 to 4 drachms to 20 ounces of water. SYPHILAS. 589 Zinc Sulpho-Carbolate: A solution of 2 grains to the ounce of water. The following formula combines solvent, stimulat- ing and powerful disinfecting qualities : R. Potass. Chloratis, Ammon. Muriatici, aa 9j. Potass. Permang., 9ss. Aq. Calidae, ^ xx. M. (Bn.) Nitrate of Silver: Gr. v-x-3, painted on (Bn.), or the fused drug, will cause large ulcers to heal. (Ing.) Chromic Acid: 5 per cent, solution, painted on ulcers for stimulation and healthy reaction in the secondary form. (Bn.) Boric Acid, 1 part, with 2 of lodol or lodoform, or Aristol, lodoform, or Europhen for deep ulceration after the sprays. Fine Powdered Camphor will serve as a deodorant. Accumulated debris adhering to the edge of ulcerations should be removed with forceps. The curette may be employed for necrotic tissue when necessary. All sequestra should be removed, but it is advisable to wait until separation has oc- curred. (Bos.) Galvano- Cautery: May sometimes be useful in re- ducing indurations. (Ing.) HEREDITARY SYPHILIS OF THE NOSE. The local treatment should mainly consist of cleansing and disinfecting lotions, as, for example : 5*. Sodii Bicarbonatis, gr. iij. Acid. Carbolici (Cal vert's No. i), M. j. Glycerin! Opt., jj. Aq. Destill., q. s. ad jfj. M. 590 DIGEST OF EXTERNAL THERAPEUTICS. In applying solutions of this nature some writers advice the use of sprays alone, considering the syringe inexpedient. The latter, however, will be found effective if the infant is placed on the nurse's knee with the face downward and the nose then syringed out. Menthol: 1 part, olive oil 9 parts, applied with a camel's hair brush, is useful for temporarily relieving erectile swelling. Cocaine Hydrochlorate: If the parts are much swollen and sensitive a few drops of a 4 per cent, so- lution may be applied before using the S3 7 ringe. The following is a useful ointment for application to the nostrils : #. Aristoli, gr. x. Lanolini, Vaselini, aa ss. M. (Bn.) SYPHILIDES. Local treatment will be required when the lesions are situated on the hand or face, and when it is de- sirable to hasten their disappearance on account of profuse and disagreeable discharges. Before the application of the proper medication, all crusts should be removed by warm antiseptic so- lutions. Ung. Hydrarg. Inunctions: Used in various S}-ph- ilides with the best results. Calomel and Traumaticin; A bath is first given, then a 25 per cent, mixture of calomel in traumaticin is painted on where there are any syphilitic manifes- tations. The results are said to be very favorable in syphilides of the papular, pustular and squamous varieties, and in small circumscribed lesions. (Cl.) SYPHILIS. 591 Hydrarg. Oleati: 20 per cent, ointment for dry lesions. For erythematous forms : I*. Resorcini, 5 s8 - Adipis Benzoinati, 5J- M. (B. H.) I*. Hydrarg. Chloridi Mitis, Pulv. Amyli, aa 5J- M. I*. Hydrarg. Chloridi Mitis, 3j- Ung. Zinc. Oxidi, Ung. Petrolei, aa gss. M. (W. M.) For papular forms : I*. Hydrarg. Praecipitati Albi, 3J- Amyli, Zinc. Oxidi, aa ij. Vaselini, ad 5J- M. (B. H.) 5*. Ung. Hydrarg. Ammoniati, 9j. Ung. Aq. Rosse, 3j. M. &. Hydrarg. Chloridi Mitis, Ung. Petrolei Carbolat., aa ^ss. M. (W. M.) For pustular forms Hot Vapor Baths followed by one of these ointments : I*. Hydrarg. Bichloridi, gr. ij. Ung. Hydrarg. Nitratis, Ung. Petrolei, aa ,^ss. M. fy. Ung. Zinc. Oxidi, 3 V J- Hydrarg. Oxidi Rub. , 3ij- M. (W. M.) 592 DIGEST OF EXTERNAL THERAPEUTICS. Alkaline Baths: Indicated in scaly lesions, partic- ularly those of the palms, which are difficult to cure. Labarraque's Solution: In conj unction with wet dressing, is of service in macerating hard crusts. (Al.) Liq. Potassae: Pure or diluted, may be used on hard indurated lesions. (B. H.) The following are also for lesions of a hard scaly character : $fc. Ung. Hydrargyri, Amyli, Zinc. Oxidi, Vaselini, Partes equales. M. #. Hydrarg. Chloridi Mitis, gr. xx. Zinc. Oxidi, 3ij- Amyli, 5ij. Vaselini, ad j- M. (B. H.) Dusting powders are of benefit, namely: Aristol, Europhen, Europhen-Aristol, Dermatol, Calomel, lodoform, Lycopodium and Bismuth Subnitrate, and Nosophen. (Cl.) Ung. Diachylon: When a soothing application is necessary. Mercurial Plasters: Have excellent effect on thick- ened epidermis and gummata. SYPHILITIC ULCERS, Compare Ulcers. Aristol: Has a remarkable influence on ulcers of this variety, and is regarded as superior to any other agent. (Sm.) lodoform: Has been freely used in various forms, but is generally disappointing for open ulcerations. (Al.) SYPHILIS. 593 Hydrarg. Oxid. Rub.: Equal parts with starch forms an excellent dressing when granulations are indolent (Al.), or the officinal ointment diluted in the proportion of 1 part to 8 or 10 of sulphur ointment. (N.) Hydrarg. Salicylas: A lotion of 5 grains of the salt, with 5 grains of carbonate of potash, to the ounce of distilled water, or an ointment of 16 grains to the ounce. (Al.) Hydrarg, Sozoiodas: An ointment of 2 to 10 per cent, or dusting powders of the same strength with talc or starch. (F.) Lotio Flava: A strong stimulant and detergent to foul ulcers. The following are advantageously applied : For inflamed ulcers : #. Hydrarg. Chloridi. Mitis, gr. x. Naphtholini, 3J- Ung. Camphorae, 3 V ^J- M. (Sm.) #. Emplast. Plumbi, gij. Ung. Hydrarg., 3<3S. Ol. Cadini, 3ij. M. (B. T.) For phagedaanic ulcerations : I*. Acid. Pyrogallici, 3J. Vaselini, 3 v. M. #. Acid. Pyrogallici, Amyli, aa vj. Vaselini, ^xviij. M. (N.) For very chronic ulcers energetic treatment is re- quired; the Cautery, Acid Nitrate of Mercury, 39 594 DIGEST OF EXTERNAL THERAPEUTICS. Chromic Acid or Zinc Chloride (the last preferable) are indicated. Applications should be preceded by cocaine. The following ointment is also useful for very chronic types : Jk. Acid. Tannici, gr. Ixxv. lyiq. Hydrarg, Nitratis, gtt. xij. Adipis, 3 V ^ SS - M. (Sn.) TATTOO MARKS. Dr. Variot, of Paris, claims to successful!}- remove tattoo marks in the following manner: A concen- trated solution of Tannin is applied to the skin, and worked in the same way as in the tattoo operation. The skin is then rubbed with a crayon or a solution of Nitrate of Silver, which is allowed to remain on until the tattoo marks stand out as black points on the tannate of silver. Any excess of fluid should be wiped off. The surface turns black and moderate in- flammation ensues ; after fourteen or fifteen days the eschar drops off, leaving a red superficial cicatrix, which after about two months will disappear. (Sh.) Bioxalate of Potassium may be used in place of nitrate of silver. Antiseptic precautions should be enjoined in making the applications and the tattoo needle employed to remove tottoo marks. (Sj.) TETANUS. The wound should receive the most energetic anti- sepsis. TETANUS. 595 Antitoxine: Recent writers claim that this treat- ment has reduced the death rate from 80 per cent, to 37.37 per cent. (A.) Roux and Vaillard recommend the following : The wound is first excised, then 100 c.c. of the active serum is injected; the injection is repeated the next and the following day, and continued daily as long as symptoms last. The serum, while it neutralizes the poison in the blood, does not act upon the germs at the wound, so, unless the source of infection can be removed, the disease may return. It is advisable, therefore, to keep up the injection for ten to twelve days after the disappearance of symptoms in order to guard against recurrence. (F.) Behring's Antitoxin is undoubtedly effective in the treatment of traumatic tetanus, and should be ad- ministered in all forms. 1. It is best to give it as early as possible. 2. The local treatment, \vhich con- sists in a complete destruction of the primary lesion as soon as possible, must not be omitted, for it might tend to a constant supply of toxine. 3. The symptomatic treatment with sedative drugs must be pursued in conjunction with serum therapy, as it maybe effective when the latter fails. 4. Old methods for eliminating the poison from the body must not be neglected. 5. The preventive treatment leaves much for further investigation. (I. M. R., 4, 16, 96.) Hydrarg. Bichlorid.: Celli's Treatment: The hy- podermic injection of this drug has been attended with success. A case is reported in which, after the failure of other remedies, injection into the buttocks of yf-j- grain twice daily resulted successfully. After the second dose the convulsions decreased in fre- 596 DIGEST OF EXTERNAL THERAPEUTICS. quency and severhy, and after the seventh ceased entirely. (F.) Carbolic Acid: By hypodermic injection, Baccelli's method, has been used successfully, though the exact status of the treatment remains uncertain ; success has been reported from doses of y 1 ^ grain of the acid every two hours (F.), an d apparently hopeless cases recovered after the administration of 12 drops of a 2 per cent, solution injected every three hours. (Sj.) Ascoli, in a recent monograph (Bull, della R. Acad- emia Medica di Roma, 1897, 1898, Fasc. IV.), con- cludes that carbolic acid injections give better results than those obtained from serum. Under its influence the convulsions diminish, the acid apparently acting as an antitoxic and sedative to reflex action, while the serum acts only as a preventive and as a cura- tive in the earlier stages of the disease. He cautions against the fear of producing carbolic acid poison- ing; in some instances a daily dose of 5 l /2 grains was administered. The dosage, according to Ascoli, is as follows : % to % grain in the form of a 2 to 3 per cent, solution, injections given several times in twenty-four hours. Morphia: Injections in the tetanized muscles give relief. (B.) Ether Spray: Apply to vertebral column, from three to five minutes every three-quarters of an hour, first along the spine, and later along the affected parts. (Sj.) Ice and Cold Water: Continuous application, or irrigation to the affected parts immediately after re- ceiving the wound maintained night and day for one week, is recommended. (Sj.) TOOTHACHE. 597 Hot Baths: In conjunction with other measures and sometimes useful adjuvants. (T., 96.) Curare: Should be useful for its effect upon the terminal nerves, but as yet experience does not con- firm it. Dose, 2^ grain hypodermically, cautiously increased. The strength of the drug may vary. (Ty.) Saline Infusions: Intravenous or subcutaneous, are valuable agents. (F.) Rest: A most important therapeutic measure. This must be literally absolute in the strictest sense of the word; every sound should be excluded, the room darkened, the ears plugged with cotton, draughts of air excluded, and the attendance must be so con- ducted as not to cause the slightest noise. (Gn.) Amyl Nitrate Inhalations and Anaesthetics may be administered for temporary relief. (B.) TOOTHACHE. See also Caries of the Teeth. Dry Heat: This much used, and often effective pal- liative, may be applied to the face in the form of the hot "water bag or a bag filled with hot hop flowers. A poultice should never be used. The following rem- edies are to be applied by saturating a small piece of cotton, inserting it in the cavity of the carious tooth and coating with collodion. Alum: A solution in nitrous ether, 3J 3vij, is said to be very effective. Tannic Acid: Druitt's formula for toothache, viz.: Tannic Acid, 9j. Mastich., gr. x. Ether, 3ss. (B.) 598 DIGEST OF EXTERNAL THERAPEUTICS. Chloroform and Camphor: A mixture of these two agents forms one of the best applications. (N.) Essential Oils: Creosote, commonly used ; Cloves, Cajuput, Chalmoogra, Origanum, Peppermint, Sa- bina, and Thyme. Cocaine Hydrochlorate: May afford relief, but is apt to aggravate the condition upon which the pain depends. Atropine: 1 per cent, solution. Aconite: A few drops of the tincture. Chloral and Camphor: Equal parts. (F.) Capsicum: A few drops of the tincture or fluid extract is sometimes used. (N.) Orthoform: Apiece of absorbent cotton saturated with an alcoholic solution placed in the cavity of the tooth is said to relieve immediately the pain. The drug being antiseptic, it is not necessary to use car- bolic acid. In pains after the extraction of teeth and roots, cases where chloroform, opium, camphor, tincture of aconite, cocaine, etc., had no effect, the remedy has been used with pleasing results. It has been applied after the extraction of an entire set of teeth when numerous wounds were present. (T. P., 8, 99.) Compare paragraph on this drug under Anaesthesia. Odontine : A name applied to various prepara- tions for the teeth. English odontine is as follows : Camphor, 5 parts. Alcohol, 10 parts. Chloroform, 20 parts. The following is said to constitute a useful pallia- tive: TOOTHACHE. 599 Oil of Cajuput, 2 parts. Oil of Cloves, Oil of Juniper, each 3 parts. Ether, 24 parts. A bit of cotton is saturated with the above and inserted into cav- ity. (F.) Odontol : A new preparation ; formula as follows : Cocaine Hydrochlorate, Oil of Cherry L,aurel, each 15 grains. Tincture of Arnica, 150 grains. Solution of Ammon. Acetate, 300 grains. If the pain is caused by caries, a piece of cotton saturated with this solution should be inserted; if by inflammation of the pulp, the mouth should be washed with odontol diluted with twice its bulk of warm linseed tea ; if the pain extends to the entire jaw, the part should be rubbed with the preparation. Caution should be observed lest any portion is swal- lowed. (F.) Carbolic Acid and Collodion : These agents are fused by melting crystals of the acid in a test tube and adding equal parts of collodion ; the mixture is a jelly. When first inserted into the tooth there will be an aggravation of pain, followed by relief. (B.) Piscedia : The most reliable preparation is the fluid extract ; it may be used with much benefit. (F.) Phenoresorcin : The powder placed in the cavity will afford relief. (B.) Tr. Aconite and Tr. Iodine: Equal parts, with or without a small quantity of Chloroform, painted on the gums is effective ; in some instances the iodine alone is used. (F.) Carbonate of Soda: A saturated solution held in mouth relieves. (B.) 600 DIGEST OF EXTERNAL THERAPEUTICS. Chloroform Water: May be used as a mouth wash for toothache. (N.) Chamomile: The flowers steeped in hot water and inserted into a small lace bag and applied to the gums over an ulcerating tooth \vill sometimes afford relief. Pyrethrum: The tincture is employed by dentists to relieve toothache and as an ingredient of mouth washes. TONGUE, FISSURE OF. Nitrate of Silver: The crayon; useful when the lesion is superficial. (Bt.) Borax: With honey or glycerine, a popular rem- edy, 40 grains, with glycerine 1 ounce, and \vater 4 ounces. (N.) Hydrastis: A valuable drug; about 5 to 10 drops to 2 ounces of water for a mouth wash. (R.) Nitric Acid 5 drops, water 3 ounces, or Carbolic Acid, same strength, are both recommended for mouth washes. (Rd.) TONGUE, ULCERS OF. For ordinary simple acute ulceration the treatment mentioned under Stomatitis and Aphthae will suffice. For syphilitic ulcerations, as far as external remedies are concerned, the same will answer, proper internal medication being all important. Lactic Acid: Applications of a 50 percent, solu- TONSILS, HYPERTROPHY OF. 601 tion made every other day, gradually increasing strength, are of service in tuberculous ulcerations. Chronic ulcerations should be removed by surgical means. (F.) TONSILS, HYPERTROPHY OF. Enlarged tonsils, in which the hypertophy is of long standing, and the tissues are dense and firm, will not yield to any form of treatment, and should be excised. There are many cases, however, in which the tissues are less dense and firm and the condition not so chronic, where remedies will pro- duce results. Astringents: Are both recommended and con- demned as of doubtful efficacy ; their action, it is claimed, being limited to the reduction of inflamma- tion, with no influence upon the hypertrophied tissues. The following are among the best : Glycerole of Tannin. Nitrate of Silver, gr. iij-v 3J. Sulphate of Zinc, gr. v x j. Sulphate of Copper, gr. iij sj. Alum, by insufflation. Infusion of Catachu. (F.) (Iv.) (Bos.) Ammonium Iodide.: 3ss,with glycerine 3j, painted on at night, has proved effective. (Wa.) Iodine: A few drops injected into the gland has been used, but the procedure is open to objection. (Bos.) Trichloracetic Acid: Has been found useful, em- ployed in the following solution : 602 DIGEST OF EXTERNAL THERAPEUTICS. 5fc. Acid. Trichloracetici, gr. v. Sodii Carbonatis, gr. ij. Potass. lodidi, gr. iiss. Glycerin!, ^j. M. (F.) Tonsillotomy: This is the one measure of relief which should be advocated in all cases unless there are special reasons contra-indicating it. The gland may be best removed by the tonsillitome, galvano- cautery, ecraseur, or cold \vire snare. In a large ma- jority of cases the tonsillitome is the best instru- ment. The galvano-ecraseur possesses the advan- tage of extirpating without haemorrhage ; it is, how- ever, slow and difficult to manipulate with children unless an anaesthetic is administered. In adults it may be used to advantage in order to avoid haemor- rhage, which should always be anticipated. (Bos.) In using this instrument the wire should not be al- lowed to go too deeply or to destroy tissue beyond the incision. Cold Wire Snare: When the tonsil is flat and deeply imbedded between the pillars of the fauces and it is impossible to reach it with a tonsillitome this can be used with advantage. The haemorrhage after tonsillotomy is usually slight ; it is advisable, how- ever, to allow the patient to hold cold water in the mouth, in which a little Gallic or Tannic Acid has been dissolved. If haemorrhage persists, saturated solutions of these remedies may be applied. If styptics are required, which is rarely the case, apply a saturated solution of Chromic Acid. In all operations it is important to avoid wound- ing the pillars of the fauces, lest haemorrhage occur, and loss of control of the muscles result. TONSILS, HYPERTROPHY OF. 603 Suprarenal Extract: For the use of this agent in controlling haemorrhage during operations on the nose and throat see Adenoid Growths of the Pharynx. Galvano- Cautery: Of the local destructive agents used for the removal of the tonsils, this may be regarded as the most satisfactory. It is, however, a slow process. A slender pointed electrode should be selected and a number of punctures made with it in the face of the hypertrophied gland. This is better than superficial burning. Ivins recommends the galvano-cautery for hypertrophied tonsils with large open crypts. The point of the needle should be thrust into the opening of the crypt while the current is turned on and removed while hot in order to avoid unnecessary pain. Two or three lacunae are thus treated at a time. Cocaine may be first ap- plied. The reaction is slight and the treatment may be repeated in five days. This method is usually the most satisfactory for treating lacunar tonsillitis. If there are bands of tissue "which prevent the free exit of caseous masses they should be divided or torn with a probe and the cavities emptied. (Iv.) Mineral Caustics: These are slow, unsatisfactory and require great caution in application, lest neigh- boring tissues are destroyed ; their use is not gener- ally commended. Chromic Acid is the best of these agents, and continues to be advocated by some authorities. The fused acid on the point of a probe may be used on enlarged glands with open and dis- tended crypts. (Iv.) 604 DIGEST OF EXTERNAL THERAPEUTICS. TONSIL, HYPERTROPHY OF THE LINGUAL. The general indications are correction of the irri- tant character of the buccal secretions and the re- moval of the growth. (L. B.) Iodine: The glycerole may be painted on. (Ba.) Chromic Acid: This agent is condemned by Len- nox Browne as dangerous. Its use, however, is al- lowed by other -writers (P. M.), especially with the mirror, and under full illumination, when pain and danger are minimized. The fused acid on a probe after cauterization is employed. Galvano-Cautery: This is undoubtedly the best agent for the removal of redundant tissues ; the por- celain point or caustic snare may be used. (L. B.) Cold Wire Snare: Suitable for the removal of large, prominent masses. (P. M.) TONSILLITIS. ACUTE FOLLICULAR TONSILLITIS. Importance of local treatment is now recognized ; mild antiseptic sprays and gargles should be em- ployed. Hydrogen Peroxide: 1 part to 8 of water does efficient service. ( F. ) Creosote: As a gargle, 1 to 2 drops to the ounce of water. (T., 98.) TONSILLITIS. 605 Salol: 5 per cent, alcoholic solution, 1 drachm to 2 ounces of lukewarm water. Izal: 1-200, as spray is said to tend to shorten attack. (T., 96.) Iron Sulphate (Monsel's Solution): Applied un- diluted to the seat of inflammation will quickly con- stringe the inflamed tissues, and promote recovery. Apply twice daily. (F.) Potassium Chlorate: Solutions may be used as a gargle in the intervals of application of Monsel's so- lution. Solutions of 3J |iv, generally, as a gargle. (P. M.) Simple gargles of Boric Acid, Borax, Phytolacca, and Boroglyceride 1 to 5. ACUTE SUPPURATIVE TONSILLITIS QUINSY. Ice : Constantly holding small bits of ice in the mouth during the onset of the disease is often useful for allaying heat and pain. Sodium Bicarbonate: The patient should be pro- vided with a saucer of soda, and every half hour, by simply wetting the forefinger, he can smear the in- flamed fauces with the remedy. This simple proced- ure is highly recommended for relieving the pain. (Bos.) A saturated solution is also used as a gargle for relief of the accumulation of ropy mucus. Hot Compresses: Flannels wrung out in hot water and laid over the region of the tonsils is sooth- ing to some patients. Tr. Guaiacum : 1 drachm, to hot water 1 ounce, held in the mouth may be comforting in the early stages of the disease. (Iv.) 606 DIGEST OF EXTERNAL THERAPEUTICS. Nitrate of Silver: A drachm to the ounce painted on once or twice a day may be said to be successful in aborting one case in four ; two or three applica- tions usually necessary. (Ing.) Steam Inhalations: In early stages, lasting five to ten minutes. A little eucalyptol may be added. (Iv.) Hot "Water Gargles: Useful in second stage. (Ba.) Incision : As soon as the presence of pus is ascer- tained, an incision should be made, followed by hot gargles for facilitating the escape of pus. In some cases it is desirable to pass a director into the open- ing to prevent too early closure. (Ba.) After recovery when the glands remain large they may be painted with the following : fy. lodi, gr. vj. Potass. lodidi, gr. xij. Ol. Menth. Pip., M.v. Glycerin! , ad gj. M. (P. M..) TORTICOLLIS OR STIFF NECK. See Muscular Rheumatism. TRACHOMA. This disease exists in so many varying degrees of severity, and the classifications of its types, according to different writers, present such divergences, that a concise summary of the plans of treatment is diffi- cult. For those cases attended with intense photo- TRACHOMA. 607 phobia, lachrymation, vascular keratitis, and even iritic disease, which appear in all grades of severity, the following preliminary treatment is recommended by Roosa : Hot Water: This should be employed as a fomen- tation, using absorbent cotton dipped in boiling w r ater, applied continuously to the eyes for twenty minutes about six times a day. Sulphate of Atropia: Instillations three to six times a day of a solution of the strength of 2 grains to the ounce. Scopolamine Hydrobromate: Instillations of a solution, a grain to the ounce, may be substituted for atropine, if desired. Cocaine Hydrochlorate: If this is successful in re- lieving the photophobia it may be repeated, using considerable quantities from four to six times a day ; the solution should contain 8 grains to the ounce. These measures will lessen the photophobia and lachrymation, and prepare the eyes for the use of astringents, of which Tannic Acid, in the form of a spray, or Alum Crystals, applied once or twice a day, are recommended as the best with which to begin. (Ro.) Sulphate of Copper: If the disease gradually yields to the above line of treatment this remedy, in the form of the crayon or crystals, may be applied once or twice a day. The results in a few weeks, even in the most obstinate cases, will be satisfactory. (Ro.) Sulphate of copper is generally regarded as one of the best preparations for ordinary forms in which there is little, if any, purulent discharge, and where there is considerable thickening of the con- junctiva. The effect can easily be regulated from a 608 DIGEST OF EXTERNAL THERAPEUTICS. slight to an almost caustic action according to the heaviness of the touch. Applications should be re- peated from every other day to once or twice a week; every part of the conjunctiva within reach should be touched, including the retrotarsal folds. (N.O.) This following antiseptic lotions applied to the everted eyelids are recommended : Mercuric Bichloride, 1-1000. Carbolic Acid, gr. vj, glycerine, j. Formalin, 1-1000-2000. (Bl.) Tannic Acid: Solutions in glycerine from 10 grains to the ounce up to a saturated solution are very effective. In chronic intractable cases they may be used twice a day, a drop in the conjunctival sac. (Ro.) A solution of 15 grains to the ounce is also recom- mended for painting on the everted eyelid. (Bl.) Nitrate of Silver: The crayon should never be used under any circumstances ; the mitigated crayon (equal parts of nitrate of silver and nitrate of pot- ash) and a solution, gr. v-x-^j, should be limited, if used at all, to cases where there is marked purulent secretion. (N. O.) Ichthyol: Is said to have excellent effect, viz.: #. Ichthyoli, ^v. Aq. Destill , ^iv. Glycerini, 3J. M. Sig. The everted eyelids are painted with the mixture, which is permitted to remain on from sixty to ninety seconds, then washed off with water. It is indicated at every stage. In children a 30 per cent, solution may be used. (T., 98.) TRACHOMA. 609 Jequirity: Burnett says this remedy is now very little used because of the danger to the cornea, which is liable to become ulcerated unless the pannus is very dense. Roosa, however, says he has used it a great deal, and in no case was there damage to the cornea. The same writer recommends that the rem- edy first be converted into a powder. The patient is placed under the care of an attendant, and the pow- dered drug, to the amount of a grain, is applied to the palpebral conjunctiva. In most cases there is re- action, consisting of pain in the lids, redness and oedema; for this ice cloths may be applied. A mem- branous deposit will be formed upon the conjunctiva in about four hours; further use of the drug must then be stopped. In obstinate cases it is necessary to repeat the application once, twice, and occasion- ally even three or four times. When the inflamma- tion produced by the application subsides the cornea will be less vascular, the photophobia decreased and the condition such as to call for the use of astring- ents, which should finish the treatment. Sulphate of copper is especially indicated at this period. The care of an attendant is necessarry for the safe application of jequirity. (Ro.) The surgical measures for chronic cases are the fol- lowing : Expression : Of the operative methods this is pref- erable. It consists of squeezing out the morbid tis- sues. The patient must be anaesthetized, the lids everted, and the loose rolls of the conjunctiva seized with the forceps, and stripped of the contents by a slow movement. This is continued until all tracho- matous granules have disappeared. The conjunctiva is then washed with boric acid ; the eyes are left open 40 610 ' DIGEST OF EXTERNAL THERAPEUTICS. afterward. In a few days astringents may be ap- plied. The conjunctiva is congested for some time, but this gradually disappears and recovery occurs with little morbid tissue remaining and but little contraction. (Ro.) Grattage: After anaesthesia the lids are everted, the fornix exposed, and put on the stretch over the blade of the forceps. The conjunctiva is scarified by making incisions close together, parallel to the mar- gins of the lids. These incisions are united by others running transversely, the depth of the incisions de- pending upon that of the trachomatous tissue ; they generally pass through it. The surface is then scraped thoroughly with a tooth brush, having short stiff bristles, dipped in a solution of bichloride of mercury, 1-500. The eye is then washed and bandaged with an antiseptic dressing. The rubbing is repeated every day after the operation for two weeks, this frequently depending upon the amount of reaction. CEdema of the lids will follow, but it is claimed by those who endorse the procedure that the reaction is generally slight. The operation does not meet with general approval. (Ro.) Galvano-Cautery : This is another method used for touching the trachomatous granules, but it is in- ferior to the method of expression when properly executed. Its use is best adapted to discreet forms with little engorgement. (N. O.) Proper hygienic surroundings are of much import- ance. Overcrowding, smoke, dust, and bad atmo- sphere of any kind should be avoided. High alti- tudes exercise a favorable influence on the disease, as it is likely to do in all forms of dyscrasia. Outdoor exercise or work is beneficial, provided it is not amid TRICHOPHYTOSIS RINGWORM. 611 dirt, dust or smoke, or in stables or at farm work. (N. O.) TRICHOPHYTOSIS RINGWORM. TRICHOPHYTOSIS BARB^B. Treatment must be governed by the duration of the disease and the condition of the hair follicles, whether they are involved, or the affection is mainly superficial ; also by the extent of inflammation. It is a matter of the utmost importance that the disease be prevented from invading the follicles. This may be accomplished as follows : The beard on the affected part should be clipped close with a pair of curved scissors, not shaved, lest the disease be spread. Scales or crusts, if present, should be re- moved by washing with warm water and potash soap thorough!}^ applied, and the loose hairs pulled out, after which an alcoholic solution of Boric Acid, 3J-3J, or Bichloride of Mercury, 1-400 or 500, or Carbolic Acid, sj siv, should be used on the hairy part of the face. After drying thoroughly a strong parasiticide should be applied. (B. H.) While the remedies for trichophytosis capitis are generally applicable to this form of the disease, the following are worthy of especial mention: Chrysarobin: An ointment of gr. xxx 3j is em- ployed advantageously. The disadvantages attend- ing this drug must not, however, be forgotten. (Mor.) Dr. W. T. Corlett recommends a solution, in traumaticin or collodion, gr. xx-xxx-^j, to be painted on when there are only two or three lesions. 612 DIGEST OF EXTERNAL THERAPEUTICS. The coating should be removed daily, the hair clipped and the varnish reapplied. Iodine : When there is much irritability and there are several lesions, the tincture may be painted on as often as the condition of the skin permits. (Ck.) Hydrarg. Bichlorid.: Very effective; may be used as follows : #. Hydrarg. Bichlorid., gr. viij. Alcoholis, ^ j . Hamamelidis Destill., 3"J- M. (Sh.> Sulphur: The following combination is effective: P. Sulphur. Prsecipitati, 3J. Acid. Carbolici, 9j. Vaselini, gj. M. (Hd.) Sig. Apply twice daily. Copper Oleate: This remedy occupies a prominent place in the treatment of this affection, viz.: I*. Cupri Oleati, 3 ss. Lanolini Cum Oleo, ^j. M. (Ck.) J*. Cupri Oleati, 9j. Ol. Chamomillae, gtt. v. Ung. Zinci Oxidi, ^j. M. (Sh.) Hyposulphite of Soda: 1 part to 8 of distilled water, mopped on the affected part three or four times daily, is useful. (Hd.) When the hair follicles are involved, the pathogen- etic changes are deep-seated, and the condition is similar to kerion. The indications for treatment under these circumstances may be briefly summarized as follows : TRICHOPHYTOSIS RINGWORM. 613 1. Remove the crusts by soaking in oil, and after- wards washing with warm water and potash soup. 2. Epilation and shaving daily or on alternate days. 3. The application of penetrating parasiticides, such as the Oleate of Mercury (20 per cent.), 30 grains, Sulphur, 30 grains, with lanolin, 4 drachms, oil of almonds, 2 drachms, thoroughly rubbed on the skin three times daily; or Oleate of Copper, 30 grains to the ounce, or Ichthyol, half a drachm to the ounce. (Corlett.) When there is much inflammation, Scarification and the application of saturated Boric Acid lint compresses is recommended by Besnier. As the growth of the parasite is favored by moist heat, poultices are contra-indicated. TRICHOPHYTOSIS CAPITIS. This is one of the most obstinate forms of ring- worm. The hair should be cut short and the scalp scrubbed with soap and water, using preferably tar soap; the diseased hairs should be pulled out with forceps, and a parasiticide applied. In boys, when the eruption is extensive, the scalp may occasionally be shaved. During the course of the treatment it will be necessary to thoroughly free the scalp from the accumulation of epithelial scales, broken hairs and medicaments ; for this purpose use German Green Soap, Soft Soap, or Tincture of Soap; after- wards the parts should be dried with alcohol or ether. As the fungus retains its vitality several years all the articles worn about the head and neck should be 614 DIGEST OF EXTERNAL THERAPEUTICS. burned. Stringent prophylactic measures must be observed in regard to unaffected children who are ex- posed to the disease. The most scrupulous cleanli- ness must be enforced, and no healthy child be per- mitted to sleep with one who is affected or use the same brush, comb, towel, cap, or other article. Bad hygienic surroundings should also be corrected, such as damp or ill- ventilated apartments. As a prophy- lactic measure it is advised to keep the hair cut short and apply an antiseptic wash, such as a Saturated Solution of Borax or Carbolized Oil. Epilation: In acute or recent cases, when the fungus has not penetrated very deeply, the ordinary parasiticides are often successful without the neces- sity of epilation. In the cases commonly encountered, however, the disease has existed for some time, and this measure is essential. For the relief of pain Crocker recommends a 10 per cent, solution of Co- caine in cosmoline, or Carbolic Acid in glycerine, 1 to 20. Bazin paints the parts with Oil of Cade, with a view of lessening the pain, removing about a quater of an inch daily. Rigolene has also been used, but local anaesthesia is not very successful. Of the numerous drugs which have been extolled for use in this affection, the following are presented for consideration. It must be borne in mind, how- ever, that thoroughness and persistence in applica_ tion are most essential if a successful result is to be attained : Oleate of Mercury: Highly endorsed, especially in the diffuse form. A 5 per cent, ointment for chil- dren under 8 years, or a 10 per cent, for older chil- dren. A small piece is rubbed vigorously into the affected part night and morning ; if there is much TRICHOPHYTOSIS RINGWORM. 615 tenderness it may be omitted for a day or two. In the early stages, when there are only a few circum- scribed patches, a more powerful application will be required ; in this case a 10 per cent, ointment may be employed. (A. W.) Stronger preparations are rec- ommended, as 1 drachm of the 20 per cent, ointment to 1 ounce. This must be used with caution for fear of salivation. (B. H.) Ammoniated Mercury: 20 grains to 4 drachms of sulphur ointment, is strongly recommended by Sir William Jenner. Chrysarobin: Unna's method of treatment is as follows : 1. Cut the hair close over the whole scalp. 2. Apply a protective zone of zinc paste, extending for a short distance over the smooth surface. 3. Then apply over the entire scalp the following oint- ment: chrysarobin, 5 to 10 per cent., salicylic acid, 2 per cent., ichthyol, 5 per cent. 4. Cover this with some impermeable substance, such as gutta percha or rubber. A flannel bandage or close cap is then ap- plied. 5. Remove cap or bandage once in twenty- four hours, loosen dressing on one side, turn it over, and apply the ointment, then seal as before. 6. On the fourth day the chrysarobin ointment is removed with pledgets of cotton, and an ichthyol ointment, 5 parts to 100, is applied daily for three days. On the expiration of the first week all dressings, including the zinc paste, are removed, and the scalp cleaned with oil and soap. The whole process is repeated for another week, and continued until cure is complete. This method is highly commended, but caution is necessary lest too active inflammatory disturbances are produced ; when such is the case, suspend the 616 DIGEST OF EXTERNAL THERAPEUTICS. chrysarobin and cleanse thoroughly with hot water and soap. (Sh.) Carbolic Acid: One of the most effective remedies ; it is used in various strengths combined with glycer- ine, or the following, suggested by Alder Smith, which has given satisfactory results : #. Acid. Carbolici Cryst., Ung. Hydrarg. Nitratis, Ung. Sulphuris, aa ^ ss. M. Sig, The patches should be rubbed twice a day and the entire scalp once. (Hy.) The ingredients are mixed without heat. The oint- ment may be used for children over eleven } r ears of age; under that age, increase the proportion of sulphur to double the amount or even more. The following combination is said to have suc- ceeded when carbolic acid, bichloride of mercury and chrysarobin have been used for four months without controlling the disease : 5*. Acid. Carbolici, Ol. Petrolei, aa ^ij. Tr. lodi, Ol. Riciui, aa ^iiss. Ol. Rusci (German), q. s. ad Oj. M. Sig. Apply over the scalp once daily for four successive days, wash off with green soap on fifth day. Then clip the hair close and wash again as before. (T., 98. ) Copper Oleate: About sj-iv-^j said to have been efficient even in the most obstinate forms. (N.) Formalin: Pure or diluted, gives very good re- sults, though its pungent odor is a drawback. (T., 98.) Boric Acid: Useful in the following: TRICHOPHYTOSIS RINGWORM. 617 Jjfc. Acid. Borici, ss. Etheris, |v. Alcoholis, 3 xx. M. (Ja.) Thymol: Sometimes it has proved of value, and may be combined as follows : #. Thymoli, gss. Chloroformi, ^ij. Ol. Olivse, 3yj. M. (Pp.) Iodine: The tincture is one of the best remedies in severe cases, painted on the parts twice a day. (F.) Coster's paste, consisting of tr. iodine 2 drachms, oil of cade 6 drachms, is useful in recent cases. Paint on with a brush. In a few days remove the black crusts, which form, by washing with soap and water; then reapply the paste. (A. W.) Hydrarg. Bichlorid.: An effective lotion is as fol- lows: I*. Resorcini, ^ij. Hydrarg. Bichlorid., gr. iij-v. Glycerini, gij. Alcoholis, 3 V J- M. In using preparations of mercury great care should be observed especially in infants and children with delicate skins. (B. H.) Salicylic Acid: The following is effective : The head is shaved in the usual way for at least an inch beyond the margin of the patch, then salicylic acid in collodion, 10 grains to the ounce, is painted on, extending beyond the diseased skin. This is repeated daily for a week ; at the end of this period the layer of collodion is removed by lifting it with the blade 618 DIGEST OF EXTERNAL THERAPEUTICS. of the forceps inserted beneath the margin ; the sali- cylic acid is then applied for another week, and the same process of removal adopted, and repeated until the disease is eradicated. Among the advantages of this method is the prevention of the access of spores to other parts. A solution of a drachm to the ounce of distilled water is also used. (Ck.) Nitrate of Silver: Devergie is in favor of applying a strong solution, 1 drachm to 8 of distilled water. This is a popular remedy both for ringworm of the head and body. Blistering: In very chronic cases and in the dis- seminated variety this is sometimes necessary. For this purpose the following : Cantharides Collodion (Squibb's) or Bichloride of Mercury, 4 grains, with Acetic Acid, 1 ounce, may be used for producing vesication. These, however, are too strong for children under six years of age and for delicate or strumous persons. The crusts which form in a few days should be removed and mild soothing dressings applied, such as liquor car- bonis detergens. Croton Oil is also advocated, but if used at all it must be with caution and on limited areas, as it may cause permanent baldness. 1 part to 10 of olive oil is usually strong enough, but the strength may be increased until a mild degree of pus- tulation is produced, when a poultice should be ap- plied and the loose hairs removed. (B. H.) Tar: May be employed in the form of the officinal ointment or oil of cade, or combined with mercury and sulphur, as follows : I*. Ung. Picis Liquidae, Ung. Hydrarg. Nitratis, aa ij. Ung. Sulphuris, 3iv. M. (Pp.) TRICHOPHYTOSIS RINGWORM. 619 9. Liq. Carbonis Detergentis, 3J-ij- Hydrarg. Ammoniati, gr. x. Lanolini Comp. Cum Oleo, ^j. M. This forms an effective and an agreeable ointment suitable for very young children and persons with delicate skins. (B. H.) Sulphur: The officinal, or Wilkinson's ointment, or the following combination, are effective : 9. Sulphur. Praecipitati, 3J. Hydrarg. Ammoniati, gss. Thymoli, gr. x. Vaselini, 3J. Ung. Simplicis, ad ^j. M. (A. W.) Naphthol: A 1 per cent, solution in alcohol is used, or the following, which is recommended by Kaposi : (fc. Naphtholi, Jss. Spts. Sapo. Viridis, 3J. Alcoholis, 3 xxv. Balsam. Peruviani, 3J- Sulphuris Loti, 3 V - M. Sig. Apply twice daily for two or three days; then scrub with green soap. During the course of treatment a change of remedy will often prove beneficial. After the disease has been apparently cured it will be advisable to continue with some mild parasiticide application for a short time. TRICHOPHYTOSIS CORPORIS. In selecting a parasiticide, the age of the patient, as well as the severity and extent of the lesion, 620 DIGEST OF EXTERNAL THERAPEUTICS. should be taken into consideration. It may be ne- cessary to remove hairs if the patient is very hirsute. The scales must first be washed off with soap and warm -water, then some slightly irritating and as- tringent, or some antiparasitic application, will in most cases readily effect a cure. For infants: Resorcin, gr. xv-xx, to alcohol or vaseline, gj. (B. H.) For adults and older children an ointment of Oleate of Copper, gr. v-xx-sj, in- creased if necessary. (Sm.) Ammoniated Mercury, gr. xv-xl-gj. (Vn.) Ichthyol, gr. x-xxx-j. (B. H.) Sulphate of Quinine, 5 per cent. (F.) Salicylic Acid, 10 to 20 per cent, ointment, used daily in con- junction with weekly applications of a Bichloride of Mercury lotion. Carbolic Acid, 3J-j, of glycerine. (B.) (Ja.) Hydrarg. Bichlorid.: Gr. ij-iv, to the ounce of alcohol or water, or a solution of 10 grains to the drachm, retained in place for a few minutes onh r . (And.) Benzoin: The compound tincture painted on once a week is effective. (Ja.) Chrysarobin: Gr. x-xxx-gj, suspended in flexible collodion or traumaticin, is excellent, but should not be used in cases of infants or about the face. (B. H.) The following is efficient in obstinate forms located on the thighs and groins : 5*. Creosoti, M.xx. Ol. Cadini, Sulphuris, aa 3"j- Potass. Bicarbonatis, 3J- Adipis, 5j. M. (Vn.) Should remedies of this class fail, blistering fluids TUBERCULOSIS. 621 may be applied : Smith's Emplastrum Cantharidis Liquid! is good; also Acetum Cantharadis, pre- pared with glacial acetic acid. It should be painted on the eruption with a small brush. One application is usually sufficient ; but if not, repeat in a few days. There are numerous other remedies, such as Sul- phurous Acid, Acetic Acid, Sodium Sulphite, etc., all of which will be found of service. To prevent re- lapse, or the spread of contagion, the clothing should be boiled, baked, or in some way disinfected. TUBERCULOSIS. TUBERCULOSIS OF THE LARYNX. The important indications of treatment are relief of the dysphagia, the dyspnoea, and the ulceration. Deep ulcers are most effectively and speedily treated by surgical means ; in rare cases cured ; in many cases relieved. Local treatment should be preceded by cleansing sprays, such as Boric Acid, Borax or Salt, gr. x j. Thorough cleansing is also essential in order to limit the irritating action of the sputum. Lactic Acid: Now accepted by most observers as one of the best topical remedies. Even in the most unfavorable cases it will relieve dysphagia. The strength of the application may vary from 10 per cent, to the pure acid. It is advisable to begin with a weak solution, as the healthy mucous membrane, if involved in the application, may become highly ir- ritated. When hardened infiltrations are present, 622 DIGEST OF EXTERNAL THERAPEUTICS. curettage or scarification should precede the applica- tion. The acid acts quickly on soft ulcerations and with especial rapidity on ulcerated surfaces. Appli- cations should be made daily with a brush; then every other day. Laryngeal spasm and a sense of burning may follow, but these conditions may be re- lieved by cocaine in 10 to 15 per cent, solutions. ( Al.) Curettement: This measure is analogous to ex- cision for the removal of the focus of infection ; fol- lowed by lactic acid applications, it has proved highly beneficial. Indications 1. Primary disease without pulmonarjr infection. 2. Cases with con- comitant lung disease incipient or nrrested before softening or hectic. 3. Circumscribed ulcerations and infiltrations. 4. Dense, hard swelling of ary tenoid re- gion, tuberculous tumors, affections of epiglottis. 5. Advanced lung disease with distressing dyspnoea. Absolute rest after the operation must be enjoined, with daily applications of Lactic Acid and Pyoktanin 1 to 2 per cent. Cicatrization is usual in from one to four weeks. (L. B.) Ichthyol: Applied pure after curettement has suc- ceeded when the operation followed by lactic acid has failed. (Sj.) Guaiacol: Affords great relief, applied pure after lactic acid applications following curettement. Also in form of a 20 per cent, spray. (T., 97.) Chromic Acid: A 3 per cent, solution acts well in superficial ulcerations. (T., 96.) Lacto-Carbolized Glycerine: The following is claimed to form a superior application : Lactic Acid, 3 s8 - Neutral Glycerine, %v. Carbolic Acid, M.xv. TUBERCULOSIS. 623 As tolerance increases, the strength of the two acids is also increased two to four times. (Sj.) Monochlorphenol: 5 per cent, solution in light petroleum oils or glycerine, is palliative in action. Parachlorphenol: Mixed with glycerine in vari- ous proportions form a soothing application. Re- port of 10 cures out of 26 cases. (Sj.) Airol : I$y insufflation, superior to iodoform or aristol. (T., 98.) Balsam Peru: As an inhalant, 10 parts to 5 of alcohol, 20 to 30 drops in a pint of boiling water. (Al.) Resorcin : Daily application of an 80 per cent, so- lution for ulcerative stage. (Al.) Iodoform: For constitutional effects this remedy may be administered by inunction as mentioned un- der Pulmonary Tuberculosis. As a local remedy it exerts a retarding influence upon the disease and is indicated at any stage, but appears to yield the best results in superficial ulcerations of the arytenoid masses. It is usually employed pure by insufflation. A small proportion of morphine may be added ad- vantageously. For an astringent stimulant effect the following : #. lodoformi, gr. 1. Bismuth. Subnitratis, Benzoin. Res., aa gr. xxxv. M. (Ing.) #. Acid. Borici, lodoformi, aa gj. M. Pyoktanin: Probes heated, dipped in the powder and rubbed on the ulcers promote cicatrization. (Al.) Creosote: Inhalations or sprays of this remedy 624 DIGEST OF EXTERNAL THERAPEUTICS. are generally contra-indicated when there is a ten- dency to haemorrhage and by high temperatures ; if used under these conditions caution must be ob- served. The following are convenient formulas : For inhalation : 1J. Creosoti, M.lxxx. Magnesise, Carbonatis, gr. xxv-xl. Aquae, 3J. M. Sig. A teaspoonf ul to a pint of water. (L,eff erts. ) #. Creosoti, Chloriformi, Alcoholis, partes equales. M. Sig. A few drops on a sponge. For a spray : I*. Creosoti, M.ij. Mentboli, gr. iv. Alboleni, %j. M. Sig. Use with an atomizer several times a day. (F. ) Terebene : 5 to 40 minims, to water 1 ounce, with about 20 grains of magnesia carbonate. Dis- solve a teaspoonful of the mixture to a pint of water and inhale the vapor at a temperature of 140 for ten minutes night and morning. (F.) Cocaine : For the relief of pain and dysphagia. A simple 4 per cent, solution as a spray (Os.), or the following : Hydrochlorate of Cocaine, gr. iv. Hydrochlorate of Morphine, gr. ij. Antipyrin, 3 SS - Cherry L,aurel Water (made by distilla- tion), Sterilized Water, aa gij. From 2 to 4 teaspoonfuls by atomization every twenty -four hours. TUBERCULOSIS. 625 Hydrochlorate of Cocaine, gr. iij. Sugar of Milk, Gum Arabic, Powdered, aa 5J- Make into a very fine powder and apply by insufflation. (T., 97-) For other remedies for the relief of dysphagia see that subject. Formaldehyde: Solution of 1 to 10 per cent, highly endorsed. Cocainization is necessary after using on account of the intense smarting ; a 20 per cent, cocaine solution may be necessary after the stronger solution. (T., 98.) Sodium Formate: Has proved of great service; may be used in solutions of 5 to 20 grains to half an ounce each of glycerine and water, or an ounce of water alone. As an insufflating powder it is com- bined with starch, 1 part to 4 of starch. This is blown on the ulcerated spots only. As a pigment it is employed in advanced cases in the strength of 40- 60 grains to the ounce. (F.) Ligno- Sulphite: By inhalation, 10 to 30 per cent, solution, relieves cough and dysphagia and improves the ulcers. (T., 98.) Hydrarg. Bichlorid.: Recommended as a spray as follows : ?*. Hydrarg. Bichlorid., gr. iv. Ammon. Chloridi, gr. x. Glycerini, gij. Aquse, l v iij- M. (Al.) For submucous injection when there is local tume- faction without ulceration the following : Pyoktanin, 2 per cent, solution. Aristol, 2 per cent, solution. 41 626 DIGEST OF EXTERNAL THERAPEUTICS. Phenazonum, 50 per cent, solution. (T., 96.) For intra-tracheal injection : #. Camphorae, Mentholi, aa gr. v. Alboleni, ^j. M. (T., 98.) TUBERCULOSIS OF THE LUNGS. lodoform Inunction: This method was introduced in the Metropolitan Hospital, Blackwell's Island, by Dr. W. B. Keiser, of the House Staff, with the ap- proval of the author. The following ointment is carefully prepared : #. lodofortni, 3 ss - Ol. Anisi, M.x-xxx. Ol. Gaultherae, 3ij. Ol. Olivae, Lanolini, aa ^v. M. This is administered in the same manner as mer- curial inunctions ; that is, rubbing the flexor surface of one arm one day, that of another the next, then the chest, abdomen, back, etc. After the different surfaces have had the inunction applied, the process is repeated and kept up until there is some indication of change. The author has observed good effects from this method and no bad results. Europhen: This remedy has been used as a sub- stitute for iodoform in the treatment of tuberculosis by inunctions. It is employed as follows : #. Europhen., 3J- Ol. Rosse, gtt. j. Ol. Anisi, 3J- Ol. Olivae vel I/anolini, giiss. M. Sig. 3 j to gss rubbed into the axilla and inside of the thighs once or twice a day. TUBERCULOSIS. 627 The remecU- should be continued for a long time after disappearance of symptoms. Results have proved its value. (Pa. M. J., 10, 99.) Inhalations. Creosote : Lessens expectoration and deodorizes, but contra-indicated when there is tendency to haem- orrhage, viz.: ty. Creosoti, Ethyl. lodidi, Terebenis, Partes equales. M. Sig. 10 to 20 drops in inhaler. #. Creosoti, Eucalyptoli, Terebenis, Partes equales. M. Sig. 10 to 20 drops in inhaler. #. Creosoti, Thymoli, Alcoholis, Partes equales. M. Sig. 10 to 20 drops in inhaler. (Sm.) Thymol: The following formula suggested by Dr. C. C. Rice is useful : fy. Mentholi, Thymoli, Acid. Carbolici, aa gr. v. Ol. Eucalypti, gij. Ol. Pini Silvestris, ^iij. M. Sig. A teaspoonful to a pint of boiling water and the vapor inhaled, or 20 to 30 drops inhaled from cotton. Eucalyptus: The oil poured on boiling water, or 628 DIGEST OF EXTERNAL THERAPEUTICS. eucalyptus water in a steam atomizer, when expec- toration is fetid. (Sm.) Terebene: Less active than other agents as a germicide, but more stimulating ; useful in combina- tion with other remedies. Tr. Benzoin Comp.: 1 drachm, to a pint of boiling water. (Ing.) Tar Water: Heated, and the fumes inhaled. (F.) lodoform: 4 per cent, solution in turpentine, or 1 drachm to turpentine 1 ounce ; 3 to 4- drops at high temperature . ( Sm . ) Iodine: Sometimes used, viz.: Sol. Iodine (Iodine, Potass. Iodide, each gr. iij, Alcohol, 3j), HJ-iv. Water, 3 v, Place in a suitable inhaler and expose to heat. Tr. Conium may be added to lessen its irritating qualities. (F.) Ethyl Iodide: This will give the effect of iodine combined with a sedative action. It may be inhaled directly from a vial or dripped upon the sponge of Yeo's perforated zinc respirator. The frequency of its administration will depend upon the severity of the case, and its duration upon the immediate effects shown. Vertigo will be produced if inhaled too long. The average time is five minutes, the average fre- quency six times a day. (F.) Turpentine: The following is a formula for in- halation : ty. Terebinthinse, gtt. j-v. Glycerini, 3J- Aquae, gj. .M. (F.) TUBERCULOSIS. 629 Peppermint: A method of use as follows : Fasten on the nostrils a piece of linen folded once ; on this a few drops of essence of peppermint are poured. The nostrils should previously be greased to avoid irrita- tion, then the patient should take eight or ten deep inspirations with closed mouth, repeating the pro- cedure every fifteen minutes for a time. (Sj.) Guaiacol: The following is to be used for impreg- nating the atmosphere of the room : I*. Guaiacoli, ^iss. Eucalyptoli , ^ j 3 i j . Acid. Carbolici, ^j. Mentholi, gv. Thymoli, iiss. Ess. Caryophylli, 3J M.xv. Alcoholis (at 90), q. s. ad Oij. M. An ounce of this is placed in the bottle of the large atomizer of Lucas Championniere, the bottle of which is two-thirds full of water. This is sprayed in the patient's room for two hours daily, and is claimed to form an important adjunct of treatment. (Sj.) Sprays. Serve to cleanse and deodorize the pharynx and upper respiratory tract, and assist in relieving dys- phagia and other distressing throat symptoms. The following may be used : Guaiacol: Especially efficacious as a deodorant in all forms of tuberculous catarrh ; 1 part to 600 of water. (F.) Hydrogen Peroxide: 1 part to 8; stronger if de- sired, repeating applications until froth has been washed away. 630 DIGEST OF EXTERNAL THERAPEUTICS. Cocaine: In solutions as mentioned for tuberculo- sis of the larynx and for relief of dysphagia. (An. ) Formalin : Recommended as a spray inhalation in early stages, viz.: #. Formalin!, 3J. Glycerini, giv. Aq. Destill., gv. M. Sig. Use four or five times a day for ten to fifteen minutes at a time. (L,., 8, 19, 99.) Creosote: Contra-indicated when there is a ten- dency to haemorrhage ; may be combined as follows : 1*. Creosoti, 3J. Tr. Benzoin. Comp., gij. Destill. Hamamelidis, Aquae, Glycerini, aa &ss. M. (Sm.) The following in the proportion of the amount mentioned to an ounce of water are also used: Boric Acid, gr. x to xx. Chlorine Water, gj. Potass. Permang., gr. j to viij. Sulphurous Acid, M.x to 33. Lactic Acid, M.vj to sj. Oil of Turpentine, M. j, with glycerine, sj. Salicylic Acid, gr. v. Guaiacol: The following combination with men- thol is used for tracheal injection, viz.: Guaiacol, 2 per cent. Menthol. 10 per cent. Olive Oil, 88 per cent. 1 to 2 drachms are rapidly injected during inspira- tion. Coughing may be avoided by quickly passing TUBERCULOSIS. 631 the nozzle of the syringe through the rima glottidis and injecting into the trachea. It is claimed there is no discomfort, and that the relief of the dyspnoea is marked. (Sj.) Guaiacol may also be administered by rectal in- jection. Milk forms an excellent excipient for this purpose ; dissolve 1 part in from 20 to 30 of milk. The solution keeps indefinitely, and readily mixes with water. For the chest pains which accompany advancing tuberculosis, the various mildly counter-irritant and soothing liniments and embrocations will assist as palliatives. For the dyspnoea the following rubbed on the chest may be employed : Croton Oil, i part. Oil of Cajuput, Alcohol, each 3^ parts. (Al.) To relieve neuralgia in phthisical patients the fol- lowing ointment will prove useful : #. Guaiacoli, Methyl. Salicylatis, aagr. Ixxx. Ext. Belladonnae, gr. iiiss Ext. Opii, gr. iv. Vaselini, Lanolini, aa ss. M. Sig. A very small quantity is lightly applied and the part covered with some impermeable material and absorbent cotton . The application must be discontinued as soon as the skin becomes even slightly reddened. In very acute cases menthol, 15 grains, or antipyrine, 30 to 45 grains, or bromide of potassium, 80 grains, may be added. (T. P., 9, 99.) 632 DIGEST OF EXTERNAL THERAPEUTICS. Sometimes an anodyne gargle will be found to afford relief to the cough and throat. For this pur- pose the following are suggested : 9>. Tr. Opii Camphoratae, Tr. Benzoin. Coinp., Tr. Kino, aa %j. M. Sig. Dilute with water and gargle, #. Tr. Opii Camphoratae, Aq. Menthae Pip., Glycerini, aa 3J. M. (Sm.) Sig. Dilute with water and gargle. Nitrate of Silver Injections over the Course of the Vagi: Acting on the theory that the primary mor- bid processes in pulmonary phthisis are fundamen- tally dependent on a neurotic base in which the vagi are seriously involved, Dr. T. J. Mays, of Philadel- phia, has employed this treatment with success. During the last year he reports that he has given more than two thousand injections. The cases were of all stages of the disease, incipient, advanced and far advanced. The cough and expectoration were lessened and the general condition of the patient im- proved. The best results were obtained in incipient cases. From 4 to 7 minims of a 2.5 per cent, solution of pure nitrate of silver (Merck's) were found to answer best in most instances, although a 5 per cent, solution was required in some cases to bring about the desired inflammatory reaction. The point of injection is over or slightly beyond the carotid artery in the region of the neck, midway between the angle of the jaw and clavicle. Caution must be observed not to puncture the carotid artery TUBERCULOSIS. 633 or jugular vein ; to avoid this accident lift the skin be- tween the thumb and finger of the left hand, and in- troduce the needle under the elevated skin. Con- siderable pain is produced which may be avoided by a previous injection of 5 minims of a 2.5 per cent, solution of cocaine. The most practical plan for the administration of this remedy, according to Dr. Mays, is as follows : "Inject the cocaine solution, detach the syringe from the needle and let the latter remain in the punc- ture. Wash out the syringe with water, draw the silver solution into the syringe, attach the latter to the needle and throw in the required amount. "The local visible effects of the injections show themselves in nodular, sometimes in diffuse swelling, and in redness and pain; but in no instance have these products become extremely pronounced. Small abscesses have occurred about a dozen times, and a slough once in about three hundred injections, two of these being produced by using too strong a solution of silver in the early stage of the experiment. Neither the rupture and discharge of the abscesses, nor the small slough in one instance, had any detrimental in- fluence on the patients." "The number of injections necessary depends on circumstances. As a rule, it is a good plan to begin by giving one injection on the side of the neck on which the affected lung is situated. In a week or ten days this is to be repeated, unless the original or pre- vious injection is followed by too much irritation. In urgent cases due to excessive coughing I have re- peated the injections in three or four days. As a rule, it seems best to concentrate the injections on the 634 DIGEST OF EXTERNAL THERAPEUTICS. affected side and to give an occasional one on the opposite side." (P. M. J., 2, 11, 99.) In a subsequent article on the subject Dr. Mays says : That the side of the neck in which the injec- tion accomplishes its best work, varies in different in- dividuals, and even in the same individual at differ- ent periods, and cannot always be readily deter- mined in advance. While it is a good plan to give most of the injections on the same side of the neck below which the infected lung is located, this being a general rule to follow throughout in some cases, it will be found in others that in time the injections be- come unserviceable on that side, and give better result on the opposite side of the neck. (P. M. J., 12, 30, 99.) Antiphthisin; This is an sozalbumin isolated by Klebs from cultures of the tuberculous bacilli. Klebs maintained that the remedy was entirely destitute of the toxic properties of tuberculin, the alkaloids and toxalbumins of which were eliminated. In from 80 to 90 per cent, of a series of cases of pulmonary tuberculosis, the administration of the remedy was attended with improvement, and in the early stages the disease was arrested and apparently cured. Anti- phthisin is usually given hypodermically ; the dose for adults should commence with one- tenth of a c.c., to be increased daily by the same amount until five- tenths have been reached. This may be repeated for several days or a week, and again increased by tenths as heretofore. When 1 c.c. has been reached, repeat this dose for a week or more, and when dis- tinct improvement is manifest, as is usually the case, this dose may be continued for a longer period. It is rarely necessary to exceed 2 c.c., although much TUBERCULOSIS. 635 larger doses are well tolerated without producing disagreeable symptoms. The remedy may be con- tinued in doses of 1 to 2 c.c., according to the results obtained and the character and stage of the disease, for several months, when it may be intermitted, espe- cially if the results are such as to point to the entire arrest of the malady. But even in these cases and in those where all symptoms have disappeared, it is well to repeat the series of injections after an inter- val of one or more months, during which time the patient should be kept under observation. As much as 10 c.c. given daily for several weeks has been used ; it has also been administered by rectal injection. It is recommended only in the earlier stages of the tuberculous process. When larger amounts than 1 c.c. are given, the dose should be divided one-half being administered in the morning and the other at night. If local irritation is produced, the medica- ment may be diluted with a small quantity of dis- tilled water and injected in the rectum. Maragliano's Serum: This was obtained from the dog, the ass and the horse, and was presumed by its discoverer, Maragliano, of Genoa, to contain a tuberculous antitoxin. He recommends that 1 c.c. should be injected systematically every two days. He first began with double the dose, but found that the smaller amount was sufficient. In continuous fevers, with persistent high temperature, as much as 5 and even 10 c.c. may be injected in one dose, re- peating in from five to eight days, and so on, when after two or three days an impression will be found to have been produced in the patient's temperature. Maragliano sums up the following results from his statistics: "1. The remedy has been proved to be 636 DIGEST OF EXTERNAL THERAPEUTICS. quite innocuous. 2. It has caused subsidence of fever. 3. It has had a modifying influence on the morbid local processes. 4. It has caused the bacilli in the sputum to diminish in number or entirely dis- appear. 5. It has brought about a notable increase of weight. 6. It has had a beneficial effect, more or less marked, according to the gravity of the disease, in 91.79 per cent, of the cases. 7. It has cured or put on the road to cure nearly all the patients with circumscribed non-febrile forms of the disease. 8. It has even cured cases in which cavities had formed. 9. It may be used to advantage in all forms of tuber- culosis." Tuberculin: A careful study of the results ob- tained by the use of this remedy in tuberculosis has led to the general conviction that its benefit is not only doubtful, but that, unless it is employed with discretion and care, harm may follow its administra- tion. In regard to the administration of tuberculin the dose varies according to different observers. It is advised that an injection should not be repeated until twenty-four hours after all signs of irritation from the previous dose has disappeared. According to Drs. Grasset and Vedel the remedy has fallen undeservedly into disrepute, owing, it is claimed, to the fact that probably too large doses have been emploj^ed, the most serviceable dose being from two-tenths to three-tenths of a milligram for the first, and a half a milligram for the second injec- tion. From experiments on fourteen cases, these writers arrive at the following conclusions : 1. In doses as above stated the remedy is quite harmless and there is no risk of aggravating an existing tuber- TUBERCULOSIS. 637 culosis. 2. In certain cases the action was sufficient to make a diagnosis of tuberculosis. 3. In two cases the reaction was doubful or absent. 4. Absence of re- action was found not to exclude the presence of tuberculosis, since there was none in three cases. This is explained on the supposition that the organ- ism had become accustomed to the toxin, when these small doses w r ould be ineffectual. 5. One case showed a slight reaction. (T., 97.) Another plan of administration is as follows : For "Tuberculin Koch" for diagnostic purposes give ^2 to 1 milligram for the initial dose, 2 milligrams for the second, 4- or 5 milligrams for the third, and 10 milligrams for the fourth dose. An interval of three to seven days should be allowed between the injec- tions. If the patient reacts to any one or all of these injections, he should be considered tuberculous. An- other method is to begin with 5 milligrams for first dose, 10 milligrams for the second, and 25 milli- grams for the third. Finally, some physicians use but one injection, and that of 10 milligrams. Previous to the injection the morning and evening temperature of the patient should be taken for two or more days. If there shall be one or two degrees above the normal, tuberculin should not be used. The temperature should be taken every two hours for the first six hours after injection, and then every hour for six hours until a period of twelve hours has passed after the injection. A reaction is said to have taken place, when the patient develops within twelve hours a rise in tem- perature of from one and one-half to two degrees or more above the mean temperature previous to the injection. Headaches, malaise, and anorexia, occa- 638 DIGEST OF EXTERNAL THERAPEUTICS. sionally vomiting and pain in the chest may follow the injection. Sibilant and moist rales will be heard in increased number over the involved area of the lung. The urine may be more copious, with lowered specific gravity. "Tuberculin New Koch" should be given in initial doses of -5^-$ milligram. It should be first diluted with an 0.6 per cent, sterilized solution of common salt. 0.1 c.c. of "tuberculin new" is added to a sterilized solution of salt to 500 c.c., 1 c.c. of the solution will represent -^ milligram of tuberculin ; this is regarded as the proper dose with which to begin. The injec- tion should be made every second day, at first, and the quantity gradually increased until 5 milligrams are given; but this dose (5 milligrams) should not be given oftener than twice a week. The dose ma}^ be increased up to 20 milligrams by degrees, and if no reaction occurs it may be discontinued or given at greater intervals. Avoid, if possible, a higher rise in temperature than one-half degree. Carbolic acid or similar agents should not be used when making the solutions of tuberculin, and solu- tions of the remedy should not be administered after they .have become turbid or cloudy in appearance. (T. P., 1, 1900.) Physical Exercise: Treatment and prophylaxis by lung gymnastics form a valuable adjunct when vital capacity is low aud chest expansion limited. Forcible expansion of the apex \vill be found useful in incipient cases. (Sj.) Respiratory' Differentiation Therapy with the Pneumatic Cabinet: The more general adoption of this method for the treatment of diseases of the lungs is urged by Solis Cohen. Inspiration of con- TUBERCULOSIS. 639 densed air and expiration into rarefied air alone or in combination are the expedients generally em- ployed, viz.: Inspiration of Condensed Air : Indicated in chronic pulmonary tuberculosis at any stage of gen- eral softening with cavities, but particulary in the early stages when deficient respiration, anaemia, poor circulation and digestive disorders suggest tuberculosis, even in the absence of pronounced phy- sical signs and of bacilli in the sputum. In such cases it may be employed, in place of change of climate, for those patients compelled to consider expense. The good results from this procedure are most strongly urged. When there is any weakness of the pulmonary vessels, or when it is inadvisable to in- crease the blood pressure in the brain, or kidneys, or other abdominal viscera, the method is contra-indi- cated. Expiration into Condensed Air: Should be com- bined with inspiration of condensed air for the relief of congestion and stimulation of absorption as in consolidation persistent after pneumonia, and in chronic pleurisy with effusion. This is highly recom- mended for tuberculosis, but is inferior to inspira- tion of condensed air with expiration into rarefied air. This method is also recommended in cases where the expiration is imperfectly performed, as a means of strengthening the respiratory muscles. It has been found of service in convalescence from pul- monary tuberculosis and as a prophylactic against the same. Expiration into Rarefied Air: Combined with in- spirations of condensed air, may be employed when it is desired to increase the activity of the circulation 640 DIGEST OF EXTERNAL THERAPEUTICS. of the amount of air in the lungs, or to get rid of ac- cumulations in the alveoli, bronchi or quiescent cav- ities. Inspiration of Rarified Air: Employed to strengthen the muscles of inspiration by increased exercise. It is indicated in cases of contracted thorax, as a preventive against pulmonary dis- ease. (F.) In spite of the high commendations, the use of the pneumatic cabinet has rather declined than in- creased. This may be owing to the impossibility of its practical application, for, in order to be efficient, the apparatus should be used two or three times a day, \vith intervals of rest; therefore, unless the patient has one at home or is in a hospital provided with one, the treatment is of no avail. Fresh Air Cure: The plan of this treatment is to place the patient in as perfect a condition as possible as far as air and hygiene are concerned. It has been pursued at the Hospital of Ormesson, situated in the remote part of the plateau of Champigny, at an elevation above the sea of about 308 feet and over- looking the valley of the river Marne. The buildings serving as dormitories consist of two immense wooden pavilions, the capacity of which is not less than 101,710 cubic feet of air, constantly renewed by perforated windows. No special medication is employed excepting cod liver oil in very cold weather. Unless there are contra-indications each patient is bathed twice a week, thoroughly soaked, then vigorously rubbed in order to obtain a com- plete reaction of the skin. Very good results are claimed. (T., 97.) Open Air Treatment: This should form part of TUBERCULOSIS. 641 the treatment in all cases except those in the last stages of the disease. Patients should live in the open air, and a good part of their time should be spent in the recumbent posture. The clothing should be light, but sufficiently warm, preferably of wool, both in underclothing and dress. The head should be protected. Wind should be avoided, but otherwise the weather need not be regarded. As soon as accustomed to outdoor life, and able to take short excusions, the patient should do so even if a shower is to be en- countered. He should be careful to protect himself with waterproof overcoat and shoes, and guard against getting cold or wet. Foggy atmosphere is not an insuperable objection, but is undesirable. The ventilation of the sleeping room is of great import- ance. The best method of airing the room in winter is by means of a bright fire and an open window. If there is no fire the window should be open night and day. (P., 8, 99.) Climate: The importance of open air life cannot be too greatly emphasized. When patients can spend all day out of doors, and when indoors live in a pure atmosphere they will do well. There is no climate where patients can be sent indiscriminately ; a suit- able locality must be selected for each case. Gener- ally speaking, a dry, equable temperature should be chosen; yet dryness is not by any means always a requisite, as evidenced by the beneficial effects of Tor- quay and Falmouth, in England, places noted for humidity. Low altitudes are sedative and soothing, high are stimulating and invigorating. The extreme cold of an Adirondack \vinter and the mild tempera- ture of Florida and the West Indies must both be 42 642 DIGEST OF EXTERNAL THERAPEUTICS. considered. Sea voyages may prove beneficial to those who are fond of the sea and are naturally good sailors. In regard to altitude the following are the conclu- sions of Dr. F. I. Knight : * High altitude is most likely to prove of benefit when the age is under fifty, temperament phlegmatic rather than nervous, with weak heart, feeble pulse, and inability to resist cold. Those showing irrita- bility from disease are not to be included in the lat- ter, as they are generally benefited. As regards disease those with : 1. Early apical affections, with little constitu- tional disturbance, are most benefited. 2. Cases of more advanced disease, with evidences of consolidation, without excavation or any serious disturbance do well. When the apices are both much involved, the pulse generally over 100, and the tem- perature above 100, it is better to begin with a low altitude. 3. Hasmorrhagic cases, early cases with haemopty- sis and without fever, or much evidence of disease, are benefited. 4. Patients with advanced disease; those with cavities or severe hectic symptoms, should not go to high altitudes. A small quiescent cavity is not a contra-indication ; hectic symptoms on the other hand are. 5. Patients in an acute condition should not be sent. 6. Patients with fibroid phthisis are not suitable subjects. transactions of the American and Climatological Assn., 1888. TUBERCULOSIS. 643 7. Convalescents from pneumonia and pleurisy usually do well. 8. Advanced cases of laryngeal tuberculosis may not do worse than elsewhere, if good local treatment and freedom from dust can be obtained. 9. When other diseases complicate, much care is necessary. Cardiac dilatation and hypertrophy, nervous palpitations, and diabetes are contra-indica- tions. A cardiac murmur, the result of an old endo- carditis, with no sign of enlargement or deranged circulation, should not deter, neither is syphilis a centra-indication . The following classification of localities, according to Dr. G. A. Evans, will be found useful : 1. Cool and moderately mild; general elevation 2,000 feet; western slope of the Appalachian chain, Adirondacks, Catskill, Allegheny, and Cumberland Montains. 2. Moderately warm and moderately moist; elevation 2250; western North Carolina (Asheville), western South Carolina, Aiken, Georgia, Marietta, and Thomasville. 3. Warm and moist; Florida (equable), southern California, coast region (equable) . 4. Warm and moderately dry ; elevation 2000 feet; southern Texas, southern California, inland. 5. Cool and moderately dry; elevation 1000 feet; Minnesota, Nebraska, Dakota. 6. Cool and dry; elevation from 4000 to 7000 feet; Montana, Wyoming, Colorado, northern New- Mexico, western Kansas. 7. Warm and dry; elevation 3000 to 5000 feet; southern New Mexico, southern Arizona. (Ev. ) Sanitaria: These institutions have demonstrated 644 DIGEST OF EXTERNAL THERAPEUTICS. their utility beyond all question. Although they have as yet only been established at moderate eleva- tions, their statistics shov\r twice as many cures as the open air treatment in the same altitude. The rigid hygienic rules and the constant intelligent supervision of the daily life of the patient have doubtless much to do with bringing about these re- sults. The comparative nearness and cheapness of these institutions place them within the reach of per- sons of moderate means, to whom the expenses of a long journey and hotel bills are matters of consid- eration. TYPHOID FEVER. The use of cold baths is now recognized as having not only reduced the mortality, but also the fre- quency of complications, excepting haemorrhage. Some practitioners employ them regularly at 6 a. m., 1 to 3 p. m., and 7 p. m., but the majority prefer to administer them with more or less frequency ac- cording to the range of temperature. Brand Treatment: A bath is prepared at a tem- perature of 65 to 80, filling the tub two-thirds foil; the patient, if sweating, should be dried, and the bladder emptied. To avoid annoyance it is better to screen the bath during preparation. When all is ready the patient is covered with a sheet and gently placed in the tub. While in the bath vigorous rubbing is applied, except on the abdomen; this is essential to prevent cyanosis and collapse. An ice compress may be applied on the head or effusion of ice water poured on it. This measure is regarded as TYPHOID FEVER. 645 important in cases with severe nervous symptoms, and should be continued for fifteen minutes. The bed should have been previously provided -with a rubber sheet and blanket, the patient should now be rubbed dry and wrapped in a blanket, hot water bags applied to the extremities and the rubber sheet and under blanket withdrawn. (Gn.) As soon as the patient ceases to shiver after the bath the temperature should be taken. After an in- terval of three hours it may be again taken ; if it is then 102 or above, the bath is repeated. If 102 or below, but above 101, it is taken again in an hour ; if below 101 and above 100 in ten hours. When the temperature reaches 102.2 a bath may be given, provided three hours have elapsed since the last. iv. Aquae, |j. M. Dobell's Solution: #. Sodii Boratis, Sodii Bicarbonatis, aa 3J. Glycerini, ^ij. Acid. Carbolici Liquifacti (90 per cent.), M.xv. Aquae, q. s. ad viij. M. Thiersch's Solution (Liq.Boro-Salicylicus): ;. Acid. Salicylici, gr. xv. Acid. Borici, S^ 88 - Aquae, q. s. ad gxvj. M. Seiler's Antiseptic Tablets: Sodium Chloride, 5 grains. Sodium Borate, 5 grains. Eucalyptol, ? \ grain. Thymol, ^ grain. Oil of Gaultheria, ^ grain. Sodium Bicarbonate, 5 grains. Sodium Benzoate, ^ grain. Sodium Salicylate, ^ grain. Menthol, ^ grain. A tablet containing the above is dissolved in 4 tablespoonfuls of water, and the solution used with the atomizer for cleansing the mucous surfaces of the nose and throat. 47 722 DIGEST OF EXTERNAL THERAPEUTICS. Labarraque's Solution: This is an aqueous solu- tion of several chlorine compounds of sodium, chiefly NaCIO and NaCl and containing at least 2.6 by weight of available chlorine. Wilkinson's Ointment: Jjfc. Sulphuris, Ol. Cadini, aa ,^ss. Sapo. Viridis, Adipis, aa gj. Cretae Preparatae, 3" ss - M. Burow's Liquor or Solution: Lead Acetate, i part. Alum Acetate, 5 parts. Distilled Water, 100 parts. KEY OF REFERENCES. A American Text-Book of Surgery. Win. Keen, M. D. ( and Wm. White, M. D., Philadelphia, 1892. A. C. Sv . . . The Various Forms of Pruritus Cutaneous and their Treatment. R. W. Taylor, M. D., Archives of Clinical Sur- gery, August, 1877. Ad Rectal and Anal Surgery. Edwin W. Andrews, M. D., Chicago, 1888. A. D. S., 95. . . Treatment of Gonorrhoea with Argonin. I. Jaddasohn, M. D., Archiv fur Dermatologie und Sypholographie, 1895. Ag Practice of Surgery. D. Hayes Agnew, M. D., Philadelphia, 1878. Ak Science and Practice of Medicine. Wm. Aitkin, M. D., Philadelphia, 1872. Al Local Therapeutics. Harrison Allen, M. D., Philadelphia, 1893. All Diseases of the Rectum. W. and H. W. Allingham, M. D., London, 1896. Alb System of Medicine. Thomas C. Allbutt, M. D., New York, 1897. Am American Text-Book of Obstetrics. R. C. Norris, M. D., and R. L. Dickinson, M. D., Philadelphia, 1895. A. M. S., 1899 . American Year Book of Medicine and Surgery. G. M. Gould, M. D., Philadelphia, 1899. 724 DIGEST OF EXTERNAL THERAPEUTICS. An Practice of Medicine. James Anders, M. D., ad Ed., Philadelphia, 1898. And Treatise on Diseases of the Skin. T. McCall Anderson, M. D., London, 1887. Arn Practice of Medicine. H. R. Arndt, M. D., Philadelphia, 1899. A. S. '-.. The Tallerman Treatment by Dry Superheated Air. Arthur Shadwell, M. D., London, 1898. A. W Diseases of Children. Henry Ashby, M. D., and G. A. Wright, M. B., London, 1889. B. Materia Medica and Therapeutics. Roberts Bartholow, M. D., gth Ed., New York, 1897. Ba Diseases of the Nose and Pharynx. James Ball, M. D., 2d Ed., London, 1894. Bac Manual of Otology. Gorham Bacon, M. D., New York, 1898. Bck Diseases of the Ear. Albert H. Buck, M. D., New York, 1898. B. H. . , . . American Text-Book of Genito-Urinary Diseases. L. B. Bangs, M. D., and W. A. Hardaway, M.D., Philadelphia, 1898. Bk Notes on the Non-Surgical Treatment of Boils, Carbuncles and Felons. L. D. Bulkey, M. D., New York, 1898. B. K. W. . . . On the Uses and Actions of Soluble Metallic Mer- cury (Hydrargyrum Colloidale orHyrgolum). Dr. Oscar Werler, of Berlin. From Dr. O. Werler's Poliklinik for Skin and Urinary Dis- eases in Berlin. Translated from the "Berliner" Klinische Wochenschrift," 1898, No. 42. Bl Contributions to this Book. Charles C. Boyle, M. D., New York. KEY OF REFERENCES. 725 B. M., Vol 5, 91. Traitement deTumeurs Blanches par laMethode Sclerogene. M. Lannelogue, Bulletin Medical, Vol. 5, 1891. B. M. J., 6, 9, 88. On the Treatment of Tubercular Leprosy by Excision. Beaver Rake, British Medical Journal, June 9, 1888. B. M. J., 10, 31, 96. The Value of Antistreptococci Serum in Severe Puerperal Septicaemia. John D. Williams, M. D., British Medical Jour- nal, October 31, 1896. B. M. J., I., 98. Local Treatment of Painful Ulceration by Ortho- form. E. S. Yonge, British Medical Journal, Vol. I., 1898. B. M. J., 10, 28, 99. On the Prebalnear Treatment of Heart Dis- ease by Inhalations of Carbonic Acid Gas and on the Uses of the Inhalations in Cardiac Dyspnoea and Anginal Pains. William Ewart, M. D., British Medical Journal, October 28, B. M. P., 8, 13, 96. Traitement de la Coquelouche par la Methode Rabinschek. Bulletin Medical de Paris, Sept. 13, 1896. B. M. S. J., ii, 22, 94. Treatment of So-called Incurable Purulent Pleurisies by the Siphon. C. G. Cunningham, M. D., Boston Medical and Surgical Journal, Nov. 22, 1894. B. M. S. J., I, 20, 96. Certain Chemical Compounds Obtained by the Union of Phenol Derivations with the Isomerides and Polymerides of Camphor. Theo. W. Shaefer, M. D., .Boston Medical and Surgical Journal, Jan. 20, 1896. Bn ....... System of Diseases of the Ear, Nose and Throat. Chas. E. Burnett, M. D., Philadelphia, 1893. Boe ..... Special Formulae. William Boericke, M. D., San Francisco, Cal. 726 DIGEST OF EXTERNAL THERAPEUTICS. Bos Diseases of the Nose and Throat. Francke H. Bosworth, M. D., 3d Ed., New York, 1897. Bp Diseases of the Ear, Nose and Throat. S. S. Bishop, M. D., New York, 1897. Br. . ... Manual of Diseases of the Ear. Thomas Barr, M. D., Glasgow, 1896. B. T. Pathology and Treatment of Venereal Diseases. Freeman J. Bumstead, M. D., and Robert W. Taylor, M. D., Philadelphia, 1883. Bt. ....... Physiological Materia Medica. William H. Burt, M. D., 4th Ed., Chicago, 1888. Bw. ...... International System of Electro-Therapeutics. H. R. Bigelow, M. D., Philadelphia, 1894. C The Prescriber. John H. Clarke, M. D., 2d Ed., London, 1886. Ca. .... The Surgeon's Hand-Book. F. M. Caird, M. D., and C. W. Cathcart, M. D., Philadelphia, 1899. C. B A Manual of Surgical Treatment. W. W. Cheyne, M. D., and F. F. Burchard, M. D., Philadelphia, 1899. C. G., 8, 24, 98. Das Vorlanfuge Ergebnis der Vaporization. Ludwig Pincus, M. D., Centralblatt fur Gyno- kologie, Sept. 24, 1894. Ch Special Formulae. E. I. Church, M. D., New York. C. J., 3, 8, 99. . Introduction of Cocaine through the Unbroken Skin by means of an Electric Current. H. Lewis Jones, M. D., Clinical Record, March 8, 1899. Ck Diseases of the Skin. H. Radcliffe Crocker, M. D., Philadelphia, 1893. KEY OF REFERENCES. 727 Cl Genito-Urinary and Venereal Diseases. Bukk G. Carleton, M. D., New York, 1898. Cln A Practical Treatise on the Sexual Disorders of Men. Bukk G. Carleton, M. D., New York, 1898. Cltn A Practical Treatise on the Sexual Disorders of Men. Bukk G. Carleton, M. D., 2d Ed., New York, 1900. Cob The Newer Remedies. Virgil Coblentz, Ph. D., New York, 1896. Cool Cooley's Encyclopedia of Practical Receipts. R. V. Tuson, F. C. S., 6th Ed., New York, 1897. C. P., 4, 18, 99. Transactions of the College of Physicians, Sec- tion of Ophthalmology. W. F. Norris, M. D., Philadelphia, April 18, 1899. Cp Text-Book of Gynaecology. A. C. Cowperthwaite, M. D., Chicago, 1898. Cr A Practical Treatise on Appendicitis. Howard Crutcher, M. D., Chicago, 1898. D Diseases of Women. F. H. Davenport, M. D., 3d Ed.; New York, 1898. Dch Diseases of the Ear. Edward B. Deneh, M. D., New York, 1894. Den System of Surgery. Frederick S. Dennis, M. D., Philadelphia, 1895.. D. H Working Hand-Book of Diseases of the Genito- Urinary System and Syphilis. F. E. Doughty, M. D., and G. P. Holden, M. D., Philadelphia, 1897. D. M. W., 3, 9, 99. A Case of Puerperal Sepsis Treated with Un- guentum Crede\ Dr. Paul Mayer, Deutsche Medicinische Wo- chenschrift, March 9, 1899. 728 DIGEST OF EXTERNAL THERAPEUTICS. Dn. ...... Practitioner's Reference Book. Richard J. Dungleson, M. D., Philadelphia, 1877. Dud. ..... Treatise on Gynaecology. E. C. Dudley, M. D., New York, 1898. Duh Cutaneous Medicine. Louis A. Duhring, M. D., Philadelphia, 1898. D. Z., Vol. IV., No. 5. Ueber Agentamin und Argonin. Dr. Rudolf Krosing, Dermatologische Ziet- schrift, Vol. IV., No. 5. E. M. J., 3, 99. Treatment of Ozsena with Special Reference to Cupric Electrolysis. P. McBride, M. D., Edinburgh Medical Journal, March, 1899. E. M. J., 4, 99. On the Prevention of Valvular Disease of the Heart. Richard Caton, M. D., Edinburgh Medical Journal, April, 1899. Erb Hand-Book of Electro-Therapeutics. Dr. Wilhelm Erb. Translated by Dr. L. Putzel, New York, 1893. Ev Phthisiology, Historical and Geographical. G. A. Evans, M. D., New York, 1888. Ew Disease of the Stomach. C. A. Ewald', M. D., New York, 1898. F Reference Hand-Book of Practical Therapeutics. Frank E. Foster, M. D., New York, 1897. Fid. '. . . . . Manual of Diseases of the Ear. George P. Field, M. D., London, 1894. Ful Diseases of the Male Sexual Organs. Eugene Fuller, M. D., Philadelphia, 1895. Ga Key-Notes of Materia Medica. Charles Gatchell, M. D., 7th Ed., Chicago, 1895. KEY OF REFERENCES. 729 G. A. O. ... Diseases of the Heart and Aorta. G. A. Osborne, M. D., New York, 1898. Ger Aseptic and Antiseptic Surgery. Arpad G. Gerster, M. D., New York, 1888. G. J Text-Book of Practical Obstetrics. E. H. Grandin, M. D., and G. V. Jarman, M. D., 2d Ed., New York, 1895. Gld American Year-Book of Medicine and Surgery. G. M. Gould, M. D., Philadelphia, 1898. Gn Practice of Medicine. William C. Goodno, M. D., Philadelphia, 1897. G. O- 3. 99- Abstract of Translation Serum Treatment of An- thrax. F. Abba, M. D., and G. Piccardi, M. D., Gezetta degli Ospedali, March 19, 1899. Gt Diseases of Rectum and Anus. S. G. Gant, M. D., Philadelphia, 1896. H System of Practical Therapeutics. H. A. Hare, M. D., Philadelphia, 1892. Ha New Remedies. E. M. Hale, M. D., 5th Ed., New York, 1880. Hb Diseases of the Skin. Ferdinand Hebra, M. D. Translated by C. Hilton Fagge, M. D., London, 1866. Hd Clinical Manual of Skin Diseases. W. A. Hardaway, M. D., 2d Ed., Philadelphia, 1898. Hel System of Surgery. William Tod Helmuth, M. D., 5th Ed., New York, 1887. Hen Lectures on Diseases of Children. E. Henoch, M. D., New York, 1882. H. F Hospital Formulary of the Department of Public Charities. 2d Ed., New York, 1898. 730 DIGEST OF EXTERNAL THERAPEUTICS. Hg Pharmacodynamics. Richard Hughes, M. D., 6th Ed., New York, 1886. HI System of Surgery. T. Holmes, M. D., Philadelphia, 1889. Hit Diseases of Infancy and Childhood. Emmet Holt, M. I)., New York, 1897. Ho Special Formulae. Henry Houghton, M. D., New York. Hpl Materia Medica and Therapeutics. Charles I. Hempel, M. D , 2d Ed., New York, 1864. Ht Diseases of the Nervous System. Ludwig Hirt, M. D., New York, 1893. Hy Treatise on Diseases of the Skin. James N. Hyde, M. D., Philadelphia, 1893. I. M. R., 4, 16, 96. Extract from Editorial. Indian Medical Review, Calcutta, April 4, 1896. Ing. .... Diseases of the Chest, Throat, and Nasal Cavities. E. Fletcher Ingalls, M. D., New York, 1898. Iv Diseases of the Nose and Throat. Horace F. Ivins, M. D., Philadelphia, 1893. Ja Diseases of the Skin. George T. Jackson, M. D., 2d Ed., New York, 1898. Jac Therapeutics of Infancy and Childhood. A. Jacobi, M D., Philadelphia, 1898. J. C. G., 5, 93. The Treatment of Suppurating Bubos by Injec- tions of lodoform. F. N. Otis, M. D., Journal of Cutaneous and Genito-Urinary Diseases, May, 1893. KEY OF REFERENCES. 731 J. C. G., 5, 99. A New Agent for the Treatment of Alopecia Areata. Granville MacGowan, M. D., Journal of Cutane- ous and Genito-Urinary Diseases, Vol. XVII., May, 1899. J. P., 7, 8, 99. . L'Acide Citrique dans la Coquelouche. M. Moncorvo, Journal des Practiciens, July 8, 1899. J. C. W American Text-Book of Applied Therapeutics. John C. Wilson, M. D., Philadelphia, 1896. J. de P Traitementdu Chancre par le Gaiacol. Djealeleddin-Moukhtar, Journal de Paris, Sept. 26, 1897. J. R. K Lectures on Fevers. John C. Kippax, Chicago, 1884. K Diseases of the Rectum and Anus. Charles B. Kelsey, M. D., New York. 1893. Kap Pathology and Treatment of Diseases of the Skin. M. Kaposi, M. D., New York, 1895. K. C Clinical Gynaecology. J. M. Keating, M. D., and H. C. Coe, M. D. ( Philadelphia, 1897. Kp. ... . . Diseases of the Skin. J. R. Kippax, M. D., Chicago, 1895. . Excerpt. Lancet, Vol. II., 1897, page 73. L., 4, 1898 . . . On the Use of Formaldehyde in Atrophic Rhinitis. Geo. L. Richards, M. D., Largyngoscope, 4, 1898. L., 8, 19, 99 . . The Value of Formalin in the Treatment of Phthisis. J. Lardner Green, M. D. Report of the British Medical Association, Lancet, Aug. 19, 1899. LM 9) 9> 99- Berlin Correspondence. Lancet, Sept. 9, 1899. 732 DIGEST OF EXTERNAL THERAPEUTICS. L,. B The Throat and Nose and Chest Diseases. I/ennox Browne, M. D., gth Ed., Philadelphia, 1899. L. M., 6, 31, 99. Infusion Bicarbonatee dans un Cas de Diabete grave en Immence de Coma. R. Lepine, M. D., L,yon Medicale, July 31, 1899. it. T. ... System of Practical Medicine. A. L. Loomis, M. D., and W. G. Thompson, M. D., New York, 1898. M Diseases of the Nose and Throat. Morrell Mackenzie, M. D., Philadelphia, 1890. M. A., 6, 99. . . Progress in Materia Medica. Merck's Archives, June, 1899. Mac Diseases of the Eye. N. L. MacBride, M. D., New York, 1897. M. C., 12, 97. . Excerpt. Medical Chronicle, Dec., 1897. Me Surgical Diseases and Treatment. J. W. McDonald, M. D., Philadelphia, 1898. M. H Metropolitan Hospital, Department of Public Charities, New York. M. H., 2, 99 . . Chloasma Uterinum. John A. Hale, M.D., Medical Herald, St. Joseph, Mo., Feb., 1899 M. M. W., 5, 17, 98. The Local Employment of Superheated Steam. Fedor Krause, M. D , Miinchener Medicinische Wochenschrift, May 17, 1898. M. M. W., 12, 6, 98. Investigation of Orthoform. Einhorn and Heinz, Miinchener Medicinische Wochenschrift, Dec. 6, 1898. M. M. W., i, 3, 99. Concerning the New Local Anaesthetic Nir_ vanin. August Luxenburger, M. D., Miinchener Medi- cinische Wochenschrift, Jan. 3, 1899. KEY OF REFERENCES. 733 M. M. W., 4, n, 99. Die Behandhmg der Ozssna mit Citronen- saure. Dr. Hainm, Miinchener Medicinische Wochen- schrift, April n, 1899. M. N., 12, 10, 98. Treatment of Constipation. Geo. R. Lockwood, M. D., Medical News, Dec. jo, 1898. Mor System of Genito-Urinary Diseases, Syphilography and Dermatology. Prince C. Morrow, M. D., New York, 1893. M. R., 9, 10, 96. Excerpt. Medical Record, Oct. 10, 1896. M. R., ii, 21, 96. Gonorrhoea in Women. Bernard Gordon, M. D., Medical Record, Nov. 21, 1896. M. R., i, 9, 97- Some Plain Rules for Operating in Appendicitis. G. F. Shrady, M. D., Medical Record, Jan. 9, 1897. M. R., 5, ii, 98. Dermatitis Venenata. J. Sobel, M. D., Medical Record, Nov. 5, 1898. Mr Essentials of Practice of Medicine. Henry Morris, M. D., Philadelphia, 1890. M. S. R. R., 5, i, 99- Excerpt. Medical and Surgical Review of Reviews, May i, 1899. M. T., 9, 97 . Excerpt. Medical Times, New York, Sept., 1897. M. T., ii, 97 . . A General Criticism of Herman Mynder's Book on Appendicitis. M. O. Terry, M. D., Medical Times, New York, Nov., 1897. M. T., 4, 98 . . Recent Improvements in the Treatment of Chronic Heart Disease by Exercises and Carbonated Bran Baths. Thomas E. Satterthwaite, Medical Times, New York, April, 1898. 734 DIGEST OF EXTERNAL THERAPEUTICS. M. T., 9, 98. . Excerpt. Medical Times, New York, Sept., 1898. M. T., 12, 98. . Prostatic Hypertrophy, Bottini's Galvano-Caustic Treatment. Bukk G. Carleton, M. D., Medical Times, New York, Dec., M. T., 10, 99. . Excerpt. Medical Times, New York, Oct., 1899. Mus Prescribing and Treatment for Infants and Chil- dren. P. E. Muskett, M. D., zd Ed., London, 1892. M. W Extra Pharmacopoeia. W. Martindale, F. C. S., and W. W. Westcott, M. B., gth Ed., London, 1898. N National Dispensatory. Stille", Maisch, and Caspari, 5th Ed., New York, 1896. N. A. J. H. . . Gonorrho2a; a Few .Clinical Observations. Bukk G. Carleton, M. D., North American Journal of Homoeopathy, April, 1899. N. E. M. J., 5, 99. Disinfection of the Alimentary Canal. A. Jacobi, M. D., New England Medical Monthly, May, 1899. N. O System of Diseases of the Eye. W. F. Norris, M. D., and A. Oliver, M. D., Philadelphia, 1898. N. M Dr. Nicholas Mihajlowitz, Twelfth International Medical Congress, Gynaecological Section. Ses- sion, August 21, 1899. Moscow. N. R., i, 8, 99. Quelques Usages de 1'Acide Lactique en Gyne"- cologie. M. Dalche. Nouveaux'Remedes, Jan. 8, 1899. N. R., 2, 24, 99. Solution Anesthetique Hemostatique son emploi en Stomatologie. A. Legrand, Nouveaux Remedes, Feb. 24, 1899. KEY OF REFERENCES. 735 N. R., 3, 8, 99. De 1'Anesthesie locale par le Chlorure d'Ethyle a la Cocain. A. L,egrand, Nouveaux Remedes, March 8, 1899. Ny Text-Book of Diseases of the Eye. Henry D. Noyes, M. D., New York, 1890. N. Y. M. J., 7, 26, 93. The Treatment of Granulating Wounds. William W. Van Arsdale, M. D., New York Medical Journal, July 29, 1893. N. Y. M. J., 7, 2, 98. L,ocal Examination of Diseases of the Upper Rectum and Sigmoid Flexure. J. P. Tuttle, M. D., New York Medical Journal, July 2, 1898. N. Y. M. J., 4, i, 99. Treatment of Eczema in Infants and Chil- dren. Chas. W. Allen, M. D., N. Y. Medical Journal, April i, 1899. N. Y. M. J., 5, 13, 99. Intrauterine Vaporization. Abram Brothers, M. D., N. Y. Medical Journal, May 13, 1899. N. Y. M. J., 6, 17, 99. The Use of Holocaine as a Local Anaes- thetic in Eye, Ear, Nose, and Throat Opera- tions. John Guttmann, M. D., N. Y. Medical Journal, June 17, 1899. N. Y, M. J., 6, 17, 99, a. A Severe Case of Puerperal Sepsis Treated by Antistreptococci Serum and Unguentum Crede". J. D. Voorhees, M. D., N. Y. Medical Journal, June 17, 1899. Os Principle and Practice of Medicine. William Osier, M. D., 3d Ed., Philadelphia, 1808. P Materia Medica and Therapeutics. C. D. F. Phillips, M. D., 3 d Ed., New York, 1882. 736 DIGEST OF EXTERNAL THERAPEUTICS. P. 8, 99. . . . Various Aspects of the Open Air Treatment of Phthisis. Alfred Hillier, M. D., The Practitioner, Aug., 1899. Pa. M. J., 10, 99. Treatment of Tuberculosis. Lawrence F. Flick, M. D., Pennsylvania Medi- cal Journal, Oct., 1899. Ped., Vol. 7, 99. The Advantages of Protargol and Argonin in the Treatment of Ophthalmia in Infants. E. S. Peck, M. D., Report. N. Y. Academy of Medicine, Pediatrics, Vol. 7, 1889. Pep Text-Book of Practice and Theory of Medicine. William Pepper, M. D., Philadelphia, 1894. Pf Diseases of the Skin. Henry G. Piffard, M. D., and R. M. Fuller, M. D., New York, 1891. Pk Treatise on Snrgery by American Authors. Roswell Park, M. D., Philadelphia, 1896. Ply Science and Practice of Midwifery. W. F. Playfair, M. D., 7th Ed., New York, 1898. P. M Diseases of the Nose, Troat, and Ear. P. McBride, Edinburgh, 1892. P. M., 3, 99. . . Progressive Medicine. H. A. Hare, M. D., New York and Philadelphia, March, 1899. P. M., 6, 99. . . Progressive Medicine. H. A. Hare, M. D., New York and Philadelphia, June, 1899. P. M., 8, 99. . . Progressive Medicine. H. A. Hare, M. D., New York and Philadelphia, Sept., 1899. P. M., 4, 15, 99. Report. Socie"te Francaise de Dermatologie et de Syphilographie. La Presse Medicale, April 15, 1899. KEY OF REFERENCES. 737 P. M. J Protargol, a Substitute for Nitrate of Silver in Opthalmia Neonatorum. F. E. Cheney, M. D., Philadelphia Medical Journal, Sept. 3, 1898. P. M. J., 9, 24, 98. Use of Formalin in Blepharitis. H. Moulton, M. D., Philadelphia Medical Journal, Sept. 24, 1898. P. M. J., ii, 12, 98. Excerpt. Philadelphia Medical Journal, Nov. 12, 1898. P. M. J., 2, n, 99. The Hypodermic Injection of Silver Nitrate in the Course of the Vagi in the Treatment of Pulmonary Consumption. T. J. Mays, M. D., Philadelphia Medical Jour- nal, Feb. n, 1899. P. M. J., 4, 22, 99. Excerpt. Philadelphia Medical Journal, April 22, 1899. P. M. J., 4, 29, 99. Excerpt. Philadelphia Medical Journal, April 29, 1899. P. M. T. 5, 27, 99. Excerpt. Philadelphia Medical Journal, May 27, 1899. P. M. J., 9, 9, 99. A Novel Treatment of Certain Forms of Head- ache, Deafness and Tinnitus Aurium. E. Iv. Vansant, M. D., Philadelphia Medical Journal, Sept. 9, 1899. P. M. J., 9, 30, 99. Tuberculous Peritonitis, Gastrotomy, Acute Appendicitis. F. S Dennis, M. D., Philadelphia Medical Journal, Sept. 30, 1899. P. M. J., 10, 7, 99. Finsen's Phototherapy. Valdemar Bie, M. D., Philadelphia Medical Journal, Oct. 7, 1899. P. M. J., 12, 30, 99. Further Thoughts on the Silver Nitrate Injec- tions in the Treatment of Pulmonary Phthisis. Thomas J. Mays, Philadelphia Medical Journal, Dec. 30, 1899. Pp System of Medicine. William Pepper, M. D., Philadelphia, 1885. 48 738 DIGEST OF EXTERNAL THERAPEUTICS. Pt Materia Medica and Therapeutics. S. O. Potter, M. D., 6th Ed., Philadelphia, 1897. Pz. ...... Treatise on Gynaecology. S. Pozzi, M. D., New York, 1897. Q Dictionary of Medicine. Richard Quain, M. D., Rev. Ed., 1894. Qy Diseases of the Nose and Throat. G. H. Quay, M. D., Philadelphia, 1897. R Handbook of Therapeutics. Sidney Ringer, M.D., 1 3th Ed., New York, 1897. Rd Text-Book of Medicine and Surgery. E. H. Ruddock, M. D., London, 1884. Rk Medical and Surgical Uses of Electricity. A. D. Rockwell, M. D., New 'Ed., New York, 1896. R. M., 12, 5, 98. Excerpt. Reforma Medica, Dec. 5, 1898. R. M., 6, 22, 99. Excerpt. Reforma Medica, June 22, 1899. Ro. . . . Clinical Manual of Diseases of the Eye. D. B. St. John Roosa, M. D., New York, 1894. Rv Excerpt. Medical Review of Reviews, Sept., 1898. Saj. Annual and Analytical Encyclopedia of Practical Medicine. C. E. de M. Sajous, M. D., New York, 1898. S. B Hydrotherapy. Simon Baruch, M. D., New York, 1898. S. F Notes on Nosophen. Stahlmann and Fulton, New York, 1892. KEY OF REFERENCES. 739 Sh Diseases of the Skin. J. V. Shoemaker, M. D., 2d Ed., New York, 1892. Sj Annual of Universal Medical Science. C. E. de M. Sajous, M. D., New York, 1896. S. M.,4, 22, 99. Les Injections d'Huile Mercurielles rendus in- dolores par 1'addition de Gaiacol. E. Bazin, M. D., L,a Semaine Medicale, March 22, 1899. Sm Materia Medica and Therapeutics. J. V. Shoemaker, M. D., 4th Ed., Philadelphia, 1897. Sn Saunder's Pocket Formulary. William M. Powell, M. D., Philadelphia, 1891. St Manual of Practical Medicine. A. A. Stevens, M. D., Philadelphia, 1896. Str Diseases of the Ear. Charles Sterling, M. D., New York, 1885. Strr American Text- Book of Diseases of Children. Louis Starr, M. D., Philadelphia, 1894. Sw Practical Gynaecology. G. R. South wick, M. D., Boston, 1891. S. W. M. . . . Fat and Blood. S. Weir Mitchell, M. D., sd Ed., Philadelphia, 1884. T., 96 International Medical Annual. E. B. Treat & Co., New York, 1896. T., 97 International Medical Annual. E. B. Treat & Co., New York, 1897. T., 98 International Medical Annual. E. B. Treat & Co., New York, 1897. T. , 99 International Medical Annual. E. B. Treat & Co., New York, 1899. 740 DIGEST OF EXTERNAL THERAPEUTICS. Ta Index of Diseases and their Treatment. T. H. Tanner, M D., 2d Ed., Philadelphia, 1877. T. C., Vol. V. . Twentieth Century Practice -Diseases of the Skin, Vol. V. ' Thomas L,. Stedman, M. D., New York, 1896. T. C., Vol. IX. Twentieth Century Practice Diseases of the Nervous System, Vol. IX. Thomas L. Stedman, M. D., New York, 1897. T. C., Vol. XIII. Twentieth Century Infectious Diseases, Vol. XIII. Thomas L. Stedman, M. D., New York,, 1898. T. C., Vol. XV. Twentieth Century Infectious Diseases, Vol. XV. Thomas L. Stedman, M. D., New York, 1898. T. C. R., 7, 99. Argonin vs. Boric Acid in Acute Suppuration of the Middle Ear. Frank Gray, M. D., and \V. R. Thompson, M. D., Texas Courier- Record of Medicine, July, 1898. T. G., 9, 15, 96. Editorial. Therapeutic Gazette, Sept. 15, 1896. T. G., ii, 15, 99. Some Clinical Experiments with Mercurol in Cases of Acute Gonorrhoea. Frederick Fraley, M. D., Therapeutic Gazette, Nov. 15, 1899. Thn Schott's Treatment of Chronic Diseases of the Heart. W. B. Thorne, M. D., New York, 1897. Tn Special Formulae. Irving Townsend, M. D. , New York. T. P., 6, 99. . . Excerpt. Therapeutic Progress, June, 1899. T. P., 8, 99. . . Abstract. Orthoform and Nirvanin. William Rotenberger, Therapeutic Progress, August, 1899. T. P., 9, 99. . . Excerpt. Therapeutic Progress, Sept., 1899. KEY OF REFERENCES. 741 T. P., 12, 99. . Excerpt. Therapeutic Progress, Dec., 1899. T. P., i, 1900. . Excerpt. Directions for Using Tuberculosis Koch and Tuberculin New Koch. G. D. Head, Therapeutic Progress, New York, Jan., 1900. Tre System of Surgery. Frederick Treves, M. D., Philadelphia, 1897. T. W Manual of Diseases of Children. J. W. Taylor, M. D., and W. H. Wells, M. D., Philadelphia, 1898. Ty Practice of Medicine. James Tyson, M. D., Philadelphia, 1899. U. S United States Dispensatory. Wood, Remington, and Sadtler, I7th Ed., Phil- adelphia, 1894. V. H Diseases of the Nose, Throat, and Ear. S. H. Vehslage, M. D., and G. DeW. Hallett, M. D., New York, 1900. Vn Handbook of Diagnosis and Treatment of Skin Diseases. Arthur Van Harlingen, M. D., 3d Ed., Phila- delphia, 1895. W System of Surgery. John A. Wyeth, M. D., 3d Ed., New York, 1898. Wa Practical Therapeutics. E. I. Waring, M. D., 3d Ed., Philadelphia, 1886. Wt Diseases of the Nose and Throat. W. L. Watson, M. D., London, 1896. W. A. E. . . . Cyclopedia of Diseases of Children (Keating), Vol. V. W. A. Edwards, M. D , Philadelphia, 1899. 742 DIGEST OF EXTERNAL THERAPEUTICS. W. C Practice of Surgery. B. F. Curtis, M. D., and H. R. Wharton, M. D., Philadelphia, 1898. Wh. Dermatitis Venenata. J. C. White, M. D., New York, 1872. Whar Minor Surgery and Bandaging. H.*R. Wharton, M. D., Philadelphia, 1893. W. M Genito-Urinary and Venereal Diseases. J. W. White, M. D., and E. Martin, M. D., Philadelphia, 1897. Y Manual of Medical and Clinical Therapeutics. J. B. Yeo, M. D., Philadelphia, 1893. INDEX, PAGE. Abscess, Acute, i Cold, 5 Acne, Simplex, 8 " Rosacea, 16 Adenitis, Acute, 19 " Chronic, 19 " Tuberculous, 21 Agalactia 22 Alopecia, 23 Areata, 27 Syphilitica, 32 Amenorrhcea ' 32 Ampullitis, 558 Anaesthesia, 33 Local, 36 by Infiltration, 41 Aneurism, 43 Angina Pectoris 46 Anosmia 47 Anthrax . .48 Anus, FissuVe of, 49 " Fistula of, 52 " Pruritus of, see Pruritus , 495 Apoplexy, 55 Appendicitis, 56 Arthritis 57 Aphthae, see Stomatitis 568 Ascarides Lutnbricoides, - 59 Vermiculares, 59 Aspergilli, 60 Asphyxia 6r 744 INDEX. PAGE. Asthma, 65 Auditory Meatus, Furuncle of, 421 Balano-Posthitis, 69 Barber's Itch, see Trichophytosis Barbae, 6n Bedsores, . 70 Bites of Insects, 72 " of Serpents, 73 Bladder, Irritability and Neuralgia of, 75 Blepharitis, 75 Blisters, 76 Boils, 77 Bowels, Obstruction of, Intussusception, Faecal Impaction, . 80 Brain, Concussion of, 82 Breasts, Swollen and Painful, 82 " Inflammation of, 83 Breath, Offensive, 86 Bromidrosis, 87 Bronchitis, Acute, 90 " Chronic, 91 Capillary, 91 Bronchiectasis, 93 Bubo, 94 Bunion 98 Burns and Scalds, 99 " of a Minor Character, . . . 106 " of the Eyelids, 107 Bursitis, 107 Cancer 108 " of the Larynx, ... 115 " " Rectum, 115 " " Uterus, 116 Cancrum Oris, 122 Carbuncle, 123 Caries and Necrosis of Bone, 126 Caries of Teeth, 128 Cellulitis, see Phlegmonous Erysipelas, 287 Cerebral Congestion, 255 Cerumen, Inspissated and Impacted, 130 INDEX. 745 PAGE. Cervicitis, Acute, 258 Chronic 258 Chafing, see Erythema Intertrigo, 289 Chancre, Hard, 130 Chancroid, 132 " Phagedaenic, 136 Chaps and Fissures of the Hands and lyips, 137 Chilblain, , 139 Chloasma, 142 Cholera, Asiatica, 144 " Infantum, .... 147 Chordee, 149 Chorea, 149 Cicatrices, 150 Cold, Effects of, Frost Bite, 151 " General Depression from, 153 Colic, 154 Collapse, see Shock, 156 Coma, ..... ... 155 " Due to Affections of the Brain and Meninges, 155 " Apoplectic, . 156 " of Infectious Toxic Origin, 156 " of Neurotic Origin, 156 " Diabetic, 157 " Uraemic, see Uraemic Poisoning, 666 Comedo, 157 Condylomata, 158 Conjunctiva, Blenorrhoea of, 160 Conjunctivitis, Acute Catarrhal, 161 Granulosa, see Trachoma, 606 Chronic Catarrhal, 163 Diphtheritic 164 Phlyctenular, 165 Purulent, 166 Constipation, 168 Contusions, ... i;o Convulsions, Epileptic, 173 Hysterical, 173 Infantile, 173 Puerperal, 175 Uraemic, see Uraemic Poisoning, 666 746 INDEX. PAGE. Cornea, Opacities of, 176 " Ulcers of, 177 Corns, 179 Cough, 181 Croup, Simple Catarrhal, 182 " Membranous, 183 Cystitis, Acute, 185 " Chronic, 186 Cysts 191 Dandruff, see Pityriasis Capitis, . 460 Dermatitis Herpetiformis, 191 Venenata, 192 Diphtheria, 195 Laryngeal, see Membranous Croup, 182 " Nasal, 204 Dysentery, Acute, 205 " Chronic, 207 Dysmenorrhcea, 207 Dysphagia 208 Dyspnoea, 209 Earache, 210 Ecchmosis, see Contusions 211 Eczema, Acute and Subacute, 212 " Chronic, 219 " Intertrigo, 219 ', in Children, 226 " of Regions 229 " of the Anus, 229 " Auditory Meatus, 231 " " Beard 232 " " Breast and Nipples, . . 233 " Ears, 234 " Eyelids 235 " Face, 236 " Genitals, 238 " " Hands and Feet, 239 " " Legs, .... 241 " " Lips, ... 243 INDEX. 747 PAGE. Eczema of the Nails, 243 " Nares 244 " Scalp, 244 " Universal, .... 248 " Seborrhoeicum, ... 249 Emphysema, 251 Empyema, 253 Encephalitis, 256 Endocarditis, Acute 256 Chronic, see Valvular Disease of the Heart, . . . 329 Endocervicitis, Acute, ... 258 Chronic 258 Endometritis, Acute, 261 Mild Forms 261 More Severe Forms, 262 Gonorrhceal, 262 After Operations, 263 Puerperal, 263 Chronic 265 Enuresis, .... 273 Epididymitis, 274 Epilepsy, see Convulsions, 173 Epistaxis, .... 276 Epithelioma, 278 Erysipelas, 283 " Phlegmonous, 287 Erythema, Simplex, 288 Intertrigo, 289 Faecal Impaction, . 80 Favus, 291 Felon, 293 Freckles, see Lentigo 364 Frost Bite, 151 Galactorrhcea, 294 Ganglion, 295 Gangrene, Moist, 295 Dry, 297 Hospital, 297 748 INDEX. PAGE. Gastralgia, 298 Gastritis, 299 Gingivitis, Simple, 301 Glanders, 302 Glands, Enlarged, 302 Gleet, see Chronic Urethritis, ... 679 Glossitis, Superficial, 303 " Parenchymatous, 304 Glottis, CEdema of, see CEdema of the Larynx, 363 Goitre, Simple Bronchocele, 304 " Exophthalmic, 307 Gonorrhoea, see Acute Urethritis, 668 in Females, see Gonorrhoeal Vaginitis, 689 Gout, Acute, 309 " Chronic, see Arthritis, . 57 Gumboil, 310 Gums, Spongy and Ulcerated, 310 Haematemesis, ^n Haemoptysis, 312 Hsematuria, 312 Haemorrhage, 312 from Bone, 314 in Dentistry, 314 from the Larynx, 315 " Post-Partum, 315 from the Rectum, 317 Haemorrhoids, External, 318 " Internal, 321 Hay Fever 326 Headache, .... 328 Heart Disease, Chronic, 329 Heat, Prostration by, 571 Hemiplegia, see Paralysis, . . 437 Hernia, Strangulated, 335 Herpes Labialis, see Herpes Simplex, 338 " Circinatus, see Trichophytosis Corporis, 619 " Progenitalis, 337 " Simplex 338 " Zoster 339 INDEX. 749 PAGE. Hiccough, 340 Hordeolum, 341 Hydrocele 341 Hyperhydrosis, see Bromidrosis, 87 Hypertrichosis, . . '. 543 Hysteria, 345 Ichthyosis, . 346 Hystrix 348 Impetigo, . . 348 Contagiosa, 349 Influenza, see Acute Rhinitis, 523 Ingrowing Toe Nail 349 Insomnia, 352 Intussusception, 80 Iritis 352 Intertrigo, see Erythema Intertrigo, 289 Keloid, 355 Keratitis, 355 Laryngitis Stridulus, 356 Acute Catarrhal, 357 Chronic Catarrhal, 359 Larynx, CEdema of , 363 " Tuberculosis of , see Tuberculosis, 621 Lentigo, Freckles, 364 Leprosy, 365 Lepto-Meningitis, , 393 Leucorrhcea, 367 Lichen Ruber 371 Locomotor Ataxia, 373 Lupus Erythematosus 377 " Vulgaris, 381 Lumbago, see Muscular Rheumatism, 391 Malignant Pustule, see Anthrax, 48 Measles, 392 Meningitis, Acute Cerebral 393 Cerebro-Spinal, 394 750 INDEX. PAGE. Menorrhagia and Metrorrhagia, 394 Metritis, Acute, 261 " Mild Forms, 261 " More Severe Forms 262 " Gonorrhceal, 262 " " After Operations, 263 " " Puerperal, 263 " Chronic, 265 Miliaria, 397 Milium, 397 Moles, See Naevus Pigmentosus 399 Mucous Patches 397 Mumps, 442 Nsevus Pigmentosus, 399 " Vascularis, 399 Nasal Polypus, 402 Naso-Pharyngeal Catarrh, Chronic, 403 Neuralgia, 405 Neurasthenia, 411 Nipples, Fissured and Sore, 412 Nodes, 413 Onychia, 413 Oophoritis, see Pelvic Inflammation, 445 Ophthalmia Neonatorum, 415 Orchitis 419 Ostitis, 449 Otitis Externa, Circumscripta, 421 " " Diffusa, . 422 " Media, Acute Catarrhal, 424 " Chronic Catarrhal, 426 " " Acute Purulent, 429 " " Chronic Purulent 433 Otorrhoaa, 433 Ozaena, see Atrophic Rhinitis, 531 Paralysis, 435 Parotiditis 442 Pediculosis Capitis, 442 INDEX. 751 PAGE.' Pediculosis Corporis, 444 " Pubis, 444 Pelvic Inflammation, Acute, 445 Chronic, 446 Pemphigus, , 446 Pericarditis, 447 Periostitis and Ostitis, 449 Peritonitis, 449 Tuberculous 450 Pernicious Malarial Fever, 451 Pertussis, 452 Phagedsena, 456 Pharynx, Adenoid Growths of 458 Pharyngitis, Acute Catarrhal 460 Chronic Catarrhal, . 462 " Follicular, 463 Phlebitis, 465 Phlegmasia Alba Dolens, 466 Pityriasis Capitis, 466 " Versicolor, 470 Plague, The Bubonic, 472 Pleurisy, Acute, 474 Pleurodynia, see Muscular Rheumatism, 521 Pneumonia, Acute Croupous, 476 Powder Stains, 481 Prickly Heat, 397 Proctitis, 482 Prostate, Hypertrophy of, 483 Prostatitis, Acute, 485 Chronic, 487 Prurigo, 488 Pruritus, 490 Ani 495 " Scroti, 499 " Vulvse, 500 Psoriasis, 502 Puerperal Fever, see Septicaemia, 553 Metritis, 263 p yae mia . 553 Pyorrhoea, Alveolaris 507 752 IXDEX. PAGE. Quinsy, see Acute Suppurative Tonsillitis, 605 Rabies, 508 Ranula, 509 Rectum, Prolapsus of, ... 509 " Ulcer of, 512 " Diseases of Upper, 558 Rheumatism, Acute Articular, ' 514 " Chronic, 516 Muscular 521 Rhinitis, Acute, 523 Simple Chronic, ....... 527 " Atrophic, 531 " Hypertrophic, . . 536 Ringworm, see Trichophytosis, 611 Scabies, 540 Scarlet Fever, 545 Sciatica, 549 Scorbutus, 549 Seborrhoea, 549 Septicaemia, 553 Septico-pysemia, 553 Shock, 556 Sigmoid Flexure and Upper Rectum, Diseases of, 558 Smallpox, see Variola, 694 Spermatorrhoea, 558 Sprains, 564 Stiff Neck, see Muscular Rheumatism, 521 Strangury, 568 Stricture, Spasmodic, 568 Stomatitis, 568 " Mercurial, 571 Sunstroke, 571 Sycosis Coccygenica, 573 Synovitis, Acute 578 " Chronic, . . . 579 Syphilis, 580 " of the Larynx, 586 " Naso-Pharynx 587 " of the Nose, Hereditary, 589 INDEX. 753 PAGE. Syphilides 590 Syphilitic Ulcers, 592 Tattoo Marks, 594 Tetanus, 594 Toothache, 597 Tongue, Fissure of, 600 Tongue, Ulcers of, 600 Tonsil, Hypertrophy of the lingual, 604 ' " Pharyngeal, 458 Tonsils, Hypertrophy, 601 Tonsillitis, Acute Follicular, 604 " Suppurative, 605 Torticollis, see Muscular Rheumatism, 521 Trachoma, 606 Trichophytosis Barbae, 611 Capitis, 613 Corporis, 619 Tuberculosis of the L,arynx, ... 621 " Lungs, 626 Typhoid Fever, 644 Typhus Fever, 653 Ulcers, . 655 " Healthy, 656 Ulcer, Irritable, 656 " Inflamed, 657 " Fungoid 657 " CEdematous, 657 " Indolent, Callous, and Chronic, 658 " Varicose, 661 " Foul, Sloughing, and Gangrenous, 662 " Tuberculous, 663 " Scrofulous, 664 " Phagedsenic, see Phagedsena, 456 " Syphilitic, see Syphilis, 580 Uraemic Poisoning, 666 Urethritis, Acute, Gonorrhoea, . . . . 668 Chronic, Gleet 679 in Females, 684 49 754 INDEX. PAGE. Urine, Retention of, 685 Urticaria, 685 Uvula, Relaxed or Elongated 686 Vaginismus, 687 Vaginitis, Simple, 688 " Gonorrhoeal, 689 Varicella, 692 Varicocele 692 Varicose Veins, 693 Variola, 694 Vomiting of Pregnancy 698 Vulvitis, 699 Warts, 703 WB330 R211d 1900 Rankin, Egbert G A digest of external therapeutics MEDICAL SCIENCES LIBRARY UNIVERSITY OF CALIFORNIA, IRVINE IRVINE, CA 92664