Chapter LXXX: Part 2 (41)

=TOOTH′ACHE.= _Syn._ ODONTALGIA, L. This annoying affection frequently arises from sympathy with a disordered stomach. In such cases a saline purgative should be administered, and an emetic, if required. When cold is the cause, an excellent remedy is a hot embrocation of poppy-heads, followed by the use of flannel and diaphoretics. When it arises from a hollow or decayed tooth, the best application is a piece of lint moistened with creasote, or a strong spirituous solution of creasote, and closely rammed into the cavity of the tooth. Laudanum, the essential oils of cloves, caraway, and cajeput, and essence or tincture of pellitory of Spain, are also used in the same way. To prevent the recurrence of the latter kind of toothache, the cavity should be filled with an amalgam of gold, or with mineral marmoratum, or some other good cement. In many cases, chewing a piece of good ginger, or, still better, a small piece of pellitory, will afford relief in a few minutes. The celebrated John Wesley recommended a ‘few whiffs’ at a pipe containing a little caraway seed mixed with the tobacco. A slight ‘shock’ from a voltaic battery will often instantly remove the toothache after all other means have failed. See DROPS, ESSENCE, TINCTURE, &c.

=TOOTH CEMENTS.= See DENTISTRY.

_Obs._ It is absolutely necessary for success that the teeth be well cleaned out, and wiped dry, before applying any of the above stoppings or cements.

=TO′PAZ.= See GEMS.

=TOR′MENTIL.= _Syn._ TORMENTILLÆ RADIX; TORMANTILLA (Ph. L. & E.), L. The root or rhizome of _Potentilla Tormentilla_, It is astringent and febrifuge, without being stimulant.——_Dose_, 20 to 60 gr.; in agues, diarrhœa, &c.; also, formerly, in syphilis.

=TORTOISE-SHELL, to Polish.= Dip a soft linen rag into rouge powder, and rub the tortoise-shell with it, and finish off with the hand. Tortoise-shell combs will not lose their polish if they are rubbed with the hand, after removal from the hair.

=TOUCH-NEEDLES.= See ASSAYING.

=TOUCH-WOOD.= See AMADOU.

=TOUS-LES-MOIS.= The fecula of the roots of _Canna edulis_ (Ph. D.); intended as a substitute for arrow-root. To the naked eye, it closely resembles the finest quality of potato-starch, but under the microscope its granules are found to be oblong, oval, with a concentric structure, and larger than those of the potato tuber.

=TOXICOL′OGY.= See POISON.

=TRAG′ACANTH.= See GUM.

=TRANSPA′′RENCIES.= Water-colour pictures on paper, linen, or calico, if executed in non-opaque or glazing colours, may be converted into transparencies by simply brushing over their backs with Canada balsam, thinned down, when necessary, with a little oil of turpentine. For coarse work, boiled oil may be employed.

=TRAPS, HOUSE.= With few exceptions, the endless varieties of traps advertised for house-drains are all modifications of the older forms of the syphon, the midfeather and the ball-trap. The syphon trap consists of a bent tube with a deep curve, in which the water lies and acts as an hydraulic valve.

The following conditions are essential for its proper action. The curve must be of such a depth as to ensure a height of not less than 3/4 inch of water always standing above the highest level of the water in the curve. The outlet pipe attached to the trap should not be too small nor have too sudden a fall as it leaves the trap, otherwise when ‘running full’ of water, all the water will be sucked out of it by the pipe beyond, owing to the too narrow bore and too perpendicular inclination of this latter.

The midfeather trap consists of a round or square box or receptacle, into the upper part of which, on one side, an inlet pipe discharges, whilst at a corresponding height on the opposite side there is an outlet pipe. The upper part of the box is divided by a partition, which dips at least 3/4 inch below the surface of the water, always standing in the receptacle, at the level of the outlet pipe. The principle, therefore, of the midfeather is similar to the syphon trap. The receptacle is so arranged that any heavy substances collected at the bottom can from time to time be removed. A useful variety of the midfeather is ‘Dean’s patent drain-trap,’ manufactured by Edwards, of Ruabon.

The ball-trap is not in very general use. By this arrangement the drain is trapped by means of a hollow ball, which rises with the water in the drain until it is carried against and closes an orifice.

The common ball-trap is stated to be inefficient and unsatisfactory. The facility with which it can be removed or placed out of gear often leads, in the hands of careless servants, to the untrapping of the drain altogether. A good description of common sink trap is Antel and Lock’s, shown in the accompanying engraving, which explains itself.

Amongst the circumstances that impair the efficiency of house-traps may be included the neglect to allow the passage of water through them sufficiently often, and with force enough to flush and cleanse the trap, and renew the water in it. The results are, that the water becomes saturated with sewage exhalations, which escape into and contaminate the air in the house; and that the trap becomes either dry or choked up.

Another contingency to which house-traps are exposed when the drains are made to form a continuous and disconnected system with the sewers, is that of the water being sucked out of the trap, owing to the combined effect of the pressure of sewer air and the aspirating power of the house, into which the sewer-gas would then pass unchecked.

In our articles DRAINAGE and SINKS, we have pointed out the peril attaching to the intimate connection between the house-drains and sewers, and given in the former practical directions for its avoidance.

To rest in the belief that the danger can be removed (although the risk may be slightly diminished) by the use of traps alone, is to entertain a very false sense of security.

=TRAUMAT′IC BALSAM.= Compound tincture of benzoin is known by this name. See TINCTURE.

=TRAUMAT′ICINE.= This article, as manufactured by the Gutta Percha Company, is simply a solution of white and dry unmanufactured gutta percha in bisulphuret of carbon. A small portion dropped on a wound, or raw surface, almost instantly forms a pliable, waterproof, and air-tight defensive covering to the part. The only objection to the preparation is the fetid odour of the menstruum, which, however, is lost in a few seconds, or may be obviated by employing chloroform as the solvent.

=TREA′CLE.= _Syn._ MOLASSES; THERIACA (B. P.), THERIACA, SACCHARI FÆX (Ph. L. & E.), L. The viscid, brown, uncrystallisable syrup which drains from moist sugar during its formation (molasses), and from the sugar-refining moulds (sugar-house molasses). The last, according to Dr Ure, has generally the sp. gr. 1·4, and contains about 75% of solid matter.

Treacle is more laxative than sugar, and always contains more or less free acid. It is used as the vehiculum in some of the pill-masses of the Ph. L. See SUGAR.

=Treacle, German.= _Syn._ THERIACA GERMANIÆ, L. An evaporated infusion or decoction of juniper berries. It is sweet-tasted, aromatic, and diuretic.

=Treacle, Venice.= _Syn._ LONDON TREACLE; THERIACA, T. ANDROCHI, L. The theriaca of the Ph. L. 1746 consists of 61 ingredients, and contains 1 gr. of opium in 75 gr.; that of the Paris Codex consists of 72 ingredients, and contains 1 gr. of opium in 72 gr.; that of the Ph. E. 1744 consists of 10 ingredients, and contains 1 gr. of opium in every 100 gr. It is prepared as follows:——Take of serpentary root, 6 oz.; valerian and contrayerva roots, of each 4 oz.; aromatic powder, 3 oz.; guaiacum resin, castor, and nutmeg, of each 2 oz.; saffron and opium (dissolved in a little wine), of each 1 oz.; clarified honey, 75 oz.; reduce all the dry ingredients to fine powder, then mix them. The confections or electuaries of catechu and opium are the representatives of the above polypharmic compounds in the modern British Pharmacopœias.

=TRI-=, TRIS-. See NOMENCLATURE.

=TRIBASIC PHOSPHATE OF LIME.= _Syn._ TRICALCIC PHOSPHATE. (Ca_{3}(PO_{4})_{2}.) Tricalcic phosphate occurs nearly pure in the mineral known as OSLEOLITE. See CALCIUM PHOSPHATE for its artificial preparation.

=TRIMETHYLAMINE.= _Syn._ TRIMETHYLIA.

{ CH_{3} }
C_{3}H_{9}N, or { CH_{3} } n.
{ CH_{3} }

An ammonia found in large quantities in the roe of the herring. It also occurs in putrefying flour and urine, and is the ingredient which gives to the _Chenopodium vulvaria_ its peculiar and disagreeable odour. It may also be obtained by distilling ergot of rye with caustic potash. Trimethylia is a volatile fluid, with a very pungent and unpleasant fishy smell. It boils at about 41° F. It is metameric with propylamine.

=TRIPE.= This is the paunch, or first portion of the ruminant stomach of the ox. It is nutritious and easy of digestion, except when very fat. Letheby gives the following as its composition:

Nitrogenous matter 13·2
Fat 16·4
Saline matter 2·4
Water 68·0
——————
100·0

=Tripe, Fried in Batter.= “Tripe is cut into pieces about three inches square, and dipped into a batter made of six ounces of flour, one tablespoonful of oil, or one ounce of butter, and half a pint of tepid water. Mix the oil with the flour, add the water by degrees, whip the whites of two eggs to a stiff froth, stir into the batter, dip the tripe in, throw it into a saucepan of boiling fat, let it fry three or four minutes, take it out, and drain.”[240]

[Footnote 240: Tegetmeier’s ‘Scholar’s Handbook of Cookery, &c.,’ Macmillan & Co.]

=TRIP′OLI.= _Syn._ ROTTEN STONE; ALANA, TERRA CARIOSA, L. A mineral employed as a polishing powder, originally imported from Tripoli, in Barbary. It consists almost entirely of silica, and is composed of the skeletons of minute infusoria, the precise character of which is readily distinguishable under the microscope.

=TRIS′MUS.= See TETANUS.

=TRITURA′TION.= _Syn._ TRITURA, TRITURATIO, L. The act of rubbing a solid body to powder. See PULVERISATION.

=TRO′CHES.= See LOZENGES.

=TRO′NA.= A native carbonate of soda, found on the banks of the soda-lakes of Sokena, in Africa.

=TROPH′AZOME.= A concentrated infusion of minced lean meat mixed with the fluid obtained from the residuum after being heated for 20 minutes in a water bath, and flavoured with salt and spices, the whole being, lastly, simmered for a few minutes. Excellent for convalescents.

=TROUT.= The _Salmo furio_ of Linnæus, a highly-esteemed fish, found in most of the rivers and lakes of this country. Other members of the genus _salmo_ are also so called, as, _S. eriox_, the bull or grey trout; _S. ferox_, the great grey or lake trout; _S. trutta_, the salmon trout, &c. All of these varieties are in the finest condition from the end of May to late in September.

The trout contains about 6 per cent. of fat. It is desirable to cook this fish as soon as convenient after taking it.

=TRUSSING.= This is a well-known operation performed on poultry or game previous to their being roasted or boiled. It simply consists in _drawing_ or removing the intestines and other objectionable parts. In doing this, care must be taken to avoid rupturing the gall-vessel, which, if broken, would impart a very bitter flavour to the poultry, &c., extremely difficult of removal.

The cook should never take for granted that poultry or game, when it comes from the dealer, has been thoroughly cleansed inside, out, in order to be safe in this matter, should always make a point of cleansing it herself.

=TULUOLE.= _Syn._ TULUOL; BENZOENE (C_{7}H_{8}.) One of the hydrocarbons homologous with benzol, with which it occurs associated with xylol and isocumole, in the light oil obtained from the distillation of coal tar. It is also one of the products of distillation of balsam of Tolu, and would seem to be identical with the _retinaptha_ obtained by Pelletier and Walter from the distillation of rosin. If oxidised by means of chromic acid it yields benzoic acid. Its boiling point is 230° F., and its sp. gr. 0·87.

=TUMOURS.= Tumours, of which there are a great variety, are abnormal growths, occurring in different parts of the body. Sir Jas. Paget describes them as belonging to the class of overgrowths or hypertrophies, their most constant distinctive characters being——1. Their deviations, both in respect to size and shape, from the normal type of the body in which they are found. 2. Their apparently inherent power and method of growth. 3. Their development and growth being independent of those of the rest of the body, and continuing with no evident purpose, when the rest of the body is only being maintained in its normal type.

Tumours are divided by pathologists into _malignant_ and _innocent_ or _benign_.

In the former division is included cancer. The most common varieties belonging to the second division are _cutaneous cysts_, _fatty tumours_, and _fibro-cellular tumours_. Cutaneous cysts, which may occur under any part of the skin, are most frequently met with in the scalp. They mostly arise from “the morbid growth of natural ducts or follicles, or by the enormous growth of elementary structures, which increase from the form of cells or nuclei, and become closed sacs with organised walls capable of producing other growths.”[241]

[Footnote 241: ‘Chambers’ Cyclopædia.’]

The most commonly occurring tumour is the fatty one. It usually develops itself on the bodies of persons of from forty to fifty years of age. It seldom occasions inconvenience, and appears to be in no way prejudicial to health; occasionally, however, these tumours are very unsightly and unpleasant to look upon. The fat of which they are composed appears to differ in no respect from ordinary human fat. The uterus is the principal seat of the fibro-cellular tumour. It occurs also in the scrotum, the bones and the subcutaneous tissue. These tumours sometimes attain great size, and grow very rapidly. They are sometimes met with exceeding 40 lbs. in weight. Certain polypi belong to this class of tumour.

A pseudo tumour is occasionally met within surgical practice, which may often be mistaken for a real one, by the unwary or inexperienced practitioner. This, which is known as a _phantom tumour_, appears to be caused by muscular contraction. Sir Jas. Paget, writing on this subject, says: “The abdominal muscles of hysterical women are most often affected, sometimes with intentional fraud. The imitation of a tumour may be so close as to require great tact for its detection; but chloroform, by relaxing the muscles, dissipates the swelling. Occasionally the apparent tumours move.

=TUNG′STEN.= W. _Syn._ TUNGSTENUM. WOLFRAMIUM, L. A heavy, grey, brittle metal, discovered by Delhuyart.

The word _tungsten_, in Swedish, signifies ‘heavy stone’ (_tung-sten_), the name being applied to the element because the source from which it is obtained is a heavy mineral called _Wolfram_. Wolfram may be regarded as a variable double tungstate of iron and manganese, and the tungsten occurs in this. A native tungstate of copper has been discovered in Chili. Tungsten is also found in the mineral _scheelite_, a tungstate of lime. From this latter compound it may be procured by digesting finely-powdered scheelite in hydrochloric acid. Chloride of calcium is formed, together with insoluble tungstic acid. Upon heating the acid to bright redness in a stream of hydrogen gas, the metal is left behind. When thus procured it is of a dark-grey colour, but under the burnisher it may be made to assume a metallic lustre. Metallic tungsten may also be obtained by the reduction of tungstic acid, by means of charcoal at a white heat. When procured by this method it is unaffected by hydrochloric or diluted sulphuric acid, although it becomes reconverted into tungstic by the action of nitric acid.

When tungsten occurs in the pulverulent form, it burns easily into tungstic anhydride, when heated in the air; and is oxidised and dissolved when boiled with the caustic alkalies or their carbonates in solution. An alloy, possessed of extreme hardness, may be procured when tungsten is combined with steel, in the proportion of 1 part of tungsten to 10 parts of steel.

There are two known oxides of tungsten, viz. a dioxide (WO_{2}) and a trioxide (WO_{3}). According to Wöhler there is a third oxide, having the composition (WO_{2}WO_{3}).

=Dioxide, or Binoxide of Tungsten.= (WO_{2}.) This is an indifferent oxide, and is obtained by treating tungstic acid with hydrogen at a low red heat. It occurs as a brown powder, which absorbs oxygen greedily from the air, and is dissolved by boiling with solution of caustic potash, hydrogen being evolved and potassium tungstate being formed.

=Trioxide of Tungsten.= (WO_{3}.) _Syn._ TUNGSTIC ANHYDRIDE. This may be obtained by decomposing wolfram with aqua regia, and evaporating to dryness. The resulting tungstic acid is dissolved in ammonia, and the ammonic tungstate purified by crystallisation. When this ammonic tungstate is heated in the air, it loses ammonia and water, pure tungstic trioxide being left behind.

=Tungstic Acid.= (H_{2}WO_{4}.) This compound may be procured by adding an excess of hydrochloric acid to a boiling solution of the trioxide in any of the alkalies. It occurs as a yellow powder.

=Tungstic Chloride.= (WCl_{6}.) This may be obtained by heating tungsten in chlorine, when it sublimes in bronze-coloured needles, which are decomposed by water. When gently heated in hydrogen, this chloride becomes converted into tetrachloride (WCl_{4}).

=Bisulphide of Tungsten.= (WS_{2}.) By heating a mixture of bitungstate of potash with sulphur, and washing the product with hot water, a black crystalline substance, having the above composition, may be obtained, resembling plumbago in appearance.

Of the salts of tungsten, tungstate of baryta has been used as a substitute for white lead in painting; but the most important of these is the tungstate of soda, described below. See also TUNGSTIC GLUE.

=TUNGSTATE OF SODIUM.= Na_{2}WO_{4}. This salt is used for rendering linen, cotton, and other fabrics uninflammable; also as a substitute for stannate of sodium as a mordant in dyeing. It may be prepared by adding 9 parts of finely-powdered tungsten to 8 parts of fused carbonate of sodium, and continuing the heat for some time; on boiling the cooled and pulverised mass with water, evaporating the filtrate to dryness, and treating the residue with luke-warm water, the salt dissolves out. Muslin steeped in a 20% solution of this salt is perfectly uninflammable when dry, and the saline film left upon its surface is so smooth that the muslin may be ironed without difficulty.

=TUNGSTIC GLUE.= Tungstic glue has been suggested as a substitute for hard india rubber, as it can be used for all the purposes to which this latter is applied. It is thus prepared:——Mix together a thick solution of glue with tungstate of soda and hydrochloric acid. A compound of tungstic acid and glue is precipitated, which, at a temperature of 86° to 104° F., is sufficiently elastic to be drawn out into very thin sheets.

=TUNNY FISH, a la Parisienne.= As a rule tunny fish is very indigestible, and may be described as “neither fish, flesh, fowl, nor good red herring;” nevertheless, some of our readers may come across this fish, and will be glad to hear of a way in which to make it palatable and digestible. Take three or four pounds of fresh tunny fish, lard it with bacon as you would veal; cook it gently in its own gravy for three hours, with salt, pepper, sweet herbs, little onions, and a small quantity of water. When well cooked, tunny fish makes a nice dish cold for breakfast.

=TUR′BOT.= The _Rhombus maximus_ (Cuvier), said to be the best, and excepting the halibut, the largest of our flat fishes. Dutch turbots are the most esteemed.

_Composition of the turbot_:

Nitrogenous matter 18·1 per cent.
Fat 2·9 ”
Saline matter 1·0 ”
Water 78·0 ”
——————
100·0

=TUR′KEY.= See POULTRY.

=TUR′MERIC.= _Syn._ CURCUMA (Ph. L. & D.), L. The rhizome of _Curcuma longa_. The best is imported from Ceylon. It is stimulant and carminative, but is chiefly used in dyeing yellow, and as an ingredient in curry powder; also as a test for alkalies. It gives a fugitive golden yellow with wold, and an orange tinge to scarlet. It dies wool and silk, mordanted with common salt, or sal ammoniac, a fugitive yellow.——_Dose_, 10 to 30 gr. See CURCUMINE.

_Composition of an average sample of Curcuma longa_:

Water 14·249
Curcumin 11·000
Turmeric 12·075
Volatile oil 1·000
Gum 8·113
Starch 3·627
Extractive 3·388
Woody fibre 46·548
Ash, included in above weights [5·463]
————————
100·000

Under the microscope turmeric presents a very characteristic structure, viz. “a cellular tissue containing large, loose, yellow cells, with here and there small, but very distinct, starch granules, similar in shape and size to those of _Curcuma arrowroot_, and some woody fibre and dotted ducts. The yellow granular cells can readily be identified whenever they occur.[242]

[Footnote 242: Dr Winter Blyth.]

=TURNBULL’S BLUE.= _Syn._ FERRICYANIDE OF IRON; FERRI FERRICYANIDUM, L. _Prep._ Precipitate a solution of protosulphate of iron with another of red prussiate of potash (ferricyanide of potassium.)

_Obs._ This is a variety of Prussian blue, remarkable for its beautiful colour, and may be distinguished from the ordinary Prussian blue of commerce by its action on the yellow prussiate of potash. When boiled in a solution of the latter it is decomposed, a portion is dissolved, and a grey residue remains.

=TURNER’S YELLOW.= See YELLOW PIGMENTS.

=TURNIP.= The _Brassica napus_. This vegetable possesses but little nutritive value, as will be inferred from the annexed description of its composition given by Letheby:

Nitrogenous matter 1·2
Starch 5·1
Sugar 2·1
Salt 0·6
Water 91·0
——————
100·0

Turnips should always be thoroughly cooked, otherwise they are very liable to produce indigestion.

=TURN′SOLE.= See LITMUS.

=TUR′PENTINE.= _Syn._ TURPENTIN; TEREBINTHINA. (Ph. L., E., D.), L. “An oleo-resin flowing from the trunk, the bark being removed, of _Pinus palustris_ (pitch or swamp pine) and _Pinus Tœda_ (loblolly or old field pine).” (Ph. L.) “From _Pinus sylvestris_ (the Scotch fir).” (Ph. D.) “From various species of _Pinus_ and _Abies_.” (Ph. E.) It is viscid, of the consistence of honey, and transparent; by distillation it is resolved into oil of turpentine, which passes over into the receiver; and into resin, which remains in the still.

=Turpentine, Bordeaux.= _Syn._ FRENCH TURPENTINE. From the _Pinus maritima_, or cluster pine. Solidifies with magnesia. (Lindley.)

=Turpentine, Chian.= _Syn._ CHIO TURPENTINE, CYPRUS T., SCIO T.; TEREBINTHINA CHIA (Ph. L. & E.), L. “An oleo-resin flowing from the incised trunk of _Pistachia terebinthus_” (Linn.). (Ph. L.) It is pale, aromatic, fragrant, and has a warm taste, devoid of acrimony or bitterness. It is much adulterated. A factitious article (terebinthina Chia factitia), made as follows, is also very generally sold for it:——Black resin, 7 lbs.; melt, remove the heat, and stir in of balsam of Canada, 7 lbs.; oils of fennel and juniper, of each 1 fl. dr.

=Turpentine, Venice.= _Syn._ TEREBINTHINA VENETA (Ph. E.), L. Liquid resinous exudation from the _Abies Larix_, or larch tree. It is sweeter and less resinous-tasted than common turpentine, but is now scarcely ever met with in trade. That of the shops is wholly a factitious article, made as follows:——Black resin, 48 lbs.; melt, remove the heat, and add of oil of turpentine, 2 galls.

=TUR′PETH MINERAL.= Basic sulphate of mercury.

=TURRET OF CHESTNUTS.= A ‘Turret of Chestnuts’ (_Tourelle de Marrons_) is the name of a most toothsome dish. Take rather over two pounds of chestnuts, peel, and cook them in water, with a pinch of salt therein, then put them, whilst hot, into a colander. Beat into a paste, with a little milk, sugar, and vanille. Put the mixture into a mould in the form of a turret, about an inch thick; when quite firm, open the mould and turn out the contents carefully, glaze with syrup. Fill the middle with whipped cream, flavoured with chocolate or vanille.

=TUR′TLE.= _Syn._ GREEN TURTLE. The _Testuda midas_ (Linn.), a chelonian reptile, highly esteemed for its flesh, eggs, and fat.

=TUSSILA′GO.= See COLTSFOOT.

=TU′TENAG.= A name sometimes applied to German silver; at others, to pale brass and bell metal. “In India zinc sometimes goes under this name.” (Brande.)

=TUT′TY.= _Syn._ TUTIA, TUTHIA, IMPURE OXIDE OF ZINC. The sublimate that collects in the chimneys of the furnaces in which the ores of zinc are smelting. Drying; astringent. Used in eye-waters and ointments.

=TYPE METAL.= An alloy formed of antimony, 1 part; lead, 3 parts; melted together. Small types are usually made of a harder composition than large ones. A good stereotype metal is said to be made of lead, 9 parts; antimony, 2 parts; bismuth, 1 part. This alloy expands as it cools, and, consequently, brings out a fine impression.

=TYPHOID FEVER.= _Syn._ GASTRIC FEVER, ENTERIC or INTESTINAL FEVER, LOW FEVER, COMMON CONTINUED FEVER, INFANTILE REMITTENT, ENDEMIC FEVER, PYTHOGENIC FEVER. Although the term ‘typhoid’ expresses the fact that this particular form of fever resembles typhus, the researches of later pathologists, including Perry, Lombard, Stewart, and Jenner, have satisfactorily demonstrated that the two diseases are altogether distinct.

“Typhus and typhoid fevers differ,” says Sir Thomas Watson, “notably and constantly in their symptoms and course, in their duration, in their comparative fatality, in the superficial markings which respectively belong to them, and which warrant our classing them among the exanthemata, in the internal organic changes with which they are severally attended, and (what is the most important and the most conclusive) in their exciting causes.”

About the beginning of the present century, the French practitioners, after several _post-mortem_ examinations, were the first to point out that the specifically distinguishing feature of this disease was an internal exanthema. This salient characteristic, coupled with the highly infectious nature of typhoid fever, have caused it to be defined by pathologists as “a contagious eruptive fever occurring on the mucous membrane of the intestines, and therefore removed from view.”

The morbid appearance presented by the intestinal mucous membrane, varies with the time that elapses between the period of seizure and death. If the patient dies within the week, the follicles on the membrane present a thickened appearance, and are raised above it, whilst they are seen to be filled with a yellowish, cheesy-looking substance. The result of these details is to give the bowels the appearance of being covered with pustules.

When death has occurred at a later period ulceration more or less extensive has been observed to have set in.

The influence of age in predisposing to typhoid fever is forcibly illustrated in the following table extracted from Dr Walter Blyth’s ‘Dictionary of Practical Hygiène’:

Years
of Age. Per cent.

Under 5 0·98
From 5 to 9 9·44
” 10 ” 14 18·16
” 15 ” 19 26·86
” 20 ” 24 19·69
” 25 ” 29 10·15
” 30 ” 34 5·36
” 35 ” 39 3·40
” 40 ” 44 2·09
” 45 ” 49 1·08
” 50 ” 54 0·60
” 55 ” 59 0·33
” 60 ” 64 0·33
” 65 ” 69 0·08
” 70 ” 79 1·33

Dr Murchison asserts that those under thirty are more than four times as liable to be attacked by typhoid fever as persons over that age. The practical bearing of the above figures is obvious. Typhoid patients should only be nursed by the middle aged.

The season of the year also exercises an influence over the development and spread of this disease. In most countries it prevails with the greatest violence, and is most general, in Autumn, and much more frequently follows a very hot and dry summer than a damp one. The carriers of the typhoid poison are the alvine and possibly the cutaneous and other excretions. The disease may therefore be conveyed by contact with the hands or skin of an infected patient, by his urine, by his body linen, the bed clothes, or by dissemination from these into the surrounding air. But the most fertile and unquestionable cause of propagation is the contamination of drinking water by matter derived from the fœcal discharges of typhoid patients, which having soaked into the soil from the privy into which they had found their way, filtered from thence into a neighbouring well, or by means of drains proceeding from a privy or cesspool, into a stream. We can easily understand that the disease when traced to potable water, should always assume so virulent and frequently fatal a character. The fever poison is thus directly conveyed into the stomach, and hence easily reaches the intestines, whence the disease originates. This will also account for the very small quantity of infected water which it has found communicates the disease.

The outbreak of typhoid fever in Marylebone, in 1874, which attacked some 500 persons, was traced to the milk vended by a certain company; this milk having been placed in cans that had merely been washed out and cooled with water obtained from a well into which it was discovered the excreta from a typhoid patient had percolated from an adjoining privy. After the statement of these facts, the thorough and efficient disinfection of all the excretions, immediately they leave the body of the patient, as well as of his body and bed linen, mattresses, &c., and also of the sick apartment, will be obvious.

The best method of effecting this will be to follow the instructions given by Dr William Budd, for the prevention of the propagation of this disease, which are as follows:

“The means by which typhoid fever may be prevented from spreading are very simple, very sure, and their cost, next to nothing.

“They are founded on the discovery that the poison by which this fever spreads is almost entirely contained in the discharges from the bowels.

“These discharges infect (1) the air of the sick room; (2) the bed and body linen of the patient; (3) privy and the cesspool, or the drains proceeding from them.

“In these various ways, including the contamination of drinking water, already described, the infection proceeding from the bowel discharges often spreads the fever far and wide. The one great thing to aim at, therefore, is to disinfect these discharges on their very escape from the body, and before they are carried from the sickroom. This may be perfectly done by the use of disinfectants. One of the best is made of green copperas.

“This substance, which is used by all shoemakers, is very cheap, and may be had everywhere. A pound and a half of green copperas to a gallon of water is the proper strength. A teacupful of this liquid put into the night-pan every time before it is used by the patient renders the bowel discharge perfectly harmless. One part of Calvert’s liquid carbolic acid in fifty parts of water is equally efficacious.

“To disinfect the bed and body linen, and bedding generally, chloride of lime, or Macdougal’s, or Calvert’s powder is more convenient.

“These powders should be sprinkled by means of a common dredger on soiled spots on the linen, and about the room to purify the air.

“All articles of bed and body linen should be plunged, immediately on their removal from the bed, into a bucket of water containing a tablespoonful of chloride of lime, or Macdougal’s or Calvert’s powder, and should be boiled before being washed; a yard of thin white gutta percha, placed beneath the blanket, under the breech of the patient, by effectually preventing the discharges from soaking into the bed is a great additional safeguard. The privy or closet, and all drains communicating with it, should be flushed twice daily with the green copperas liquid, or with carbolic acid diluted with water.[243]

[Footnote 243: See SPOROKTON.]

“In towns and villages where the fever is already prevalent, the last rule should be put in force for all the houses, whether there be fever in them or not, and for all public drains.

“In the event of death, the body should be placed as soon as possible in a coffin sprinkled with disinfectants. Early burial is on all accounts desirable.

“As the hands of those attending on the sick often become unavoidably soiled by the discharges from the bowels, they should be frequently washed.

“The sick room should be kept well ventilated day and night.

“The greatest possible care should be taken with regard to the drinking water. When there is the slightest risk of its having become tainted with fever poison, water should be got from a pure source, or should at least be boiled before being drunk.

“Immediately after the illness is over, whether ending in death or recovery, the dresses worn by the nurses should be washed or destroyed, and the bed and room occupied by the sick should be thoroughly disinfected. These are golden rules.

“Where they are neglected the fever may become a deadly scourge; where they are strictly carried out it seldom spreads beyond the person first attacked.”

No part of the globe appears to be exempt from the visitations of typhoid fever, since it occurs not only in all the older countries of Europe and Asia and Africa, but in those also included in the North and South American Continents, as well as in Australia, Tasmania, and New Zealand. It would appear also to have prevailed in the earliest ages, since it is evidently alluded to in the works of Hippocrates, Galen, and others. Later writers, including Sydenham and Hoffman, also constantly refer to it under a different name.

Pathologists differ as to the time that this disease lies dormant in the system before developing itself. Some practitioners contend that the usual period is from ten to fourteen days, whilst others think it is much less than this, and, in some instances, that it may not exceed one or two days.

The late Dr Murchison entertained the latter opinion. The symptoms, when they show themselves, are as follows:——An irritable condition of the stomach, accompanied by sickness or vomiting; pain, with more or less tenderness, about the abdomen; sometimes the patient suffers from great constipation, at others from diarrhœa; he also experiences great prostration of strength, has a feeble pulse, and a brown furred tongue; he is extremely restless, and at night frequently delirious; the lower limbs are frequently cold; he passes but little urine, and that of an offensive smell; the stools are dark, offensive, and very frequently bloody, this latter being a very characteristic accompaniment of typhoid fever. Bleeding from the nose sometimes occurs. The perspiration has a sour and fetid odour. After seven or eight days, small rose-coloured spots or _petechiæ_ make their appearance on the skin.

_Treatment._——The abdomen should be leeched, and mustard poultices applied. If not too prostrated, the patient should be given a hot bath; but if he be not sufficiently strong to venture upon this, ablution of the whole of the body with hot water and soap should be had recourse to, the operation being performed by means either of a sponge or a flannel.

An effervescing draught, consisting of twenty grains of carbonate of ammonia, dissolved in water, to which a tablespoonful of lemon-juice should be added, ought to be administered, and drunk whilst effervescing, every three or four hours. The diet should consist of beef tea, nutritious broth, milk, and eggs.

The necessity of thorough ventilation of the patient’s apartment, together with the methods of disinfection of the bodily discharges, the linen, &c., have been already emphasised in the directions given by Dr Budd for the prevention of the propagation of this fever.

It is, perhaps, needless to state that the outline of treatment given above is intended only for adoption by the emigrant, or of any one so unfortunately situated with regard to locality as to be unable to secure the services of a medical practitioner. Where these are obtainable the patient or his friends should use all speed in procuring them.

_Horses._——Horses are occasionally attacked with typhoid fever, the symptoms of which bear a general resemblance to those which characterise the disease in the human subject. The appearances presented after death are also very similar, particularly in the lesions observable in the mucous membrane of the intestines. As in man, the disease is greatly aggravated by insanitary surroundings and depressing external agencies, and by the animals partaking of water containing decaying organic matters.

Upon the commencement of the attack give a few doses of calomel or laudanum, or of tincture of aconite, and if the bowels are costive two or three drachms of aloes, afterwards keeping up the laxative effect by mild clysters and mashes. Afterwards administer, three or four times a day, a drachm each of chlorate of potash and chloride of ammonium, adding to these an ounce of oil of turpentine or ether, or sweet spirit of nitre, if the animal exhibit dulness or weakness. If there is tenderness or pain about the abdomen, apply hot fomentations constantly, and should there be much flatulence give occasional drenches of ammonia, carbonate of ammonia, or whiskey and water.

The food of the animal must be nutritive and generous. He should be kept in a loose box, his legs should be bandaged in flannel, and warm rugs should envelop his body. Rest and quiet are essential. During convalescence let him have small doses of gentian, chloride of iron, with ale.[244]

[Footnote 244: Finlay Dun.]

=TYPHUS FEVER.= This fever is known under various names, such as SPOTTED TYPHUS, JAIL FEVER, SHIP FEVER, CAMP FEVER, MILITARY FEVER, IRISH AGUE, FAMINE FEVER, BRAIN FEVER, PESTILENTIAL FEVER, MALIGNANT FEVER, OCHLOTIC FEVER, TYPHO-RUBEOLOID.

“1. Typhus prevails for the most part in great and wide-spread epidemics.

“2. The epidemics appear during seasons of general scarcity and wants, or amidst hardships and privations arising from local causes, such as warfare, commercial failures, and strikes among the labouring population. The statement that they always last for three years and then subside is erroneous.

“3. During the intervals of epidemics, sporadic cases of typhus occur, particularly in Ireland, and in the large manufacturing towns of Scotland and England.

“4. Although some of the great epidemics of this country have commenced in Ireland, and spread thence to Britain, appearing first in those towns on the west coast of Britain where there was the freest intercourse with Ireland, it is wrong to imagine that all epidemics have commenced in Ireland, or that typhus is a disease essentially Irish. The disease appears wherever circumstances favorable to its development are present.

“5. In many epidemics typhus has been associated with relapsing fever, and the relative proportion of the two fevers has varied greatly.

“6. From the earliest times, typhus has been regarded as a disease of debility, forbidding depletion, and demanding support and stimulation.

“7. The chief exception to the last statement originated in the erroneous doctrines taught in the early part of this century, according to which the disease was looked upon as symptomatic of inflammation or congestion of internal organs.

“8. The success believed at one time to follow the practice of venesection was only apparent. It was due to the practice, for the most part, having been resorted to in cases of relapsing fever and acute inflammations, and to the result having been compared with those of the treatment by stimulation of the much more mortal typhus.

“9. Although typhus fever varies in its severity and duration at different times, and under different circumstances, there is no evidence of any change in its type or essential characters. The typhus of modern times is the same as that described by Fracastorius and Cordames. The period during which epidemic fever was said to present an inflammatory type was that in which relapsing fever was most prevalent, and the times in which the type has been described as adynamic have been those in which relapsing fever has been scarce or absent.” (Murchison.)

In the article ‘Typhoid fever’ it has been stated that its propagation was mainly due, and had been very clearly traced, to the drinking of water contaminated by the alvine discharges of typhoid patients; in the dissemination of typhus, on the contrary, the air in the neighbourhood of the infected person appears to be the great medium for the conveyance of the disease, the poison, it is conceived, being disseminated into the surrounding atmosphere from the surface of the body or the lungs of the patient, or from the cloths, body linen, &c., worn and discarded by him. Hence it is we find, as we should expect, in the past no less than in the present, that the spread and degree of virulence of the malady have always been associated with overcrowding and bad ventilation. Although amongst the causes that predispose and induce susceptibility to its attacks, as shown above, are poverty and consequent deficiency of food and clothing, and squalor, it has been demonstrated that, with all these unfavorable conditions, patients may often recover from typhus provided they are supplied with a sufficiency of fresh air.

The fact that of late years typhus has rarely visited the inmates of our prisons, barracks, or shops, and that their comparative immunity from it has been coincident with improved ventilation and the avoidance of overcrowding, can lead to no other deduction than that previous to this reform these sanitary conditions were altogether neglected. We may narrate some of these outbreaks of typhus that have taken place previous to the application of hygienic principles to the treatment of the disease. During an assize held at Cambridge in 1522, the disease which had broken out amongst the prisoners, spread to the justices, the bailiffs, and other officers, as well as to many people frequenting the court-house, with the result that many of those so seized died.

Another outbreak of a very malignant character occurred at Exeter in 1586. Some Portuguese were captured at sea, and (the words of the old historian who records the fact clearly indicate the cause of the virulent nature of the malady) were “cast into the deep pit and _stinking dungeon_.” When brought into court they imparted the contagion to those around them. The judge and eleven out of the twelve jurymen who were thus attacked died, whilst the disease spread through and devastated the whole country.

A fourth case is recorded by Howard “at the Lent assizes in Taunton in 1730. Some prisoners who were brought there from Ivilchester Jail infected the court, and Lord Chief Baron Pengelly, Sir James Shepherd, serjeant, John Pigot, Esq., sheriff, and some hundreds besides, died of the jail distemper.”

Another eruption, which broke out during an assize held at the Old Bailey in 1750, resulted in the contraction of the disease by the Judge, the Lord Mayor, and the Alderman, and caused the death of forty persons who were present in the close and narrow court-house during the judicial proceedings. One circumstance recorded in connection with this last attack needs no comment. It is to the effect that “a hundred prisoners were put into two rooms measuring fourteen feet by eleven feet, and seven feet high.” The instances above quoted explain why it was this disease acquired the name of _jail fever_.

During the present century six different epidemics of typhus have broken out amongst the convicts on board the Toulon Galleys. They occurred in 1820, 1829, 1833, 1845, 1855, and 1856. Although the above statement of facts indisputably points to the intimate connection existing between the prevalence and violent character of typhus and overcrowding, and consequent contamination and vitiation of the air breathed by the patient, it is still a moot point with pathologists whether the disease can be generated _de novo_ by these conditions, or whether they merely assist to disseminate and intensify it. Dr Parkes, writing on this subject, says:——“With reference to the particular kind of fever in Metz, it may be noticed that an important argument against the production of exanthematic typhus from simple overcrowding has been drawn from the experience both of Metz and Paris. In both places during the sieges there was overcrowding, wretchedness, and famine, particularly at Metz; yet, as pointed out by Professor Chauffard to the Académie de Médicine, there was scarcely any or no typhus, as there had been in the wars of the first Napoleon. There was typhus in the German besieging force, but so strict was the blockade that it was not imported into Metz, and was not generated there.”[245]

[Footnote 245: Blyth.]

The mortality which has been caused in large armies by the ravages of typhus has been enormous. During the ‘thirty years’ warfare that desolated Germany from 1619 to 1648, innumerable soldiers fell victims to it, the Bavarian army alone having lost 20,000 men from this cause. Typhus also committed appalling havoc among the legions of the first Napoleon, the Bavarian contingent of the French army in the Campaign in 1812, lost nearly 26,000 men from this cause; whilst in Mayence 25,000 of Napoleon’s soldiers in garrison perished from the same cause in six months. More lately, viz. during the Crimean campaign (in 1856), typhus slew more than 17,000 French soldiers.

It frequently infested the German armies during the Franco German war of 1869-70, and committed great havoc both amongst the hosts of Russia and Turkey in the late war between those countries.

When we turn to the civil population, we find that typhus has been no less ruthless, and has slain its myriads of these also. Confining our attention to our own country, we find it to have especially devastated Ireland, which has suffered from no less than eleven violent outbreaks of typhus within the last 130 years.

In one of these visitations, viz. that of 1840, 80,000 people are estimated to have died from the disease. The largest recorded epidemic of typhus within our islands during the present century was that of 1846. It extended over the whole of the British islands, and the number of persons attacked by it were nearly 1,400,000, out of which 1,000,000 occurred in Ireland. “The Irish flocked to England in thousands, bringing the pestilence with them. It therefore was extremely prevalent in Liverpool, no less than 10,000 persons dying of typhus in that city.”[246] The latest outbreaks in England have been in 1862 and 1869; they were principally confined to London.

[Footnote 246: Blyth.]

Dr Murchison says that 14,000 persons were admitted to the London Fever Hospital during the two epidemics, and that amongst them a small number only were Irish.

All European countries, as well as North America and some parts of Asia, suffer from the ravages of this alarming disease. Africa, however, as well as Australia and New Zealand, are said to be exempt from it.

_Symptoms._——The symptoms of typhus are thus described by Dr Murchison:——“More or less sudden invasion, marked by rigors or chilliness; frequent compressible pulse; tongue furred, and ultimately dry and brown; bowels in most cases constipated; skin warm and dry; a rubeloid rash appearing between the fourth and seventh days, the spots never appearing in successive crops, at first slightly elevated, and disappearing on pressure, but after the second day persistent, and often becoming converted into true petechiæ; great and early prostration; heavy flushed countenance; injected conjunctivæ; wakefulness and obtuseness of the mental faculties, followed, at the end of the first week, by delirium, which is sometimes acute and noisy, but oftener low and wandering; tendency to stupor and coma, tremors, subsultus, and involuntary evacuations, with contracted pupils. Duration of the fever from ten to twenty-one days, usually fourteen. In the dead body no specific lesion, but hyperæmia of all the internal organs, softening and disintegration of the heart and voluntary muscles, hypostatic congestion of the lungs, atrophy of the brain, and œdema of the pia mater, are common.”

_Treatment._——The following remarks, bearing on this branch of the subject, are suggested for adoption by the non-medical reader, in the event of his being precluded by circumstances from calling in the aid of the medical practitioner. The most important points to be observed are the isolation of the patient and the thorough ventilation of his apartment by the continuous admission into it of fresh air without stint or hindrance. Dr Parkes recommends the patient to be put in the top room of the house or hospital, since there is strong evidence to show that the contagious virus is volatile and ascends through the atmosphere.

The forms of disinfection best suited for adoption in this disease, together with the method of employing them, will be found fully described in the article ‘DISINFECTANTS,’

The body of the patient should also be frequently sponged with Condy’s fluid, properly diluted, or covered with olive oil, to which has been added a small quantity of carbolic acid.

As internal remedies, dilute hydrochloric or nitro-hydrochloric acids have been highly commended. Chlorate of potash, in large doses, was formerly much employed.

These remedies may be supplemented by the use of saline medicines, sudorifics, and moderate purgatives. The diet should consist largely of milk and water, beef tea, broth, and such like digestible and nutritious food.

=UDDER, Inflammation of.= _Syn._ GARGET MAMMITIS. Amongst domestic animals, cows are the most frequently subject to this affection. It is most common amongst those cows that have lately calved or have been thoroughly milked. Heifers and even young cows that have never had a calf, however, are not exempt from it, and occasionally suffer from its attacks. The inflammation varies in intensity, in some cases only showing itself in a dryness, tenseness, heat and tenderness of the skin of the udder, whilst in others it is much more serious, and extends to the interior parts and vessels; in the latter case, giving rise to hard lumps amongst the softer texture of the udder.

Inflammation of the udder appears to result from various causes——indigestion, over driving, the too long retention of the milk in the udder, and cold; it is also very frequently associated with murrain, rheumatism, and swelling of the joints.

_Treatment._——If the disease be constitutional, as indicated by the suddeness of the attack, the best course will be to administer at once a good dose of Epsom or Glauber salts combined with a little ginger, and to give copious doses of nitre. A modified form of this treatment should be kept up for some little time by means of gentle aperients, and smaller doses of nitre. In the milder form of inflammation, viz. in that confined to the exterior of the udder, it will be best to have recourse to spirit lotions or refrigerant applications, such as ice water, or a mixture of chloride of ammonium and nitre applied immediately after mixing with water. The udder should be kept constantly cool by means of these. When the inflammation is deeper seated, as evidenced by the presence of lumps in the udder, the continuous application of warm water is advisable. Whether the cold or hot treatment be indicated, it should be diligently kept up for a day at least. In the adoption of either the cold or hot local remedies, above specified, they should be combined with some means of support (by the agency of a proper bandage) to the udder. It is also important to have the milk removed every three or four hours; if the milking operation cause pain, a syphon should be used. The hard lumps will be found to disperse best under gentle friction applied by the hand twice a day, for an hour each time, the hand being previously anointed with lard. When the surface pits or becomes soft, and very hot, it may be assumed that suppuration has set in, in which case the confined pus must be liberated by means of the lancet.

=ULCERATED SORE THROAT.= This form of sore throat, in which ulcers develop themselves upon the tonsils, is a very frequent accompaniment of scarlatina, syphilis, and other diseases, in which cases to prescribe the method of treatment would be beyond our province. For ordinary ulcerated sore throat arising from cold, chronic inflammation of the part, or a low state of health, the best course will be to gargle the throat four or five times daily with either of the following gargles: 1. Alum, 30 gr.; infusion of rose, 6 oz. 2. Sulphate of zinc, 30 gr.; distilled water, 6 oz. 3. Hydrochloric acid, 1 dr.; water, 6 oz. Should these fail, touch the ulcers every morning with a solution of nitrate of silver, containing ten grains of the nitrate to an ounce of distilled water.

=ULCERS.= These are open sores, mostly accompanied by a discharge of pus, or serous matter. They differ from ordinary wounds by the edges showing no disposition to unite. When they extend or deepen, it is by a process of absorption; while they heal by granulation, whereby they become filled up with little granular growths of flesh. Ulcers may appear on all parts of the body, but they most frequently attack the legs and arms.

In enfeebled states of the body, wounds, boils, and abscesses may degenerate into ulcers; they are also a consequence of enlarged or varicose veins, or the result of some specific poison in the system.

Ulcers may be classed into simple, irritable, indolent, and specific.

_Treatment._——When an ordinary wound or sore shows a disinclination to heal, but on the contrary, extends or deepens, it should be poulticed with bread and water or linseed meal. Should these remedies be ineffectual, an old fashioned but useful one, viz. a carrot poultice, may be applied. When the ulceration is irritable or painful, the poultices may be supplemented by the frequent use of a lotion consisting of four parts of water to one of tincture of opium, or of a warm decoction of poppy heads applied by means of a linen rag. Filling the cavity with prepared chalk has been recommended.