Chapter X: Part II: Synopsis or Index of Diseases (2)

_Hæmorrhage from Cuts, Wounds, &c._ When the blood is of a bright red colour, and comes out in jets, indicating that an artery is wounded, apply first a stream of _cold_ water, iced if possible, from a large sponge, which will not only wash away all clots, dirt, &c., but promote contraction of the vessel, and _perhaps_ arrest the bleeding at once. If not, try the fresh juice of the Physic Nut Plant (302*), or Alum (25). If these fail, or are not at hand, at once apply pressure with the finger or fingers upon the exact point from which the blood is found to issue, and there retain for some time, pressing against the bone or hard substance. If the mouth of the bleeding vessel be clearly visible, and the hæmorrhage still continues, it may be pinched up firmly between the finger and thumb, or it may be seized with a pair of pincers or forceps, drawn forward, and a ligature, silk if procurable, passed round it and firmly tied. Not more of the surrounding flesh should be included in the ligature than can be possibly avoided. If none of these plans succeed or are applicable, or if the wound be large and bleeds much, apply pressure to the limb by means of the STICK TOURNIQUET figured below.[2]

In order to apply this properly, "tie tightly, at some little distance above the wound, a pocket-handkerchief or cravat once or twice passed round the limb; then, obtaining a piece of tough stick, push it under the handkerchief, and, by turning the stick, twist the handkerchief more and more tightly until the bleeding ceases. As soon as this result has been attained, fasten the stick by another handkerchief round the stick and limb together. This rude tourniquet may save life not unfrequently, by enabling the injured person to be transported even for some distance without fear of further bleeding." Position is a very important consideration in wounds, the bleeding sometimes being at once arrested by raising the injured limb above the level of the body.

[Footnote 2] The above woodcut, and the mode of applying it, is reprinted by permission from _First Help in Accidents_, by Dr. C. H. Schaibe, published by R. Hardwicke, 192 Piccadilly, London. A very useful little book.

_Hæmorrhage from the Lungs, Stomach, Bowels, Kidneys, Uterus, or other Internal Organs_, if attended by feverishness and heat of skin, a solution of Nitre (267) or Sal Ammoniac (330) may be given, with the plentiful use of Lemonade (233), Tamarind drink (346), Vinegar (379), and other refrigerants. In the absence of fever, Alum (25) may be given with safety and advantage. A far more effectual remedy in these cases is the Acetate of Lead in doses of three or four grains, made into a pill with half a grain of Opium, and followed immediately by a draught containing a little vinegar. These pills and draughts may be repeated every three or four hours till the bleeding begins to abate, when the interval between the doses may be lengthened, and the quantities decreased. In all these cases a perfect rest in a recumbent posture, in a cool, well-ventilated apartment, and the avoidance of all excitement and stimulants, are essential to the success of the above, or any other remedies. In these cases Ice externally applied in bags exercises a marked influence in checking internal hæmorrhage, especially from the lungs. It should not be kept on sufficiently long to produce a chill. Sucking small pieces of ice is also a useful practice. _Exhaustion from excessive Hæmorrhage_ requires Brandy Mixture (426) and other stimulants. _Hæmorrhage after Labour_, see _Labours_. _From Piles_, see _Piles_.

_Hæmorrhage from the Nose_ may generally be checked by one of the following simple means: 1. the application of a cold body, as a key or a piece of ice to the nape of the neck. 2. By compressing the _opposite_ nostril. 3. By standing in the upright position and holding both arms in the air for a few minutes. If these measures fail, recourse may be had to Alum (25*), Sulphate of Copper (116), or Vinegar (379). Should feverishness be present, treat as directed in preceding article.

_Hæmorrhage from Leech Bites._ _See_ Paragraph 205.

_Head, Affections of, where there is determination of blood to the head, with sleeplessness, restlessness, and anxiety._ Mustard Bath (249*).

_Headaches_ generally must be treated with reference to their cause. _If from Constipation_, Castor Oil (83), Kaladana (187), Myrobalans (256), or other purgatives. _Of Fever_, hot water stupes to the nape of the neck (393). _From Bilious derangement_, the same purgatives preceded by a dose of Calomel (three grains) if at hand, and followed by Sal Ammoniac (328*). _Nervous, Hysterical, and Rheumatic Headaches_ often yield to Sal Ammoniac (328), persevered in for a few days, and the local use of Camphor Lotion (71*). _From suppression of the Menstrual_ _Discharge_, Leeches to the inner surface of the thighs (210). _From stoppage of bleeding from Piles_, Leeches to the verge of the anus (210); in both these last cases Aloes (19) should be given internally. The other measures occasionally useful are Ginger Plaster (157), Hot Water Fomentations (393), and Mustard Poultices or Mustard Foot-baths (248) to the extremities.

_Heart, Palpitations of._ See _Palpitations_.

_Heartburn_ often yields to Lime Water (221) given with milk or with Omum Water (317); or with Chiretta (98), if associated with indigestion.

_Hepatitis._ See _Liver, Inflammation of_.

_Hoarseness_ may be treated by inhalations of the vapour of Hot Vinegar (377*), or Decoction of Abelmoschus (3), by gargles containing Capsicum (78*), Black Pepper (300), or Moringa root (238); by chewing Ginger (158), or allowing a piece of Catechu (89) to dissolve in the mouth.

_Hooping Cough._ In the early stages regulate the bowels with Castor Oil (83), and give Country Ipecacuanha (370) and Sal Ammoniac (329). As soon as the feverish symptoms have subsided give Alum (28*); should this fail, try Sulphate of Iron (180), with or without Asafœtida (37). If weakness and emaciation exist, or in very obstinate cases, give Fish Liver Oil (140); Mustard Poultices (252) and friction with Opium Liniment (291) to the spine seem useful in the chronic stage.

_Hydrocephalus_ (_Water on the Brain_) occurring in weak, emaciated children of a scrofulous habit occasionally improves under Fish Liver Oil (139).

_Hysterical Affections._ Amongst the means useful in controlling these are Asafœtida (35*), Aloes and Asafœtida Pills (19), Jatamansi (184), Omum Water (318), Turpentine Enemas (364), and Cold Water Affusion (386).

_Indigestion, or Dyspepsia._ Tonics, as Chiretta (98, 99*), Sweet Flag Root (12), Country Sarsaparilla (163), and Guluncha (352), combined with stomachics, as Cloves (105), or Cinnamon (102), Capsicum (79), and Omum Water (318*), offer the best prospect of success. _With great increased Secretion_, Butea Gum (62). _With acidity of the Stomach_, Lime Water (221). _With torpidity of the Bowels_, Tincture of Kariyát (192), Without strict attention to diet, and careful regulation of the bowels and other secretions, medicines will have comparatively little effect.

_Inflammations, Local or External_, require, according to circumstances, Leeches (212), Hot Water Fomentations (393), Water Dressings (394), Evaporating Lotion (380), Sal Ammoniac Lotion (332), and Rice-Flour or Rice Poultices (322) as external applications. A solution of Acetate of Lead (30 grains in a pint of water) forms an excellent soothing lotion, and one which may always be resorted to with safety. The inflamed parts should be kept constantly wet with it by means of moistened cloths.

_Influenza._ Give plentifully of Solution of Nitre (264), and treat otherwise as described in _Catarrh_.

_Insanity._ A free action on the bowels by Croton Pill or Croton Oil (120, 121), and the employment of a Mustard Bath (249), are of service in the early stages. No time should be lost in placing the patient under proper medical care.

_Insensibility_, from whatever cause arising, may be treated in the first instance by the cautious use of Cold Water Affusion (386). A Turpentine enema (364) may also be of service.

_Irritation of the Genital Organs._ See _Genital Organs_.

_Itch._ Use Sulphur Ointment (341), or Kerosene Oil (416).

_Jaundice._ Mild cases often yield to Sal Ammoniac (331), and the free use of purgatives, as Kaladana (187), or Myrobalans (256).

_Joints, Injuries or Enlargement of._ In the early stages apply lotions of Alum (32), and Sal Ammoniac (332), and subsequently liniments of Camphor (68), and Turpentine (366). _In Chronic Enlargements_, Croton Liniment (122). _Scrofulous affections of the Joints_ improve under the use of Fish Liver Oil (138).

_Kidneys, Irritable state, and painful affections of._ Give plentifully of diluents, as Decoction of Abelmoschus (2), Ispaghúl Seeds (305), or Rice _Conjee_ (322). These, with Opium (286), and the use of the Hip Bath (392), are calculated to afford great relief.

_Bleeding from._ See _Hæmorrhage_.

_Labours._ Don't interfere unnecessarily; Nature, if left to her own unaided efforts, will accomplish her work in natural, uncomplicated labours. Many a woman has _lost her life through meddlesome interference on the part of ignorant midwives. Should the labour be very prolonged, apparently for want of action or power in the womb_, a few doses of Borax and Cinnamon (58) may be given. _For Flooding_ (_hæmorrhage during or after labour_) lose no time in resorting to Cold Water Affusion (388), and subsequently use Vinegar locally (379). _To promote the Lochial Discharge, if scanty or arrested_, use Hot Water Fomentations (393). _For After-pains_ give a dose of Opium (289). _Convulsions, attendant on_, see _Convulsions_.

_Leech Bites, to arrest bleeding from._ See Paragraph 205.

_Leeches, to dislodge from nose and other passages._ See Paragraph 206.

_Leprosy._ Chaulmúgra (94), Gurgun Balsam (161*), Hydrocotyle (169*), or Mudar (242); with these may be advantageously conjoined a prolonged course of Fish Liver Oil (142), or the latter may be tried alone. _For the ulcerations_, poultices of Hydrocotyle (169) or Ním Leaves (261) may be applied with advantage. Opium (283) is often necessary _to relieve pain and procure sleep. Whatever other treatment may be adopted, diligent oily frictions over the whole body should form an essential part of it_ (161-338). Carbolic Acid promises to prove a most valuable agent in this disease. The treatment of Leprosy by Carbolic Acid Vapour Baths, introduced by Surgeon-General W. Johnston, M.D. (_Times_, June 3, 1882), promises good results, and seems well worthy of further trials. All that is required is an ordinary vapour bath apparatus (397), in which the patient sits, and _outside a chattie_ or vessel of sufficient size to contain about a quart of liquid, and made with a lengthened curved spout, to fit accurately on an elastic tube of sufficient length as to pass within the vapour-proof envelope. The calibre of this elastic tube should be such as would admit of a continuous and abundant supply of the vapour as it comes from the vessel, resting on a spirit-lamp having a flame sufficient to keep the fluid in the vessel boiling briskly. Prior to the use of this bath, sponging the body with tepid water, holding a piece of washing soda in solution, seems to aid the absorption of the vapour. The Carbolic Acid should be Calvert's Disinfecting Fluid, of which a mixture of three or four parts to six or seven of water may be employed. In this vapour bath the patient should remain from 30 to 60 minutes (care being taken that a continuous supply of vapour is kept up from outside), and it may be repeated every second or third day according to circumstances. Dr. Johnston informs me that he has never seen any ill effects result from the use of this carbolised aqueous vapour, even in cases presenting extensive ulcerated surfaces. Some care is requisite in arranging the fold or frill round the aperture through which the head protrudes. "Were the patient to breathe a little of it," Dr. J. remarks, "little injury would result, possibly good, but still, for obvious reasons, he should not be allowed to breathe too much." Dr. Aitchison directs leprous ulcerations to be treated with a solution of Carbolic Acid (one to seven or ten of Sweet Oil, according to circumstances), and that at the same time the whole body should be rubbed with a weaker solution (1 to 20). This treatment, he remarks, at once removes the horrid odour usually attendant upon these cases, and the patients will readily adopt it, when they distinctly refuse to wash or clean themselves. With a change in diet, under this treatment, these cases, he adds, improve remarkably.

_Leucorrhœa_ ("_Whites_"). Cubebs (125), Nitre (269), Gurjun Balsam (160), or Sulphate of Iron (174*), internally; with vaginal injections containing Babúl Bark (9), Alum (30*), Galls (149), or Lime Water (224), are indicated.

_Lice infesting the hair on various parts of the body, especially the pubes_, may be destroyed by Cocculus Indicus Ointment (107), Vernonia Seeds (373_b_), or Kerosene Oil (416). Carbolised Oil (1 Acid to 20 of Sweet Oil), applied night and morning, is said to be an effectual remedy.

_Lime, Particles of, in the Eye_, may be dissolved and removed by dilute Vinegar (382).

_Liver, various Affections of_, are often greatly benefited by Sal Ammoniac (331). _Enlargement of_, Sal Ammoniac (331*), Papaw Juice (296). _Congestion of this organ, especially if arising from over-feeding_, often subsides under a dose of Calomel (three or four grains) at night, followed, in the morning, by an active aperient of Kaladana (187), or Castor Oil (83). Further relief may be obtained by Hot Water Fomentations (393), Turpentine Stupes (362), or Betel Leaves (48) over the region of the liver; if these fail, Leeches to the same site, or to the verge of the anus (211), may afford manifest relief. All, however, will be useless without strict attention to diet, and careful avoidance of all stimulating articles of food and drink.

_Lock-jaw._ See _Tetanus_.

_Loins, pain in the._ See _Lumbago_.

_Lumbago._ Sal Ammoniac (326) internally, with Liniments of Camphor (68), Lemon Grass Oil (217), Opium (291*), Datura Liniment or Poultices (130), or Turpentine (366) externally, often succeed in affording relief. Turpentine Stupes (362) may be tried in severe or obstinate cases.

_Lungs, Affections of._ See _Coughs_, _Consumption_, _and Bronchitis_. _Bleeding from._ See _Hæmorrhage_.

_Maggots on surface of Ulcers, to destroy._ Butea Seeds (65).

_Maggots in the Nose_ (_Pecnash_). Injections of Oil of Turpentine (363_b_).

_Measles._ An occasional mild aperient, just sufficient to keep the bowels gently open, the plentiful use of Lemonade (232), or Rice _Conjee_ (322), with or without Nitre (264), together with confinement to bed in a cool, well-aired apartment, and farinaceous diet for a few days, will generally suffice for recovery in mild, uncomplicated cases. _To allay irritation of the surface_, sponge with diluted Vinegar (376) or Water (385), and dust the surface well over with Rice Flour (322). _Should Cough occur_, use some of those means enumerated under Coughs. _The advanced stages, in bad cases, characterised by great exhaustion_, call for the use of Camphor (74), Brandy Mixture (426), and plentiful nourishment.

_Menstrual Discharge, Suspension, or Irregularity of_ (_Amenorrhœa_). Aloes (18), Borax (58), and Sulphate of Iron (174*), alone or combined, may prove serviceable. Try also hip bath with Sesamum Seeds (338_a_). _Excessive or long-continued Menstruation_, Alum (25) and Vinegar (379). _When attended with much pain and distress_ (_Dysmenorrhœa_), Opium Liniment (291) or Datura Poultice or Liniment (130) to the loins; also hip bath containing Sesamum Seeds, which also may be tried internally (338_a_).

_Mercury, salts of, as Corrosive Sublimate, Poisoning by._ If vomiting is not already present it must be excited by a Mustard (246) or other emetic, and the stomach having thus been emptied of any of the poison it may contain, prompt recourse should be had to the white and yolk of raw eggs, which may be given alone or beaten up with rice-flour into a paste with milk or water. The after-treatment consists in the free use of Rice _Conjee_ and other demulcent drinks, gargles of Alum (29) or Borax (55), to control the salivation; small doses of Opium, should there be much pain, and a milk or farinaceous diet.

_Mesenteric Affections of Children_ are best treated with Fish Liver Oil (139).

_Milk, for Increasing the Secretion of_, Leaves of Castor Oil Plant (85), or of Physic Nut Plant (302); _for Diminishing or Arresting the Secretion of_, Betel Leaves (49), or flowers of Jasminum Sambac (Aiton).

This twining plant is cultivated throughout India for the sake of its white fragrant flowers, which are used as votive offerings. The lactifuge property of these flowers was first brought to notice by Mr. J. Wood (_Ph. of India_, p. 136), who speaks of the fact being well known in Madras. Two cases illustrative of their efficacy occurring in the practice of Dr. Mackenzie, C.B., are recorded by Dr. Bidie (_Madras Jour. Med. Sci._, Aug. 1870). In one case especially, an English lady, all ordinary means had failed to arrest the flow of milk before the flowers were applied; within a few hours they afforded complete relief, and the secretion of milk, which had been unusually copious, was from that time entirely arrested. The results of the other trial were equally satisfactory. For this purpose two or three handfuls of the fresh flowers bruised are to be applied unmoistened to each breast and renewed once or twice a day. The secretion is sometimes arrested in twenty-four hours, though this generally requires two or three days (Wood). The native names of these flowers are Mogra ka phúl (_Hind._, _Duk._), Mogra phúl (_Beng._, _Guz._), Malligraip-pú, Mallip-pú (_Tam._), Mallelú (_Tel._), Mullup-pú (_Mal._), Pich-chi-mal (_Cing._), Múgra (_Punj._).

_Milk Abscess._ In the early stages apply either Sal Ammoniac Lotion (325), or hot Vinegar Stupes (381). Should matter form, treat as _Abscess_.

_Mouth, Ulceration of._ Try first Sulphate of Copper (112) or Lime Juice (231); if these fail use some of the other remedies mentioned in Art. _Gums, Ulceration and Sponginess of_. _For Aphthous Ulcerations, i.e., small white specks or ulcers in the mouths of infants and young children_, apply Borax (55*), or Alum (29), or Sulphate of Copper (112); Country Sarsaparilla (163) may at the same time be advantageously given internally. _In severer forms_ (_Ulcerative Stomatitis_), try Alum (29).

_Mumps._ Beyond a dose of Castor Oil (83) or Infusion of Senna (336), so as to keep the bowels gently open, little is required beyond keeping the swollen parts covered with a piece of flannel, to protect them from cold draughts of air, and the use of a farinaceous diet for a few days. Should there be much pain, Opium Liniment (291) may be smeared over the surface of the swollen gland at bedtime. Should there be much fever, heat of skin, &c., a few doses of solution of Nitre (264) may be given.

_Muscles, Pains in._ Give Sal Ammoniac (327) internally, and use Liniments containing Camphor (68), Lemon Grass Oil (217), Opium (291), or Turpentine (366) externally.

_Mosquito Bites, to relieve the irritation_, try Lime Juice (235), or Vinegar (380).

_Nettle-rash, to allay irritation_, apply Borax Lotion (57).

_Neuralgia._ Try Sal Ammoniac (326), or when the pain returns periodically, Sulphate of Iron (177), or better still Cinchona Febrifuge (402*). When Neuralgia of the Head or Face (_Tic Douloureux_) recurs at stated periods, and is apparently of malarious origin, no remedy is equal to Quinine, which may be given in one large dose (ten grains) shortly before the time when the pain is expected to return. Should it not yield after three or four doses, no advantage will be gained by continuing it. Another plan is to give it in three-grain doses in a glass of wine thrice daily between the paroxyms of pain. Some obstinate cases which resist these and other remedies yield to a course of Fish Liver Oil (141). Among external applications are Datura Liniment or Poultices (130), Lemon Grass Oil (217), Mustard Poultices (253), and the Camphorated Opium (291), or Turpentine Liniment (366).

_Nipples, sore or cracked_, are benefited by Borax Lotion (56), or Castor Oil (84), or Lime Water (225), locally applied. As a preventive use Infusion of Catechu (90). [To ensure prevention, the nipple should be carefully washed and dried immediately the child is removed from the breast, and the tissues may be hardened by washing them for a short time before delivery, and after each application to the breast, with a little brandy and water. It is also a useful practice to wear over the nipple a metallic shield, which should be constantly applied when the child is not at the breast.—_Prof. Ringer._]

_Nodes, or Painful Swellings on the Shin-bone._ Apply Datura Poultice (130), or other means mentioned in _Tumours, painful_.

_Nose, discharge of Matter from._ Use injections of Lime Water (225), or tepid Milk and Water, and give Fish Liver Oil (138) internally. _Maggots in_, see _Pecnash_.

_Nux Vomica, Poisoning by._ Follow the treatment advised for poisoning by Cocculus Indicus (see _Index_). Bland Oils, _e.g._, Til, Cocoa-nut, or Ground-nut Oil, seem to retard its action, hence may be given largely.

_Ophthalmia._ See _Eyes, Diseases of_.

_Opium, Poisoning by._ The stomach having been emptied as speedily as possible by an emetic of Sulphate of Copper (117) or Mustard (246), every means should be adopted for rousing the patient; this is to be effected by dashing cold water over the head and chest, walking him quickly about, supported by two attendants in the open air, applying strong salts, &c., to the nostrils, irritating the leg by flagellation with a wet towel, and administering strong coffee, _café noir_, or if there should be great depression, a little brandy or other stimulant. When the patient can swallow, Decoction of Galls should be given as directed in Paragraph 152. In extreme cases artificial respiration (subsequently described in Appendix, in Art. _Drowning, Recovering from_) must be tried. These measures should _be long persevered in_; as long _as life lasts, hope_ of recovery is _not to be banished_.

_Pains, Muscular._ See _Muscles, Pains in_.

_Palpitations of the Heart, Nervous._ These may in a great measure be controlled by Asafœtida (35), Camphor (70), or Infusion of Jatamansi (184), either alone or used conjointly. _Palpitations or flutterings in the region of the Heart_ which occur in weak, nervous, hysterical subjects, often yield to Bromide of Potassium, in dose of five to ten grains dissolved in water, twice or thrice daily.

_Paralysis._ Little can be done by non-professionals beyond giving internally Fish Liver Oil (142), alone or with Sulphate of Iron (177), in anæmic or debilitated subjects, and applying irritants, as Croton Liniment (122), Petroleum (410), externally.

_Pecnash_ (_Maggots in the Nose_). Oil of Turpentine (363_b_).

_Phthsis._ See _Consumption, Pulmonary_.

_Physic Nut, Poisoning by._ See _Croton Seeds_.

_Piles._ Sulphur (344) internally, and Gall Ointment (148), or astringent enemas, as Decoction of Babúl Bark (9), or Galls (148), suffice in ordinary cases. In old debilitated subjects Confection of Pepper (300) proves very useful. _When inflamed and painful_, the Hip Bath, or sitting over the steam of hot water (392), and the application of a solution of Borax (56) and soft Rice Poultices (322), with or without the addition of Opium (293), give great relief. The Acetate of Lead Solution advised for _Inflammations_ (see _Index_) is peculiarly serviceable in these cases. It may be used cold or warm, as is most agreeable to the patient's feelings. _To control bleeding from_, use Alum (25), or enemas of Sulphate of Iron (179). When bleeding from piles in residents in hot climates has been long continued, it is unadvisable, so long as it remains within moderate bounds, to take any means of arresting it suddenly; the suppression of the discharge having in some instances been known to be followed by congestion and even abscess in the liver, and in others by congestive headaches and determination of blood to the head. It seems to be an effort of nature to relieve the abdominal circulation, which it is unwise to interfere with, unless the discharge be so profuse as to debilitate the patient, and then the object should be rather to moderate than to arrest it altogether. Persons subject to Piles will do well to avoid the use of coffee, as this often appears to aggravate the severity of the symptoms. Cleanliness in these cases is of the greatest importance: the parts should be well washed with soap and water after each motion, and if the piles are internal and protrude during evacuations, they should be washed before they are returned.

_Pregnancy._ _For Pains in the Loins_ use Camphor (68) or Camphorated Opium Liniment (291). _To allay the Vomiting_ try Infusion of Cloves (105), Mustard Poultice (251). A cup of hot coffee and a piece of dried toast should be taken in bed very early in the morning, after which the woman should remain quiet until the usual hour for rising; by this means the vomiting may often be prevented. When procurable, a glass or two of Sparkling Moselle is often productive of the best effects, allaying the vomiting, and enabling the patient to retain and digest food.

_Prickly Heat_ may in a great measure be relieved by Solution of Borax (57) or Sulphate of Copper (115), and subsequently dusting the surface with Rice Flour (322) or finely powdered Sandal Wood (333).

_Pyrosis._ See _Water Brash_.

_Rectum, Stricture and Painful Affections of._ Castor Oil (83), Fish Liver Oil (139).

_Rheumatism, Acute._ _Rheumatic Fever_ may be treated much in the same way as _Ardent or Continued Fever_ (see _Fever_, Index); by confinement to bed in a cool, well-ventilated apartment, farinaceous diet, and abstinence from alcoholic and other stimulants. Nitre (270) should be given freely, with Lemonade (232) as an ordinary drink. The bowels should be carefully regulated, one or two motions procured daily by a dose of Calomel (three or four grains) and Opium (one grain, or even two grains if there should be great pain or restlessness) at bedtime, followed by Infusion of Senna (336), or Castor Oil (83), in the morning. To the swollen and painful joints a strong solution of Nitre (270) should be kept constantly applied; it generally affords great relief; if not, a Datura Poultice or moistened Datura leaf (or Tobacco leaf), applied as directed in Paragraph 130, may be tried.

_Rheumatism, Chronic._ Here Sal Ammoniac (327) and Country Sarsaparilla (163) promise to be of much use. Chaulmúgra (94), Mudar (242), and Gulancha (352), have been advised, but in long-standing cases more benefit may be expected from Fish Liver Oil (142). The action of the skin may be kept up by Camphor, both internally and in the form of Vapour Bath (69), and by hot Infusion of Ginger (156) at bedtime, and by constantly wearing flannel next to the skin. _Amongst external applications_, Camphorated Opium Liniment (291) and Lemon Grass Oil (217) are the best; the others comprise liniments containing Camphor (68), Croton Oil (122), Oil of Country Nutmeg (274), Petroleum (410), Physic Nut Oil (302), Sulphur (343), and Turpentine (366); Piney Tallow (373) has been well spoken of. Should one or more joints be specially attacked, make trial of the applitions advised in Acute Rheumatism, or of Flour of Sulphur, as directed in Paragraph 343.

_Rickets._ Fish Liver Oil (138) may be used with great advantage: it may be combined with Sulphate of Iron (177) if the child is weak and anæmic. Lime Water and Milk (222) forms an eligible ordinary drink.

_Ringworm._ Apply Borax and Vinegar (60), Cassia alata Ointment (81), Unripe Papaw fruit (295), Sulphate of Copper (115), Oil of Turpentine (367), or Kerosene Oil (416).

_St. Vitus's Dance._ See _Chorea_.

_Salivation._ Use gargles of Alum (29) or Borax (55), or try Catechu in substance (89).

_Scalled Head._ See _Ringworm_.

_Scarlatina or Scarlet Fever._ Commence with an emetic of Country Ipecacuanha (368) or Mudar (241); place the patient in a cool, well-ventilated apartment; give plentifully of Lemonade (232) or rice _Conjee_ (322) to allay thirst and feverishness, and give Capsicum Mixture (78) internally. _For the sore throat_, inhale the fumes of hot Vinegar (377), and use Capsicum gargle (78). Sponging the surface with diluted Vinegar (376) or Water (385) is attended with great comfort to the patient, and is otherwise beneficial. The advanced stages, complications, and subsequent debility, are treated in the same manner as in Fevers (see _Index_).

_Sciatica._ See _Neuralgia_. Enveloping the whole of the painful limb in the "Wet sheet" (397_b_) proves sometimes successful when other remedies fail. Quinine in full doses, five to eight grains thrice daily, may be given at the same time.

_Scorpions, Stings of._ Alum (32). See also _Bites, Venomous_.

_Scrofula._ Fish Liver Oil (138) proves most useful in cases in which _Abscesses, Ulcers, or Skin Diseases_ are present. _Scrofulous Ophthalmia_ is also greatly benefited by it. When the patient is debilitated and anæmic, the Oil may advantageously be combined with Sulphate of Iron. Chaulmúgra (94), Hydrocotyle (169), and Lime Water (225), are amongst the remedies occasionally useful. A dose of Opium (283) or Tincture of Datura (128) may be given at night, if the pain or irritation from ulcers or skin disease occasion sleeplessness. A liberal animal diet, gentle outdoor exercise, and sea-bathing are valuable adjuncts to the above remedies.

_Scurvy._ Lime-juice (231) holds the highest rank both as a curative and preventive agent. All acidulous fruits, Lemons, Oranges, Tamarinds (346), &c., may be used with the greatest advantage. As a preventive of Scurvy in jails, &c., Lime Juice and other analogous agents will prove of comparatively little use unless attention is paid to hygienic measures, _e.g._, the cleanliness, ventilation, dryness of the building, reduction of numbers in cases of overcrowding, and the use of a liberal and wholesome diet, containing a large proportion of fresh vegetables. _Diarrhœa of_, give Bael (44).

A new antiscorbutic called ÁM-CHUR has lately been brought into use amongst our native troops in India, and promises to be a powerful rival to Lime Juice. It consists of green Mangoes, skinned, stoned, cut into pieces, and dried in the sun. According to Dr. Clarke, Deputy Surgeon-General Eastern Frontier District, Ám-chur not only maintains the digestive energy of the men, but its use amongst troops, where neither a variety of food nor vegetables is obtainable, commends itself strongly as a result of practical experiment to the military authorities. One ration should be half an ounce, which would be equivalent to an ounce of Good Lime Juice. (_British Med. Jour._, Sept. 30, 1882.) Another anti-scorbutic well worthy of attention, especially as an article of diet on long voyages, consists of DRIED OR PRESERVED BANANAS. When carefully prepared, they are agreeable to the taste, much resembling dried figs, of small cost, and will keep good for a lengthened period.

Sweet Mango pickle, _freely_ eaten with the diet, is an excellent method of administering Ám-chur.

_Seminal Discharges, Involuntary._ Give Camphor (72) at bedtime. When attended with much sexual excitement, a full dose of Bromide of Potassium, 20 to 30 grains in a wineglassful of water at bedtime, is often most serviceable. These discharges being sometimes due to irritation caused by Thread Worm in the lower bowel, attention should be directed to this point. See _Worms_.

_Skin Diseases._ Country Sarsaparilla (163*), Chaulmúgra (94), or Mudar (242); or where the affection occurs in debilitated, scrofulous, or leprous individuals. Fish Liver Oil (138) may be given internally. One of the following may at the same time be applied externally: Cassia alata (81), Chaulmúgra (94), Lime Liniment (225-229), Myrobalan Ointment (257), Sulphur (342), Turpentine (367), Kerosene Oil (414*), or Petroleum (411). The Vapour Bath (396) is often very useful where the skin is hard, dry, and rough. Borax lotion (57) in many instances will allay the irritation.

_Sleeplessness in Head Affections._ Mustard Bath (249). A full dose of the Bromide of Potassium, 20 to 30 grains in a wineglassful of water, taken at bedtime and persevered in for days and weeks, will often be found more effectual and less hurtful than the most powerful narcotics. _From pain attendant on Ulcers, Rheumatism, &c._, Opium (283) or Tincture of Datura (128) at bedtime. [N.B.—_Sleeplessness, arising from no evident cause, as bodily pain, mental anxiety, &c., is often dependent on an empty state of the stomach_, and many a sleepless night may be prevented, and many a wakeful hour obviated, by the simple process of eating a few biscuits or a crust of bread before going to bed, or during the night as occasion may require.]

_Small-pox._ Commence with a mild aperient of Castor Oil (83) or Senna (336); place the patient in a cool, well-ventilated room, and give freely Lemonade (232), Rice _Conjee_ (322), &c., with solution of Nitre (264); sponge the surface daily with diluted Vinegar (376) or Water (385); and, still further, to _allay irritation_, dust the eruption freely with Rice Flour (322). The Carbolic Acid treatment promises the best results. Carbolic Acid, as an external application in Small Pox, is strongly recommended by Dr. Aitchison. He directs that from the very earliest stage of the disease the whole body be rubbed with a mixture of the Acid (one part) and Sweet Oil (ten parts) twice daily. "This application," he remarks, "relieves the patient marvellously—the oil soothing and cooling the skin, the acid deodorising the stench, and destroying the contagious influence of the particles thrown off from the skin. The oil is as much a part of the treatment as the disinfectant, and is an old Egyptian remedy for this disease. In many cases the application seems to destroy the Smallpox poison to the extent that the disease does not reach the pustular stage; the vesicles form themselves into hard lumps, dry up, and disappear, without the usual Small-pox pustular cicatrix." (See Appendix C for details of treatment.) With the view of _preventing pitting_, apply Lime Liniment (229). _In the advanced stages, attended with great exhaustion, delirium_, &c., give Camphor (74), Brandy Mixture (426), and other stimulants, with nutriment. _Subsequent debility and Convalescence_, treat as in Fever. (See _Index_).

_Snake Bites._ See Appendix B.

_Sneezing, when violent or prolonged._ Insert lightly into the nostrils a small piece of cotton wool. A case in which this gave instantaneous relief, when all other remedies had failed, is recorded by Dr. Bradley. (_British Med. Jour._, Dec. 1879.)

_Spermatorrhœa._ See _Seminal Discharges_.

_Spleen, Enlargement of, "Ague Cake."_ Give Sulphate of Iron and purgatives, as advised in Paragraph 176, or Papaw juice (296), or, better still, Cinchona Febrifuge (402). Extract of Gulancha (353) is worth a trial. Quinine, in doses of five to eight grains thrice daily, produces the best effect in these cases; it may be advantageously combined with Sulphate of Iron (176). The most effectual local application is Biniodide of Mercury Ointment (16 grains of the Biniodide to simple Ointment, one ounce). In obstinate cases change of air is the best and only remedy.

_Sprains, Blows, and Bruises._ Solution of Sal Ammoniac (332), Hot Water Fomentations (393), or Evaporating Lotion (380) are most suitable applications for the early stages. Should there be much swelling and heat of skin, Leeches (212) may be necessary. When the active symptoms have subsided, Liniments of Camphor (68), Opium (291), Lemon-grass Oil (217), or Turpentine (366), are indicated. _In Sprains_, warm applications, with perfect rest of the part, are best suited for the first few days. The sprained part should be kept in a raised position, well supported, and should on no account be allowed to hang down. The following treatment is highly spoken of in cases of _Sprained Ankle_. As soon after the accident as possible immerse the foot in a tub of _hot_ water for ten minutes, and then into a tub of cold water for a similar period. Afterwards put on a wet bandage pretty tight, and cover with oil-silk, plantain leaf, or other impermeable covering. _To remove subsequent swelling_, apply Alum Lotion (32). _To remove discoloration_, Solution of Sal Ammoniac (332).

_Stiff Neck._ Apply Opium Liniment (291).

_Stomach, Acidity of._ Give Lime Water (221). _Bleeding from._ See _Hæmorrhage from internal organs_. _Pains in._ See _Flatulence, Flatulent Colic, and Bowels, Spasmodic Affections of_.

_Stomatitis._ See _Mouth, Ulceration of_.

_Sunstroke._ Employ Cold Water Affusion and other measures advised in Paragraph 386. Artificial Respiration, as described in Appendix A, is worth a trial where the insensibility is deep and prolonged.

_Syphilis._ On the first appearance of a chancre or ulcer on the penis, sprinkle its surface with a little very finely powdered Sulphate of Iron, and this having been removed, dress subsequently with Black Wash (225) till the sore shows signs of healing. As a local application, Dr. Aitchison advocates Carbolic Acid. "No time should be lost," he remarks, "in obtaining medical aid when an ulcer on the penis has formed. But when it is impossible to get such aid, touch the sore with pure Carbolic Acid, taking care that the healthy parts are not touched with it. Apply Sweet Oil to the parts after burning the ulcer, and then dress it as you would any healthy ulcer until the slough caused by the acid falls off." Mercury (if at hand) should be given so as to induce slight soreness of the gums.

To effect this, give one grain of Calomel, with a quarter or half a grain of Opium, night and morning, and should the gums at the end of a week not be affected, the dose of Calomel may be doubled. Soreness of the gums, with a peculiar (mercurial) fetor of the breath and metallic taste in the mouth, may be taken as an indication that the remedy has been carried to the required extent, and this condition it is desirable to maintain until the sore heals or the symptoms subside; this may occupy four or five weeks. No good, but rather great harm, will result from carrying the use of mercury beyond this point. Should it cause much increased flow of saliva (which is very undesirable), use the remedies advised for _Salivation_, or if during a course of mercury, the sore, instead of improving, becomes worse, it should at once be discontinued. Stimulants and all kinds of excitement, as well as exposure to atmospherical changes, especially wet, should be avoided during its use; in fact, this treatment requires the greatest care throughout, and should, if possible, _be never undertaken except under proper medical supervision_.

Country Sarsaparilla (163), Hydrocotyle (169), and Mudar (242), are better suited for the more advanced stages of the disease, or when it becomes constitutional. The use of the Country Sarsaparilla, however, may well be conjoined with the mercurial treatment from the very commencement. N.B.—Avoid all the crude preparations of Mercury in use by the native doctors, or sold in the bazaars; they are likely to do _incalculable mischief_.

_Tetanus_ (_Lock-jaw_). Try Datura (131). The treatment of Tetanus by smoking GUNJAH (INDIAN HEMP), introduced by Assistant-Surgeon A. C. Khastagir (_Indian Medical Gazette_, August 1878), promises to supersede all others in India if it were only from the fact that the remedy is procurable at a trifling cost in every bazaar throughout the country, and that its application is simple in the extreme. A pipe, _hookah_, or Indian hubble-bubble, charged with about 15 grains of dried Gunjah leaves, alone or mixed with twice as much tobacco leaves, is to be kept in readiness, and immediately on the indication of a spasm coming on it is to be lighted and handed to the patient with directions to smoke. By the time this is finished, or even before, the spasm relaxes, the eyes close, and the patient falls into a kind of slumber. The pipe is again charged, and kept in readiness for the approach of the next spasm, when the process is repeated with similar results. In this way the drug is administered day and night uninterruptedly, during which the irritation of the nervous system slowly but steadily yields to its influence. Mr. K. details five cases successfully treated in this manner. No auxiliary medicine, beyond an occasional purgative if required; no solid food allowed; milk and soup the only nutriments. This treatment is further advocated by Dr. J. C. Lucas, of the Bombay Medical Service (_Med. Times and Gaz._, February 21, 1880). The advantages which he claims for it are—(1) the spasms are cut short; (2) they reappear gradually at longer and longer intervals; (3) they gradually become not only less frequent, but less severe; this (4) saves the patient's vital powers, and thus, by prolonging life and preventing death, life, which would otherwise have succumbed, may eventually be saved. He places the dose at from eight to thirty grains, commencing with the smaller dose, and gradually increasing it as tolerance is established. He insists, properly, on the vast importance of quiet, _perfect quiet_, in a pure air (without too much breeze or draught), and he directs that the patient should on _no account be disturbed to take his food or for any other reason_, for which opportunity is to be taken when the patient awakes of his own accord, or from the recurrence of spasm. In the case of very young children, this mode of treatment cannot, of course, be carried out, but in all others it seems well worthy of a fair trial.

_Throat, Dry and Irritable States of, giving rise to Cough_, inhale the vapour of Hot Decoction of Abelmoschus (3) or of Hot Water (390). _In Inflammatory States of, without Ulceration_, use the same inhalations, and allow a piece of Nitre to dissolve in the mouth (266). _Relaxed or Ulcerated Sore Throat._ Use gargles of Alum (29), Capsicum (78), Moringa (238), Black Pepper (300), or Pomegranate Rind (313), Catechu (89), Ginger (158), and Omum Seeds (316), used in substance, prove useful in some cases, as do inhalations of the vapour of Hot Vinegar (377), or simple Hot Water (390).

_Tic Douloureux._ See _Face Ache and Neuralgia_.

_Tongue, Fissures or Cracks of, in the advanced stages of Fever, &c._ Use Borax (55) or Alum (29).

_Toothache_ sometimes yields to Opium (292*) or Catechu (89) locally applied, with or without Ginger (157), or Mustard Poultices (253) externally. Extraction is the only certain cure in the majority of cases.

_Tumours, Painful._ Apply Datura in one of the forms advised in Paragraph 130, and give Opium (283) or Tincture of Datura (128) at night to procure sleep. A Tobacco leaf may often be advantageously substituted for Datura.

_Ulcers_ may be successfully treated by the local application of solution of Sulphate of Copper (114*). Ceromel (167*) "Oil Dressing" (338) "Water Dressing" (394), (Dr. Aitchison states that for years he has discarded Water Dressing in any form to ulcers, but has substituted for cleansing and dressing them a mixture of one part of Carbolic Acid and ten of Sweet Oil. He pronounces this a far more effectual mode of treatment), and Rice Poultices (322), varied according to circumstances; _if attended with fetid discharge_, Charcoal Poultices (91); _if with much discharge_, Catechu Ointment or Lotion (90) and Myrobalans Ointment (257). _To destroy Maggots on surface of_, Butea Seeds (65). _Sloughing, Gangrenous, or Ill-conditioned Ulcers_ require Alum Ointment (31), Borax (59), Camphor (75), Ním Poultices (261), Oil of Country Nutmeg (274), Petroleum (412), _Toddy_ Poultices (355*) Turpentine Ointment (367), Resin Ointment (372), or Sugar (408). "Irrigation" (395) is most useful in removing the slough and stimulating to healthy action. _If the pain and irritation are so great as to prevent sleep_, Opium (283) or Tincture of Datura (128). _To excessive Granulations_ ("_Proud flesh_"), apply Sulphate of Copper (114). In all cases Country Sarsaparilla (163), Hydrocotyle (170), or Mudar (242) may advantageously be given internally; and _for Ulcers occurring in Scrofulous subjects_, Fish Liver Oil (137, 138) proves most useful. "Whenever in India an ulcer looks angry and is in an _unhealthy_ and _non-healing_ condition, as is the case with Scind boils, Multan sores, Delhi sores, &c. &c., all applications to the ulcer itself are useless until the general health of the patient undergoes a thorough alteration. The want of power to heal in the ulcer shows that the system is in an unhealthy condition and that it is incapable of putting on the healing process in the ulcer. This state of things is no doubt due to the climate, malaria, poor food, and bad water; these combined develop in the system, scurvy, or a condition of the body allied to scurvy.

"An addition to, and a change in the diet is of the first consequence. This is to be done by administering _as drugs_ a daily liberal proportion of _good butter_, _sugar_, and _lime-juice_.

"In many parts of India, especially during the hot weather, _good_ butter is not to be got as a fresh article of food; an excellent substitute for it is the tinned article, now so readily obtainable, which, if salt, can be carefully prepared for use by having the salt washed out of it. The lime-juice should be, if possible, in the form of _fresh_ limes, lemons, or oranges; rather than the lime-juice of commerce. Where fresh limes, &c., or lime-juice cannot be procured, sweet mango pickles, lime pickles, or the bazaar commodity Ám-chur (see _Index, Scurvy_) should be employed; from the last excellent preserves and tarts can be made, which are relished as a diet.

"The water supply should be changed, and even, if necessary, condensed water be drunk, in place of the saline stuff so common along our north-west frontier, where the river water is to be preferred to that of brackish wells full of nitrates.

"Other vegetables, such as potatoes, cauliflower, and artichokes should be added to the dietary if obtainable, and when possible an immediate change of climate, even for a few days, and to another _water supply_ is of immense importance.

"The good results in following up the above proposals can be at once seen in the rapid alteration of the conditions of the ulcer, or ulcers, which at once begin to take on a healing action. They require after this but simple dressing, and indeed disappear as if by a miracle, leaving, however, behind them a _scar_, a well known momento of having once lived in an unhealthy climate."—_Aitchison._

_Urine, to relieve pain and scalding on passing._ Nitre (269), with Rice _Conjee_ (322), Decoction of Abelmoschus (2), or of Ispaghúl Seeds (305) and the Hip Bath (392) generally afford relief. _For Retention_ _of Urine_, Opium (287*) and a Hip Bath (392), with Hot Water Fomentations to the pubes, often succeed in recent cases; if these fail, _no time should be lost in placing the patient under medical care_.

_Uterus, Painful Affections of._ Camphor (73), Opium (289*), Datura Poultices (130), and Hip Bath (392), either alone or conjointly, are calculated to afford relief. _Chronic Affections of_, Borax and Cinnamon (58). _For Prolapsus or descent of_, use vaginal injections of Decoction of Galls (147), or of Babúl Bark (9), holding Alum (25*) in solution. _Bleeding from_, see _Hæmorrhage_, and _Menstrual Discharge, Excessive_.

_Vaginal Discharges._ Cubebs (125), and Gurjun Balsam (160) internally (_given by the mouth_) and vaginal injections of Lime Water (224), Alum (30) and Decoctions of Babúl Bark (9), Galls (149), or Pomegranate Rind (313) are indicated. [Employ at first simply cold or warm water injections, regulating the temperature according to the feelings of the patient; if these do not benefit, try Solution of Sugar (one part), Water (four parts). Add Alum or other astringents, if necessary, but do not commence with them until a fair trial has been given to the simpler means.—_Aitchison._] For the _Vaginal Discharges of Young Children_, the local application of Lime Water (224), with Fish Liver Oil (138) internally offer the best chance of success.

_Vaginal Irritation_ is often removed, like a charm, by the application to the parts of a very weak solution of Carbolic Acid (one to twenty of Sweet Oil); if used stronger it is apt to cause pain, this pain is at once removed by a free application of sweet oil alone (_Aitchison_).

_Voice, Loss of._ Catechu (89), or any of the other measures directed for _Hoarseness_.

_Vomiting._ Amongst the remedies to allay this, are Infusion of Cloves (105), Infusion of Ginger, (155), Lemon Grass Oil (216*), and Omum Water (318), with or without the addition of a little Opium (290). Apply Mustard Poultices (251), or Turpentine Stupes (362). In obstinate cases try Leeches (213). Lime Water (223*), though especially adapted for _Vomiting arising from Acidity of the Stomach_, is well worthy of a trial in all obstinate cases, especially in the _Vomiting of Infants and Young Children_. It is best given in milk. _Vomiting in Fevers._ Hot Water (358).

_Warts_ seldom resist the persevering application for a week or two of Sulphate of Copper (108); a piece of it moistened should be rubbed lightly over the wart, avoiding the surrounding skin. It may be applied once every day, or every other day.

_Wasps Stings of._ See _Bites, Venomous_.

_Water on the Brain._ See _Hydrocephalus_.

_Water-brash (Pyrosis)._ Butea Gum (62), and Lime Water (223) may often be used with advantage.

_Whites._ See _Leucorrhœa, and Vaginal Discharges_.

_Womb, Affections of._ See _Uterus, Affections of_.

_Worms._ _For Tænia, or Tape Worm_, give Kamala (189), Pomegranate Root Bark (314), or Turpentine (365). When one fails another will often succeed. _For Lumbricus or Common Round Worm_, try Butea Seeds (64), Vernonia Seeds (373_b_), or Papaw Juice (295).

The best remedy in these cases is SANTONIN, and considering the great prevalence of these worms amongst the people of India, and the many anomalous nervous and other affections to which they give rise, it is advisable always to have on hand a supply of this drug. The dose for children under four years is from two to four grains; above twelve years from six to eight grains, rubbed up with about twice its weight of sugar repeated every six or eight hours thrice in succession. A good plan is to give the Santonin at bedtime, and a small dose of Castor Oil in the morning, three days in succession. In many cases, it has been stated, no aperient is needed, one or two stools succeeding its administration containing the worms, if any are present; still, it is safer to follow up its use by an aperient. It is of little or no use in Tape Worm; and in Thread Worm, though it will aid, often strikingly, in removing the worms, it will not prevent their reappearance. For Round Worm it is by far the most effectual remedy we possess. _For Ascarides, or Thread Worm_, use enemas of Lime Water (227), Asafœtida (36), or Turpentine (365).

_Wounds, Ulcerated._ See _Ulcers, Bleeding from_. See _Hæmorrhage_.