Chapter VI: Part I (3)

192. The following preparation has been highly spoken of: Take of Kariyát, cut small, 6 ounces; Myrrh and Aloes, in coarse powder, of each 1 ounce; Brandy, 2 pints. Macerate for seven days in a closed vessel, occasionally shaking it, strain, press, filter, and add sufficient Brandy to make 2 pints. Of this the dose is from one to four teaspoonfuls in a little water taken on an empty stomach. It acts as a gentle aperient, and is said to prove very useful in many forms of _Dyspepsia, especially when attended with torpidity of the bowels_.

193. _In the Bowel Complaints of Children_ a decoction of the fresh leaves of the Kariyát plant has been well spoken of. It is prepared by boiling 2½ ounces of the fresh leaves in 1½ pints of water down to 6 ounces; of this the dose is one ounce every two or three hours. It may be used in conjunction with other remedies as required.

194. +Kokum Butter.+ The concrete oil of the seeds of Garcinia purpurea, _Roxb._

Kokam-ká-tél (_Hind._).

195. This oil is obtained by first exposing the seeds to the action of the sun, when sufficiently dry bruising them, and then subjecting them to boiling; the oil collects on the surface, and on cooling, concretes into a solid cake. When purified it is rather brittle, of a pale yellowish colour, bland and mild to the taste, melting in the mouth, and leaving an impression of cold on the tongue. It melts at 98° F. From its bland, unirritating properties, as well as from its consistence, it seems admirably adapted for replacing animal fats in the preparation of ointments, &c. Were it largely produced, which it unfortunately is not, it might be extensively utilised in tropical pharmacy.

196. +Lawsonia alba+, _Linn._, or +Henna Shrub+.

Mhíndí (_Hind._), Mhéndí or Méndí (_Duk._, _Punj._), Méhedi (_Beng._), Móhnz (_Kash._), Marutónri, Aivanam (_Tam._), Góranta (_Tel._), Mayilánchi, Marutónni (_Mal._), Górante (_Can._), Méndhi (_Mah._), Méndi (_Guz._), Maritondi (_Cing._), Dánbin (_Burm._), Hinie (_Malay_).

197. The leaves of this common Indian shrub, in almost universal use throughout the East for staining the nails, &c., are well worthy of a trial in the treatment of that troublesome and painful affection of the natives called _Burning of the Feet_. For this purpose the fresh leaves should be beaten into a paste with vinegar or lime juice, and applied as a poultice to the soles of the feet. Another plan, which is sometimes more effectual, is to use strong friction with the bruised leaves over the parts. Like all other remedies, however, they not unfrequently fail to afford more than temporary relief; still, from occasionally succeeding, they merit a fair trial.

198. +Leeches.+

Jók (_Hind._), Jónk (_Duk._, _Beng._, _Punj._), Drik (_Kash._), Attái (_Tam._), Attalu, Jela-galu (_Tel._), Attá (_Mal._), Jígani (_Can._), Jala (_Guz._), Kudallu, Púdal (_Cing._), Míyon, Minyon (_Burm._), Lintah (_Malay_).

199. Leeches are procurable, especially during the monsoon, in most parts of India, in the neighbourhood of tanks and swamps. As they are a valuable resource in many diseases, when properly applied in proper cases, a few preliminary remarks may be acceptable.

200. Leeches vary considerably in size; and their blood-extracting capacity is, as a general rule, in proportion to their size. It has been found that small Leeches will abstract two and a half times, small middle-sized four times, large middle-sized five and a half times, and large ones nearly six times their own weight of blood. Hence, to abstract a certain quantity of blood, a very much larger number of small Leeches is required than of large ones. The middle-sized Leech, from 1½ to 2 inches in length when at rest, is in all cases preferable. The very small leeches so commonly supplied in India are objectionable on account of the number of bites, the length of time required in their application, and the indefinite small oozing of blood which follows their application, and the difficulty in arresting the flow by pressure. On the other hand, the very large Leech is objectionable, from the large gaping wound left by its bite, which often results in an ugly scar; this applies with peculiar force to childhood and infancy.

201. Where only one or two Leeches have to be applied, they may be taken in the hand and held to the spot where it is desired they should bite, but this is a long and tedious process; when several are to be applied, they should be put in a wineglass and thus held to the surface till they have all taken.

202. In order to make Leeches bite readily, thoroughly cleanse the skin with soap and water, and then dry it; this is particularly necessary if a liniment has been previously employed. If they will not bite, one or more of the following plans may be tried: 1. Remove them from the water and keep them for ten minutes in a dry, warm cloth. 2. Smear the skin with cream or sugared milk. 3. Apply a small mustard poultice over the spot. After carefully cleansing with hot water, apply the Leeches. Not only will they bite more readily, but the flow of blood will be far greater than it otherwise would be. 4. Make a small puncture or scratch on the skin, and smear the blood over the surface; this often succeeds when everything else fails. It should also be remembered that the fumes of sulphur, vinegar, or tobacco in a room, will often prevent Leeches from biting at all.

203. To make Leeches bite on particular spots, take a piece of blotting-paper and make in it as many small holes as there are Leeches, the holes corresponding with the spots on which it is desired to apply the Leeches; they are then to be covered over with a wineglass or tumbler; the Leeches, finding themselves on a rough surface, creep about till they come to the holes in the paper, when they instantly bite the exposed points of the skin; the blotting-paper is easily removed by being moistened.

204. When Leeches will not drop off naturally, which they generally do in about fifteen minutes or less, or if you wish to remove them, sprinkle them with a little salt or vinegar, or touch them with a piece of onion; the last is an old Bengali practice.

205. To promote the bleeding from Leech-bites, use hot fomentations; to arrest it apply burnt rag, and make firm pressure with the finger over the bite. A piece of tobacco leaf, or spider's web, or the nap off a hat, sometimes succeeds better than burnt rag. If these fail try powdered alum (25) or sulphate of copper (116). See also _Hæmorrhage_ in Index.

206. If Leeches get into the rectum or nostrils, or any of the other passages, they may be dislodged by using an injection of, or by simply touching them with, vinegar or a solution of salt.

207. Leeches should not be applied immediately over a large prominent vein, nor to the eyelids, nor to the bosom of a woman, especially during pregnancy, nor to the loose skin of the penis or scrotum, as the bites in these situations are apt to be followed by infiltration or inflammation.

208. Additional care is necessary in applying Leeches to young children, as they bleed so much more freely than adults; they should, when practicable, be placed where a bone is near the surface, so that in case of excessive bleeding pressure may be made against it. Morning is the best time for their application; if put on in the evening, the bites may burst out bleeding whilst _the attendants are asleep_, and the _child die from hæmorrhage_; such cases are on record. As a general rule, one Leech is sufficient for each year of a child's age up to six; after that age up to adolescence, the latter number continues to be enough in ordinary cases.

209. _In Fevers attended with much Headache_, Leeches are very useful, but they should only be applied in the early stages of the disease; when the patient is young and vigorous, four or six Leeches to each temple may be applied, but they sometimes give most relief if put at the nape of the neck, close to the point where the head joins to the spine. _In severe Pain in the Chest or Abdomen occurring during Fevers_, eight or ten Leeches applied immediately over the seat of pain often afford manifest relief.

210. _In severe Headache, or fulness of Head depending upon the stoppage of a discharge of blood from Piles_, Leeches close to the anus frequently afford great relief, but great care is necessary to prevent them creeping up into the rectum. When the _Headache depends upon the sudden stoppage of the Menstrual Discharge_, the leeches should be applied to the inner part of the thighs.

211. _In Acute Dysentery_, a few Leeches (six to nine) to the verge of the anus are often most serviceable in relieving the pain and straining at stool, and otherwise prove beneficial. The same measure is also of great service in _Congestion of the Liver_, or they may be placed over the region of the liver, but a fewer number afford a greater amount of relief when applied to the verge of the anus.

212. _In all local Inflammations of the Skin_, _Incipient Abscesses_, _Boils_, and _in Bruises_, _Sprains_, and _Blows_, where there is much pain and heat of the part, six or eight Leeches, followed by hot fomentations, tend to relieve the pain and cause the subsidence of inflammatory action.

213. _Obstinate Vomiting_ may occasionally be checked by a few Leeches to the pit of the stomach after ordinary means have failed.

214. +Lemon-grass Oil.+ The oil obtained by distillation from several species of Andropogon.

Akyá-ghas-ká-aitr (_Hind._), Hazár-masáleh-ká aatar (_Duk._), Agya-ghans-tail (_Beng._), Vásh-anap-pullu-yenney, Karpúra-pullu-yenney (_Tam._), Nimma-gaddi-núnay (_Tel._), Vásanap-pulla-enna (_Mal._), Purvali-hullú-yanne (_Can._), Lilli-chaya-tél (_Guz._), Pengrimá-tel (_Cing._), Sabalen-si (_Burm._), Miniak Sárie (_Malay_), Iz-khar (Punj.), Babber-i-Khát (_Kash._).

215. Specimens of Lemon-grass Oil met with in India differ somewhat in appearance, but they all partake more or less of the same medical properties, being powerful stimulants whether taken internally or applied externally. The true Lemon-grass Oil is of a pale sherry colour, transparent, with an extremely pungent taste and a peculiar fragrant lemon-like odour.

216. _In Flatulent Colic and other Spasmodic affections of the Bowels_, a dose of from 3 to 6 drops on sugar or in emulsion often affords great and speedy relief. Thus given it proves effectual in allaying _Obstinate Vomiting_. Even in _that of Cholera_ it has been found successful when other remedies have failed, and in these cases it proves additionally serviceable by acting as a stimulant to the system generally; it is well worthy of a more extended trial in the treatment of this disease. The dose (5 or 6 drops) may be repeated every hour or oftener in severe cases.

217. _In Chronic Rheumatism_, _Lumbago_, _Neuralgic Pains_, _Sprains_, _and other painful muscular affections_, an embrocation of equal parts of this oil and any bland oil, well rubbed in twice daily, has been found useful in many instances. In old chronic cases it is necessary to use the undiluted oil in order to obtain relief.

218. +Lime.+ Calcareous earth, the oxide of calcium.

Chúnah, Chúna (_Hind._), Chunnah (_Duk._), Chún, Chúná (_Beng._, _Punj._, _Kash._), Shunnámbu (_Tam._), Sunnam (_Tel._), Núra (_Mal._), Sunnú (_Can._), Chunná (_Mah._), Chúno (_Guz._), Hunu (_Cing._), Thónphiya (_Burm._), Kapor (_Malay_).

219. Lime in a medical point of view is of great importance as the basis of LIME WATER (in India it is essentially necessary to see that nurses and sick attendants understand the difference between Lime Water and Lime Juice; accidents have been known to occur from their ignorance), a mild and useful antacid; it is prepared by adding two ounces of slaked lime to one gallon of water, in a stoppered bottle, shaking well for two or three minutes, and then allowing it to stand till the lime is deposited at the bottom. In cases of emergency, as burns, &c., half an hour is sufficient for this purpose; otherwise it should be allowed to stand for twelve hours at least before being used. It is _only the clear water which holds a portion of Lime in solution, which is employed in medicine_. It is advisable always to keep a supply ready prepared, as it is useful in many ways, and it will remain good for a long time, if kept in well-stoppered bottles, so that the air cannot have access to it. The dose for adults is from 1 to 3 ounces twice or thrice daily; it is best administered in milk.

220. Another form, called the SACCHARATED SOLUTION OF LIME, thought to be better adapted for internal use in the diseases of childhood and infancy, is prepared by carefully mixing together in a mortar one ounce of Slaked Lime and two ounces of powdered White Sugar, and adding this to a pint of Water, as described above. It should be kept in a well-stoppered bottle. The dose of _the clear water_ is from 15 to 20 drops or minims in milk twice or thrice daily.

221. _In Acidity of the Stomach, in Heartburn, and_ _in those forms of Indigestion arising from or connected with acidity of the stomach_, Lime Water in doses of 1½ to 2 ounces, is often speedily and permanently effectual. It is particularly useful in indigestion when the urine is scanty and high coloured, and when vomiting and acid eructations are prominent symptoms. It is best given in milk.

222. _In Diarrhœa arising from Acidity_ Lime Water frequently proves useful; it is best given in a solution of gum arabic or other mucilage, and in obstinate cases ten drops of Laudanum with each dose increases its efficacy; it may also be advantageously combined with Omum water (317). _In Chronic Dysentery_ the same treatment sometimes proves useful. Enemas of Lime Water diluted with an equal part of tepid milk or mucilage have also been used with benefit. It is especially adapted for the _Diarrhœa and Vomiting of Infants and young children which result from artificial feeding_; in these cases a sixth or a fourth part of Lime Water may be added to each pint of milk. The Saccharated Solution of Lime (220) has also been found of great service in this class of cases.

223. _Obstinate Vomiting_ sometimes yields to a few doses of Lime Water in milk, when other more powerful remedies have failed. It is worthy of a trial in the _Vomiting attendant on the advanced stages of Fever_; it has been thought to arrest even the black vomit of yellow fever. It is also a remedy of much value in _Pyrosis or Waterbrash_.

224. _To relieve the distressing Irritation of the Genital Organs_ (_Pruritus Pudendi_) bathing the parts well with tepid Lime Water three or four times a day sometimes affords much relief. _Leucorrhœa and other Vaginal Discharges_ have in some instances been mitigated and even cured by the use of vaginal injections of a mixture of 1 part of Lime Water and 2 or 3 of Water.

225. _In Scrofula_, Lime Water in doses of ½ ounce in Milk, three or four times a day, proves beneficial in some cases; it is thought to be especially adapted for those cases in which abscesses and ulcers are continually forming. To be of service, it requires to be persevered in for some time. _Scrofulous and other Ulcers attended by much discharge_ have been found to improve under the use of Lime Water as a local application. For _Syphilitic Ulcers or Chancres_, one of the best applications is a mixture of Lime Water ½ pint, and Calomel 30 grains; this—commonly known as BLACK WASH—should be kept constantly applied to the part by means of a piece of lint or rag moistened with it. Many forms of _Skin Disease_, attended with much secretion and with great irritation or burning, are benefited by Lime Water either pure or conjoined with oil (229). _To sore or cracked Nipples_ it proves very serviceable. Diluted with an equal part of water or milk it forms a useful injection in _Discharges from the Nose and Ears_ occurring in scrofulous and other children.

226. _In Consumption_, Lime Water and milk has been strongly recommended as an ordinary beverage. The same diet-drink has been advised in _Diabetes_; but little dependence is to be placed upon it as a _cure_; it may produce temporary benefit.

227. _In Thread Worm_, enemas of 3 or 4 ounces of Lime Water, repeated two or three times, have sometimes been found sufficient to effect a cure.

228. _In Poisoning by any of the Mineral Acids_, Lime Water given plentifully in milk is an antidote of no mean value, though inferior to some of the other alkalies. It may also be given in _Poisoning by Arsenic_.

229. _To Burns and Scalds_ few applications are superior to LIME LINIMENT, composed of equal parts of Lime Water and a bland oil. Olive Oil is generally ordered for this purpose, but Linseed Oil answers just as well, and where this is not at hand Sesamum Oil (338) forms a perfect substitute. When thoroughly shaken together, so as to form a uniform mixture, it should be applied freely over the whole of the burnt surface, and the parts kept covered with rags constantly wetted with it, for some days if necessary. This Liniment on cotton-wool, applied to the pustules, is said to be effectual in preventing _Pitting in Smallpox_.

230. +The Lime.+—The fresh fruit of Citrus Bergamia, _Risso_.

Límú, Níbú Nínbú (_Hind._, _Duk._), Nébu (_Beng._), Niúmb (_Kash._), Elumich-cham-pazham (_Tam._), Nimma-pandu (_Tel._), Cheru-náranná, Jonakam-náranná (_Mal._), Nimbo-hannu (_Can._), Límbu (_Mah._), Límbu, Nímbu (_Guz._, _Punj._), Dehi (_Cing._), Sámyá-si, Tambiya-sí (_Burm._), Limowe Nipis (_Malay_).

231. The fresh juice of the Lime is a valuable resource to the Indian practitioner. In _Scurvy_ it deservedly ranks highest in our list of remedies, and should be taken to the extent of not less than three ounces twice daily: the addition of sugar increases its efficacy. Should the patient be very debilitated, it may be advantageously combined with tonics, as Infusion of Chiretta (98), or Decoction of Ním Bark (260). Diluted with half its quantity of water it forms an excellent gargle for _Scorbutic and other Ulcerations of the Mouth, and Sponginess of the Gums_. When scurvy appears in a jail or other place where numbers of people are congregated together, the daily use of Lime Juice should be strictly enforced amongst the healthy, as it is one of our best preservatives against an attack of the disease. For other remarks, see Art. _Scurvy_, in Index.

232. _In Smallpox, Measles, Scarlatina, and other forms of Fever_, where there is a hot, dry skin, and much thirst, a very useful refrigerant drink, "Lemonade," may be made by pouring a pint of Boiling Water on five or six peeled Limes cut in thin transverse slices. When cool, strain, sweeten to taste, and let the patient drink as plentifully as he likes. In the same class of cases, when the mouth is dry and clammy, sucking a fresh Lime cut in slices is often both agreeable and useful, though when at hand a slice of Pineapple is said to answer the purpose even more effectually. The stringy portion should not be swallowed. _In Diabetes_, weak lemonade is preferable to plain water for allaying the great thirst; like other fluids, in this disease, it is better taken during the intervals between, than at meals.

233. _In cases of Hæmmorrhage from the Lungs, Stomach, Bowels, Uterus, Kidneys, or other internal organs_, especially when attended with feverish symptoms, the drink described in the last section, or made somewhat stronger, may be taken with advantage in considerable quantities. The patient should at the same time remain quiet in the recumbent position, and kept as cool as possible.

234. _In Poisoning by Croton Oil Seeds_, _Castor Oil Seeds_, _the Physic Nut_, _and the fresh root of the Bitter Cassava_, _Mandioc_, _or Tapioca plant_, almost immediate relief to the purging, vomiting, and other urgent symptoms will be obtained by drinking Lime Juice, 4 or 5 ounces at a time, diluted with an equal quantity of _conjee_ or plain water. It is an antidote which should always be first tried, because it is generally at hand, and seldom fails to afford more or less relief. A full dose of Castor Oil should be subsequently given.

235. _For relieving the irritation, &c., of Mosquito bites_, the local application of Lime Juice often proves more effectual than anything else. Applied to the surface at nights before going to bed, it is thought also to afford protection from the attacks of mosquitoes.

236. +Moringa, or Horseradish Tree.+ Moringa pterygosperma, _Gærtn._

Shájnah, Ségvá (_Hind._), Mungé-ká-jhár (_Duk._), Sojná (_Beng._), Sohánjná (_Punj._), Morúnga, Murungai (_Tam._), Munaga (_Tel._), Murinna (_Mal._), Nugge-gidá (_Can._), Munagácha-jháda (_Mah._), Murungá (_Cing._), Dándalon-bin (_Burm._), Kaylor, Ramoongie (_Malay_).

237. The fresh root of this tree closely resembles in taste, smell, and general appearance, the common Horseradish of Europe, hence its ordinary name amongst Anglo-Indians. There is good reason for supposing that it possesses similar medical properties as a stimulant and diuretic, and in these characters it is worthy of trial in _Dropsical Affections attended with Debility_: it may be given as follows. Take fresh Moringa Root and Mustard Seed, of each, well bruised, one ounce. Boiling Water, one pint; infuse for two hours in a covered vessel and strain. Of this the dose is about one ounce and a half (a wineglassful) thrice daily. It may also be used as a vehicle for nitre and other more active remedies.

238. _In Hoarseness and Relaxed Sore Throat_, a decoction of Moringa root (or the above infusion) has been found serviceable as a gargle.

239. In the preparation of mustard poultices when it is desired to make them act more speedily or energetically, the addition of the expressed juice of the fresh root, or the scraped root, answers these purposes effectually.

240. +Mudar.+ Calotropis procera and C. gigantea, _R. Brown_.

Ák, Ákond, Madár (_Hind._, _Punj._), Ák, Akrá, (_Duk._), Ák, Ákondo (_Beng._), Ak-a-múl (_Kash._), Erukku or Erukkam (_Tam._), Jillédu-chettu, Mándáramu (_Tel._), Erukka (_Mal._), Yakkeda-gidá (_Can._), Ákda-cha-jháda (_Mah._), Ákda-nu-jháda (_Guz._), Vára, Vára-gaha (_Cing._), Mayo-bin (_Burm._), Ramegu (_Malay_).

241. One or other of the above species of Calotropis is found everywhere in India, and although some doubt exists as to which of them is the Mudar which some years since attained high repute in the treatment of leprosy, they both possess the same medical properties and may be used indiscriminately. The only part employed in medicine is the root-bark; and it is necessary carefully to attend to the subjoined directions for collecting and preparing it for medical use, a disregard of them having been, in some instances, the apparent cause of the failure of the remedy. The roots should be collected in the months of April and May, from sandy soils, and all particles of sand and dirt having been carefully removed by washing, they should be dried in the open air, without exposure to the sun, until the milky juice contained in them becomes so far dried that it ceases to flow on incisions being made. The bark is then to be carefully removed, dried, reduced to powder, and preserved in well corked bottles. In small doses, from 2 to 5 grains, long continued, its action is that of an alterative tonic; in larger ones, from 30 to 60 grains, for adults, it acts freely as an emetic, and in this character it is regarded by some as one of the best Indian substitutes for Ipecacuanha.

242. _In Leprosy_, _Constitutional Syphilis_, _Obstinate Ulcerations_, _and in Chronic Rheumatism_; _also in Skin Diseases arising from the abuse of Mercury_, powdered Mudar (_ante_) has been found highly useful in some instances, whilst in others it has altogether failed. The commencing dose is 3 grains, gradually increased to 10 grains or more, thrice daily.

243. _In the Dysentery of Natives_ it has been highly spoken of. In the severer class of cases in adults, a large dose, from 20 to 60 grains, may be given at once, in the same manner as Ipecacuanha (see Art. _Dysentery_ in Index). In ordinary cases, smaller doses are preferable. For children the dose is 1 or 2 grains for every year of age, three or four times a day. Its effects are said to be very similar to those of Ipecacuanha, like which, it may be given variously combined, as circumstances may require.

244. +Mustard.+ The seeds of Sinapis juncea, _Linn._ and other species of Sinapis.

Rái Ráyán (_Hind._, _Duk._), Rái (_Beng._, _Punj._), Ásúr (_Kash._), Kadugú (_Tam._), Áválu (_Tel._), Katuka (_Mal._), Sásave (_Can._), Moharé (_Mah._), Ráyi (_Guz._), Abbé (_Cing._), Munniyén-zi (_Burm._), Biji Sa-sarvi (_Malay_).

245. English Mustard imported in bottles is procurable in most of the large bazaars, or is met with as an article of domestic economy in the household of almost every European. If not at hand, however, the common country Mustard seed may be substituted, especially in the formation of poultices. For this purpose, however, they require to be thoroughly ground down into the required consistence with a little water. If previously deprived of their fixed oil by expression, their activity is increased. By long keeping they lose much of their pungency; hence fresh seeds should, when practicable, be employed.

246. With English Mustard at hand you can never be in want of a safe and efficient emetic. A full teaspoonful (piled up) in a tumblerful of warm water, generally produces free vomiting; if it does not, in five or ten minutes it may be repeated, and should this not produce the desired effect, a third dose may be given after a similar interval. Should this fail, then some other emetic may be tried. It is especially indicated in _Drunkenness_, _Narcotic and other Poisoning_, _and in all cases where the stomach is overloaded with hard, indigestible food or intoxicating drinks_, when it is desirable simply to unload the stomach without producing any depressing effect on the system. It is very doubtful whether country Mustard may be safely used as an internal medicine.

247. MUSTARD POULTICES are usually made with the flour of Mustard mixed to the consistence of a poultice with water or vinegar, spread on a piece of stout brown paper or rag, and applied to the skin. A few points require notice: _a._ Cold water should be used in their preparation; it is a mistake to suppose that hot water or vinegar is better suited for this purpose, _b._ If it be desired to make the poultice act more speedily or strongly, this may be done by adding a small portion of bruised Capsicum or the scraped fresh root of the Moringa tree (239). _c._ For persons of delicate skins, as women and children, it is advisable to place a piece of thin muslin between the poultice and the skin; for the sake of cleanliness also this is desirable. _d._ As a general rule it should be removed when it produces redness of the skin, whether it causes much pain or not. _e._ Some skins are very susceptible to its action; in these cases the poultice should be at once removed if it causes great pain. _f._ If allowed to remain in contact with the skin for twenty or thirty minutes it is apt to act as a blister, which is very undesirable, as _the ulcers which result are difficult to heal_. _g._ In cases of fever and acute disease, the morning or early part of the day is preferable to the evening for applying a Mustard poultice.

248. _In Apoplexy_, _Convulsions_, _Delirium_, _and violent Headaches occurring during Fevers or Smallpox_, Mustard poultices to the feet and calves of the legs are often very useful in relieving the affection of the head. Where the patient is able to sit up for the purpose, a Mustard foot bath [an ordinary foot bath, to which is added a handful of Mustard] is even more effectual. The water should be as hot as can be well borne, and the higher the fluid reaches up the leg, the better. In _Delirium Tremens_ it should be used every night before bedtime.

249. _In some Head Affections_, e.g., _the early stages of Insanity, and Delirium Tremens, where there is determination of blood to the head_, _with sleeplessness_, _restlessness and anxiety_, a plan which has been found effectual in some cases has been to envelop the whole of the legs and lower part of the abdomen in cloths steeped in a mixture of Mustard and hot water, a cold wet towel being at the same time applied round the head. It has a very calming effect, and is occasionally productive of sleep. The Mustard foot bath, described in the last section, is also worthy of a trial, repeated every night before the usual bedtime.

250. _In Dropsy_ Mustard occasionally proves useful. It is best administered in the form of Whey, made by boiling half an ounce of the bruised seed in a pint of milk, and straining. This quantity may be given daily in divided doses.

251. _In Cholera_, _Colic_, _and Spasms of the Bowels_, when unattended by inflammation, a Mustard poultice placed over the abdomen in many cases affords considerable relief. _Vomiting, especially that accompanying Fevers, and Pregnancy_ may often be allayed by a Mustard poultice applied to the pit of the stomach. _In Cholera_, when the patient is very low, the poultice may be placed over the heart, or the left side of the chest.

252. _In Coughs, attended with much difficulty of breathing_, Mustard poultices to the chest often afford relief. They may also be advantageously applied on the back between the shoulder-blades. They may be used for children as well as adults. _Hooping Cough_ is occasionally much relieved by Mustard poultices along the spine.

258. _Toothache_, _Faceache_, _and Neuralgic Pains of_ _the Head and Face_, are frequently relieved by the application of a Mustard poultice over the seat of pain.

254. +Myrobalans, Chebulic.+ The dried fruit of Terminalia Chebula, _Retz._

Har, Harrá, Pilé-har (_Hind._), Haldá, Harlá, Pílá-halrá (_Duk._), Hárítakí, Hórá (_Beng._), Zard halélá (_Punj._, _Kash._), Kadú-káy (_Tam._), Karakkáya (_Tel._), Katukká (_Mal._), Alale-káyi (_Can._), Hiradá (_Mah._), Harlé, Pílo-harlé (_Guz._), Aralu (_Cing._), Buah Kaduka (_Malay_).

255. Chebulic Myrobalans, met with in all the bazaars of India, are of an ovoid shape, about an inch in length, sometimes tapering towards the lower extremity, round or obscurely five- or six-sided, more or less furrowed longitudinally, smooth, of a yellowish brown colour, and astringent taste.

256. Myrobalans is a safe and effective aperient, and given to natives in the following form, has been found to act very satisfactorily: Take of Myrobalans bruised 6, Cinnamon or Cloves bruised 1 drachm, Water or Milk 4 ounces; boil for ten minutes, strain, and set aside till cold. This quantity taken at a draught generally produces on an adult native three or four copious stools without griping, vomiting, or other ill effects. Youths from twelve to fourteen years require only half the above quantity, or even less. For infants and young children Castor Oil or Senna is preferable as an aperient. It is well adapted for ordinary cases of _Constipation occurring in Natives_ and in other states where aperients are required.

257. _Chronic Ulcerations, Ulcerated Wounds, and many Skin Diseases attended with profuse discharge_, often manifestly improve under the use of an ointment composed of equal parts of dried Myrobalans and Catechu, both finely powdered, and sufficient ghee or some bland oil to make them into a thick paste: this, spread on a rag, should be applied to the part, and renewed twice daily.

257_a_. Mr. W. Martindale, chemist, of New Cavendish Street, London, has forwarded to me a preparation of another kind of Myrobalans, EMBLIC MYROBALANS, the fresh fruit of _Phyllanthus Emblica_ (_Linn._), a common Indian tree, preserved in sugar. The pulp, which has an agreeable taste, is stated by Mr. M. to possess purgative properties in doses of one or two of the preserved fruit. Commenting on this preparation it is stated in the _British Medical Journal_ (July 29, 1882, p. 173): "We have tried it carefully in several cases of habitual constipation, and have no doubt it is a valuable addition to our list of laxatives.... It may be eaten at dinner or dessert, and it would be absurd to regard it as a medicine. It is most valuable for children." It should be added that it is only in the fresh state that it possesses aperient properties; in the dried state, as they are commonly met with in Indian bazaars, they are astringent, containing a large proportion of gallic acid. Their ordinary vernacular names are Ánvulá, Ánvurah (_Hind._), Ámlá Ánlá (_Beng._), Nelli-kay, Tóppi (_Tam._), Ámala-kamu (_Tel._), Nelli-káyi (_Can._, _Mal._), Avalá (_Mah._), Nelli, Nellika (_Cing._), Zíphiyu-sí (_Burm._).

258. +Ním Tree or Margosa.+ Azadirachta Indica, _Iuss._

Nínb, Nímb (_Hind._), Ním, (_Duk._, _Beng._, _Punj._), Vémbu, Véppam, Véppa-marum (_Tam._), Véppa-chettu, Ním-bamu (_Tel._), Véppa, Aviya-véppa (_Mal._), Bévina-mará (_Can._), Límbacha, jháda (_Mah._), Límbdanu-jháda (_Guz._), Kohum-ba, Nímba-gahá (_Cing._), Tamá-bin, Kamákha (_Burm._), Dawoon Nambu, Baypay (_Malay_).

258_b_. The Ním Tree, according to Dr. Pulney Andy (_Madras Jour. of Med. Sci._, vol. xi. (1867), p. 105), is held in veneration by the Hindús as being dedicated to the goddess Mariathá, the deity which is supposed by them to preside over all epidemics: or rather the epidemics themselves are thought to be visitations of this goddess, in honour of whom the leaves are in common use amongst Hindús, particularly in _Smallpox_ epidemics. The leaves are spread on the bed of the patient, fans made of them are used for fanning him, besides which a bunch of them is fixed above the door as a sign of the presence of the goddess in the house. Dr. Pulney Andy was thus led to make trials of the fresh tender young leaves as an internal remedy in fourteen cases, and of these thirteen recovered; but how far the recoveries were due to the remedy is very problematical. He prescribed about five grains made into a pill, with liquorice powder, and a few drops of water, thrice daily. In the absence of fresh leaves he suggests the use of dried ones in infusion or decoction (3j to Water Oj) in doses, for an adult, of one ounce twice or thrice daily. The efficacy of this remedy is open to grave doubts.

259. Ním bark varies much in appearance, according to the size and age of the tree producing it. The bark from the trunk of a tree above three or four years of age is covered with a thick scaly epidermis, and varies in thickness from a quarter to half an inch. That from the smaller branches is smooth, of a dullish purple colour, marked by longitudinal lines of ash-coloured epidermis from one-eighth to one-twelfth of an inch apart. The inner layer of the bark, of a whitish colour in the fresh state, is powerfully bitter, far more so than the outer dark-coloured layer, which, however, possesses a greater amount of astringency. According to the analysis of Mr. Broughton it contains a bitter neutral resin, in which apparently the activity of the remedy resides.

260. Ním bark is a valuable astringent tonic, and when dried and reduced to powder, may be given in doses of one drachm three or four times a day. A better form, however, is a decoction prepared by boiling two ounces of the bruised inner layer of the bark in a pint and a half of water for a quarter of an hour, and straining whilst hot; of this, when cold, the dose is from 2 to 3 ounces. It, as well as the Powdered Bark, is a remedy of considerable value in _Ague or Intermittent Fever_; and in these cases it should be given every second hour previous to the time at which the attack is expected to return. It is chiefly adapted for mild, uncomplicated cases, especially in natives. _For Convalescence after Fevers_, _General Debility_, and _Loss of Appetite_, the Decoction, in somewhat smaller doses than those mentioned above, proves of great service, and its efficacy is increased and its taste improved by the addition of a few bruised Cloves or a little Cinnamon. As the decoction readily spoils in hot weather, it should be prepared fresh for use when required.

261. _To Indolent and Ill-conditioned Ulcers, especially those of long standing_, a poultice of Ním leaves acts beneficially as a stimulant. It is easily prepared by bruising a sufficient quantity of the fresh leaves with a little tepid water, and applying it, spread on a rag, to the ulcerated surface; should it cause pain and irritation, as it sometimes does, an equal weight of rice flour may be added.

262. +Nitre, Saltpetre, Nitrate of Potash.+

Shórá (_Hind._, _Duk._, _Punj._), Sórá (_Beng._), Saféd-shora (_Kash._), Pot-luppu (_Tam._), Peti-luppu, Shúrá-karam (_Tel._), Veti-uppa (_Mal._), Pet-luppu (_Can._), Shóra-mítha (_Mah._), Sóro-khár (_Guz._), Pot-lunu, Vedi-lunu (_Cing._), Yán-zin (_Burm._), Sun-dawa (_Malay_). In Kashmir the term Shorá means Gunpowder, hence one must speak of White Gunpowder (_Saféd Shorá_), which is the name of Nitre, if it is wished to procure it. (Dr. Aitchison.)

263. Nitre is obtainable in most of the bazaars of India, but often in a very impure state. To fit it for internal use it should be purified by dissolving it in boiling water, removing the scum after the liquid has been allowed to settle, straining the solution through calico and setting aside to crystallise. Pure specimens, which are sometimes met with in large bazaars, should be in white crystalline masses or fragments, colourless, and of a peculiar, cool, saline taste.

264. _In Fever_, when the skin is hot and dry, the tongue parched, the thirst great, and the urine scanty and high-coloured, an excellent refrigerant drink may be made by dissolving two drachms of Nitre in a quart bottle of thin _conjee_, and sweetening to the taste with honey or sugar candy. This quantity may be taken daily, in divided doses as an ordinary drink. Tamarind or Lime Juice may be added to improve the flavour if desired. It will be found to moderate the fever, cause some perspiration, and increase the quantity of urine. Should the patient reject the first one or two doses, it should still be persevered in, unless it should manifestly disagree. _In Smallpox_, _Measles_, _Influenza_, and _Catarrhal attacks_, the above drink has also been found useful. For children the strength should be reduced one-half or more.

265. _For the relief of Headache and Delirium, occurring in the course of Fever_, a very cold and agreeable lotion for the head may be made by dissolving two ounces of Nitre, and an equal quantity of Sal Ammoniac, in a quart bottle full of Water; this should be applied by constant relays of freshly wetted cloths.

266. _In Inflammatory Sore Throat_, a popular remedy, sometimes successful in the early stages, is a small piece of Nitre allowed to dissolve slowly in the mouth.

267. _In Bleeding from the Lungs, Stomach, Uterus, or other internal organs, attended by Fever_, Nitre proves serviceable though it is not to be relied upon as the sole means of cure. It may be given in doses of ten to fifteen grains, in three ounces of _conjee_ or simple water four of five times a day; the patient at the same time being kept perfectly quiet and cool.

268. _In Asthma_, great relief in many instances results from the inhalation of burning Nitre. For this purpose, dissolve four ounces of the salt in half a pint of boiling water in an open vessel; immerse moderately thick blotting-paper in it for a few minutes, then dry it by exposure in the air or to the fire; when quite dry, cut it in pieces about four inches square, and keep ready for use. Immediately when an attack threatens, burn one, or, if required, two pieces of this paper, so that the fumes may be freely inhaled; but it should not be held too near the face, or the fumes may prove too irritating, and increase rather than diminish the symptoms. The same measure proves very useful in _Spasmodic Coughs_, whether connected with _Chronic Bronchitis_ or not. Persons thus afflicted will do well to burn one or two pieces of this NITRE PAPER in the bedroom before retiring to rest at bedtime, care being taken to prevent the too ready escape of the fumes.

269. _In Gonorrhœa_, a solution of a drachm of Nitre in a pint of rice _conjee_ or decoction of Abelmoschus (2) taken freely as a drink, serves to allay the heat on passing urine. Obstinate cases of _Leucorrhœa_ sometimes yield to a combination of Nitre (10 grains) and Alum (5 grains) taken thrice daily. It may be advantageously given in conjunction with infusion of Moringa (237). Nitre has been found to act beneficially as a diuretic in the early stages of _Dropsy_.

270. _In Acute Rheumatism_, Nitre may be given with advantage, commencing with doses of 40 grains, twice daily: this may be gradually increased to 60, 90, up to 120 grains, the vehicle in each case being half a pint of warm rice _conjee_. The quantity of Nitre may be diminished as the severity of the symptoms subsides. A strong solution of Nitre (three ounces to a pint of water) forms a most soothing application to the swollen and painful joints; cloths saturated with it should be kept constantly applied; the ease which it affords is often very great.

271. +Nutmegs and Mace.+ The products of Myristica officinalis (_Linn._).

_Nutmegs._

Jáé-phal (_Hind._, _Duk._, _Beng._), Záfal (_Kash._), Jádi-káy (_Tam._), Jájí-kaya (_Tel._), Játi-ká (_Mal._), Jaji-káyi (_Can._), Jái-phal (_Mah._, _Punj._), Jáye-phal (_Guz._), Jádi-ká, Sádi-ká (_Cing._), Zádi-phu (_Burm._), Buah-pala (_Malay_).

272. _Mace._

Jáé-patrí (_Hind._, _Can._, _Tel._, _Guz._), Jótri (_Beng._), Jáuntari (_Punj._), Jów-watir (_Kash._), Jádi-pattírí, (_Tam._, _Mal._), Vasá-vási (_Cing._), Zadi-phu-apóén (_Burm._), Bunga-pala (_Malay_).

273. Nutmegs and Mace, generally procurable in bazaars, are aromatic, stimulant, and carminative, closely allied to Cloves and Cinnamon, for which they may be substituted. Nutmegs in large doses are thought to possess some narcotic properties, hence some care is necessary in their use.

274. THE NATIVE OR COUNTRY NUTMEG, the produce of Myristica Malabarica, _Lam._, is larger than the officinal Nutmeg, possesses little of its fragrance or its warm aromatic taste, and is very inferior as an internal remedy. Bruised and subjected to boiling, it yields a considerable quantity of a yellowish concrete oil, which, when melted down with a small quantity of any bland oil, is regarded as an excellent application to _Indolent and Ill-conditioned Ulcers_, allaying pain, cleansing the surface, and establishing healthy action. It deserves a trial as an embrocation in _Chronic Rheumatism_.

275. +Opium.+ The inspissated juice of Papaver somniferum, _Linn._

Afyún (_Hind._), Afím (_Duk._), Afím, Afín (_Beng._, _Punj._, _Kash._), Abini (_Tam._), Abhini (_Tel._), Kasha-kasha-karappá (_Mal._), Afímu (_Can._), Afín (_Mah._), Afím (_Guz._), Abin (_Cing._), Bhain, Bhín (_Burm._), Afíun (_Malay_).

276. Opium is one of the most valuable medicines we possess when properly employed, but as it is very powerful in its operation, it may be productive of _great mischief if used without care and caution, or in unsuitable cases_.

277. The Opium procurable in the bazaars is always more or less adulterated, hence the quantity procured in one shop is sufficient to procure a good sleep whilst the same quantity procured at another shop will perhaps produce no sensible effect whatever on the system. This shows the necessity of _great caution_ in its employment.

278. The uncertainty which attends the operation of bazaar Opium leads me to recommend that establishments at out-stations should be always provided with a supply of genuine Smyrna or Turkish Opium imported from Europe. It seems advisable to have it in two forms—_a._ In 1 grain pills, done up ready in an impermeable covering, like those sold by Kirby and others; by keeping it in this form it is always ready for an emergency. _b._ In the form of Tincture, LAUDANUM, which is a very convenient form when small or fractional doses of Opium are required, or when it is desirable to obtain a _speedy_ effect. Fifteen minims contain one grain of Opium; this holds good, however, only with recently prepared or carefully preserved laudanum. It should be borne in mind in all hot climates that evaporation of the spirit constituent will take place even in well stoppered bottles, and that in proportion as this evaporation takes place, the strength of the tincture is _increased_, so that in long kept Laudanum ten minims, or even less, may contain a grain of Opium. Hence, in using old Laudanum it is advisable to commence with smaller doses than in that recently prepared; the dose can be subsequently altered according to the effect produced or desired.

279. Preparations of Opium should always be kept _under lock and key_, or they may disappear at a rate which cannot be accounted for by evaporation or the heat of the climate! Opium in all its forms is a temptation which few natives have moral courage enough to resist.

280. The preparations of Opium mentioned above should be reserved for internal administration; for external application, where uniformity of strength is of comparatively little consequence, bazaar Opium may be employed, but even here it is desirable that good specimens of the best kinds should be used. A few additional observations on this point may be acceptable.

281. Of the several kinds of Opium met with in India the chief are:

1. _Patna Garden Opium_; and 2. _Malwa Opium._—The former, prepared exclusively for medicinal purposes, occurs in square packages of from two to four pounds weight, covered with layers of talc, and further defended by a case of brown wax about half an inch in thickness. It is solid, brittle in the cold season, of a brown colour, and fine smell; it yields a large proportion (7 to 8, or even 10 per cent.) of Morphia. Of Malwa Opium there are many varieties; of these the two principal are, first, that in flat circular cakes, of about a pound and a half in weight, without any exterior covering; dull opaque, blackish brown, externally; internally somewhat darker and soft; odour resembling that of Smyrna Opium, but less powerful, and combined with a slight smoky smell; taste, intensely and permanently bitter: it yields only from 3 to 5 per cent. of Morphia. The other, a superior kind of Malwa Opium, occurs in balls or cakes of smaller size, about ten ounces in weight, covered with a coarse dust composed of broken poppy petals; colour internally, dark brown; texture, homogeneous; odour and taste similar to the other variety; it yields from 7 to 8 per cent. of Morphia. The other varieties of Indian Opium, the Himalayan or "Hill Opium," the Kandeish, the Kutch, &c., are less applicable than the preceding for medicinal purposes, on account of their varying strength. (_Pharm. of India._)

282. There are some points connected with the use of Opium which should always be kept in mind:

_a._ Some persons are very intolerant to the action of Opium; in these even the smallest dose produces great nervous excitement, violent headache, and vomiting. When this peculiarity is known to exist, the drug should be avoided.

_b._ Infants and young children bear Opium badly; cases are on record in which _three drops of Laudanum have proved fatal to infants_. Still, there are diseases of childhood in which it proves valuable, but in these it _should not be given except under professional advice or superintendence_.

_c._ It should be avoided as far as possible during pregnancy. Recent experience seems to show that its frequent or habitual use exercises a prejudicial effect on the fœtus.

_d._ The previous habits of the patient materially influence the effects of this medicine. A confirmed Opium-taker requires a far larger dose to produce a given effect, than one not habituated to it.

_e._ When the use of Opium is clearly indicated, and the patient from any cause is unable to swallow, it may be given in an enema; in this case a larger dose, a third or even a half larger, is required than when given by mouth.

_f._ Whenever in doubt as to the advisability of giving Opium, _take the safer course and—avoid it_!

For treatment of poisoning by Opium, see Index.

283. There are many diseases as _Rheumatism_, _Tumours of different kinds_, _Cancer_, _Carbuncles_ (_Rajah Boils_), _Abscesses_, _and Ulcers connected either with Leprosy, Syphilis or Scrofula_, in which the pain, especially at night, effectually banishes sleep; here Opium is invaluable. An adult may commence with one grain pill or fifteen drops of Laudanum, taken about an hour before the usual bedtime: if this succeeds in procuring sleep it may safely be repeated nightly; if not, the dose may be doubled the second night, and trebled the third night; but it is not advisable to go beyond this quantity except under professional advice. Even these quantities after a week or two's use lose much of their power, and may require to be cautiously increased. When the pains are lessened and the patient is improving, the quantity of Opium should be decreased gradually, rather than the whole supply left off at once. _To control the Sleeplessness and Restlessness of Delirium Tremens_, Opium given as above may be necessary, but each dose should be combined with four or five grains of Camphor in the form of pill; in fact, Camphor alone in doses of 2 to 3 grains every three or four hours, exercises a most soothing influence, and when this treatment is adopted, the Opium at bedtime may be given alone.

284. _In Spasmodic Affections of the Bowels_, _violent Colic_, _and the Passage of Gall Stones_, and when the pain is violent, a full dose of Opium, _e.g._, 20 to 25 drops of Laudanum in a wineglassful of Omum water, or Infusion of Sweet Flag root (12), often affords speedy relief; should it not do so, however, in half an hour the dose may be repeated, and a third dose after an hour, should the pain continue unabated. At the same time, hot water fomentations, a turpentine stupe, or a mustard poultice, should be applied externally. When the pain has subsided a dose of Castor Oil is advisable, especially when there is reason to suspect that the attack has arisen from the use of crude or indigestible articles of food.

285. _In Cholera_ the practice of giving Opium in large and repeated doses, especially in the solid form, in all stages of the disease, _is fraught with danger_. Administered judiciously at the proper time, and in proper cases, it is capable of doing much good, but its indiscriminate use often produces the worst effects. At the outset of an attack, few remedies are more useful when combined with Acetate of Lead. (_See_ Index.) Again, it is a valuable adjunct to the "Calomel treatment" of Dr. Ayre, which consists in giving one or two grains of Calomel, with from one to five drops of Laudanum, every five, ten, or fifteen minutes, according to the urgency of the symptoms, till the quantity of Laudanum has reached altogether 60 or 80 drops, when it should be discontinued. An essential part of this treatment, which has sometimes proved very effectual, is the free use of cold water as a drink.

286. _For relieving the pain and irritation of the Bladder, caused by the presence of Stone in the Bladder, Gravel_, &c., no medicine gives more relief than Opium in full doses, as advised in paragraph 284. It proves, however, even more effectual if introduced into the rectum, either in the form of suppository (two grains of Opium with four grains of Soap), or in enema (30 to 40 drops of Laudanum in two ounces of thin _conjee_ water). It may also be given with great benefit _in Irritable states and Painful Affections of the Kidneys_.

287. _In Retention of Urine arising from Spasmodic Stricture of the Urethra_, a hot bath and a full dose of Opium (25 to 30 drops of Laudanum), followed by a dose of Castor Oil, will often suffice to give relief in recent cases of no great severity following a debauch, exposure to wet, &c. The Opium given in an enema of two or three ounces of rice _conjee_, sometimes succeeds when it fails if given by mouth.

288. _In Diabetes_, Opium occasionally produces the most beneficial results, especially in old cases occurring in the aged. It requires to be given in full doses and to be persevered in, the effects being carefully watched; the dose diminished, or the remedy left off altogether, if it gives rise to headache or other bad symptoms. It is worthy of remark, however, that persons suffering from this disease will take large doses with impunity.

289. _In many painful Affections of the Uterus_ Opium is of the greatest service. Besides being employed in the form of suppository or enema, as mentioned in paragraph 286, Camphorated Opium Liniment (291) warmed, may likewise be rubbed into the loins, or a hot rice poultice sprinkled with Laudanum applied over the lower part of the abdomen. When given internally in these cases it requires to be given in full doses, and it may be advantageously combined with Camphor (73). For the relief of _After-Pains_, 15 or 20 drops of Laudanum in a wineglassful of Camphor julep, or Omum water, or a little simple _conjee_, generally affords speedy relief. _In threatened Abortion from a fall, over-exertion_, &c., a similar dose of Laudanum, with perfect rest in the recumbent position, may suffice to prevent further mischief; should there be great restlessness or pain, it may be repeated with advantage.