Véppa-marum (_Tam._), Véppa-chettu, Ním-bamu (_Tel._), Véppa,
Aviya-véppa (_Mal._), Bévina-mará (_Can._), Límbacha, jháda (_Mah._),
Límbdanu-jháda (_Guz._), Kohum-ba, Nímba-gahá (_Cing._), Tamá-bin,
Kamákha (_Burm._), Dawoon Nambu, Baypay (_Malay_).
258_b_. The Ním Tree, according to Dr. Pulney Andy (_Madras Jour. of
Med. Sci._, vol. xi. (1867), p. 105), is held in veneration by the
Hindús as being dedicated to the goddess Mariathá, the deity which is
supposed by them to preside over all epidemics: or rather the epidemics
themselves are thought to be visitations of this goddess, in honour of
whom the leaves are in common use amongst Hindús, particularly in
_Smallpox_ epidemics. The leaves are spread on the bed of the patient,
fans made of them are used for fanning him, besides which a bunch of
them is fixed above the door as a sign of the presence of the goddess in
the house. Dr. Pulney Andy was thus led to make trials of the fresh
tender young leaves as an internal remedy in fourteen cases, and of
these thirteen recovered; but how far the recoveries were due to the
remedy is very problematical. He prescribed about five grains made into
a pill, with liquorice powder, and a few drops of water, thrice daily.
In the absence of fresh leaves he suggests the use of dried ones in
infusion or decoction (3j to Water Oj) in doses, for an adult, of one
ounce twice or thrice daily. The efficacy of this remedy is open to
grave doubts.
259. Ním bark varies much in appearance, according to the size and age
of the tree producing it. The bark from the trunk of a tree above three
or four years of age is covered with a thick scaly epidermis, and varies
in thickness from a quarter to half an inch. That from the smaller
branches is smooth, of a dullish purple colour, marked by longitudinal
lines of ash-coloured epidermis from one-eighth to one-twelfth of an
inch apart. The inner layer of the bark, of a whitish colour in the
fresh state, is powerfully bitter, far more so than the outer
dark-coloured layer, which, however, possesses a greater amount of
astringency. According to the analysis of Mr. Broughton it contains a
bitter neutral resin, in which apparently the activity of the remedy
resides.
260. Ním bark is a valuable astringent tonic, and when dried and reduced
to powder, may be given in doses of one drachm three or four times a
day. A better form, however, is a decoction prepared by boiling two
ounces of the bruised inner layer of the bark in a pint and a half of
water for a quarter of an hour, and straining whilst hot; of this, when
cold, the dose is from 2 to 3 ounces. It, as well as the Powdered Bark,
is a remedy of considerable value in _Ague or Intermittent Fever_; and
in these cases it should be given every second hour previous to the time
at which the attack is expected to return. It is chiefly adapted for
mild, uncomplicated cases, especially in natives. _For Convalescence
after Fevers_, _General Debility_, and _Loss of Appetite_, the
Decoction, in somewhat smaller doses than those mentioned above, proves
of great service, and its efficacy is increased and its taste improved
by the addition of a few bruised Cloves or a little Cinnamon. As the
decoction readily spoils in hot weather, it should be prepared fresh for
use when required.
261. _To Indolent and Ill-conditioned Ulcers, especially those of long
standing_, a poultice of Ním leaves acts beneficially as a stimulant. It
is easily prepared by bruising a sufficient quantity of the fresh leaves
with a little tepid water, and applying it, spread on a rag, to the
ulcerated surface; should it cause pain and irritation, as it sometimes
does, an equal weight of rice flour may be added.
262. +Nitre, Saltpetre, Nitrate of Potash.+
Shórá (_Hind._, _Duk._, _Punj._), Sórá (_Beng._), Saféd-shora
(_Kash._), Pot-luppu (_Tam._), Peti-luppu, Shúrá-karam (_Tel._),
Veti-uppa (_Mal._), Pet-luppu (_Can._), Shóra-mítha (_Mah._), Sóro-khár
(_Guz._), Pot-lunu, Vedi-lunu (_Cing._), Yán-zin (_Burm._), Sun-dawa
(_Malay_). In Kashmir the term Shorá means Gunpowder, hence one must
speak of White Gunpowder (_Saféd Shorá_), which is the name of Nitre,
if it is wished to procure it. (Dr. Aitchison.)
263. Nitre is obtainable in most of the bazaars of India, but often in a
very impure state. To fit it for internal use it should be purified by
dissolving it in boiling water, removing the scum after the liquid has
been allowed to settle, straining the solution through calico and
setting aside to crystallise. Pure specimens, which are sometimes met
with in large bazaars, should be in white crystalline masses or
fragments, colourless, and of a peculiar, cool, saline taste.
264. _In Fever_, when the skin is hot and dry, the tongue parched, the
thirst great, and the urine scanty and high-coloured, an excellent
refrigerant drink may be made by dissolving two drachms of Nitre in a
quart bottle of thin _conjee_, and sweetening to the taste with honey or
sugar candy. This quantity may be taken daily, in divided doses as an
ordinary drink. Tamarind or Lime Juice may be added to improve the
flavour if desired. It will be found to moderate the fever, cause some
perspiration, and increase the quantity of urine. Should the patient
reject the first one or two doses, it should still be persevered in,
unless it should manifestly disagree. _In Smallpox_, _Measles_,
_Influenza_, and _Catarrhal attacks_, the above drink has also been
found useful. For children the strength should be reduced one-half or
more.
265. _For the relief of Headache and Delirium, occurring in the course
of Fever_, a very cold and agreeable lotion for the head may be made by
dissolving two ounces of Nitre, and an equal quantity of Sal Ammoniac,
in a quart bottle full of Water; this should be applied by constant
relays of freshly wetted cloths.
266. _In Inflammatory Sore Throat_, a popular remedy, sometimes
successful in the early stages, is a small piece of Nitre allowed to
dissolve slowly in the mouth.
267. _In Bleeding from the Lungs, Stomach, Uterus, or other internal
organs, attended by Fever_, Nitre proves serviceable though it is not to
be relied upon as the sole means of cure. It may be given in doses of
ten to fifteen grains, in three ounces of _conjee_ or simple water four
of five times a day; the patient at the same time being kept perfectly
quiet and cool.
268. _In Asthma_, great relief in many instances results from the
inhalation of burning Nitre. For this purpose, dissolve four ounces of
the salt in half a pint of boiling water in an open vessel; immerse
moderately thick blotting-paper in it for a few minutes, then dry it by
exposure in the air or to the fire; when quite dry, cut it in pieces
about four inches square, and keep ready for use. Immediately when an
attack threatens, burn one, or, if required, two pieces of this paper,
so that the fumes may be freely inhaled; but it should not be held too
near the face, or the fumes may prove too irritating, and increase
rather than diminish the symptoms. The same measure proves very useful
in _Spasmodic Coughs_, whether connected with _Chronic Bronchitis_ or
not. Persons thus afflicted will do well to burn one or two pieces of
this NITRE PAPER in the bedroom before retiring to rest at bedtime, care
being taken to prevent the too ready escape of the fumes.
269. _In Gonorrhœa_, a solution of a drachm of Nitre in a pint of rice
_conjee_ or decoction of Abelmoschus (2) taken freely as a drink, serves
to allay the heat on passing urine. Obstinate cases of _Leucorrhœa_
sometimes yield to a combination of Nitre (10 grains) and Alum (5
grains) taken thrice daily. It may be advantageously given in
conjunction with infusion of Moringa (237). Nitre has been found to act
beneficially as a diuretic in the early stages of _Dropsy_.
270. _In Acute Rheumatism_, Nitre may be given with advantage,
commencing with doses of 40 grains, twice daily: this may be gradually
increased to 60, 90, up to 120 grains, the vehicle in each case being
half a pint of warm rice _conjee_. The quantity of Nitre may be
diminished as the severity of the symptoms subsides. A strong solution
of Nitre (three ounces to a pint of water) forms a most soothing
application to the swollen and painful joints; cloths saturated with it
should be kept constantly applied; the ease which it affords is often
very great.
271. +Nutmegs and Mace.+ The products of Myristica officinalis (_Linn._).
_Nutmegs._
Jáé-phal (_Hind._, _Duk._, _Beng._), Záfal (_Kash._), Jádi-káy
(_Tam._), Jájí-kaya (_Tel._), Játi-ká (_Mal._), Jaji-káyi (_Can._),
Jái-phal (_Mah._, _Punj._), Jáye-phal (_Guz._), Jádi-ká, Sádi-ká
(_Cing._), Zádi-phu (_Burm._), Buah-pala (_Malay_).
272. _Mace._
Jáé-patrí (_Hind._, _Can._, _Tel._, _Guz._), Jótri (_Beng._), Jáuntari
(_Punj._), Jów-watir (_Kash._), Jádi-pattírí, (_Tam._, _Mal._),
Vasá-vási (_Cing._), Zadi-phu-apóén (_Burm._), Bunga-pala (_Malay_).
273. Nutmegs and Mace, generally procurable in bazaars, are aromatic,
stimulant, and carminative, closely allied to Cloves and Cinnamon, for
which they may be substituted. Nutmegs in large doses are thought to
possess some narcotic properties, hence some care is necessary in their
use.
274. THE NATIVE OR COUNTRY NUTMEG, the produce of Myristica Malabarica,
_Lam._, is larger than the officinal Nutmeg, possesses little of its
fragrance or its warm aromatic taste, and is very inferior as an
internal remedy. Bruised and subjected to boiling, it yields a
considerable quantity of a yellowish concrete oil, which, when melted
down with a small quantity of any bland oil, is regarded as an excellent
application to _Indolent and Ill-conditioned Ulcers_, allaying pain,
cleansing the surface, and establishing healthy action. It deserves a
trial as an embrocation in _Chronic Rheumatism_.
275. +Opium.+ The inspissated juice of Papaver somniferum, _Linn._
Afyún (_Hind._), Afím (_Duk._), Afím, Afín (_Beng._, _Punj._, _Kash._),
Abini (_Tam._), Abhini (_Tel._), Kasha-kasha-karappá (_Mal._), Afímu
(_Can._), Afín (_Mah._), Afím (_Guz._), Abin (_Cing._), Bhain, Bhín
(_Burm._), Afíun (_Malay_).
276. Opium is one of the most valuable medicines we possess when
properly employed, but as it is very powerful in its operation, it may
be productive of _great mischief if used without care and caution, or in
unsuitable cases_.
277. The Opium procurable in the bazaars is always more or less
adulterated, hence the quantity procured in one shop is sufficient to
procure a good sleep whilst the same quantity procured at another shop
will perhaps produce no sensible effect whatever on the system. This
shows the necessity of _great caution_ in its employment.
278. The uncertainty which attends the operation of bazaar Opium leads
me to recommend that establishments at out-stations should be always
provided with a supply of genuine Smyrna or Turkish Opium imported from
Europe. It seems advisable to have it in two forms—_a._ In 1 grain
pills, done up ready in an impermeable covering, like those sold by
Kirby and others; by keeping it in this form it is always ready for an
emergency. _b._ In the form of Tincture, LAUDANUM, which is a very
convenient form when small or fractional doses of Opium are required, or
when it is desirable to obtain a _speedy_ effect. Fifteen minims contain
one grain of Opium; this holds good, however, only with recently
prepared or carefully preserved laudanum. It should be borne in mind in
all hot climates that evaporation of the spirit constituent will take
place even in well stoppered bottles, and that in proportion as this
evaporation takes place, the strength of the tincture is _increased_, so
that in long kept Laudanum ten minims, or even less, may contain a grain
of Opium. Hence, in using old Laudanum it is advisable to commence with
smaller doses than in that recently prepared; the dose can be
subsequently altered according to the effect produced or desired.
279. Preparations of Opium should always be kept _under lock and key_,
or they may disappear at a rate which cannot be accounted for by
evaporation or the heat of the climate! Opium in all its forms is a
temptation which few natives have moral courage enough to resist.
280. The preparations of Opium mentioned above should be reserved for
internal administration; for external application, where uniformity of
strength is of comparatively little consequence, bazaar Opium may be
employed, but even here it is desirable that good specimens of the best
kinds should be used. A few additional observations on this point may be
acceptable.
281. Of the several kinds of Opium met with in India the chief are:
1. _Patna Garden Opium_; and 2. _Malwa Opium._—The former, prepared
exclusively for medicinal purposes, occurs in square packages of from
two to four pounds weight, covered with layers of talc, and further
defended by a case of brown wax about half an inch in thickness. It is
solid, brittle in the cold season, of a brown colour, and fine smell; it
yields a large proportion (7 to 8, or even 10 per cent.) of Morphia. Of
Malwa Opium there are many varieties; of these the two principal are,
first, that in flat circular cakes, of about a pound and a half in
weight, without any exterior covering; dull opaque, blackish brown,
externally; internally somewhat darker and soft; odour resembling that
of Smyrna Opium, but less powerful, and combined with a slight smoky
smell; taste, intensely and permanently bitter: it yields only from 3 to
5 per cent. of Morphia. The other, a superior kind of Malwa Opium,
occurs in balls or cakes of smaller size, about ten ounces in weight,
covered with a coarse dust composed of broken poppy petals; colour
internally, dark brown; texture, homogeneous; odour and taste similar to
the other variety; it yields from 7 to 8 per cent. of Morphia. The other
varieties of Indian Opium, the Himalayan or "Hill Opium," the Kandeish,
the Kutch, &c., are less applicable than the preceding for medicinal
purposes, on account of their varying strength. (_Pharm. of India._)
282. There are some points connected with the use of Opium which should
always be kept in mind:
_a._ Some persons are very intolerant to the action of Opium; in these
even the smallest dose produces great nervous excitement, violent
headache, and vomiting. When this peculiarity is known to exist, the
drug should be avoided.
_b._ Infants and young children bear Opium badly; cases are on record in
which _three drops of Laudanum have proved fatal to infants_. Still,
there are diseases of childhood in which it proves valuable, but in
these it _should not be given except under professional advice or
superintendence_.
_c._ It should be avoided as far as possible during pregnancy. Recent
experience seems to show that its frequent or habitual use exercises a
prejudicial effect on the fœtus.
_d._ The previous habits of the patient materially influence the effects
of this medicine. A confirmed Opium-taker requires a far larger dose to
produce a given effect, than one not habituated to it.
_e._ When the use of Opium is clearly indicated, and the patient from
any cause is unable to swallow, it may be given in an enema; in this
case a larger dose, a third or even a half larger, is required than when
given by mouth.
_f._ Whenever in doubt as to the advisability of giving Opium, _take the
safer course and—avoid it_!
For treatment of poisoning by Opium, see Index.
283. There are many diseases as _Rheumatism_, _Tumours of different
kinds_, _Cancer_, _Carbuncles_ (_Rajah Boils_), _Abscesses_, _and Ulcers
connected either with Leprosy, Syphilis or Scrofula_, in which the pain,
especially at night, effectually banishes sleep; here Opium is
invaluable. An adult may commence with one grain pill or fifteen drops
of Laudanum, taken about an hour before the usual bedtime: if this
succeeds in procuring sleep it may safely be repeated nightly; if not,
the dose may be doubled the second night, and trebled the third night;
but it is not advisable to go beyond this quantity except under
professional advice. Even these quantities after a week or two's use
lose much of their power, and may require to be cautiously increased.
When the pains are lessened and the patient is improving, the quantity
of Opium should be decreased gradually, rather than the whole supply
left off at once. _To control the Sleeplessness and Restlessness of
Delirium Tremens_, Opium given as above may be necessary, but each dose
should be combined with four or five grains of Camphor in the form of
pill; in fact, Camphor alone in doses of 2 to 3 grains every three or
four hours, exercises a most soothing influence, and when this treatment
is adopted, the Opium at bedtime may be given alone.
284. _In Spasmodic Affections of the Bowels_, _violent Colic_, _and the
Passage of Gall Stones_, and when the pain is violent, a full dose of
Opium, _e.g._, 20 to 25 drops of Laudanum in a wineglassful of Omum
water, or Infusion of Sweet Flag root (12), often affords speedy relief;
should it not do so, however, in half an hour the dose may be repeated,
and a third dose after an hour, should the pain continue unabated. At
the same time, hot water fomentations, a turpentine stupe, or a mustard
poultice, should be applied externally. When the pain has subsided a
dose of Castor Oil is advisable, especially when there is reason to
suspect that the attack has arisen from the use of crude or indigestible
articles of food.
285. _In Cholera_ the practice of giving Opium in large and repeated
doses, especially in the solid form, in all stages of the disease, _is
fraught with danger_. Administered judiciously at the proper time, and
in proper cases, it is capable of doing much good, but its
indiscriminate use often produces the worst effects. At the outset of an
attack, few remedies are more useful when combined with Acetate of Lead.
(_See_ Index.) Again, it is a valuable adjunct to the "Calomel
treatment" of Dr. Ayre, which consists in giving one or two grains of
Calomel, with from one to five drops of Laudanum, every five, ten, or
fifteen minutes, according to the urgency of the symptoms, till the
quantity of Laudanum has reached altogether 60 or 80 drops, when it
should be discontinued. An essential part of this treatment, which has
sometimes proved very effectual, is the free use of cold water as a
drink.
286. _For relieving the pain and irritation of the Bladder, caused by
the presence of Stone in the Bladder, Gravel_, &c., no medicine gives
more relief than Opium in full doses, as advised in paragraph 284. It
proves, however, even more effectual if introduced into the rectum,
either in the form of suppository (two grains of Opium with four grains
of Soap), or in enema (30 to 40 drops of Laudanum in two ounces of thin
_conjee_ water). It may also be given with great benefit _in Irritable
states and Painful Affections of the Kidneys_.
287. _In Retention of Urine arising from Spasmodic Stricture of the
Urethra_, a hot bath and a full dose of Opium (25 to 30 drops of
Laudanum), followed by a dose of Castor Oil, will often suffice to give
relief in recent cases of no great severity following a debauch,
exposure to wet, &c. The Opium given in an enema of two or three ounces
of rice _conjee_, sometimes succeeds when it fails if given by mouth.
288. _In Diabetes_, Opium occasionally produces the most beneficial
results, especially in old cases occurring in the aged. It requires to
be given in full doses and to be persevered in, the effects being
carefully watched; the dose diminished, or the remedy left off
altogether, if it gives rise to headache or other bad symptoms. It is
worthy of remark, however, that persons suffering from this disease will
take large doses with impunity.
289. _In many painful Affections of the Uterus_ Opium is of the greatest
service. Besides being employed in the form of suppository or enema, as
mentioned in paragraph 286, Camphorated Opium Liniment (291) warmed, may
likewise be rubbed into the loins, or a hot rice poultice sprinkled with
Laudanum applied over the lower part of the abdomen. When given
internally in these cases it requires to be given in full doses, and it
may be advantageously combined with Camphor (73). For the relief of
_After-Pains_, 15 or 20 drops of Laudanum in a wineglassful of Camphor
julep, or Omum water, or a little simple _conjee_, generally affords
speedy relief. _In threatened Abortion from a fall, over-exertion_, &c.,
a similar dose of Laudanum, with perfect rest in the recumbent position,
may suffice to prevent further mischief; should there be great
restlessness or pain, it may be repeated with advantage.
289_a_. _In Dysentery_, Opium in full and repeated doses (one to two
grains three or four times a day) was formerly in great repute, but it
has fallen into disuse since the Ipecacuanha treatment has been
reintroduced; still, amongst the natives it seems, in many cases, to
answer better than the latter drug. Even when Ipecacuanha is employed, a
preliminary dose of Laudanum (25 to 30 drops) is often of great service
in enabling the stomach to bear it and in preventing its emetic
operation. _For the relief of the local pain, bearing down, and
straining in this disease_, a small enema (two ounces) of _conjee_, with
30 to 40 drops of Laudanum in it, affords more relief than anything
else. Opium is a valuable adjunct to Catechu and other astringents in
the treatment of _Diarrhœa_.
290. _Vomiting_ is sometimes speedily relieved by a few drops of
Laudanum (5 to 10 drops) in an effervescing draught, or a little Omum
water. It may also be advantageously combined with Infusion of Cloves
and other remedies.
291. There are many external or local diseases, including _Chronic
Rheumatism_, _Lumbago_, and other _Muscular and Neuralgic Pains_,
_Spasms_, and _Bruises_, _Enlarged Glands_, _Mumps_, &c., in which
simple OPIUM LINIMENT, readily made by rubbing down a drachm of bazaar
Opium in two ounces of Cocoanut, Sessamum, or other bland oil, proves
very useful. Its efficacy, however, is greatly increased by conjoining
it with an equal quantity of Camphor Liniment (68). This, which may be
called CAMPHORATED OPIUM LINIMENT, is an excellent application in many
painful external affections. It should be well shaken before being used,
which it may be night and morning, or oftener if required; care should
be taken not to apply it to an abraded or sore surface; it is only
adapted for the sound skin, and not even then if the pain is attended
with much heat and redness; under these circumstances, cooling lotions
(325, 380) are better adapted. This Camphorated Liniment, well rubbed in
along the course of the spine, is occasionally very useful in _Hooping
Cough_. For _Stiff Neck_, warm Laudanum rubbed in over the part answers
better.
292. _In Ophthalmia attended with great intolerance of light_, great
relief may be obtained by fumigating the eye with the vapour of boiling
water, to which has been added a teaspoonful of Laudanum, or a couple of
grains of Opium. An excellent eyewash in these cases is composed of
Laudanum, Vinegar, and Brandy, each one part, and Water four parts.
_Toothache_, depending upon a decayed tooth, is often relieved by a
grain of Opium put into the hollow of the tooth; the saliva should not
be swallowed. _Earache_ also frequently yields to a mixture of equal
parts of Laudanum and any bland oil, inserted into the outer passage of
the ear on a piece of cotton wool: care should be taken not to push it
in too far.
293. _To Painful Piles_, where there is much swelling and heat, a very
soothing application is a soft rice poultice, the surface of which has
been sprinkled with Laudanum, or smeared over with simple Opium Liniment.
294. +Papaw Tree.+ Carica Papaya, _Linn._
Popaiyáh (_Hind._), Popáí (_Duk._), Papaiyá (_Beng._), Pappáyi
(_Tam._), Boppáyí (_Tel._, _Can._), Pappáya (_Mal._), Pópayá (_Mah._),
Papáyi (_Guz._), Pepolká (_Cing._), Pimbo-si (_Burm._), Papaya
(_Malay_).