ADMINISTRATION OF REMEDIES. (continued 2)

But however dangerous may be the knife operation, there is no danger at all to be apprehended from removing the tumors by a ligature. To accomplish this, take a soft cork about three-fourths of an inch in diameter, and one inch long—make a hole through the center from end to end, about one-eighth of an inch in diameter—cut crucial grooves in the top of the cork about an eighth of an inch deep, bevel down the lower end nearly to an edge, make a cord of saddler's silk, three fold twisted together and waxed, about eight or ten inches long, double this in the middle and pass the loop down through the cork out at the sharp end, the two loose ends of the string being out at the grooved end. Make a strong hickory stick about three-sixteenths of an inch in diameter, and just long enough to pass across the square end of the cork. Now have the patient protrude the Pile tumors as far out as possible, being placed on his knees with the head bent to the floor, pressing out firmly as if to evacuate the bowels. Let the tumors be dried as much as possible by gently pressing a soft, dry cloth to them; then let the loop of the string projecting from the flattened end of the cork, be pushed on over the largest tumor, and held down at its base, while an assistant places the stick in one of the grooves, ties the two ends of the cord firmly down over the stick, or toggle, by a square bow knot; then turn the stick round once, twice, or more, until the pressure upon the tumor is sufficient to strangulate it perfectly, and prevent the string from slipping off. Care should be taken to keep the cord down to the base of the tumor while it is being tied and tightened, as in many cases the base is much the larger part of the tumor, and the cord tends to slip up. After the ligature is applied and tightened, apply arnicated water to the parts, and a large, warm poultice of superfine slippery elm bark, wet so as not to be too soft and slippery, on the face of which Arnica may be put. Keep it on with a T bandage. The patient must be put to bed and kept quiet until the ligature and tumor come off, which will be in about six or seven days, sometimes sooner. Once a day the "toggle" must be turned part, or the whole of a circle or more, to tighten the cord as the patient can bear. This will be very painful from beginning to end of the ligating, but any, even the most sensitive, patient can bear it. The patient must have quite warm hip baths two, three, or more, times a day, or as often as the pain is severe, the poultice being replaced after each bath, and kept constantly on.

If there are several tumors protruding, apply ligatures to two of the largest, when these are removed, the others will disappear.

Injections of mucillage of slippery elm should be carefully used to move the bowels daily, or at least once in two days. Let the diet be of corn or oat meal mush, or rice. As the tumor gradually sloughs off, the surface heals, so that, though the base where the ligature was applied, may have been an inch or more across it, there will not be a raw surface of over an eighth of an inch in diameter, to which Calendula Cerate should be applied. The patient must keep quiet for a few days longer. Though this is a painful operation, it is not in the slightest degree dangerous. I have effected complete and permanent cures by this mode in numerous instances.

Sea-Sickness.

Nux Vomica should be used once in about four hours, for twelve hours before sailing, as a preventive to sea-sickness.

If, however, symptoms, such as dizziness or blur before the eyes, and headache, begin to come on, a dose of Nux should be taken, followed in an hour with Pulsatilla.

If the nausea comes on, Ipecac and Arsenicum should be taken alternately between the paroxysms of vomiting, should that symptom appear.

If practicable, the patient should lay still upon the back until the sickness passes off. I have removed sea-sickness immediately in several instances with Pulsatilla alone, and the last time I had an opportunity to prescribe for this affection I gave Podophyllin. It removed all the symptoms in a few minutes. That is the only time I ever tried it, but from the provings I am satisfied it is one of the best remedies.

Asiatic Cholera.

I was practicing in Cincinnati during the prevalence of Cholera in the years 1849, and 1850, and in Northern Ohio in 1854, and had abundant opportunity to observe and treat it. The disease generally begins with a diarrhœa, which may continue for several days, or only a few hours before other symptoms set in, such as vomiting, then cramping in the stomach and muscles of the legs, arms, hands and feet, followed by cold sweats, great prostration, restlessness, excessive and burning thirst, drinks being immediately rejected. These symptoms continue, the patient sinking rapidly into collapse, when the skin looks blue and shriveled, the eyes sunken, the surface covered with a cold, clammy sweat, the extremities, nose, ears, tongue and breath cold, the voice hollow and unnatural. This condition continues from two to eight or ten hours, the patient regularly failing, sometimes becoming delirious before he dies.

In some cases the vomiting and diarrhœa set in simultaneously, and the other symptoms follow, as above described, in rapid succession. In others the cramping may be the first symptom, the others following it.

In a large proportion of cases, the disease takes the course first described above, the diarrhœa, called the premonitory symptoms, or sometimes cholerine, coming on several hours, if not a day or more, before any other symptoms.

The diarrhœa is not usually painful, hence the patient may not be alarmed so as to attend to it until the more dangerous symptoms appear. It begins in some cases with pain and some griping, the discharges rather consistent, having a bilious appearance, so that the patient supposes it to be an ordinary bilious diarrhœa, which is not dangerous, his fears being thus quieted. But however the diarrhœa begins, it becomes sooner or later, copious, watery, and light colored, (rice water) painless but rapidly prostrating.

TREATMENT.

In the early stages of the diarrhœa, Veratrum, taken about twice as often as the evacuations occur, will frequently arrest it in a few hours, especially if the patient lies down and keeps quiet. But if not, and it increases in frequency, or becomes more copious, or any sickness is felt at the stomach, the patient should, at once, be laid upon a bed and strong tincture of Camphor should be given in drop doses, once in five minutes, for one hour or more, and as the symptoms abate, once in ten, fifteen or twenty minutes, for six or eight hours.

A teaspoonful of the Camphor tincture may be put into a tumbler of cold water, ice water if at hand, and the water agitated until it becomes clear, giving a teaspoonful of this camphorated cold water as a dose, stirring the water each time. I think this is better than to give the pure tincture. After the patient becomes quiet and easy, Veratrum should be given in alternation with Camphor, a dose in four to six hours for several days, or oftener if he feels any symptoms like a threatened return of the disease. These two medicines serve as prophylactics (preventives) of Cholera.

If, however, the disease continues in spite of the Camphor and Veratrum, in the first instance, or later, (as the Camphor may be given in many cases with success in the advance stage,) you must resort to other remedies.

If vomiting comes on with burning in the stomach give Ipecac and Arsenicum in alternation as often as the vomiting occurs, and if the diarrhœa continues give Veratrum between the doses of the other two, in a violent case, as often as every ten to fifteen minutes, and at longer intervals when the disease is slow in its progress. If the vomiting and diarrhœa, or either, occur with a kind of explosion, the vomiting ceasing suddenly for the time, after the first gush, or the discharges from the bowels are involuntary, Secale is the specific remedy.

For the cramping, Cuprum and Veratrum are the remedies to be given alternately.

If, however, the cramping comes on as the first symptom, which is sometimes the case, the patient being suddenly seized with it before any other alarming symptoms occur, Camphor is the great remedy, and in this case it may be given in doses of double or treble the quantity before directed.

If he sinks into the collapse and lies quiet, indifferent to everything, the pulse sinking, or he is pulseless, Carbo Veg. will sometimes arouse and restore him, hopeless as the case appears. It should be given once in half an hour until the pulse begins to rise. If, however, instead of being quiet he is restless and thirsty, give Arsenicum in alternation with Carbo Veg., repeating the dose as above directed. In some cases, after all the active symptoms cease, the patient will become quiet and drop to sleep, and instead of the pulse rising, as it will if he is recovering, it sinks, or does not appear if he has been pulseless, and the breathing becomes irregular and feeble—he is sinking. If aroused, he sinks back into the stupor in a few moments as before. Laurocerasus is a specific for this condition. It should be given once an hour until he is aroused.

If, however, besides the stupor, the head is hot, the face red, the breathing oppressed, the pulse slow and sluggish, Opium is to be used, and may be given in alternation with Laurocerasus.

For the irritation of the brain, and furious delirium that sometimes sets in after the cessation of cholera symptoms, Secale and Belladonna in alternation will prove specific.

Let the patient have warm or cold drink as he prefers, and let his covering be light or plentiful as is most agreeable. As soon as he gets easy, and the vomiting and purging cease, and his pulse begins to return, keep him quiet as possible, let the room be darkened and everything still, so that he may go to sleep, which he is inclined to do, this being the surest restorer. I am quite sure I have known several patients carried off by a return of the disease, after it had been effectually arrested, in consequence of sleep being prevented by the rejoicing officiousness and congratulations of friends, disturbing and preventing that early and quiet slumber which nature so much needs, and must have, or hopelessly sink. The diet for two or three days after recovery, should be a little oat meal gruel or rice.

Small Pox—Variola.

This disease begins with pain in the head and back, chilly sensations, followed by a high fever, so similar in all respects to a severe attack of Bilious or "winter" fever, that it is difficult or impossible to distinguish it with certainty, as Small Pox. The fact of the prevalence of the disease at the time, and the exposure of the patient, may lead the Physician and friends to suspect Small Pox. There is one very striking symptom of Small Pox, however, that exists from the beginning, which, though it may be present in fever simply, is not uniformly so. This is a severe and constant aching pain in the small of the back. The headache is also constant.

The Small Pox is of two varieties or degrees, distinct and confluent. The distinct is when the pustules are separated from each other, each one a distinct elevation, with more or less space between them not affected by the eruption.

The confluent is where the pustules spread out from their sides and run together, covering the whole surface as one sore.

It may be distinct on some parts, as on the body, and confluent on others, as the arms, face, and parts most exposed to the air.

In the Distinct variety the fever continues without abatement until the eruption appears, when it entirely subsides, and that quite suddenly. The eruption comes out about the third day of the attack, sometimes not discoverable until the end of the third or beginning of the fourth day. The eruption is at first very slight, beginning with small red pimples on the forehead, upper part of the cheeks, neck and upper part of the breast, extending by degrees to the arms, and other parts of the body and limbs. About the end of the fourth or forepart of the fifth day, the eruption is complete.

There is a symptom, not mentioned in the books, which will often determine the disease before the occurrence of any eruption. It is the appearance of hard shot-like pimples, to be felt under the skin in the palms of the hands, while there is, as yet, no trace of eruption to be seen upon the surface.

On the eighth or ninth day, the eruptions become vessicular, have flattened tops, and contain a limpid fluid. The parts continue to swell, the eruptions to enlarge, and become filled with purulent matter, having a dark color at the top, up to about the fourteenth or fifteenth day, when they begin to flat down, to dry up, and some of the scabs become loose. At this time, some fever arises, often quite severe, with headache and other inflammatory symptoms. If the eruption is very severe, fever will be of corresponding violence, and lighter or wanting when the eruption is mild. This fever rarely lasts more than twenty-four hours, from which time the patient rapidly recovers.

In the Confluent variety, all the symptoms are more violent, the fever continuing after the eruption begins. The pustules burst early, and run into each other, covering nearly or quite the whole skin; the surface swells and turns black or dark brown, the lungs are more or less irritated, producing cough, and not unfrequently the stomach is nauseated, and vomiting ensues.

If the patient survives the irritation up to the fifteenth or sixteenth day, when the secondary fever sets in, he is liable to be taken off by an affection of the brain or lungs, during this fever. If he recovers, his whole surface, especially that part exposed to air, is deeply pitted.

TREATMENT.

As it is not often known for a certainty, in the early febrile stage, that it is the small pox, the treatment will be first adopted that would be proper for a like fever arising from other causes. But in all my observations in this disease, and they extend to several hundred cases, I have not found in a single instance, any of the ordinary fever remedies, such as Aconite and Bell., which would be applicable for such symptoms in an ordinary case, to do any good in small pox. They are directed, however, for these symptoms by the authorities, in the febrile stage of the small pox; but I am quite sure they are not the proper remedies.

From the great similarity, the almost absolute identity of small pox headache and backache, with the same symptoms developed by the Macrotys racem. as well as the nausea and restlessness produced by the drug, I was led several years ago to the conclusion that this, or the Macrotin was valuable in small pox. Not only so, but during the prevalence of small pox in Cincinnati, to an extraordinary degree in the winter of 1849-50, I treated about one hundred cases, including both sexes, and all ages, from infants a few weeks old, to very old persons, giving the Macrotin to all, and had the good fortune to see all my patients recover. Since that time I have prescribed it for every case successfully.

Having then, been entirely successful in so many cases, with this medicine, I am not inclined at this time to give any other the preference. I must admit, however, that though my patients all recovered, I was not able to greatly abridge the duration of the disease, nor to prevent the development of all the stages in their proper order, as is claimed by M. Teste, for his use of Mercurius cor. and Causticum. I was satisfied with so far modifying the symptoms, as to enable my patients to live through, and come out well in the end. I would then direct, if small pox is suspected, the patient having been exposed to contract it, or from the peculiarity of the symptoms, in the early stage, or when the disease is discovered after the eruption, to give Macrotin at the first trituration, in one grain doses, once in two hours, while the fever, headache and backache continue, after which, during the whole course of the disease, give it three times a day. This will prevent the development of a dangerous secondary fever, as well as irritation of the lungs, stomach or bowels. In addition to this medicine I give the patients daily, from half an ounce to two ounces of pure (unrancid) Olive oil. This serves to prevent the development of pustules in the throat, lungs and stomach; is more or less nutritious, and keeps the bowels in a healthy condition. Wash the surface once a day in weak soap suds, following it with a bath of milk and water, and keep cloths moistened with warm milk and water, constantly upon all parts that are exposed to the air, lubricating the surface with Olive oil after the bath of milk and water. This keeps the surface quite comfortable.

The best diet is corn or oat meal mush and molasses, to be taken in small quantities. Cold water is the proper drink, though it should not be very cold.

The room should, at all times, be well ventillated, but in cold or cool weather, sufficient fire must be kept up, to keep the room warm and dry. A temperature of about 65° is the best. Hardly any thing can be worse for a small pox patient than to be in a cold or damp room, and to breathe cold air. Uniform temperature is important.

If the eruption is tardy about appearing, or after it is out, a recession takes place, the Alcoholic Vapor bath will soon bring it out. (See Rheumatism p. 30).

Occasionally the feet and limbs below the knees, will swell prodigiously, and become extremely painful, causing the principal suffering. For this, wrap the feet and legs in cloths wet in a strong solution of Epsom salts, quite warm, and cover with flannels so as to keep them warm. This will afford immediate relief, and reduce the swelling in a day or two. The finely pulverized Epsom salts, dry, sprinkled on the pustules, will very often prevent pitting. It is the safest and surest remedy of which I have any knowledge.

Varioloid

is small pox modified by vaccination. It is to be treated as a mild case of small pox. The Macrotin has been used with apparent success as a prophylactic (preventive) to small pox, taken three times daily.

Painful Urination, Incontinence of Urine,

Involuntary Urination.

Where the discharge of urine produces smarting and burning of the urethra, Cantharis is the remedy. Where there seems to be an over secretion of acrid urine, producing inflammation of the neck of the bladder, known by pain in the glans penis, Copaiva, and Apis mel. are the remedies. If there appears to be a partial palsy of the neck of the bladder, the discharge taking place in sleep, Podophyllin is the surest remedy. I have cured some bad cases by the use of these three remedies, given in rotation three or four hours apart.

Injections of a solution of borax into the bladder, have, in several cases, been sufficient to effect a perfect cure, without any other remedy. This may be used in connection with the other remedies. For painful urination with a distressed feeling in the neck of the bladder, causing a constant disposition to evacuate urine, the Althœa Officinalis is a certain remedy; it acts like a charm. It is an important remedy for inflammation of the bladder. A good mode of using it is in form of a warm infusion in doses of a table spoonful every half hour or hour, according to the urgency of the symptoms. The Althœa Rosa (Hollyhock) may be used as a substitute, though it is not as good. Every family should cultivate the Althœa Officinalis (Marsh Mallow), so that the fresh green root, which is the best, can be procured at any time. I have been able to relieve patients with it, especially females, when all other remedies seemed unavailing. It is particularly useful for urinary difficulties of pregnant females.

Neuralgia.

Aconite and Bell. are two important remedies in this affection. If given low, and applied directly along the course of the affected nerves, at full strength of the tincture, they will almost always effect a cure. The proper way to use them is to give them internally at the second dilution, at intervals of fifteen to thirty minutes, when the pain is severe and nearly constant, and apply Aconite tincture as hot as practicable over the course of the nerve, by means of wet cloths, for an hour or two hours, and if the pain has not subsided use Bell. locally in the same manner.

If the Neuralgia is periodical, coming on at regular intervals, Arsenicum and China are the remedies, and they should be used externally as directed for the others, both at the first dilution, and given internally at intervals, in proportion to the violence of the symptoms, the Arsen. at the 3d and the China at the first dilution. If the patient has used alcoholic drinks to excess, Nux is to be used in place of Arsenicum.

Periodical Neuralgia generally requires the same treatment as ague. In females when there is uterine disease, Pulsatilla and Macrotin are the remedies to be used, as directed above.

Jaundice.

This disease depends upon derangement of the liver. The skin and whites of the eyes become yellow; the patient grows weak, loses his appetite, is dull and sluggish in all his actions, melancholly and discouraged in his moods.

TREATMENT.

Mercurius and Podophyllin given in alternation, each twice a day, will nearly always effect a cure. If the patient is costive, Nux should be taken at night, until his bowels become regular.

Bathing the surface daily, or oftener, is a very important measure in the treatment of this affection. As often as once in two or three days, an alkaline bath should be taken. If the patient has fever every day, or once in two days, ever so slight, China should be used with Podophyllin. If he has been drugged with Mercury in any form, in large doses, even six months or a year before, give Hydrastin in place of Mercurius.

Itch.

I shall say but little about this very common and very obstinate affection. Everybody has a "cure for itch" yet nobody cures it short of the use of Sulphur in some form. Though the attenuations of Sulphur may sometimes cure itch, it must be acknowledged that such cures are so rare in this country, and the time requisite to accomplish it is so long, as a general rule, that few will trust them.

The most successful remedy, and the one that will always cure quickly, if at all, is Hepar Sulphurus Potassium, the common Hepar Sulphur (sulphuret of Potassa) of the shops. To succeed with it most certainly, let the patient be thoroughly bathed with warm soap suds, quite strong, in a room at the temperature of 90 to 100°, continuing the bathing and rubbing for an hour or more, then dry off the surface with soft cloths, and apply the Hepar sul. with water, at the strength of thirty drops of the strong alcoholic solution, with a gill of water, wetting every eruption on the whole surface and let it dry on. This causes some smarting, but it is effectual; it kills the acarus, (itch animalcule) and in a few days the sores heal, the itching all subsides immediately. If every pustule has not been touched, those left may continue to itch, in which case, a second application is necessary. Hepar Sul. should be given internally at the third dilution, for a month, once a day, after the baths. Avoid greasy food. For the

Scald Head

of children, where there is a discharge of yellow and watery pus from the sores, and the eruption extends to the ears or face, like the disease called the crusta lactea (milk crust), the same washes as for itch, are the most effectual, while at the same time, and for a month or two, the child should have Hepar Sul. 5th at night, and Petroleum 3d in the morning. Daily ablutions of the head with warm soap suds, and keeping it covered, are absolutely essential.

Carbuncle.

This affection, though it somewhat resembles a common boil, and is by some writers considered only such, in an overgrown state, is, nevertheless, far from being identical with it.

While a boil is only a sanitive effort of nature to eliminate the cause of a morbid process, and tends to a spontaneous, healthy termination, the carbuncle, on the contrary, is the very essence of disease; its constant tendency being towards the dissemination of diseased action, causing destruction of the parts affected. It, in fact, appears like a parasite, living by the destruction of surrounding tissues, literally absorbing them and "thriving on death." It begins with a red, livid color, slight aching and burning pains, the part swells and is elevated some like a boil, except that it does not "point," but has a broad base rising like a cone and flattened at the top. It feels soft and spongy, and will appear to fluctuate, but if punctured, blood only flows. The pain and burning increases rapidly, and sooner or later several openings appear upon the top, varying from three or four to half a dozen or more, looking like the holes in a sponge, out of which issues a fluid like thin gruel. Instead of becoming easier after the suppuration begins, as is the case with a boil, the burning increases to an alarming and unbearable extent; cold chills, loss of appetite, great depression of spirits, general nervous and muscular debility come on. The tumor continues to discharge, turns purple; gangrene beginning in the carbuncle extends to other parts and death follows.

The disease is nearly always confined to quite feeble persons and those past the meridian of life; but I have seen it on younger though feeble patients. It is generally located on the back, occasionally on the head, where it is very dangerous from its liability to affect the brain.

TREATMENT.

If treated very early, strong tincture of Arnica applied to the surface of the carbuncle, by cloths wet and laid over the tumor, will often arrest it so that the swelling will not be developed to the suppurative stage. However, to reap any benefit from Arnica, it must be applied while the pain is not severe, and the parts only feel bruised and tender to pressure, like a common bruise.

After the ulceration occurs, Arsenicum is the great remedy to be relied on. It should be given at the second or third attenuation as often as every three hours, when the pain is severe, and applied to the surface of the carbuncle freely by cloths laid over it, wet in the first dilution, or by sprinkling the first trituration of the oxyde (1-10) freely upon the open surfaces, so that it may penetrate into the open mouths or orifices. Over this powder apply an emolient poultice, or soft cloths wet in water hot as can be endured. This will soon allay or greatly lessen the pain. It should be repeated as often as any of the burning pain peculiar to the carbuncle returns, until the tumor suppurates in a tolerably healthy manner; then lessen the strength of the Ars. applications, and continue them until it has the appearance of a healthy abscess, when only simple dressings are necessary. Some may suppose such strong applications injurious, but I can assure them from abundant experience, that there is not the slightest danger. The carbuncle should never be punctured or cut into. Such operations always make them worse, and induce a more rapid approach to gangrene.

The patient should have nourishing food, and good native wine may be taken in moderate quantities, by a very feeble person, with decided advantage.

Though the knife operations for the removal of carbuncle are always injurious, the chemical effect of Potash is frequently most beneficial. I have, in repeated instances, applied to the ulcerated surface, caustic potash freely, allowing the dissolved caustic to penetrate to the very "core" by running into the orifices. At first it would produce some smarting, but the pain is different from that of the carbuncle, and the change is agreeable rather than otherwise. Soon after the application all pain ceases, and the tumor, under the use of a poultice, begins to slough off in a few days, leaving a raw surface, disposed to heal kindly. Occasionally, however, the healing process is tardy, when Arsenicum, at the third, applied and taken internally, will soon effect a cure.

I have occasionally used Hepar Sul. with good effect in the latter stage.

Felon—Whitlow.

For this disease, in the early stage, when the sensation is that of sharp, sticking pain, feeling as though a brier or thistle was in the finger, immerse the part in water as hot as possible, into which put common salt as long as it will dissolve; hold it in this hot salt bath for an hour or more at a time, and when removed, apply finely pulverized salt, wet in Spirits of Turpentine; bind on the salt with several thicknesses, and keep it constantly wet with the sp'ts turpt. for twenty-four hours, when, if all symptoms of felon are gone, no further treatment is necessary. As a general rule, the hot bath should be repeated three times a day, especially if the symptoms have existed for several days and there is much pain or swelling, and the dressings should be kept on as above directed for several days, more or less, until all symptoms disappear.

I am quite confident that a large majority, if not all, of the cases if thus treated at any time before pus is formed, will be discussed and cured. If pus has begun to form before the treatment is commenced, this will not cure the felon, but it is good treatment, especially the hot bath, as it will greatly lessen the pain.

By holding it in hot water for an hour or two each day, the suppurative process will be hastened, and as soon as the pus can be felt at any point, fluctuating, puncture and let it out; then continue the hot bath, with Calendula (Marygold) flowers in the water, keeping the part all the time warm and moist.

For the restless and nervous irritability that frequently occurs, especially in females, Aconite is the best remedy. It should be given, one drop of the tincture to a gill of water, in teaspoonful doses, once in one or two hours, and the same applied to the sore.