Chapter CD: AB. 3 aces 150 (8)

(_e_) Mix equal quantities pure glycerine and pure water together, and add as much common salt as the liquid will dissolve. Rub this frequently on the cracked portions of the hands, giving an extra quantity just before going to bed.

(_f_) Salicylic acid and borax, each 1½ dr., glycerine up to 2 oz.

(_g_) Equal quantities carbolic acid and glycerine.

_Chilblains._--(_a_) Chilblains are likely to be caused by sudden change from cold to heat or _vice versâ_. This will explain why the hands and feet, nose and ears, are mostly the parts affected, because they are the parts most prominently exposed to such changes. Invalids and scrofulous persons are more likely to suffer than the robust and healthy. As prevention is better than cure, care should be taken to protect the parts by substances which are non-conductors of heat. Woollen socks, stout boots, and warm gloves are safe preventives, and especially taking care not to warm the parts affected by cold by any other means than friction, and in case of persons predisposed to chilblains, the frequent ablution of the extremities in tepid water and the use of good yellow soap is advisable, bathing the feet and hands in tepid water slightly salted, every night, is a good antiphlogistic. Should these means fail, where the skin is not broken, use a liniment of 1 oz. camphorated spirits of wine mixed with ½ oz. Goulard’s extract; but the best remedy is a lotion composed of 1 dr. iodine in 3 oz. rectified spirits of wine, to be applied with a brush not more than once a day. Should the chilblain be broken or ulcerated a different treatment must be adopted--warm poultices ought to be applied, and discontinued after about 3 days; the sores must then be touched with the tincture of iodine once a day, and then dressed with basilicon ointment; when they begin to granulate freely, a simple dressing of the above ointment is sufficient to complete a cure. Care ought always to be taken not to let chilblains break through the skin, as they are very liable to mortify.

(_b_) Copper sulphate in solution is about the best thing to allay the itching before they break. Also is used with very good effect an embrocation composed of 1 dr. tincture of capsicum and 7 dr. soap liniment. After they have broken, the best application will be carbolic acid and linseed oil--1 part of the former to 5 of the latter, to be applied with a feather (the pure acid should be used for this). This is the most useful application for any open sore.

(_c_) 1 dr. sugar of lead, 2 dr. white vitriol, then add 4 oz. water; shake well before using. Rub well on the affected parts with the hand before a good fire; the best time is in the evening. Do not use this on those that are broken. This scarcely ever fails to cure the most inveterate chilblains by once or twice using.

(_d_) Quite effective for unbroken chilblains, but it might be poisonous to broken ones, so be very careful:--A small quantity of yellow soap is dissolved in very little water, then methylated spirit is added to just thin it a little, then add, while hot, tincture of iodine drop by drop, stirring it the while; when it begins to change colour there is enough; let get cold, and apply night and morning, letting it dry on. It is only good while the spirit is in it.

(_e_) Take some precipitated chalk, and mix it in a mortar (or with a knife in a plate, but the first way is best) with some salad oil to something thicker than cream--about the thickness of Devonshire cream. At night apply it thoroughly over all the fingers, rubbing it in, and smearing it thickly on them, putting a pair of gloves on. Persevere every night.

(_f_) 6 gr. copper sulphate, ½ oz. Eau-de-Cologne, ½ oz. distilled water. To be applied twice a day with camel-hair brush. A capital remedy to arrest inflammation in chilblains.

(_g_) 2 oz. black bryony root, 10 oz. spirit of wine, 2 oz. water. Macerate 7 days and filter. Apply night and morning with a camel-hair pencil.

_Cold Feet._--(_a_) There are two remedies--the hot bottle and lamb’s-wool socks, either or both of which may be used. When we consider that during the day, whilst we are active, we wear stockings and shoes, does it not seem strange that at night, when the temperature of the air is lower, and when we are inactive, that our feet should have less covering than during the day? The reasonable plan is to have a special pair of socks for night use, putting them on when going to bed, and change them when getting up; the result will be better and more serene sleep, consequently we shall be more able to undergo our daily exertions. A good walk for ½ hour before retiring warms the feet, and sends a nice glow all through the body, and disposes to sleep. (_b_) Wear horse-hair soles winter and summer, as a remedy for cold and damp feet.

_Coughs and Colds._--The _British Medical Journal_ remarks that there are several well-known processes by which a cold may be caught. As a disease, there is nothing so common; and yet it is only very recently that anything like an approach to a knowledge of its pathology has been attained. There is now, however, a large accumulation of evidence which points very strongly in the direction that “taking cold” is actually “being cold.” Colds are most frequently caught from a wetting. The clothes we wear are good non-conductors of heat, and so prevent the loss of body-heat which would occur without them. But let them become moist or saturated with water, and then they become heat-conductors of a much more active character, and a rapid and excessive loss of body-heat follows. Nothing is more certain, however, than that prolonged exposure in wet clothes is commonly followed by no evil results; that is, so long as there is also active exercise. The loss of heat is then met by increased production of heat, and no harm results. But let the urchin who has been drenched on his way to school sit in his wet clothes during school-hours, and a cold follows. No matter how inured to exposure the person may be who, when drenched, remains quiet and inert in his wet clothes, he takes a cold. Here there is an increased loss without a corresponding production of heat, and the temperature of the body is lowered, or the person “catches cold.”

The effect of exercise in producing heat is well known. Unless the surrounding air be of a low temperature and the clothes light, the skin soon glows with the warm blood circulating in it, and then comes perspiration with its cooling action. Here there is a direct loss of heat induced to meet the increased production of heat. Exercise, then, in wet clothes, produces more or less a new balance, and obviates the evil consequences which would otherwise result.

The loss of heat is more certainly induced if the skin be previously glowing and the circulation through the skin, the cooling area, be active. Thus, a person leaves a ballroom with his cutaneous vessels (pores of the skin) dilated, and a rapid loss of body-heat follows, unless there be a thick great-coat or a brisk walk; if the clothes become moistened by rain, or be saturated with perspiration, the radiation of heat is still more marked. Such is the causation of the cold commonly caught after leaving a heated ballroom. It is probable that exhaustion is not without its effect in lowering the tonicity of the vessels, and so those of the skin do not readily contract and arrest the loss of heat.

A damp bed gives a cold, because the moist bedclothes are much better conductors of heat than are the same clothes when dry. The temperature of the body is lowered, and a cold results. Long exposure in bathing leads to similar consequences. The second feeling of cold in bathing tells that the body is becoming chilled, and that the production of heat is insufficient to meet the loss. A run on the river-bank, or a brisk walk after dressing, commonly restores the lost balance.

The plan of permitting the wet clothes to dry on the wearer is very objectionable. The abstraction of heat from the body by the evaporation of moisture in the clothes produces a marked depression of the body-temperature, and a severe cold. This is most strikingly seen in the effects of a wetting in the Tropics. The smart shower or downpour is quickly followed by a hot sun and a breeze, and the loss of heat under these circumstances is considerable. The person is “chilled to the bone,” and the effects are felt for a long time afterwards.

Alcohol has been abandoned in Arctic regions. It dilates the cutaneous vessels and increases the loss of body-heat. The drunken man perishes of cold when the abstainer survives.

When the exposure follows a long continued warmth, the cutaneous vessels do not contract, but become dilated or paralysed, and then a large bulk of warm blood courses through the cooling surface, and a great loss of body-heat is entailed. Not only so, but the current of chilled blood passes inwards to the right heart and the lungs. Inflammations of the lungs are common along with severe colds; and this is possibly the explanation. Such inflammation is specially liable to occur if at the same time cold air be inspired. The cold respired air and the currents of chilled blood together, produce those vaso-motor disturbances in the lungs which, in their graver aspects, are known as pneumonia.

The practical considerations which are the outcome of this review of the pathology of cold are these. Never wear wet clothes after active muscular exertion has ceased, but change them at once; meet the loss of the body-heat by warm fluids and dry clothes; avoid long-sustained loss of heat which is not met by increased production of heat; increase the tonicity of the vessels of the skin by cold baths, &c., so educating them to contract readily on exposure--by a partial adoption, indeed, of the “hardening” plan; avoid too warm and debilitating rooms and temperatures; take especial care against too great a loss of heat when the skin is glowing; and prevent the inspiration of cold air by the mouth by some protecting agent, as a respirator. We can readily understand how a respirator should be an effective protection against winter bronchitis in those so disposed. Of course, no one should, even in summer, dispense with the use of flannel next the skin, or some substitute, such as merino. It is as important at that period of the year, as in winter.

Dr. Graham gives the following advice: “When you come out of a cold atmosphere you should not at first go into a room that has a fire in it, or if you cannot avoid that, you should keep for a considerable time at as great a distance as possible, and, above all, refrain from taking warm or strong liquors when you are cold. This rule is founded on the same principle as the treatment of any part of the body when frost-bitten. If it were brought to a fire it would soon mortify, whereas, if rubbed with snow, no bad consequences follow from it. Hence, if the following rule were strictly observed--when the whole body, or any part of it, is chilled, bring it to its natural feeling and warmth by degrees--the frequent colds we experience in winter would in a great measure be prevented.”

To neglect the conditions upon which strength of constitution and purity of blood depend, and then strive to avoid in a sedulously careful manner the evil influence of colds upon the body, is like neglecting the substance for the shadow of health; or more properly, it is like one who starves his body, and then strives to keep quiet in order that his strength shall not be exhausted. Let food be taken, and the exhaustion from exercise will not ensue; let all the conditions of health be observed, and then the natural changes of the weather will fall harmlessly on the healthy functions of the body.

Occasionally a cold may be arrested, in the first stage, by taking at the very outset, a hot bath on retiring to rest, with 10 gr. Dover’s powder at bedtime, followed by a hot drink, such as a basin of hot gruel or a tumbler of hot toddy, with a dose of castor-oil in the early morning about 6 o’clock. It is well to remain indoors for the day. Should, however, these means fail, or the ailment have progressed too far before the remedy is applied, and the patient complains of soreness of chest, with cough and feverishness, then he should keep bed for 3 days. Mustard and linseed poultices are to be applied to the chest, warm diluent drinks are to be given, such as gruel, with honey and vinegar in it, to promote gentle perspiration, and to relieve the severity of the cough. Ipecacuanha wine, 10-15 drop doses in water every 4 hours, will be found useful in promoting expectoration. Laxative medicine will probably be necessary, and the diet should be light.

The Continental remedy, lime-flower tea or tisane de tilleul is made in a teapot in the same way that tea is made, substituting lime blossoms for tea leaves, and using about 4 times the quantity to make it. It is taken hot, and used for colds, coughs, &c., much in the same way that gruel, wheys, and possets are taken in England.

Dr. Ferrier, of King’s College, communicates a remedy for cold in the head, which has been found effectual. It is a white powder used as snuff, and composed as follows:--2 gr. hydrochlorate morphia, 2 dr. acacia powder, 6 dr. bismuth trisnitrate. The whole makes up a quantity of powder, ¼-½ of which may be safely taken in 24 hours. Dr. Ferrier has twice cured himself of very severe colds by this means, once by the use of bismuth trisnitrate alone, which is a very powerful remedy for catarrh of the mucous membrane, and is the most important ingredient in the above mixture. Others have used the snuff with perfect success. Instead of increasing the tendency to sneeze, it almost immediately begins to diminish it. (_Lancet._)

Prof. Strambio, in a note to an Italian medical journal, says that, notwithstanding the failure of all remedies hitherto recommended for the immediate cure of a cold, he wishes to communicate to the profession the great success he has found attending a new one in his own person, and to ask them to test its efficiency. He found prolonged mastication and swallowing of a dried leaf or two of the _Eucalyptus Globulus_ (Blue gum) almost immediately liberated him from all the effects of a severe cold.

In the treatment of persistent cold in the head, or nasal catarrh, when there is much discharge from the nasal passages, we are advised to use a spray-producer with the following solution:--1 gr. carbolic acid, 2 dr. glycerine, 2 oz. water. After the passages are clean, a small quantity of vaseline is melted in the bowl of the spray-producer, and 2-5 drops pinus canadensis mixture are added. This mixture consists of:--15 gr. pinus canadensis, ½ oz. glycerine, ½ gr. carbolic acid, 1½ oz. water. This is to be applied by the spray to every part.

Dr. Sheppard says, in respect to the use of hot water as a remedial agent in the treatment of inflammation of the mucous membranes:--“I have used hot water as a gargle for the past 6-8 years. In throat and tonsil inflammation, and in coryza (cold in the head), if properly used in the commencement of the attack, it constitutes one of our most effective remedies, being frequently promptly curative. To be of service, it should be used in considerable quantity (½-1 pint at a time), and just as hot as the throat will tolerate.”

Coughing is greatly under the control of the will, and children ought to be taught to try to restrain the inclination to cough; very often, by this very effort, the desire to cough will vanish. If it cannot be avoided, they should be taught _how_ to cough. It is not in the least necessary to give way to coughing on every occasion, even though there be really something to expectorate, until the mucus or other irritating matter be within easy reach, and then one good, effective, deliberate cough will do as much, or probably more, for the relief of the individual, than perhaps a dozen repeated, noisy, resultless fits of coughing. The noise which accompanies the act can be greatly modified at the will of the individual. There are some people who make not the slightest effort to lessen this annoyance. In many cases the mouth may be closed, and in all the hand may be held before the mouth during the act, whereby considerable modification of the noise may be attained.

Avoid making use of any nostrum vaunted as a cure for all sorts of coughs and colds: all contain opium in some form, and may prove prejudicial to the complaint which initiates the cough. At the same time, a distressing cough calls for amelioration. There never can be harm in causing the patient to inhale steam from a sponge or basin of boiling water; or infusion of hops may be inhaled. Lozenges of various kinds are often useful, e.g. fruit, gum, glycerine, liquorice, marsh-mallow, tamarind, ipecacuanha, &c. Linseed-tea is a bland, soothing demulcent, useful in sore throat, and in allaying tickling cough.

The common mullein, _Verbascum thapsus_, has long been used in Ireland as a domestic remedy for consumptive cough, and Dr. Quinlan finds that when boiled in milk the patient takes the decoction readily, and experiences a physiological want when it is omitted. Its power of checking phthisical looseness of the bowels and the relief afforded to coughing are very marked, so that patients take hardly any other cough mixture. In early stages it appears to have a distinct power of increasing weight, but in advanced cases Dr. Quinlan remarks that he is not aware of anything that will do this except koumiss. (_Brit. Med. Jour._)

Dr. Square recommends a solution of 1 part ethyl bromide in 200 of water as a remedy for whooping-cough. This is of similar strength to the chloroform water of the British Pharmacopœia, and its dose is the same, namely, ½-2 oz.

A German journal mentions a case of whooping-cough treated with turpentine by Ringk, of Berlin, with astonishing results. The patient was a little girl 3½ years of age, and a fatal issue seemed imminent. The doctor prescribed ol. terebinth., 10 grams; syr. altheæ, 80 grams; a teaspoonful every 3 hours. The next day the child was sitting up in bed, with a great slice of bread and butter in her hand, which she was eating and evidently enjoying. The cough had totally disappeared, and no evil results followed.

Following are a few simple recipes for expectorants, useful for winter coughs. The first is particularly suitable for young children:--(_a_) 1 fl. dr. syrup of squills, ½ fl. dr. gum acacia, powdered, 8 gr. ammonium chloride, enough peppermint water to make 2 fl. oz. Dose for a child, 1 teaspoonful every 2 hours. (_b_) For older children and adults, 2 parts syrup of ipecac., 4 syrup of squills, 1 paregoric. Dose, ½-1 teaspoonful, repeated as often as necessary. (_c_) 1 oz. syrup of ipecac., 1 oz. syrup of tolu, ½ oz. paregoric, 1 oz. syrup wild cherry. (_d_) For hoarseness, Dr. Eichelberger gives the following, which he says is very good:--2 dr. tinct. chloride of iron, 4 dr. glycerine, 4 dr. water. Dose, ½ teaspoonful.

Sore throat is a constant accompaniment of some very serious disorders, such as scarlet fever, measles, smallpox, diphtheria, &c., but is most frequently the result of exposure to cold and damp, when the body is heated. It may be confined to the parts situated at the back of the mouth, i.e. the tonsils, palate, and pharynx, or it may extend a little further into the windpipe. The affection is an inflammation of the mucous membrane of the parts enumerated. Many cases speedily recover without any active treatment, provided the invalid will have patience for a few days, confine himself to the house, better to one apartment, and still better to bed, for a couple of days; avoid all conversation; apply a warm poultice to the throat, or a moist compress round the throat night and day. This last is made by wringing a piece of lint, or a pockethandkerchief, out of water sufficiently so that it does not drip, and it is of small moment whether the water be cold or warm; it is now applied to the throat, and covered with a piece of macintosh, and then a woollen comforter is put over all. Ice may be sucked continuously, if agreeable to the patient. If it be not, then a gargle of warm milk and water should be employed every hour. A smart aperient dose of Epsom salts or castor oil should be taken in the morning before breakfast, 1 tablespoonful salts in a tumblerful of hot water. If, under this treatment, the throat do not improve in 2 days, it has ceased to be a minor ailment, and the physician must be sent for.

A very painful form of sore throat is that called quinsy. It is inflammation of the tonsils, two glands situated at the back of the mouth. This inflammation is principally observed in changeable climates; and seems to attack, by preference, young adults. Children rarely suffer from quinsy. Persons who have once been the subjects of this ailment are very liable to a recurrence of the disorder. The most common exciting cause is exposure to wet and cold, with a chilly east wind.

Those who are liable to this form of sore throat, and know from the premonitory symptoms what is impending, ought at once to adopt preventive measures. These consist in using strong astringent gargles; in the administration of single drop doses of tincture of aconite, every hour, for half a day, and a brisk saline purgative in the morning, such as a dose of Rochelle salts. For gargle, one of the best is the old-fashioned homely mixture, consisting of 3 tablespoonfuls red wine (port or claret), 1 of vinegar, ½ teaspoonful powdered alum, and a little sugar, in a tumbler of cold water. This to be used every hour. If, however, the affection has gone too far for this abortive treatment, then the patient must be confined to bed; hot poultices must be kept constantly applied to the throat; steam from hot water should be inhaled often; a gargle of hot milk and water should be used hourly; and ice, if grateful, may be constantly sucked. A sal prunelle ball may be allowed slowly to dissolve in the mouth. The diet should be in semi-solid form, e.g. arrowroot made with milk, soup thickened with rice-flour, or better still, beef-jelly, if the patient can be persuaded to swallow at all. If the abscess do not speedily rupture, and more particularly if both tonsils be simultaneously affected, then it may be necessary to call in the aid of the surgeon to lance it. The necessity for this will be evident by continued and increasing distress of the sufferer, great difficulty in breathing, and extreme restlessness and feverishness. In a first attack, too great delay ought not to be allowed to take place before getting professional assistance.

Every one has a cure for sore throat, but simple remedies appear to be most effectual. Salt and water is used by many as a gargle, but a little alum and honey dissolved in sage tea is better. An application of cloths wrung out of hot water and applied to the neck, changing as often as they begin to cool, has the most potency for removing inflammation. It should be kept up for a number of hours; during the evening is the usually most convenient time for applying this remedy.

For loss of voice in singers and speakers, Dr. Corson recommends the patient to put a small piece of borax (2-3 gr.) into the mouth and let it dissolve slowly. An abundant secretion of saliva follows. Speakers and singers about to make an unusual effort should the night before take a glass of sugared water containing 2 dr. potassium nitrate (saltpetre) in order to induce free perspiration. In similar circumstances this gargle may also be used:--6 oz. barley water, 1-2 dr. alum, ½ oz. honey. Mix, and use as a gargle. Or an infusion of jaborandi, made by putting 2 scr. of the leaves in a small cup of boiling water, drunk in the morning before getting up. The free sweating is said very quickly to restore the strength of the voice.

_Constipation._--Short of mechanically obstructive disease, there are many states in which constipation is the most marked feature. On the nature of these, apart from the mere symptom, the possibility of permanent relief by treatment must of course largely depend. We may procure comfort with a pill, but often we cannot retain it with many. Habit cannot be reformed or expelled by purges. Accordingly, when we proceed against the fault of habit, now under notice, we must take account of the constitution and circumstances in which it is formed. By so doing we do much to ensure the desired relief, though it may be that even then we fail somewhat of complete success. A bowel long deficient in activity, dilated irregularly, with torpid though thickened walls, does not soon, if ever, renew its original tone and contractility. The difficulty is a pathological one, and arises from structural as well as functional perversion. The natural efforts to obtain relief are hindered and enfeebled by the effects of some cause which may still be operative. If we would undo the past or prevent further mischief, we must seek and treat that cause. Aperients of different kinds, however potent at the time, are but temporary palliatives of discomfort so long as no pains are taken to trace the trouble to its origin. Whether it be a sedentary habit of life, an excess of food overloading and overworking the viscus, purgation draining and depleting it, gout, diabetes, struma, chlorosis, altering either the structure of the intestinal wall or the consistence of its contents, it must be sought for as a chief guide to the means of cure. It is not likely that constipation will ever form the chosen hobby of a specialist. A far too general view of medicine and its adjuvant sciences is necessary for successful treatment to encourage such appropriation. We are not, however, outside the sphere of nostrums. There is in our time, if anything too much reliance on physic-taking for constipation. More might be done by appropriate dieting and by inculcating active habits of life than is customary. It may be noted, with regard to diet in particular, that a free use of simple fluids, as water, or mild mineral waters, is of distinct advantage in assisting both digestion and evacuation. There are also many aperient vegetable foods which, with the same end in view, we should like to see in daily use at the table. Almost any kind of wholesome fruit and green vegetable might thus be made serviceable. When, again, we come to medicines, we must remember that the disorder which we have to combat is a complex one. We cannot in this case, more than in any other morbid state, put a finger on one tissue as alone or invariably at fault. Thus in the costiveness of anæmia we have atony of the intestinal muscle combined with defective secretion, and both but part of a general tissue starvation; in the gouty disorder of elderly people the same conditions appear, though due to a very different dyscrasia; and so on. We may say, therefore, speaking generally, that no single drug can be relied on to meet the intestinal difficulty. An agent which aids secretion either of bowel or liver will not alone suffice. The long-inactive muscular coat likewise requires assistance. A free purge may have its value now and then, but when the object to be attained is the correction of a habit, a milder remedy used regularly is much more effective. To meet these various necessities, perhaps no combination is superior to the time-honoured union of belladonna with the compound rhubarb pill and nux vomica, or the most recent mixture of the fluid extract of cascara with the last-named drug. An agreeable change of remedy is afforded by many aperient mineral waters. The effect of these latter, however, is unfortunately apt to pass off after a time, probably from their causing a too copious intestinal secretion. The action of saline or other enemata is not quite similar. More strictly local, and exerted rather on the fæces than the bowel, it gives relief without so much exhausting the latter by secretion or peristalsis; while the very rest which the colon thus easily obtains is itself a help to the recovery of normal nutrition and muscular tone. The chief points which we would therefore bear in mind, whatever the remedies used in combating the habit of costiveness, are the need for recognition of its primary cause, and the fact that its proximate condition is an atonic bowel. (_Lancet._)

Dr. Mortimer Granville gives 3 prescriptions for habitual constipation. It is indispensable to regard persistent inactivity of the bowels, when not demonstrably due to other causes, as the result of, either defect of peristaltic action; deficient glandular secretion; or interruption of the _habit_ of periodic evacuation.

When there is a lax and torpid condition of the muscular coat of the alimentary canal, we get food retained in the stomach or intestines until it ferments, or sometimes “decomposes,” with the result of distension, pain mechanically induced, and either eructations or incarcerated flatus. In a considerable number of cases this last-mentioned trouble is so great, and at the same time so masked, as to give rise to the impression that grave disease exists; whereas every anomalous symptom has quickly disappeared as soon as the muscular tone has been restored, and the contents of the bowels have commenced to pass naturally on their course. The essential fault is partial, in some instances almost complete, loss of the reflex contractility of the muscular coat, so that the presence of ingesta at any part of the canal does not excite the intestine to contract and propel it onwards. It is worse than useless to employ ordinary aperients in such a condition as this; they only irritate without strengthening the nerves, on the healthy activity of which everything depends. When, therefore, there is the form of “constipation” which requires treatment, use a prescription something like the following; and it is, in the majority of instances, successful:--

Sodæ valerianatis gr. xxxvi.; tincturæ nucis vomicæ ♏ lx.; tincturæ
capsici ♏ xlviii.; syrupi aurantii ℥iss.; aquâ ad ℥vj. Misce, fiat
mistura, cujus sumatur cochleare magnum ex aquâ ter die, semihorâ
ante cibum.

The second form of constipation, in which there is a deficiency of glandular secretions generally throughout the intestine, manifested by a peculiarly dry and earthy character of the dejecta when the bowels _do_ act, may be treated by a mixture such as this:--

Aluminis ʒiij.; tincturæ quassiæ ℥j.; infusi quassiæ ℥vij. Misce,
fiat mistura, cujus sumantur cochlearia duo magna ter quotidie,
post cibum.

The third form, which depends chiefly on interruption of the natural habit of periodic discharge, often results from repeated failure to move the bowels, in consequence of one or other of the two preceding forms of this trouble. This may generally be relieved by directing a perfectly regular attempt to go to stool, and by the use of the following draught, taken the first thing after _rising_ from bed--not on awakening--in the morning, as nearly as possible at the same hour. It will be observed that it is not an aperient in the ordinary sense of the term. It is, as a rule, neither necessary nor desirable to continue it for longer than a fortnight. In most instances, it will be found to re-establish the normal habit in a week or less.

Ammoniæ carbonatis ʒj., tincturæ valerianæ ℥j.; aquæ camphoræ ℥v.
Misce, fiat mistura; capiat partem sextam in modo dicto. (_Brit.
Med. Journ._)

The value of castor oil as a family aperient is undoubted. Referring to its use, Dr. Soper enlarges on the great advantages of a combination of castor oil and glycerine in equal proportions to act as a purgative. Glycerine has great therapeutic value, especially in its solvent properties, and this combination renders it especially valuable. In regard to castor oil, a great mistake is often made in the largeness of dose administered; in this mixture, only ½ teaspoonful is required combined with an equal bulk of glycerine. In all cases of chronic constipation, piles, &c., it has proved most useful. Also ½ teaspoonful doses in the early stages of bronchitis seem to promote exudation from the tubes, and is certainly expectorant. The great difficulty is the obstinacy with which the mixture becomes a mixture, as it can only be made by placing the bottle in hot water and violently agitating. By adding the oil to the glycerine gradually, and mixing the two in a mortar, the taste of the oil completely disappears. The following is recommended as a pleasant form for children:--1 dr. castor oil, 1 dr. glycerine, 20 drops tincture orange peel; 5 drops tincture senega; cinnamon water to make up ½ oz. mixture.

_Consumption._--It is highly probable that adult mortality from phthisis might be considerably reduced, if members of phthisical families, and persons of phthisical habit and tendency, could be induced to pursue an intelligent course of life. In wisely-chosen food, suitable exercise, well-adapted clothing, and pure air, are four distinct and potent details of every-day life, well within control, which may be turned to efficient account in the prevention of phthisis. Precautions, if they are to be effectual, must not be put off until signs of lung mischief become manifest. Then the evil can only be mitigated, not avoided. If consumption be apprehended, the daily diet should be rich both in nitrogenous flesh-forming and fatty constituents. The especial nutritive value of milk in such a case is universally recognised. Next to well-arranged daily food, exercise in the open air is of the greatest importance. On this point the late Dr. Parkes laid down the rule that “the best climates for phthisis are perhaps not necessarily the equable ones, but those which permit the greatest number of hours to be passed out of the house.” By well-adapted clothing, many of the chills, catarrhs, and pulmonary congestions which often lead up to consumption, might be prevented. The rules in this respect are well established. The feet should always be dry and warm; the covered parts of the body, excepting the head, should be clothed in suitable woollen fabrics; the underclothing should be kept of the same thickness all the year round, and variations of apparel to suit the changes of season be made only in the outer garments; and no constrictions or compressions should be allowed to hamper the respiratory play of the chest and abdomen, or to impede the circulation of blood through the lungs and heart. With regard to the respiration of pure air, it may be said generally that it is within doors that the breathing of vitiated air is most likely to become dangerous, and is such a powerful excitant of consumption. (_Brit. Med. Journ._)

No person, particularly if young, should be allowed to sleep in the same bed, or even in the same room, with a consumptive. No person should be allowed to remain for too long a time in too close or too constant attendance on a consumptive. Ventilation as perfect as possible should be secured. The expectoration of phthisical patients should be carefully disinfected. Those phthisical patients who are in the habit of mixing freely with other persons should wear one of those antiseptic respirators which are now to be obtained for a few pence.

_Corns._--(_a_) Salicylic plaster has recently been put upon the market as a cure for corns, bunions, and thickened skins generally. The price is reasonable enough, but some may prefer to make it for themselves. Dissolve 2 dr. each of salicylic acid and common yellow resin in 6 dr. sulphuric ether, and paint the solution over belladonna or opium plaster spread on swan’s-down. The mixture dries almost instantaneously, and the plaster is then ready for cutting up into suitable sizes for corns. Considering that the whole does not cost more than 3-4_s._ per yd., and that several thousand plasters may be made out of that quantity, it is cheap.

(_b_) Some corns are so painful that neither paint nor plaster can be endured, something of the nature of a shield alone giving relief. For such cases as these, the following wrinkle may be appreciated: Take a corn-shield, enlarge the diameter of the hole to a small extent by means of a knife or scissors, and apply in the usual way. Then place in the hollow thus formed over the corn, a small quantity of any of the following solutions: Salicylic acid and extract cannabis indica dissolved in ether; or ½ dr. extract cannabis indica dissolved in 2 dr. liquor potassæ; or a saturated solution of iodine, or iodide of potash, in strong alcohol. The shield does the double service of taking the pressure of the boot off the corn, and at the same time preventing the liquid being rubbed off by the sock; while all these solutions penetrate the skin with more rapidity than the usual collodion preparation, and are consequently much more effective in their operation. The saturated solution of iodine often succeeds in removing corns and indurated epidermis when other remedies have failed, and the well-known solvent action of liquor potassæ is a sufficient credential to induce for it at least a trial.

(_c_) Many corns may be removed by a persevering application of the ordinary shield, which, relieving the pressure of the boot, enables nature to throw off the old skin. Acetic acid, too, is an excellent remedy for corroding the indurated epidermis; but it is necessary to protect the surrounding parts by means of a paper shield.

(_d_) Mix 16 fl. oz. collodion with 2 oz. (avoir.) salicylic acid, and, when this is dissolved, add 1 oz. (avoir.) zinc chloride. Keep it tightly stoppered and away from lights or fire.

(_e_) Three dr. euphorbium, 6 dr. powdered cantharides, 4 dr. Venice turpentine, 4 oz. alcohol. Macerate the euphorbium and cantharides with the alcohol for 48 hours, strain, and add the Venice turpentine; spread on French tissue-paper with a soft brush--size of each sheet about 18 by 24 in. This article is in much repute for the cure of corns and bunions, and the relief of gout.

(_f_) Dissolve 1 part salicylic acid in 40 of collodion: apply several times a week. The corn dissolves with little trouble.

(_g_) For hard corns apply at night a mixture of 1 part carbolic acid, and 10 of distilled water, glycerine, and soap liniment. Envelop with guttapercha tissue, and the corn may generally be removed the next morning.

(_h_) Gezou’s remedy for corns and warts is prepared as follows:--30 gr. salicylic acid, 10 gr. ext. cannabis indica, ½ oz. collodion.

(_i_) Fasten a piece of lemon on the corn, and renew night and morning. Simple but very effective.

_Diarrhœa and Dysentery._--Beyond everything stands a strict regulation of the diet. When the intestinal canal is in a diseased state almost any substance introduced into the stomach acts mischievously, and it is not infrequently necessary to suspend all food until the intestine is in a condition to bear it. Every solid article is then mischievous, but even fluids, by reason of their temperature, may act as prejudicially. In most cases taking a few spoonfuls of warm soup, or drinking a mouthful of cold water will immediately be followed by severe colics, and soon afterwards by evacuations. Only allow lukewarm soups or other drinks, and only by a spoonful at a time. Of course these stringent rules apply to very obstinate diarrhœa, and especially dysentery, for there are many cases of temporary diarrhœa in which the patients continue to eat fruits and the like, and still soon get well. Such cases must, however, not be taken into account, and it is always most prudent at the commencement of diarrhœa to cut off the supply of food as far as possible, and at all events to prohibit all articles likely to augment the affection.

Opium is the most valuable medicine in diarrhœa, for it keeps the sphincter in a state of permanent contraction, a contraction which is often propagated to the large intestine, and the small intestine is unable to propel its contents far enough to induce the irritation which causes their expulsion. When, by reason of this contraction, these contents are retained, their amount may become considerably diminished by the absorption of the fluid. Frequently, however, there is no spot of the canal which is not so diseased as to prevent such absorption taking place, and then the diarrhœa will continue in spite of the opium and of the contraction of the sphincter. It appears, moreover, that opium, besides its action on the muscular portion of the canal, exerts, by contact, a soothing effect upon the mucous membrane. In consequence of the diminution of the irritation of this membrane, its secretion is probably lessened, as are possibly those of the liver and pancreas. However this may be, opium acts very favourably in profuse secretion from the intestinal mucous membrane. From ½-3 gr. may be given in the 24 hours, the best preparation being the _ext. opii aquosum_.

If opium or morphia do not suffice, it must be aided by astringent remedies, by far the best of which, and the most easily supported, is zinc sulphate. One would have supposed that tannin in its separate state would have proved more useful than zinc, but this is not the case, and it is much less easily borne. It acts much better and more energetically when employed as a household remedy (e.g. as a decoction of sloe or wild pear tree) than in its separated form, and is then of great service in practice among the poor. Alum is of no use whatever in diarrhœa. Lead approaches zinc in efficacy, but still it is less certain than it. The dose should not be greater than ¼ gr., and this may be repeated every 2-3 hours, and at most every hour. If these means do not suffice, we must have recourse to enemata of salep or starch (with which may be combined 1 gr. opium or ½ gr. zinc) not throwing up more than 2 oz. at a time. If the clyster does not cause pain in the rectum, and the disease continues obstinate, the dose of zinc may be increased to 2 gr. Tannin may be added to the enema, but the zinc is far more serviceable. In the most obstinate cases we must have recourse to cauterisation; but this is only the case when there is a diseased condition of the lower part of the rectum. Very obstinate cases of blenorrhœa confined to the anus maybe completely cured by the application of silver nitrate, in substance as high as it can be passed. The injection of a strong solution does not usually attain the same end. (Prof. Skoda.)

A case of chronic diarrhœa, which had lasted for nearly 40 years, was cured by the administration of a saturated solution of salt in cider vinegar, 1 dr. being taken 3 or 4 times a day; it always produces good results.

For cholera, a ready remedy is Dr. Rubini’s tincture of camphor, taken on sugar, not in water. Or 1 teaspoonful cayenne pepper in ½ wine glass brandy.

To stop violent diarrhœa, take 2 drops each brandy and laudanum in 1 teaspoonful water every 3 minutes; go up to 60 doses if necessary.

Dr. Christopher Elliott speaks strongly in favour of the use of camomile tea in infantile diarrhœa. The dose for infants under 1 year is ½-1 dr., and double that quantity for older children, given 2 or 3 times a day, or oftener. The _rationale_ of the action is the power the drug possesses of subduing reflex excitability. This power belongs especially to the volatile oil contained in the flowers.

_Dislocations._--These are distinguished from broken bones by stiffness at the joint, intense pain and swelling. They demand surgical skill and must not be touched by any one but a doctor.

_Ear complaints._--Do not wear anything over the ears which presses upon them. Growths may occur in the ear from the custom of wearing ear-rings, and especially when of base metal, although gold ones sometimes give rise to the same. Such may require removal by the surgeon’s knife. Inflammation may be set up in the lobe after piercing it for wearing ear-rings, should a portion of gristle happen to be transfixed by the needle, and all the more likely should that be a dirty or rusty one. The best thing to do is to bathe it frequently with hot water. The silly habit of pulling children’s ears is very liable to cause disease and injury. Never “pick” the ears with any sharp implement. For removing excess of wax, syringe gently with warm water, softening it first, if necessary, by dropping a little glycerine and water or soda dissolved in water, into the ear for a night or two. Any foreign body (including insects) accidentally getting into the outer ear can generally be removed by dropping a little warm water or salad oil into the ear, and then inclining the head. The popular dread of their getting into the brain is utterly unfounded: the drum head of the ear is an effectual stop. Dr. Jacobi remarks that closing the mouths of infants and children and simply blowing into the nose is often a very valuable method of relieving earache, the cause of the trouble probably being a catarrhal affection of the Eustachian tube. Perhaps even better is the method of inflating the ear by blowing into it gently, while the mouth and nose are held closed, and syringing the ear with warm water. Much harm has been done by putting oil, chloroform, laudanum, the heart of roasted onion, and similarly improper things into the ears of children.

_Eye complaints._--In every case skilled advice should at once be sought. The following remarks relate only to what should be done in urgent cases ere professional assistance can be obtained. In inflammation, simple bathing with water (either cold or tepid as the sensations may direct) is the safest remedy, and no other application should be had recourse to, till sanctioned by the doctor. The practice of applying poultices, common bread and water, bread and milk, tea-leaves, porridge, &c., to an inflamed or injured eye is totally wrong, often endangering the sight. Keeping wet cloths applied to the eye, and bandaging up an inflamed eye, may also be productive of much mischief, and should never be employed without orders.

A particle of foreign matter entering the eye will often produce such a flood of tears that it is soon washed out, especially if the eye be kept closed and not rubbed for a few minutes; but sometimes the irritating substance finds its way under the upper eyelid, and remains fixed there by the pressure of the lid. In some cases plunging the face into cold water and opening the eyes under the water will suffice to remove it, but generally the eyelid requires to be turned inside out, and the offending body picked off with a feather; or the upper eyelid drawn forwards off the eye by means of the eyelashes, and the lower eyelid pushed up under it: when the eyelids are released, the eyelashes of the lower lid will brush over the inner surface of the upper lid, and almost certainly remove any substance that may lodge there. To evert the lid, lay a bodkin or pencil along it, and turn it up by taking hold of the eyelashes about the middle, the patient meanwhile looking down. Should such simple means fail, the eye may be tied up with a pad of cotton wool over it, so as to prevent the eyelid moving till professional advice be secured.

Serious damage is frequently occasioned by lime or other caustic substance getting into the eye. Wash the eye as quickly as possible thoroughly with cold water or vinegar very much diluted with water (say 1 teaspoonful vinegar in 2 oz. warm water), a stream being allowed to course across the opened eye, while any particle of caustic substance that remains should be carefully removed. A drop of castor oil or olive oil applied every half-hour to the inside of the eye will greatly allay irritation. Never bandage or poultice. In all cases of injury the less done at home the better. A light pad of cotton wool applied over the closed lids and kept in position by a handkerchief or a pledget of cotton wool soaked in _cold_ water reapplied _cold_ at least every 5 minutes, may be employed till the doctor comes.

Dr. Louis Fitzpatrick says he has never seen a single instance in which a stye continued to develop after the following treatment had been resorted to: The lids should be held apart by the thumb and index finger of the left hand, or a lid retractor, if such be at hand, while tincture of iodine is painted over the inflamed papilla with a fine camel’s-hair pencil. The lids should not be allowed to come in contact until the part touched is dry. A few such applications in the 24 hours are sufficient. (_Lancet._)

_Hair complaints._--Ladies should undo their hair at night, unplait the hair, and wear it loosely in a net. In this way the nourishment of the hair is duly provided for. Night-caps should always be light. When forced to remain in bed for long periods, through illness, have the hair oiled and combed with a coarse comb daily; if circumstances permit, the head may be washed twice a week with soap and water, warm, lukewarm, or cold, as taste or health directs. In long-continued illness, it is often advisable to cut the hair, so as to reduce its length by about a third, not merely from considerations connected with the cleanliness of the hair, but also that stronger aftergrowth may be encouraged. Few realise the injurious effects of curling-irons and hair-dyes.

Ordinary baldness may be constitutional or local. The former is a matter for the medical man. For persistent daily loss of hair, the following remedy is recommended by Pincus:--15 gr. soda bicarbonate dissolved in 1 oz. water; a little to be well rubbed into the scalp daily, and persisted in. Sir Erasmus Wilson says that a lotion composed of 1 oz. each spirits of hartshorn, chloroform, and sweet almond oil, added to 5 oz. spirits of rosemary, and well rubbed into the roots of the hair after brushing, is effective; it may be used half-strength, diluted with eau-de-cologne. Other lotions are:--(_a_) 2 dr. tincture of Spanish flies, ½ oz. tincture of nux vomica, 1 dr. tincture of capsicum, 1½ oz. castor oil, 2 oz. eau-de-cologne; apply night and morning with a sponge to the roots of the hair after brushing. (_b_) 2 oz. spirit minderus, ½ dr. ammonia carbonate, ½ oz. glycerine, ½ oz. castor oil, 5 oz. bay rum; apply as in (_a_). These will be found serviceable in the treatment of commencing general baldness, where the whole scalp is parting with its hair. Singeing the hair is not of the slightest use for hair stimulation, and the frequent use of the “curling-tongs” cannot but be detrimental to the health of the head-covering. When the hair demands a tonic application, the following--which any chemist will compound--may be tried:--1 oz. tincture of red cinchona bark, 2 dr. tincture of nux vomica, ½ dr. tincture of cantharides, add eau-de-cologne and coconut oil to make up 4 oz.; apply to the roots of the hair with a soft sponge night and morning. Where means are being taken to restore the health in cases of sudden or premature greyness of hair, Dr. Leonard recommends the following application:--2 oz. coconut oil, 3 dr. tincture of nux vomica, 1 oz. bay rum, 20 drops oil of bergamot. Washing with egg yolk is highly commended in such cases.

The common trouble known as dandriff (dandruff) frequently occurs in strumous (scrofulous) individuals who are anæmic (poor-blooded) and have a sluggish circulation, marked by cold hands and feet. Adolescence is its peculiar time of appearance, and chlorotic (greenish skinned) young girls are apt to be annoyed by it. It is an attendant upon chronic debilitating diseases, as rheumatism, syphilis, phthisis, and the like, and comes on after profound disturbances of the constitution, such as fevers and parturition. Dyspepsia and constipation are very common exciting causes or aggravants of the disease. Improper care of the scalp, the use of the fine-toothed comb, and of pomades, hair “tonics,” and hair-dyes will give rises to disorder.