Chapter IX: Part II: Synopsis or Index of Diseases (1)

_The numbers have reference to the paragraphs; the asterisk_ (*) _denotes those most deserving of attention_.

_Abdomen, Flatulent Distension of._ See _Flatulence_.

_Abortion._ Use Vinegar externally and internally (379); if great restlessness or pain is present, give Opium (289); if the hæmorrhage continue unabated, apparently from want of power in the uterus to contract, try Borax and Cinnamon (58), or administer a Turpentine enema (364). In cases where there is much hæmorrhage, which does not abate under the above means, the Acetate of Lead and Opium Pills advised for _Hæmorrhage, Internal_, may be given with signal advantage. With these exceptions, let nature complete her work by herself; more harm than good may result from meddlesome interference. Perfect rest of mind and body, a strictly recumbent posture in a cool, well-ventilated apartment, and careful avoidance of all stimulant articles of diet and mental excitement, are essentials to successful treatment. _Threatened Abortion from a fall, over-exertion, &c._, may sometimes be averted by a dose of Opium (289), and strict attention to the above hygienic rules. See also _Hæmorrhage, Internal_.

_Abscess._ In the early stage apply Hot Water Fomentations (393); if there be much inflammation and pain, apply Leeches (212), and keep constantly to the part a solution of Sal Ammoniac (325), or Evaporating Lotion (380). If matter forms, apply Rice Poultices (322); when it comes so near the surface that it can be felt fluctuating under the finger the abscess should be opened with a lancet at the most prominent point; and after the matter has been evacuated by gentle pressure, the Rice Poultices should be continued, and changed twice or thrice daily. Should the pain be so great as to prevent sleep, a dose of Opium (283) or Tincture of Datura (128) at bedtime is advisable. Should the discharge be profuse and the patient weak, support the strength with a liberal diet and tonics, as Chiretta (98, 99), or Country Sarsaparilla (163), or Ním Bark (260). N.B.—_Abscesses in the neck should be opened only by a doctor, or by one who is conversant with the anatomy of the part._

_Acidity of the Stomach._ See _Stomach, Acidity of_.

_Acids, Poisoning with._ Give copious draughts of Lime Water (228) and milk, or, if this be not at hand, soap and water, or chalk, or the plaster of the apartment beaten up with water. Rice _Conjee_ (322) and other mucilaginous drinks, white of eggs, or draughts containing any bland oil, should be given freely. Much of the success in these cases depends upon the promptitude with which the remedies are applied.

_Ague._ See _Fever, Intermittent._

_Ague Cake._ See _Spleen, Enlargement of_.

_Albuminuria._ Try Alum (27).

_Amenorrhœa._ See _Menstrual Discharge, Suspended_.

_Anus, Prolapsus of._ See _Bowel, Descent of_.

_Aphthæ, or Aphthous Ulceration._ See _Mouth, Ulceration of_.

_Apoplexy._ If the patient is young and vigorous, pour cold water from a height on the head and spine as directed in 386. Keep Evaporating Lotion (380) to the head; give a Croton Pill (120), or if the patient is unable to swallow, place a drop or two of Croton Oil (121) at the back of the tongue. Apply Turpentine Stupes (363) or Mustard Poultices to the feet and calves. Should the insensibility continue, give a Turpentine enema (364). For the old and debilitated, and for natives generally, a little Brandy Mixture (426), or other stimulant judiciously given, offers a better prospect of success than _bloodletting, which should never be had recourse to except under medical supervision_.

_Appetite, Loss of._ First try Chiretta (98, 99*); should this fail, give one of the following: Sweet Flag Root (12), Country Sarsaparilla (163), Ním Bark (260), or Gulancha (352). Stomachics, as Capsicum (79), Cinnamon (102), or Cloves (105), may be advantageously combined with them, care being taken at the same time to regulate the bowels.

_Arsenic, Poisoning with._ As speedily as possible empty the stomach by an emetic of Sulphate of Copper (117) or Mustard (246), and then give copious draughts of white of eggs beaten up in milk, or a mixture of equal parts of Lime Water and Sesamum, Cocoa-nut, or other bland oil. Powdered Sugar has been advised in these cases, but if of any service, it can only act like the preceding mixtures, mechanically, by enveloping the particles of the poison; this remark applies also to Powdered Charcoal, which has also been well spoken of. When the vomiting has abated, give a full dose of Castor Oil (83) to carry off any of the poison which may have passed into the intestines, and this may be repeated every day for two or three days. Should there be great exhaustion, a little stimulant, as Brandy Mixture (426), may be given, and a dose of Opium may be advisable, to subdue any subsequent great pain and restlessness.

_Asthma._ To relieve the severity of a paroxysm, try one or more of the following: Turpentine Stupes (362*), or Hot Water Fomentations to the chest (393), Camphor (70*), or Asafœtida (37) internally, and the inhalation of the fumes of Nitre Paper (268*) or of Datura (129*). A cup of hot, strong, milkless, sugarless Coffee _café noir_, drunk as hot as can be borne, sometimes gives great relief. Daily sponging the chest with Vinegar is thought to act in a measure as a preventive (378). A better preventive is the careful regulation of diet. Many a fit of asthma can be clearly traced to a hot supper, or some other error of diet.

_Atrophy, or Wasting of the Body._ Try Fish Liver Oil (142), with tonics, as Chiretta (98, 99), and change of air.

_Bed Sores._ To prevent these, bathe the parts daily with a solution of Camphor in spirit (75), or with Brandy or Eau de Cologne, or apply Alum and White of Egg (31*), and relieve the local pressure as much as possible by change of position, &c. A small circular pillow with a hollow centre (just like the pads worn by the _coolies_ on their heads in carrying weights, only thinner) is most useful for this purpose. Should a sore form notwithstanding, it should be treated as an ordinary ulcer. See _Ulcer_.

_Beri-beri_, Petroleum (410).

_Bish_ (_Aconite Root_), _Poisoning with._ Strong stimulants, as Brandy and Ammonia; Cold Water Affusion (386), and persistent friction of the limbs and spine, appear to offer the best chance of success. Decoction of Galls (152) has been advised as an antidote. Strong hot Coffee, _café noir_, is worth a trial, if the patient can swallow.

_Bites, Venomous, and Stings, e.g., of Centipedes, Scorpions, Wasps._ All that is required in ordinary or mild cases, after immediate suction of the bite, is application of Vinegar (380), or Alum (32), or a strong solution of salt and water. Inunction of warm oil has been highly recommended. If Ipecacuanha is at hand, a small portion of it made into a thick paste with a few drops of water, and locally applied, is said in many instances to afford great and immediate relief. Brown Sugar is said to be specially useful in _Wasp Stings_. Soda is also said speedily to relieve the pain in these cases. Should the symptoms be severe, as is sometimes the case, Liquor Ammoniæ and stimulants, as advised for Snake Bites (Appendix B), should be given.

_Bladder, Painful Affections and Irritable States of_, are best relieved by Opium (286*), the free use of demulcents, as the Decoctions of Abelmoschus (2), Ispaghúl seeds (305), or Rice _Conjee_ (322), and the use of the Hip Bath (392). The Extract of Gulancha (353) seems well worthy of a trial, especially in _Chronic Inflammation of the Bladder_.

_Bleeding._ See _Hæmorrhage_.

_Blows._ See _Sprains_.

_Boils_ are to be treated much in the same way as Abscesses, by Hot Water Fomentations (393), Sal Ammoniac Lotion (332), and Rice Poultices (322). Leeches (212) are rarely necessary, unless there should be much pain and inflammation. Decoction of Country Sarsaparilla (163) may be given internally if there is any constitutional disturbance. A popular and useful "drawing plaster" is a compound of equal weights of Brown Sugar and English Yellow Soap; a still better one is the ointment described in paragraph 399; a portion of either of these spread on rag should be applied over each boil. _Rajah Boil._ See _Carbuncle_.

_Bones, Scrofulous Affections of._ Give Fish Liver Oil (138).

_Bowel, Lower, Descent of._ The protruded part having been carefully washed, should be replaced by gentle pressure with the hand: should there be any difficulty in doing this, the forefinger well oiled should be pushed up into the anus; and it will, unless the parts be greatly swollen, carry the protruded part in with it. The patient should then remain quiet for some hours in a recumbent posture, and apply cloths saturated with Decoction of Galls (147), or Babúl Bark (9), holding Alum (25*) in solution. Subsequently enemas of the above solutions, or others containing Sulphate of Iron (179), act usefully in constringing the parts and preventing a return of the accident. In weak, debilitated subjects, Confection of Pepper (300) proves very serviceable. The bowels should be kept open by mild aperients, of which Sulphur and Cream of Tartar (344) is by far the best. All straining at stool should be carefully avoided. A person subject to this accident should wear a pad to keep the parts up.

_Chronic Descent of the Bowel in Children_ may be frequently cured by making the child, when at stool, sit on a seat sufficiently high, so that its feet cannot touch the ground or have other support. (Dr. Aitchison.)

_Bowels, Spasmodic, and other Painful Affections of._ Mild cases generally yield to Omum Water (318*), Lemon Grass Oil (216), or the Infusions of Ginger (155), Dill Seeds (134), or Cloves (105), with or without a single dose of Opium (284). Severe cases require the repetition of the Opium (284) in Omum Water, &c., together with either Hot Water Fomentations (393), Mustard Poultices (251), or Turpentine Stupes (362) externally to the abdomen; followed in protracted cases by an enema of Turpentine (364), or Asafœtida (36). In all cases a dose of Castor Oil is advisable when the pain has abated. _In Children._ See _Colic_. _For Irregularity of the Bowels_, try Bael Sherbet (45); _in that of Children_, Decoction of Kariyát Leaves (193). _Constipation of._ See _Constipation_. _Bleeding from._ See _Hæmorrhage_.

_Breast, Abscess of, in Women._ See _Milk Abscess_.

_Breathing, Difficulty of, occurring without evident cause or in connection with a cold_, sometimes yields to Camphor and Asafœtida Pills (70), and Turpentine Stupes (362), or Mustard Poultices (247) to the chest. Great relief, especially in the case of children, is often derived from external application of Betal Leaves (48), or bags of hot salt. See also _Cough_.

_Bronchitis, Chronic._ Decoction of Sweet Flag (13), Country Ipecacuanha (370), Asafœtida (37), and Fish Liver Oil (140) internally, with Rice Poultices (322), Croton Liniment (122), and Turpentine Stupes (362) externally, may be used with advantage. The inhalation of the vapour of hot Decoction of Abelmoschus (2) is also serviceable. The temperature of the apartment should be kept as uniform as possible. For the relief of a paroxysm of cough, the fumes of burning Nitre Paper (268) are worthy of a trial in all cases. A blister to the chest often affords great relief.

_Bronchocele._ See _Goitre_.

_Bruises._ See _Sprains_.

_Buboes_ often subside under a non-stimulant diet, perfect rest in the recumbent posture, and the continued application of Sal Ammoniac Lotion (332), the bowels being at the same time carefully regulated. Should matter form, treat as Abscess (_which see_). Should ulceration result, apply Borax Lotion (59), Resin Ointment (372), &c., as advised for ulcers. "Buboes, especially of the groin, when not in an inflamed condition, are often immensely benefited by having a smooth stone of two pounds weight or thereabout, laid over them; this rapidly causes absorption." (Dr. Aitchison.)

_Burning of the Feet in Natives._ Apply Henna or Mhíndí Poultice (197) locally, and try Bromide of Potassium, 5 to 10 grains dissolved in water, twice or thrice daily.

_Burns and Scalds._ As soon after the accident as possible, apply freely to the whole of the burnt surface Lime Liniment (229), or in its absence Jinjili Oil (337), or any other bland oil, dusting thickly over with Rice Flour; or even with simple Rice Flour without any oil as directed in paragraph 322. The object in each case is to prevent, as far as possible, the access of air to the burnt surface. These first dressings should remain undisturbed for at least twenty-four hours, and should then be repeated in the same, or in a modified form. Subsequent ulcerations should be treated with Ceromel (167) or Resin Ointment (372). Carbolised Oil or Liniment is advocated by Dr. Aitchison. Dr. A.'s directions are as follows: "Employ a Liniment of Carbolic Acid, one part Acid to 15 of a sweet Oil, carefully mixed; apply this freely over the burnt or scalded surface, cover the whole with a thick piece of cotton wool, and apply a bandage over all. On no account change the cotton dressing unless there is any disagreeable odour. If the dressing is becoming dry and thus causing irritation, take off the bandage and moisten cotton wadding thoroughly with the same Liniment without moving it. On no account allow water to come in contact with the injured part." The treatment of very extensive burns of the lower limbs with carbolic acid is considered to be prejudicial, but not so of the upper extremities. Should the injured surface be extensive, the constitution should be supported by liberal diet, tonics, and stimulants, as Brandy Mixture (426) at stated intervals. Any great restlessness or excessive pain may require a dose of Opium at bedtime (283). N.B.—Whenever the burn is in the neighbourhood of the joint, or in the neck, it is important that the parts should be kept in a straight or stretched position, otherwise contraction is apt to result during the healing process.

_Cancer._ To relieve the pain and restlessness, give Opium (283) or Tincture of Datura (128). _To correct the fœtor of the discharge_, apply relays of Charcoal Poultices (91), cleansing the ulcer each time the poultice is changed with Borax Lotion (59). N.B.—On the smallest suspicion of a cancer forming, no time should be lost in placing the case under regular medical care.

_Carbuncle "Rajah Boil" of the Natives._ The treatment of the early stages is similar to that for Abscess (_ante_); only if leeches are deemed necessary, they should be placed round the edge and not on the hardened surface. When ulceration sets in, the _Toddy_ Poultice (355) is useful in stimulating to healthy action; and the removal of the slough is greatly accelerated by the daily practice of Irrigation (395). Turpentine Ointment (367) or Petroleum (412) also prove useful in this stage. Should there be much fœtor, apply Charcoal Poultices (91) and the Borax Lotion (59) as advised in _Cancer_. Opium (283) may be necessary to relieve pain and give rest. When the slough has come away, the ointments advised in paragraphs 367 and 372, or Ceromel (167), may be used as dressing. A generous animal diet, with a daily portion of stimulants, should be allowed, and tonics as Chiretta (98, 99), or Country Sarsaparilla (163) administered. Whenever practicable, the case should be placed _under proper surgical care_, as incisions are often necessary for the removal of the slough.

_Cassava Root, Poisoning by._ Give Lime Juice (234).

_Castor Oil Seeds, Poisoning by._ Give Lime Juice (234).

_Cataract._ Datura (128).

_Catarrhs or Colds_ may often be cut short at the outset by a draught of hot Infusion of Ginger (156) or White Wine Whey (428) at bedtime, and covering the body well, so as to produce copious perspiration. A Vapour Bath (396) will answer the same purpose. To relieve feverishness give Solution of Nitre (264), Decoction of Abelmoschus (2), and Country Ipecacuanha (370). Inhalation of the fumes of burning Turmeric (359) manifestly relieves troublesome congestion or fulness of the head, nose, &c. See also _Cough_.

_Caterpillar's Hairs, to Extract._ Some Indian Caterpillars are armed with a thick hairy covering, and if these come in contact with the skin the hairs are apt to pierce the cuticle, and by their presence create great pain, irritation, &c. To extract them the following ingenious plan, devised by Dr. Alexander Grant, late Bengal Medical Service, is said to be very effectual. Take a lock of human hair, tie firmly with thread about one-eighth of an inch from the cut end, so as to form a short, firm, even brush, not however to be used as such, but as forceps. This held between the thumb and forefinger, is allowed to descend perpendicularly and uncompressed among the caterpillar hairs. When the two sets of hairs are commingled, the brush is compressed as forceps are, and drawn straight up, bringing the hairs with it, and so on until all the hairs are pulled out.

_Centipedes, Bites of._ See _Bites, Venomous_.

_Chest, Pains in, during Fevers._ See _Fevers_.

_Childbirth._ See _Labours_.

_Children, Debility of._ To relieve pallor and wasting, give Country Sarsaparilla (163), and Fish Liver Oil (139), with generous diet, and gentle outdoor exercise. A change of air will often do more good than medicine. _Constipation of_, see _Constipation_, _Convulsion of_, see _Convulsions_. _Colic of_, see _Colic_. _Coughs of_, see _Coughs_. _Diarrhœa of_, see _Diarrhœa_. _Difficulty of Breathing_, see _Breathing, Difficulty of_.

_Cholera._ To check the premonitory diarrhœa or purging, give the Alum Powders (26), or Alum with Infusion of Sweet Flag (12), or Omum Water (319); should these not succeed in checking it, try a few of the Compound Pepper Pills (299), but it is unadvisable to continue them long on account of the large proportion of Opium which they contain (285). One of the most useful forms of Cholera Pills, which should be commenced at the earlier stages when the purging sets in, is composed of 24 grains of Acetate of Lead, and two grains of Opium, made into a mass with a few drops of Honey, and divided into eight pills. Of these one may be given every hour or half-hour, according to the urgency of the symptoms, till the whole eight have been taken; but this number should not be exceeded, in consequence of the quantity of Opium they contain. Each pill may be taken in a wineglassful of Omum Water. Should the disease progress, Dr. Ayre's plan of treatment (285*), if the ingredients are at hand, should be pursued, together with the persevering use of Lemon Grass Oil (216) and Omum Water (318), for the purpose of checking the vomiting and stimulating the system. For the latter purpose also give an ounce (two table-spoonfuls) of the Brandy Mixture (426) every half-hour or oftener, unless Champagne or other sparkling wine is available, this being decidedly the best form of stimulant in these cases—only it must be given in moderation at stated periods; more harm than good is done by over-stimulation. The patient should be encouraged to drink plentifully of _cold_ water, iced if possible; though the first draught or two may be rejected, it will soon be retained if persevered in. Chicken Broth, or Lime Water and Milk, may also be given plentifully as a drink. The other accessories to the above are Mustard Poultices (251) or Turpentine Stupes (363) over the heart (left side of the chest), bags of hot sand or salt to the spine, feet, and legs, and diligent friction with the hand or hot towels. At the same time the patient should not be moved about more than can be possibly helped.—N.B. During an epidemic of Cholera _impress_ upon everybody the necessity of applying for medicines _directly they feel unwell or have the slightest purging_; those who come thus early for treatment stand a much better chance of recovery than those who delay even a few hours. _Here time is of the most vital importance._

_Chorea, St. Vitus's Dance._ Fish Liver Oil (141), Infusion of Jatamansi (184), and Sulphate of Iron (177), alone or in combination, according to circumstances, are worthy of a trial. N.B.—This, as well as other nervous affections, is often due to intestinal worms: attention should therefore be paid to this point. (See _Convulsions_.)

_Cocculus Indicus, Poisoning by._ Having emptied the stomach by an emetic of Sulphate of Copper (117) or Mustard (246), give copious draughts of Decoction of Galls (152), followed by a full dose of Castor Oil to carry off any of the poison which may have passed into the intestines. Brandy or other stimulants are required should there be great depression or exhaustion.

_Colds._ See _Catarrhs_.

_Colic in Adults_ is to be treated in a manner described in Spasmodic Affections of the Bowels. _The_ _Colic of Children_, usually connected with flatulence, generally yields to Omum Water (318*), Infusion of Dill (134), with or without Asafœtida (36), and a Hot Bath (387), followed by a dose of Castor Oil.

_Constipation._ For the immediate relief of this, aperients are required. Castor Oil (83) and Senna (336) are best adapted for children and delicate females; Aloes (18, 19) for women suffering from irregularity or suspension of the menstrual discharge; Myrobalans (256) and Kaladana (187) for otherwise healthy adults; and Croton Pills (120) or Croton Oil (121) when strong and speedy purgation is indicated. _The Constipation of Hysterical Females_ is best treated by Aloes and Asafœtida Pills (19); _Habitual Constipation_, by Aloes, as directed in Paragraph 20, or by Sulphur (344); _that of Children_ by Fish Liver Oil (139), together with the use of oatmeal as an article of diet. A remedy for habitual constipation in children, as well as in adults, is to be sought for in tonics rather than in purgatives; the repeated use of the latter lays the foundation of great subsequent mischief. N.B.—The practice of native _ayahs_ (female servants) of inserting a piece of tobacco stem into the anus of young children to relieve constipation, _cannot be too strongly reprobated_.

_Consumption, Pulmonary (Phthisis)._ The persevering use of Fish Liver Oil (138) is chiefly to be relied upon, with or without Lime Water and Milk (226), as an ordinary drink. _As a preventive_ sponge the chest daily with diluted Vinegar (378). Mustard Poultices (247) or Croton Liniment (122) to the chest sometimes gives relief to _the Cough and Difficulty of Breathing_, as does the inhalation of the vapour of Hot Water (390) or Decoction of Abelmoschus (3). _For the Diarrhœa_, try the Alum Powders (26) or Sulphate of Copper (110). _For the excessive Perspirations_, sponge the chest with Vinegar (378). _For the Sore Mouth or Fissures of the Tongue_, apply Borax (55), or Alum (29). _For Bleeding from the Lungs_ try some of the means mentioned in _Hæmorrhage, Internal_.

_Convulsions in Adults, arising without evident cause_, are best treated by cold Affusion (386), Mustard Poultices (248), or Turpentine Stupes (363) to the feet and legs, and a strong purgative, as Croton Pills (120), Croton Oil (121), or Kaladana (187). If the patient be unable to swallow, a Turpentine enema (364) may be used. _When the Convulsions are due to poisons, &c., taken into the stomach_, an emetic of Mustard (246) or Sulphate of Copper (117) should precede all other measures. _In the Convulsions of Labour_, Turpentine Stupes (363) or Mustard Poultices (248) should be applied to the extremities, and Evaporating Lotion (380) to the head, whilst Camphor and Calomel Pills (73), or Borax and Cinnamon (58), are given internally. A Turpentine enema (364) may also prove useful. _The Convulsions of Children_ are best treated with a Hot Bath (387), and a full dose of Castor Oil (83), preceded by one or two grains of Calomel when at hand, or a dose or two of Asafœtida Mixture (36). _In the Convulsions of Infancy and Childhood_, especially when the cause is obscure, unconnected with teething, &c., Bromide of Potassium is often more serviceable than any other remedy, in doses of a quarter of a grain for a child under six weeks of age, half a grain under three months, one grain above that age to nine months, and one grain additional for every year up to three or four years of age. And these doses may be safely repeated every two, three, or four hours until the convulsions subside. The smaller doses may be obtained with exactitude by dissolving, say, one grain of the Bromide in four teaspoonfuls of water, and giving one, two, or three spoonfuls, or the whole quantity, as one quarter, one half, one third, or one grain respectively is required. It is worthy of a fair trial in all cases which resist ordinary means, but should not be used to the exclusion of the hot bath and careful regulation of the bowels. When the child is very much exhausted, a few drops of Brandy, three to six, or more, according to age, are often most useful. Convulsions of early childhood are frequently connected with teething, hence lancing the gums is often of essential benefit.

N.B.—Convulsions and nervous affections occurring in Natives and Anglo-Indians are very frequently due to the presence of worms in the intestines; their existence may perhaps be unsuspected, or even denied; hence in all cases which resist ordinary treatment, it is advisable to give a trial to one or more of the remedies recommended for _Worms_, especially those for the _Lumbricus_ or _Round Worm_, which is so extensively prevalent in India.

_Corns_ are best treated by immersion in hot soap and water, paring off the hardened cuticle and wearing a piece of thick plaster, with or without a hole in the centre, to ward off the pressure and friction. _For Corns between the Toes_ nothing is more effectual than a piece of thick blotting-paper worn so as to protect the opposing surface: it should be renewed daily. If only ordinary thin blotting-paper be available, two folds are advisable.

_Corrosive Sublimate, Poisoning by._ See _Mercurial Salts, Poisoning by_.

_Coughs._ Try Sal Ammoniac (329) and Country Ipecacuanha (370); with Rice Poultices (322) or Mustard Poultices (247), Turpentine Liniment (366), or Camphorated Opium Liniment (291) externally, and the inhalation of the vapour of Hot Water (390) or Decoction of Abelmoschus (2). If severe, a blister (349, 350) to the chest may be necessary. _In Chronic cases, especially when attended with much expectoration and debility_, give Fish Liver Oil (140). _In Spasmodic Coughs_, violent paroxysms may be relieved by inhaling the fumes of Nitre Paper (268), or by smoking Datura (129). _For the Cough of Old Age_, Cubebs (126) is worth a trial. _For the Cough of Childhood_, Syrup of Country Liquorice (6), Asafœtida (37), Honey and Vinegar (166), and Fish Liver Oil, may be resorted to according to circumstances. Camphor Liniment (70), Mustard Poultices (247), or bags filled with hot salt, or better still, Betel Leaves (48), applied externally, tend to _relieve difficulty of breathing in these cases_. Sponging the chest with Vinegar is thought to lessen the liability to attack (378).

_Coup de Soleil._ See _Sunstroke_.

_Croton Oil Seeds, Poisoning by._ See Par. 234.

_Croup._ Sulphate of Copper (111) as an emetic, and Hot Water Stupes (390) externally, are valuable accessories in the treatment of this disease.

"The best and readiest emetic," writes Dr. Aitchison, "is a pinch of Ipecacuanha Powder placed dry at the back of the child's tongue. This usually acts instantaneously, so be prepared for the emergency. Sponges dipped in extremely hot water, then rinsed out, and continuously applied over the throat, will often check a coming attack. Poultices are useful, but are apt to do much harm if allowed to become cold. Mustard poultices should not be applied, as without due care they are apt to make the skin tender, and thus prevent the use of hot fomentations."

_Datura, Poisoning by swallowing the seeds of, &c._, is to be treated in the manner directed for Opium poisoning. _Where Insensibility arises from the Inhalation of the Fumes_, Cold Water Affusion (386) in the open air often succeeds in removing it at once. The patient should be aroused by any or all of the means enumerated in poisoning by Opium. The nervous symptoms may continue for two or three days, and yet recovery follow.

_Debility, Constitutional_, requires the use of the following tonics, either alone or combined: Chiretta (98, 99*), Sweet Flag Root (12), Country Sarsaparilla (163), Kariyát (191), Ním Bark (260), or Gulancha (352). _When attended with Anæmia or great pallor of the surface, especially of the inner surface of the eyelids and tongue_, Sulphate of Iron (174) is indicated. The efficacy of all these remedies is increased by a liberal animal diet, and gentle exercise in the open air. _Debility after Fevers._ See _Fevers_.

_Delhi Sores._ The Borax Ointment (59) is strongly recommended. See also _Ulcers_.

_Delirium_ generally is best treated by Evaporating Lotion (380) to the head, the Mustard Foot Bath (248), or Turpentine Stupes (363) to the extremities and a strong purgative; _for that occurring in Fevers_, see _Fevers_.

_Delirium Tremens._ _To relieve sleeplessness and anxiety_, give Opium and Camphor (283), or better still, Bromide of Potassium, as advised in _Sleeplessness in Head Affections_. See that article. Try also the Mustard Foot Bath (248, 249), or the Wet Sheet (397b). _To support the strength_, give Brandy Mixture (427*) and a nourishing diet.

_Diabetes._ Vapour Baths (396) in the early stages, Alum Whey (27) and Lime Water (226) internally, with Opium (288), at bedtime, prove occasionally useful as palliatives. Their operation is assisted by a full animal diet, with a diminished quantity of rice and other farinaceous food, and by warm clothing. Use Lemonade as a drink (232).

_Diarrhœa._ _In the early stages, especially if attended with heat of skin_, &c., give Country Ipecacuanha (369) and Ispaghúl seeds (304), with a mild aperient, as Castor Oil, if there is reason to think that the attack arises from crude, undigested food in the intestines. The Acetate of Lead and Opium Pills advised for Cholera are often very successful in these cases. One may be given every two or three hours, or oftener, according to the urgency of the symptoms; they are especially useful in _Epidemic Diarrhœa_. _In the advanced stages or in Chronic Diarrhœa_ try Sulphate of Copper (110), Catechu (88), Alum (26), or one of the following: Decoction of Babúl Bark (9), Infusion of Sweet Flag (12), Bael (44), Butea Gum (62), Galls (146), Decoction of Pomegranate (312), and Omum Water (317), with or without the addition, in each case, of a small portion of Opium (289). Turpentine Stupes (363) to the abdomen are useful if much pain is present. _When the disease is apparently of malarious origin or connected with periodic Fevers of any kind_, Quinine (three to five grains twice or thrice daily) should be associated with whatever other remedies are being employed. Try also Warm Water Enemas (393). _When connected with Acidity of the Stomach_, give Lime Water (222). _When caused by Over-eating or by Indigestible Food_, follow up an emetic of Mustard (246) or Country Ipecacuanha (368), to unload the stomach, by Omum Water (318), and subsequently by a dose of Castor Oil. Capsicum (79) is thought to be specially useful _in Diarrhœa arising from the use of putrid food, e.g., fish. The Diarrhœa of Children_ often yields to a dose of Castor Oil, if given early; if not, one of the following may be tried: Acorus or Sweet Flag (13*), Bael (44), Catechu (88), Sulphate of Copper (110), Sulphate of Iron (181*), Saccharated Solution of Lime (220), or Ispaghúl Seeds (304). Omum Water (318) may be advantageously combined with any of the above. _The Diarrhœa which precedes Cholera._ See _Cholera_. N.B.—In all cases of diarrhœa the food should be mild and unirritating, thick Arrowroot (423) being the best suited for the purpose, and, in every obstinate or chronic case, a flannel bandage should always be worn round the abdomen.

_Dropsy_ occurring in the young and vigorous is best treated at the outset by strong purgatives, as Croton Pills (120) or Croton Oil (121), or Kaladana (187), followed by medicines which increase the flow of urine, as Decoction of Asteracantha (39), Infusion of Moringa (237), Mustard Whey (250), or Infusion of Pedalium (297), with which Nitre (269) or Sal Ammoniac (331) may be combined, as circumstances require. The Vapour Bath (396) twice a week proves useful in recent cases, where the patient is strong enough to bear it. Where the patient is very debilitated and anæmic, Sulphate of Iron (174, 178) should be tried.

_Drunkenness._ After a debauch, a Mustard emetic (246) proves most useful in unloading the stomach of any spirit remaining in it. A few drops, six to twelve, of Liquor Ammoniæ in water subsequently given, are often of signal success. Strong Coffee, _café noir_, is also most useful. _To allay the subsequent cravings for drink_ try Omum Water (320).

_Dysentery._ In the early stages give Country Ipecacuanha (369) and Ispaghúl Seeds (304), or Sesamum leaves (338_a_), with or without Opium (289*, 289_a_), and apply Hot Fomentations to the abdomen and Leeches to the verge of the anus (211); the latter tend much to relieve the pain and straining, as do also Opiate enemas (289_a_). The treatment of Acute Dysentery by large doses of Ipecacuanha, reintroduced into practice in 1858 by Dr. Docker, is acknowledged by the most experienced authorities to be far more effectual than any other. It consists, in the main, of administering, as early in the disease as possible, 25 to 30 grains of Ipecacuanha, in as small a quantity of fluid as possible, premising half an hour previously 25 to 30 drops of Laudanum. The patient should keep perfectly still in bed, and abstain from fluids for at least three hours. If thirsty, he may suck a little ice, or may have a teaspoonful of cold water. It is seldom, under this management, that nausea is excessive, and vomiting is rarely troublesome, seldom setting in for two hours after the medicine has been taken. Mustard Poultices (247) or Turpentine Stupes (362) should be applied to the abdomen. In from eight to ten hours, according to the urgency of the symptoms and the effect produced by the first dose, Ipecacuanha in a reduced dose should be repeated, with the same precautions as before. The effects of this treatment are soon manifest and surprising; the griping and straining subside, the motions quickly become feculent, blood and slime disappear; and often, after profuse action of the skin, the patient falls into a tranquil sleep and awakes refreshed. The treatment may require to be continued for some days, the medicine being given in diminished doses, care being taken to allow a sufficient interval to admit of the patient taking some mild nourishment suited to the stage of the disease. As the disease abates, the dose should be reduced. It is well, however, to administer 10 or 12 grains at bedtime for a night or two, after the stools are, to all appearance, healthy. Fomentations or Turpentine Stupes to the abdomen lessen griping and diminish suffering. If a little diarrhœa without the dysenteric odour remain, it may be checked with a little astringent mixture, with or without Opium. Astringents in any shape during the acute stage are not _only useless, but dangerous_. (Dr. Maclean.) To sum up, it appears—1. That acute dysentery is more successfully and speedily treated by large doses of Ipecacuanha than by other means. 2. That it is more effectual in the acute than in the chronic forms. 3. That large doses, such as are mentioned above, may be given with perfect safety, without fear of ill effects; and 4. That it is less successful with the natives of India than with Europeans. In the acute dysentery of natives, small doses, _e.g._, from six to eight grains thrice daily, so as to keep up a slight degree of nausea, short of actual vomiting, seem to answer better than the large doses mentioned above. It may be advantageously combined with Opium, from a quarter to half a grain with each dose.

_When of malarious origin or when occurring in the course of periodical Fevers_, Quinine (three to five grains twice or thrice daily) should form part of whatever other treatment is being followed. _In the advanced stages, or when it passes into Chronic Dysentery_, apply Turpentine Stupes (362) to the abdomen, and give Sulphate of Copper (110), Bael (44), Infusion of Kariyát (191), Decoction of Pomegranate Rind (312), or Sal Ammoniac (331). When an aperient is required, give Sulphur and Cream of Tartar (344) or Castor Oil, with the addition of a small portion of Opium. _For the Dysentery of Natives_, Decoction of Sweet Flag (13), Galls (146), Mudar (243), Opium (289a), and Decoction of Pomegranate Rind (312) seem best suited. _For the Chronic Dysentery of Children_ the Saccharated Solution of Lime (220), Bael (44), Sulphate of Copper (110), or Sulphate of Iron (181) are indicated. See also _Diarrhœa of Children_. N.B.—In all cases of dysentery the food should be mild and unirritating, and a flannel bandage worn round the abdomen. Soups containing mucilage of Abelmoschus (2) prove useful.

_Dysmenorrhœa._ See _Menstruation, Painful_.

_Dyspepsia._ See _Indigestion_.

_Ear, Discharges from, in Scrofulous Subjects._ Syringe the ear daily with Lime Water (225), or tepid water, or milk and water, and give Fish Liver Oil internally (138). _Buzzing or Noises in the Ear_ often depend upon an accumulation of wax in the outer passage; to remove this and effect a cure all that is necessary in many cases is to insert a drop or two of sweet oil for an hour or two, and then to syringe the ear well out with tepid water or soap and water, and repeat the same twice or thrice daily. This also sometimes relieves _Ear-Ache_: if not, use Opium as directed in Paragraph 292.

_Elephantiasis._ The paroxysms of fever which accompany this disease are to be treated in the manner directed for Intermittent Fever (_infra_). The only means of arresting the progress of the disease is to remove permanently from a locality in which it is endemic or prevalent to another situated at least ten miles distant from the sea-coast; the higher and drier the site the better.

_Epilepsy_ sometimes improves under Fish Liver Oil (141); its use may be combined with Sulphate of Copper, in doses of a quarter of a grain twice or thrice daily. For this purpose, dissolve two grains in one ounce of Omum Water; of this, the dose is a teaspoonful. Far superior to all other remedies for _Epilepsy_ is Bromide of Potassium in doses of 10 to 15 grains, in a wineglassful of water, thrice daily. Should the disease not yield to these doses, they may be gradually increased to double or even treble these quantities. The earlier in the disease this remedy is resorted to, the greater are its chances of success; and as a general rule it proves more useful when the fits are severe and frequent, and occur mainly in the daytime, than in the milder attacks, which come only at night. In all cases it is worthy of a fair trial. See also remarks at the end of _Convulsions_ in this Index.

_Exhaustion from Hæmorrhage after Fevers or other causes_, give Brandy Mixture (426).

_Eyes, Affections of._ Datura (128β). For "_Country Sore Eye_," apply Alum, as directed in Paragraph 23, and Decoction of Turmeric (360) to relieve the burning sensation. Try also Solution of Sugar (406). _For other forms of Ophthalmia, attended with copious discharge_, try Sulphate of Copper (113). _To relieve great pain and intolerance of light_, use Opium locally (292). _Blows on the Eye_: Alum Poultice (24), followed by Sal Ammoniac Lotion (332), to remove discoloration. _Particles of Lime in the Eye_ may be dissolved and removed by dilute Vinegar (382). _Particles of Dirt, &c._, may often be speedily dislodged and removed by drawing the upper eyelid well over the under one as far as possible for a few seconds. This simple plan is often successful when others fail. If this fail, try Solution of Sugar (406). Fresh Plantain Leaf (307) forms an excellent shade for the eyes in all affections of those organs.

_Face-Ache, Neuralgic or Rheumatic._ Sal Ammoniac (326), Sulphate of Iron (177), or Fish Liver Oil (141) internally; and Datura (130), and Mustard (253), or Ginger (157) Poultices locally, are measures which, used conjointly, often prove successful. _When periodical_, Cinchona Febrifuge (402*).

_Fainting_ generally yields to dashing cold water over the face and neck (386), and applying strong smelling salts to the nostrils; when partially recovered, Omum Water (318) or Asafœtida (35) may be given, or should there be much exhaustion, a dose of Brandy Mixture (426).

_Fevers, Ardent or Continued._ In most cases it is advisable to commence with a purgative of Kaladana (187), Castor Oil (83), or Myrobalans (256), or if the patient be a strong adult, a Croton Pill (120); after its operation the Solution of Nitre (264) may be given, and Decoction of Abelmoschus (2), Lemonade (232), or Tamarind Infusion (346), _to allay the thirst and cool the system_. A very useful and refreshing drink in all fevers, especially if there is irritability of the stomach, is a mixture of equal parts of Milk and Soda Water, with the addition of a piece of ice if procurable. Sucking small pieces of ice also allays thirst and cools the system; for this latter purpose, also, sponging the surface with Water (385) or diluted Vinegar (376) may be employed. The diet should consist chiefly of Rice _Conjee_ (322) and other farinaceous articles, and the apartment should be kept cool and well ventilated. _To relieve Headache or great fulness of the head_, apply constantly Evaporating Lotion (380) or Nitre Lotion (265), or, if these fail to afford relief, Hot Water Fomentations (393). Leeches to the temples or nape of the neck (209) and Mustard Poultices to the feet (248) may also be necessary in severe cases. _For any severe or acute pain arising in the chest or abdomen_, Leeches (209) over the seat of pain should be applied, but if these fail try a Blister (349). _For Vomiting and Irritability of Stomach_ give Lime Water (223), or else give Hot Water as a drink (385), and apply Mustard Poultices (251); _for Bilious Diarrhœa accompanying_ use Warm Water Enemas (393). _For Sore Throat or Fissures of the Tongue_, apply Borax (55) or Alum (29); _for Dryness of the Mouth and Fauces_ sucking sliced limes, or, better still, pineapples, generally suffices. _In the advanced stages, when great exhaustion, delirium, &c._, are present, give Camphor (74) and Brandy Mixture (426) internally, and apply Turpentine Stupes (363) to the extremities; Turpentine Enemas (364) are also valuable in this condition. _For subsequent Debility and during Convalescence_ give one of the following tonics: Chiretta (98), Atís (42), Bonduc (52), Kariyát (191), Ním Bark (260), Gulancha (352-3), or Cinchona Febrifuge (402). A combination of Chiretta and Sweet Flag Root (12) or Chiretta Wine (99) is perhaps best suited for this purpose. A liberal animal diet should be allowed. N.B.—Throughout the attack it is essential to keep the bowels properly regulated.

_Fever, Intermittent or Ague, and Remittent or Jungle Fever._ Commence with an aperient, as in Fever (_ante_), and should the stomach be foul give an emetic of Country Ipecacuanha (368). _In the cold stage_, cover the body well up with blankets, give Infusion of Ginger (156), and place bags containing hot sand or hot salt along the spine. _In the hot stage_, give plentifully of Lemonade (232), Solution of Nitre (264), and adopt generally the other measures advised above in Fever. _In the sweating stage_, do nothing but protect the surface from cold draughts of air or cold wind. In the intermission or periods between the paroxysms give one of the following: Atís (42), Bonduc Nut (52), Chiretta (98), Sulphate of Iron (175), Ním Bark (260), or Gulancha (352). When one fails another may succeed; when each fails, given singly, they will sometimes prove effectual given in combination. They are all greatly inferior in efficacy to Quinine and Cinchona Febrifuge (401, 403). _For these Fevers in Natives_, Galls, with Chiretta and Sweet Flag Root (12), have been favourably spoken of. _Swelling of left side after Ague_, see _Spleen, Enlargement of_.

In mild, ordinary, uncomplicated cases of _Intermittent Fever_, all that is required, due attention being paid to the state of the bowels and secretions, is to administer Quinine in doses of from three to five grains, so that 10 or 12 grains be taken in the intermissions between the paroxysms. It is best given in solution, in water or coffee. In the severer forms, or even in ordinary cases, Professor Maclean, of the Netley Hospital, has proposed a treatment which appears very judicious, and which in his hands has for years proved very successful. It consists in administering 30 grains in three equal doses during the period of intermission; the first dose, in solution, should be given towards the close of the sweating stage, and the last about as far as can be calculated, an hour before the next anticipated paroxysm. Should there be much irritability of the stomach, it should be given in enema in doses of 15 grains in place of 10 grains. After the paroxysm has by this means been arrested, a moderate degree of cinchonism, _i.e._, giddiness, buzzing in the ears, flashing before the eyes, &c., should be maintained for some days, by giving three or four grains in solution every four hours. In cases where the fever returns at the first lunar period, as it is apt to do, the patient a day or two previously should be brought under the influence of Quinine, which should be maintained until the time is past. Should it fail to influence the fever, attention should be directed to the state of the liver and bowels. When from any cause it cannot be given internally, trial may be made with it applied endermically; the experiments of Dr. Guastamacchia and others tending to prove that it becomes absorbed into the system through the skin, and operates as an antiperiodic almost as certainly as when given internally. He dissolved eight grains in half an ounce of spirit, and rubbed first one half, and after the interval of a quarter of an hour, the second half along the spine. When this was done at the commencement of the cold fit, it very often prevented even a single recurrence. Dr. Daunt also bears testimony to this method in the fevers of South America.

In _Remittent and Jungle Fever_, Quinine is a remedy of the highest value, but its exhibition requires more caution and discrimination than in simple intermittents. Dr. Maclean's treatment appears to be worthy of every attention. After premising, in most cases, a cathartic, immediately on the first signs of remission, he administers a full dose of Quinine, 10 grains, often 15, sometimes 20 grains, never exceeding that dose, and not deterred by the presence of headache or a foul tongue, nor because the remission is slight or imperfectly marked; and this dose he repeats every second hour until 30 or 35 grains have been taken before the hour of the expected exacerbation. Should the stomach be too irritable to bear it, it should be given in enema in large doses (20 grains). As soon as the second remission appears, it must be given as before until full cinchonism or distinct abatement of the disease occurs. During the remission the patient should have mild farinaceous diet, milk, chicken-broth, &c.; as soon as gastric irritability subsides, beef tea should be given, and on the first sign of exhaustion, nourishment and stimulants should be resorted to at short intervals. With regard to the administration of Quinine during exacerbations, Dr. Maclean is of opinion that in the adynamic forms of fever, as met with in some parts of India, and in neglected or mismanaged cases, where depletion has been carried too far, and the fever assumes more of a low continued type, it may be given at any period irrespective of remission. Here it requires to be conjoined with the assiduous use of support and stimulants at short intervals.

As a preventive of _Malarious Fever_, the power and value of Quinine have been proved beyond a doubt. Every person engaged in forests, swamps, or low, malarious sites, should be provided with a stock of it, and four grains of it in a cup of hot coffee should be taken the first thing in the morning or in a glassful of wine later in the day. Even if it should fail, which it rarely does, no harm can result from its use, and it is essential that it should be continued for at least fourteen days after quitting a malarious locality.

_Fits._ See _Convulsions_, and _Hysterical Affections_.

_Flatulence, and Flatulent Colic._ Give Omum Water (318*), Lemon Grass Oil (216), infusion of Ginger (155), or of Jatamansi (184); with Mustard Poultices (251) and Turpentine Stupes (362) externally; in severe cases an enema of Asafœtida (36) will generally afford relief. See also _Bowels, Spasmodic Affections of_. _Of Children_, see _Colic_.

_Gall Stones._ _To allay the severe pain attendant on passing_, give Opium (284) and a Hip Bath (392).

_Genital Organs, Great Irritation of._ Try Camphor (72) internally (in these cases Bromide of Potassium, in doses of eight to ten grains dissolved in water, twice or thrice daily, is well worthy of a trial, especially in females) and use Borax (57) and Lime Water (224) locally. Sitting over the steam of hot water, or a tepid hip-bath, often affords great relief. When the irritation arises, as it often does, from worms in the intestines, give some of the remedies for _Worms_. Crab-lice, which are very difficult to distinguish on a dark skin, are also a frequent cause; if present, use Kerosene Oil (413), or other remedy named in Art. _Lice_.

_Glands, Enlarged._ Apply externally, in the early stages, Sal Ammoniac Lotion (332), Betel Leaves (48), Camphor Liniment (68), or Opium Liniment (291). If matter forms, treat as abscess, and give Fish Liver Oil internally.

_Gleet_ may be treated with Cubebs (125), Galls (149), Gurjun Balsam (160), or Sandal Wood Oil (334) internally, and Alum Injections (30); these last named, however, _require great caution_, and should not generally be used except under medical supervision.

_Goitre._ Give Sal Ammoniac (324), in ten-grain doses, thrice daily, persevering in its use for weeks or months if necessary. Dr. Stevens (_London Med. Record_, June 15, 1880) obtained signal benefits from it in six cases. Biniodide of Mercury, in the form of Ointment (16 grains of the Biniodide to one ounce of Simple Ointment), is the best local application we possess. Its effects are best produced by exposing the surface on which it has been rubbed to the direct rays of the sun. If this cannot be done, then to the heat of a fire; this, however, is not nearly so efficacious as the solar heat. (Dr. Aitchison.)

_Gonorrhœa._ After a purgative of Kaladana (187), Myrobalans (256), or Castor Oil (83), give Nitre (269) with Decoction of Abelmoschus (2), Ispaghúl (305), or Rice _Conjee_ (322), for the purpose of allaying the pain and heat in passing urine. Pedalium (297) is said to be very effectual for this purpose, and should be tried if procurable. Injections of a solution of Sugar (407) are recommended by Dr. Aitchison. When the inflammatory symptoms begin to abate, one of the following should be given: Cubebs (125*), Gurjun Balsam (160), Sandal Wood Oil (334), or Galls (149), Alum (30*), locally, is of great use in certain cases. _To relieve Chordee_ (painful erection at night), Camphor (72) is one of our best remedies. Bromide of Potassium, in doses of 20 to 30 grains, in a wineglassful of water at bedtime, is highly spoken of, as preventing the occurrence of this symptom.

_Guinea Worm._ On the head of the worm appearing, it should be gently drawn down so as to secure it by rolling it round a small piece of twisted rag, or a thin piece of quill (let a native practitioner perform this operation); and Water Dressing (394) applied, or should there be much pain, a Datura Poultice (132). Every day gentle traction should be made, and if this can be done whilst the limb or part is immersed in a running stream or in a _chattie_ of cold water, the extraction is rendered additionally easy. _Great gentleness and skill_ are requisite to prevent the worm breaking, as this accident is followed by inflammation and the formation of abscesses, which are difficult of healing. See _Abscess_.

_Gums, Ulceration and Sponginess of_, may be treated with one of the following:—Decoction of Babúl Bark (9), Alum (29*), Catechu (89*), or Lime Juice (231).