the manner directed for Opium poisoning. _Where Insensibility arises
from the Inhalation of the Fumes_, Cold Water Affusion (386) in the open
air often succeeds in removing it at once. The patient should be aroused
by any or all of the means enumerated in poisoning by Opium. The nervous
symptoms may continue for two or three days, and yet recovery follow.
_Debility, Constitutional_, requires the use of the following tonics,
either alone or combined: Chiretta (98, 99*), Sweet Flag Root (12),
Country Sarsaparilla (163), Kariyát (191), Ním Bark (260), or Gulancha
(352). _When attended with Anæmia or great pallor of the surface,
especially of the inner surface of the eyelids and tongue_, Sulphate of
Iron (174) is indicated. The efficacy of all these remedies is increased
by a liberal animal diet, and gentle exercise in the open air. _Debility
after Fevers._ See _Fevers_.
_Delhi Sores._ The Borax Ointment (59) is strongly recommended. See also
_Ulcers_.
_Delirium_ generally is best treated by Evaporating Lotion (380) to the
head, the Mustard Foot Bath (248), or Turpentine Stupes (363) to the
extremities and a strong purgative; _for that occurring in Fevers_, see
_Fevers_.
_Delirium Tremens._ _To relieve sleeplessness and anxiety_, give Opium
and Camphor (283), or better still, Bromide of Potassium, as advised in
_Sleeplessness in Head Affections_. See that article. Try also the
Mustard Foot Bath (248, 249), or the Wet Sheet (397b). _To support the
strength_, give Brandy Mixture (427*) and a nourishing diet.
_Diabetes._ Vapour Baths (396) in the early stages, Alum Whey (27) and
Lime Water (226) internally, with Opium (288), at bedtime, prove
occasionally useful as palliatives. Their operation is assisted by a
full animal diet, with a diminished quantity of rice and other
farinaceous food, and by warm clothing. Use Lemonade as a drink (232).
_Diarrhœa._ _In the early stages, especially if attended with heat of
skin_, &c., give Country Ipecacuanha (369) and Ispaghúl seeds (304),
with a mild aperient, as Castor Oil, if there is reason to think that
the attack arises from crude, undigested food in the intestines. The
Acetate of Lead and Opium Pills advised for Cholera are often very
successful in these cases. One may be given every two or three hours, or
oftener, according to the urgency of the symptoms; they are especially
useful in _Epidemic Diarrhœa_. _In the advanced stages or in Chronic
Diarrhœa_ try Sulphate of Copper (110), Catechu (88), Alum (26), or one
of the following: Decoction of Babúl Bark (9), Infusion of Sweet Flag
(12), Bael (44), Butea Gum (62), Galls (146), Decoction of Pomegranate
(312), and Omum Water (317), with or without the addition, in each case,
of a small portion of Opium (289). Turpentine Stupes (363) to the
abdomen are useful if much pain is present. _When the disease is
apparently of malarious origin or connected with periodic Fevers of any
kind_, Quinine (three to five grains twice or thrice daily) should be
associated with whatever other remedies are being employed. Try also
Warm Water Enemas (393). _When connected with Acidity of the Stomach_,
give Lime Water (222). _When caused by Over-eating or by Indigestible
Food_, follow up an emetic of Mustard (246) or Country Ipecacuanha
(368), to unload the stomach, by Omum Water (318), and subsequently by a
dose of Castor Oil. Capsicum (79) is thought to be specially useful _in
Diarrhœa arising from the use of putrid food, e.g., fish. The Diarrhœa
of Children_ often yields to a dose of Castor Oil, if given early; if
not, one of the following may be tried: Acorus or Sweet Flag (13*), Bael
(44), Catechu (88), Sulphate of Copper (110), Sulphate of Iron (181*),
Saccharated Solution of Lime (220), or Ispaghúl Seeds (304). Omum Water
(318) may be advantageously combined with any of the above. _The
Diarrhœa which precedes Cholera._ See _Cholera_. N.B.—In all cases of
diarrhœa the food should be mild and unirritating, thick Arrowroot (423)
being the best suited for the purpose, and, in every obstinate or
chronic case, a flannel bandage should always be worn round the abdomen.
_Dropsy_ occurring in the young and vigorous is best treated at the
outset by strong purgatives, as Croton Pills (120) or Croton Oil (121),
or Kaladana (187), followed by medicines which increase the flow of
urine, as Decoction of Asteracantha (39), Infusion of Moringa (237),
Mustard Whey (250), or Infusion of Pedalium (297), with which Nitre
(269) or Sal Ammoniac (331) may be combined, as circumstances require.
The Vapour Bath (396) twice a week proves useful in recent cases, where
the patient is strong enough to bear it. Where the patient is very
debilitated and anæmic, Sulphate of Iron (174, 178) should be tried.
_Drunkenness._ After a debauch, a Mustard emetic (246) proves most
useful in unloading the stomach of any spirit remaining in it. A few
drops, six to twelve, of Liquor Ammoniæ in water subsequently given, are
often of signal success. Strong Coffee, _café noir_, is also most
useful. _To allay the subsequent cravings for drink_ try Omum Water
(320).
_Dysentery._ In the early stages give Country Ipecacuanha (369) and
Ispaghúl Seeds (304), or Sesamum leaves (338_a_), with or without Opium
(289*, 289_a_), and apply Hot Fomentations to the abdomen and Leeches to
the verge of the anus (211); the latter tend much to relieve the pain
and straining, as do also Opiate enemas (289_a_). The treatment of Acute
Dysentery by large doses of Ipecacuanha, reintroduced into practice in
1858 by Dr. Docker, is acknowledged by the most experienced authorities
to be far more effectual than any other. It consists, in the main, of
administering, as early in the disease as possible, 25 to 30 grains of
Ipecacuanha, in as small a quantity of fluid as possible, premising half
an hour previously 25 to 30 drops of Laudanum. The patient should keep
perfectly still in bed, and abstain from fluids for at least three
hours. If thirsty, he may suck a little ice, or may have a teaspoonful
of cold water. It is seldom, under this management, that nausea is
excessive, and vomiting is rarely troublesome, seldom setting in for two
hours after the medicine has been taken. Mustard Poultices (247) or
Turpentine Stupes (362) should be applied to the abdomen. In from eight
to ten hours, according to the urgency of the symptoms and the effect
produced by the first dose, Ipecacuanha in a reduced dose should be
repeated, with the same precautions as before. The effects of this
treatment are soon manifest and surprising; the griping and straining
subside, the motions quickly become feculent, blood and slime disappear;
and often, after profuse action of the skin, the patient falls into a
tranquil sleep and awakes refreshed. The treatment may require to be
continued for some days, the medicine being given in diminished doses,
care being taken to allow a sufficient interval to admit of the patient
taking some mild nourishment suited to the stage of the disease. As the
disease abates, the dose should be reduced. It is well, however, to
administer 10 or 12 grains at bedtime for a night or two, after the
stools are, to all appearance, healthy. Fomentations or Turpentine
Stupes to the abdomen lessen griping and diminish suffering. If a little
diarrhœa without the dysenteric odour remain, it may be checked with a
little astringent mixture, with or without Opium. Astringents in any
shape during the acute stage are not _only useless, but dangerous_. (Dr.
Maclean.) To sum up, it appears—1. That acute dysentery is more
successfully and speedily treated by large doses of Ipecacuanha than by
other means. 2. That it is more effectual in the acute than in the
chronic forms. 3. That large doses, such as are mentioned above, may be
given with perfect safety, without fear of ill effects; and 4. That it
is less successful with the natives of India than with Europeans. In the
acute dysentery of natives, small doses, _e.g._, from six to eight
grains thrice daily, so as to keep up a slight degree of nausea, short
of actual vomiting, seem to answer better than the large doses mentioned
above. It may be advantageously combined with Opium, from a quarter to
half a grain with each dose.
_When of malarious origin or when occurring in the course of periodical
Fevers_, Quinine (three to five grains twice or thrice daily) should
form part of whatever other treatment is being followed. _In the
advanced stages, or when it passes into Chronic Dysentery_, apply
Turpentine Stupes (362) to the abdomen, and give Sulphate of Copper
(110), Bael (44), Infusion of Kariyát (191), Decoction of Pomegranate
Rind (312), or Sal Ammoniac (331). When an aperient is required, give
Sulphur and Cream of Tartar (344) or Castor Oil, with the addition of a
small portion of Opium. _For the Dysentery of Natives_, Decoction of
Sweet Flag (13), Galls (146), Mudar (243), Opium (289a), and Decoction
of Pomegranate Rind (312) seem best suited. _For the Chronic Dysentery
of Children_ the Saccharated Solution of Lime (220), Bael (44), Sulphate
of Copper (110), or Sulphate of Iron (181) are indicated. See also
_Diarrhœa of Children_. N.B.—In all cases of dysentery the food should
be mild and unirritating, and a flannel bandage worn round the abdomen.
Soups containing mucilage of Abelmoschus (2) prove useful.
_Dysmenorrhœa._ See _Menstruation, Painful_.
_Dyspepsia._ See _Indigestion_.
_Ear, Discharges from, in Scrofulous Subjects._ Syringe the ear daily
with Lime Water (225), or tepid water, or milk and water, and give Fish
Liver Oil internally (138). _Buzzing or Noises in the Ear_ often depend
upon an accumulation of wax in the outer passage; to remove this and
effect a cure all that is necessary in many cases is to insert a drop or
two of sweet oil for an hour or two, and then to syringe the ear well
out with tepid water or soap and water, and repeat the same twice or
thrice daily. This also sometimes relieves _Ear-Ache_: if not, use Opium
as directed in Paragraph 292.
_Elephantiasis._ The paroxysms of fever which accompany this disease are
to be treated in the manner directed for Intermittent Fever (_infra_).
The only means of arresting the progress of the disease is to remove
permanently from a locality in which it is endemic or prevalent to
another situated at least ten miles distant from the sea-coast; the
higher and drier the site the better.
_Epilepsy_ sometimes improves under Fish Liver Oil (141); its use may be
combined with Sulphate of Copper, in doses of a quarter of a grain twice
or thrice daily. For this purpose, dissolve two grains in one ounce of
Omum Water; of this, the dose is a teaspoonful. Far superior to all
other remedies for _Epilepsy_ is Bromide of Potassium in doses of 10 to
15 grains, in a wineglassful of water, thrice daily. Should the disease
not yield to these doses, they may be gradually increased to double or
even treble these quantities. The earlier in the disease this remedy is
resorted to, the greater are its chances of success; and as a general
rule it proves more useful when the fits are severe and frequent, and
occur mainly in the daytime, than in the milder attacks, which come only
at night. In all cases it is worthy of a fair trial. See also remarks at
the end of _Convulsions_ in this Index.
_Exhaustion from Hæmorrhage after Fevers or other causes_, give Brandy
Mixture (426).
_Eyes, Affections of._ Datura (128β). For "_Country Sore Eye_," apply
Alum, as directed in Paragraph 23, and Decoction of Turmeric (360) to
relieve the burning sensation. Try also Solution of Sugar (406). _For
other forms of Ophthalmia, attended with copious discharge_, try
Sulphate of Copper (113). _To relieve great pain and intolerance of
light_, use Opium locally (292). _Blows on the Eye_: Alum Poultice (24),
followed by Sal Ammoniac Lotion (332), to remove discoloration.
_Particles of Lime in the Eye_ may be dissolved and removed by dilute
Vinegar (382). _Particles of Dirt, &c._, may often be speedily dislodged
and removed by drawing the upper eyelid well over the under one as far
as possible for a few seconds. This simple plan is often successful when
others fail. If this fail, try Solution of Sugar (406). Fresh Plantain
Leaf (307) forms an excellent shade for the eyes in all affections of
those organs.
_Face-Ache, Neuralgic or Rheumatic._ Sal Ammoniac (326), Sulphate of
Iron (177), or Fish Liver Oil (141) internally; and Datura (130), and
Mustard (253), or Ginger (157) Poultices locally, are measures which,
used conjointly, often prove successful. _When periodical_, Cinchona
Febrifuge (402*).
_Fainting_ generally yields to dashing cold water over the face and neck
(386), and applying strong smelling salts to the nostrils; when
partially recovered, Omum Water (318) or Asafœtida (35) may be given, or
should there be much exhaustion, a dose of Brandy Mixture (426).
_Fevers, Ardent or Continued._ In most cases it is advisable to commence
with a purgative of Kaladana (187), Castor Oil (83), or Myrobalans
(256), or if the patient be a strong adult, a Croton Pill (120); after
its operation the Solution of Nitre (264) may be given, and Decoction of
Abelmoschus (2), Lemonade (232), or Tamarind Infusion (346), _to allay
the thirst and cool the system_. A very useful and refreshing drink in
all fevers, especially if there is irritability of the stomach, is a
mixture of equal parts of Milk and Soda Water, with the addition of a
piece of ice if procurable. Sucking small pieces of ice also allays
thirst and cools the system; for this latter purpose, also, sponging the
surface with Water (385) or diluted Vinegar (376) may be employed. The
diet should consist chiefly of Rice _Conjee_ (322) and other farinaceous
articles, and the apartment should be kept cool and well ventilated. _To
relieve Headache or great fulness of the head_, apply constantly
Evaporating Lotion (380) or Nitre Lotion (265), or, if these fail to
afford relief, Hot Water Fomentations (393). Leeches to the temples or
nape of the neck (209) and Mustard Poultices to the feet (248) may also
be necessary in severe cases. _For any severe or acute pain arising in
the chest or abdomen_, Leeches (209) over the seat of pain should be
applied, but if these fail try a Blister (349). _For Vomiting and
Irritability of Stomach_ give Lime Water (223), or else give Hot Water
as a drink (385), and apply Mustard Poultices (251); _for Bilious
Diarrhœa accompanying_ use Warm Water Enemas (393). _For Sore Throat or
Fissures of the Tongue_, apply Borax (55) or Alum (29); _for Dryness of
the Mouth and Fauces_ sucking sliced limes, or, better still,
pineapples, generally suffices. _In the advanced stages, when great
exhaustion, delirium, &c._, are present, give Camphor (74) and Brandy
Mixture (426) internally, and apply Turpentine Stupes (363) to the
extremities; Turpentine Enemas (364) are also valuable in this
condition. _For subsequent Debility and during Convalescence_ give one
of the following tonics: Chiretta (98), Atís (42), Bonduc (52), Kariyát
(191), Ním Bark (260), Gulancha (352-3), or Cinchona Febrifuge (402). A
combination of Chiretta and Sweet Flag Root (12) or Chiretta Wine (99)
is perhaps best suited for this purpose. A liberal animal diet should be
allowed. N.B.—Throughout the attack it is essential to keep the bowels
properly regulated.
_Fever, Intermittent or Ague, and Remittent or Jungle Fever._ Commence
with an aperient, as in Fever (_ante_), and should the stomach be foul
give an emetic of Country Ipecacuanha (368). _In the cold stage_, cover
the body well up with blankets, give Infusion of Ginger (156), and place
bags containing hot sand or hot salt along the spine. _In the hot
stage_, give plentifully of Lemonade (232), Solution of Nitre (264), and
adopt generally the other measures advised above in Fever. _In the
sweating stage_, do nothing but protect the surface from cold draughts
of air or cold wind. In the intermission or periods between the
paroxysms give one of the following: Atís (42), Bonduc Nut (52),
Chiretta (98), Sulphate of Iron (175), Ním Bark (260), or Gulancha
(352). When one fails another may succeed; when each fails, given
singly, they will sometimes prove effectual given in combination. They
are all greatly inferior in efficacy to Quinine and Cinchona Febrifuge
(401, 403). _For these Fevers in Natives_, Galls, with Chiretta and
Sweet Flag Root (12), have been favourably spoken of. _Swelling of left
side after Ague_, see _Spleen, Enlargement of_.
In mild, ordinary, uncomplicated cases of _Intermittent Fever_, all that
is required, due attention being paid to the state of the bowels and
secretions, is to administer Quinine in doses of from three to five
grains, so that 10 or 12 grains be taken in the intermissions between
the paroxysms. It is best given in solution, in water or coffee. In the
severer forms, or even in ordinary cases, Professor Maclean, of the
Netley Hospital, has proposed a treatment which appears very judicious,
and which in his hands has for years proved very successful. It consists
in administering 30 grains in three equal doses during the period of
intermission; the first dose, in solution, should be given towards the
close of the sweating stage, and the last about as far as can be
calculated, an hour before the next anticipated paroxysm. Should there
be much irritability of the stomach, it should be given in enema in
doses of 15 grains in place of 10 grains. After the paroxysm has by this
means been arrested, a moderate degree of cinchonism, _i.e._, giddiness,
buzzing in the ears, flashing before the eyes, &c., should be maintained
for some days, by giving three or four grains in solution every four
hours. In cases where the fever returns at the first lunar period, as it
is apt to do, the patient a day or two previously should be brought
under the influence of Quinine, which should be maintained until the
time is past. Should it fail to influence the fever, attention should be
directed to the state of the liver and bowels. When from any cause it
cannot be given internally, trial may be made with it applied
endermically; the experiments of Dr. Guastamacchia and others tending to
prove that it becomes absorbed into the system through the skin, and
operates as an antiperiodic almost as certainly as when given
internally. He dissolved eight grains in half an ounce of spirit, and
rubbed first one half, and after the interval of a quarter of an hour,
the second half along the spine. When this was done at the commencement
of the cold fit, it very often prevented even a single recurrence. Dr.
Daunt also bears testimony to this method in the fevers of South America.
In _Remittent and Jungle Fever_, Quinine is a remedy of the highest
value, but its exhibition requires more caution and discrimination than
in simple intermittents. Dr. Maclean's treatment appears to be worthy of
every attention. After premising, in most cases, a cathartic,
immediately on the first signs of remission, he administers a full dose
of Quinine, 10 grains, often 15, sometimes 20 grains, never exceeding
that dose, and not deterred by the presence of headache or a foul
tongue, nor because the remission is slight or imperfectly marked; and
this dose he repeats every second hour until 30 or 35 grains have been
taken before the hour of the expected exacerbation. Should the stomach
be too irritable to bear it, it should be given in enema in large doses
(20 grains). As soon as the second remission appears, it must be given
as before until full cinchonism or distinct abatement of the disease
occurs. During the remission the patient should have mild farinaceous
diet, milk, chicken-broth, &c.; as soon as gastric irritability
subsides, beef tea should be given, and on the first sign of exhaustion,
nourishment and stimulants should be resorted to at short intervals.
With regard to the administration of Quinine during exacerbations, Dr.
Maclean is of opinion that in the adynamic forms of fever, as met with
in some parts of India, and in neglected or mismanaged cases, where
depletion has been carried too far, and the fever assumes more of a low
continued type, it may be given at any period irrespective of remission.
Here it requires to be conjoined with the assiduous use of support and
stimulants at short intervals.
As a preventive of _Malarious Fever_, the power and value of Quinine
have been proved beyond a doubt. Every person engaged in forests,
swamps, or low, malarious sites, should be provided with a stock of it,
and four grains of it in a cup of hot coffee should be taken the first
thing in the morning or in a glassful of wine later in the day. Even if
it should fail, which it rarely does, no harm can result from its use,
and it is essential that it should be continued for at least fourteen
days after quitting a malarious locality.
_Fits._ See _Convulsions_, and _Hysterical Affections_.
_Flatulence, and Flatulent Colic._ Give Omum Water (318*), Lemon Grass
Oil (216), infusion of Ginger (155), or of Jatamansi (184); with Mustard
Poultices (251) and Turpentine Stupes (362) externally; in severe cases
an enema of Asafœtida (36) will generally afford relief. See also
_Bowels, Spasmodic Affections of_. _Of Children_, see _Colic_.
_Gall Stones._ _To allay the severe pain attendant on passing_, give
Opium (284) and a Hip Bath (392).
_Genital Organs, Great Irritation of._ Try Camphor (72) internally (in
these cases Bromide of Potassium, in doses of eight to ten grains
dissolved in water, twice or thrice daily, is well worthy of a trial,
especially in females) and use Borax (57) and Lime Water (224) locally.
Sitting over the steam of hot water, or a tepid hip-bath, often affords
great relief. When the irritation arises, as it often does, from worms
in the intestines, give some of the remedies for _Worms_. Crab-lice,
which are very difficult to distinguish on a dark skin, are also a
frequent cause; if present, use Kerosene Oil (413), or other remedy
named in Art. _Lice_.
_Glands, Enlarged._ Apply externally, in the early stages, Sal Ammoniac
Lotion (332), Betel Leaves (48), Camphor Liniment (68), or Opium
Liniment (291). If matter forms, treat as abscess, and give Fish Liver
Oil internally.
_Gleet_ may be treated with Cubebs (125), Galls (149), Gurjun Balsam
(160), or Sandal Wood Oil (334) internally, and Alum Injections (30);
these last named, however, _require great caution_, and should not
generally be used except under medical supervision.
_Goitre._ Give Sal Ammoniac (324), in ten-grain doses, thrice daily,
persevering in its use for weeks or months if necessary. Dr. Stevens
(_London Med. Record_, June 15, 1880) obtained signal benefits from it
in six cases. Biniodide of Mercury, in the form of Ointment (16 grains
of the Biniodide to one ounce of Simple Ointment), is the best local
application we possess. Its effects are best produced by exposing the
surface on which it has been rubbed to the direct rays of the sun. If
this cannot be done, then to the heat of a fire; this, however, is not
nearly so efficacious as the solar heat. (Dr. Aitchison.)
_Gonorrhœa._ After a purgative of Kaladana (187), Myrobalans (256), or
Castor Oil (83), give Nitre (269) with Decoction of Abelmoschus (2),
Ispaghúl (305), or Rice _Conjee_ (322), for the purpose of allaying the
pain and heat in passing urine. Pedalium (297) is said to be very
effectual for this purpose, and should be tried if procurable.
Injections of a solution of Sugar (407) are recommended by Dr.
Aitchison. When the inflammatory symptoms begin to abate, one of the
following should be given: Cubebs (125*), Gurjun Balsam (160), Sandal
Wood Oil (334), or Galls (149), Alum (30*), locally, is of great use in
certain cases. _To relieve Chordee_ (painful erection at night), Camphor
(72) is one of our best remedies. Bromide of Potassium, in doses of 20
to 30 grains, in a wineglassful of water at bedtime, is highly spoken
of, as preventing the occurrence of this symptom.