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Willis Webster Grube.

A compendium of practical medicine for the use of students and practitioners of medicine online

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tubes, (esophagus, posterior nares, larynx, vagina, and rectum
may be involved. The constitutional symptoms are chill, fever,
pain in the head and back, nausea, vomiting, and even convul-
sions. The temperature may be 103° or 104° F., the pulse 120
to 130. The patient's condition grows worse each day. until
about the end of one week, when the membrane is thrown off.
The loss of tendon reflex often occurs as early as the first, sec-
ond or third day. It is a symptom of diagnostic value. Dr.
McDonnell made the following statement: "Knee-jerk is absent
from the very first day of the illness, in many cases of diph-
theria.' 1

Symptoms which indicate danger: 1. Diarrhoea may cause
exhaustion. 2. Nausea and vomiting coming on late in the dis-
ease. 3. Albuminuria, and coma may occur as a result of the



152 A COMPENDIUM OF PRACTICAL MEDICINE.

nephritis. 4. An irregular and intermittent pulse throughout
the entire course of the disease. 5. If the temperature falls to
the normal, or below, and the exudation shows no sign of ex-
foliating. 6. Convulsions occurring late in the disease.

Sequelae. — After the exudation disappears and convalescence
is apparently established, sequelae may develop, which may con-
tinue for months, and even years. The commonest is paralysis
of some of the voluntary muscles ; the muscles most frequently
affected are those of the soft palate and pharynx. There is diffi-
culty in swallowing and inability to articulate clearly. As the
pharyngeal paralysis is disappearing — or from two to ten days
after — the muscles of the lower or upper extremity may be in-
volved. Before the occurrence of the paralysis there will be a
sensation of coldness, pricking, crawling and numbness in the
part about to be affected. There maybe paralysis of any muscle.
Paralysis of the heart may occur. Diphtheritic paralysis is
always entirely recovered from. These paralyses may follow the
mildest as well as the more severe cases. In mild cases its dura-
tion is two or "three weeks, while in others it has continued one
or two years. Other sequels are nephritis and, endocarditis
(Loomis).

Differential Diagnosis. — The diagnosis of diphtheria rests on
the presence of a membranous exudation. Ordinary sore throat
or catarrhal pharyngitis is sometimes confounded with diphtheria.
Membranous croup is a local affection, while diphtheria is a con-
stitutional disease. Croup is not contagious or inoculable, while
diphtheria is markedly so. In croup the exudation is on the
surface of the mucous membrane; in diphtheria it is in its sub-
stance as well as on its surface. The submaxillary glands may
be, and often are, enlarged in diphtheria, but never in croup.
An erythematous eruption sometimes makes its appearance on
the upper part of the chest and back in diphtheria (Loomis).

Prognosis. — Death rate is from twenty to fifty per cent.
Duration varies from three to fourteen days. Cases that are
apparently doing well sometimes terminate very unexpectedly
and suddenly by paralysis of the heart. Complications make
the prognosis more unfavorable. Death may occur from diph-
theritic blood-poisoning.



DIPHTHERIA. 153

Treatment. — The patient should be kept in bed, and the
room well ventilated, and have a temperature of 70 to 75 degrees.
The patient should be kept scrupulously clean. Hot poultices
should be applied externally to the throat ; steam inhalation
should be constant fiom the onset of the disease, until the exuda-
tion has disappeared ; iron and brandy should be given freely;
and the diet should be fluid, milk preferably (Loomis). Accord-
ing to Bartholow, a solution of lactic acid — strong enough to
taste sour — frequently applied by means of a mop, gives excel-
lent results. He also recommends highly the inhalation of the
vapor, as it arises from the slacking of lime. The false mem-
brane may be dissolved by very frequent inhalations of atomized
lime-water and lactic acid. Bartholow gives the following to
prevent systemic infection:

Jfc Liquor iodi comp 3ij.

Acidi carbolici oj — M.

Sig. : One-fourth of a drop to two drops in water every four
hours. Also, moderate doses of whiskey or brandy for the same pur-
pose.
He also recommends iron, quinine, strychnine, galvanism
and faradism for the paralytic affections of diphtheria. As a
solvent for the false membrane, Dr. J. L. Smith recommends the
following :

Jfc Olei eucalypti oij-

Sodii benzoat oj •

Sodii bicarbonatis oij-

Glycerines Sij •

Aquas calcis... 0. j. — M.

Sig.: To be used with the hand atomizer from three to five
minutes every half hour, or with the steam atomizer almost con-
stantly.

PRESCRIPTIONS FOR DIPHTHERIA.

{& Papayotin 5j.

Aquas 5iv.

Glycerinas 5 viij . — M.

Sig.: Apply locally to membrane. — Jacobi.

fy Trypsin gr. xxx.

Sodii bicarbonatis gr. x.

Aquse destillatse 5j. — M.

Sig. : Apply locally to membrane. — Fernald.



154 A COMPENDIUM OF PRACTICAL MEDICINE.

|Jr Acidi carbolici gtt. x.

Liq. ferri subsulph oiij-

Gtycerinae 5j. — M.

Sig. : To be applied every three to six hours with a camel's hair
brush. — J. Lewis Smith.

JJ- Tincturse ferri chloridi oii-iij-

Potassii chlorat 3j.

Acidi muriatic! dil ...gtt. x.

Syrupi simplicis oiv. — M.

Sig.: A teaspoonful every hour or two. — J. Lewis Smith.

DIPSOMANIA.

Is a term commonly applied to an uncontrollable desire for
alcoholic drinks. In cases of dyspepsia there may be a morbid
craving for alcohol. The habitual drunkard feels a desire for
continued indulgence, and lacks moral strength enough to govern
an acquired appetite which represents a morbid condition. Dip-
somania is to be treated as a disease of body and mind. The
treatment consists in withdrawing the patient from the use of
alcohol in any form, and in the employment of medicinal and hy-
gienic measures. This morbid craving for alcohol is the sad
inheritance from drunken parents (Flint). According to Ringer,
ten -minim closes of tincture of capsicum obviate the morning vom-
iting, remove the sinking at the pit of the stomach, the intense
craving for stimulants, and promote appetite and digestion in
dipsomaniacs.

PRESCRIPTIONS FOR DIPSOMANIA,

J$r Tincturae capsici IRx.

Potassii bromidi gr. x.

Spiritus ammonias 3j- — M.

Sig.: This to be taken at one dose, and repeated several times
daily.

Jfc Tinctures gentianae comp

Tincturae columbas comp...aa Sij-

Tincturae nucis vomicae... ilt.Lxxx. — M.

Sig. : A dessertspoonful before each meal. — Loomis.



DIET-EATING DEOPSY. 155

DIRT=EATING.

Is a morbid habit which heretofore prevailed to a consider-
able extent among the plantation negroes of the Southern States.
The kind of earth selected is loam or clay. According to Dun-
can, a very common disease among negroes on plantations is a
state of anaemia, very often attributed to the pernicious habit of
dirt- eating. Almost every large j3lantation has three or four
such cases. With negroes, dirt- eating proceeds from the same
propensity which leads white females to resort to chalk, mag-
nesia, and slate pencils, etc., in order to relieve a disordered acrid
condition of the stomach. Discover and treat the cause (Flint).

DROPSY.

Is an abnormal collection of watery fluid in the areolar
tissue, or in the serous cavities of the body. Dropsy is not a
disease, but a symptom. It is associated with various disorders.
Dropsies may be external or internal. To internal dropsy be-
long hydrocephalus, or dropsy of the brain, hydrothorax, or
dropsy of the chest, and ascites, or dropsy of the abdomen. Ex-
ternal dropsies are illustrated by anasarca and oedema: the first
is a universal accumulation of serous fluid in the areolar tissues;
the second, a localized collection in the same tissue, differing in
nothing but extent. Both exhibit painless swelling of the sur-
face, devoid of redness; a skin often stretched and shining,
pitting upon pressure, and both, if punctured, allow a watery
fluid to run out. (Edema is most commonly perceived around
the ankles. Anasarca is usually dependent upon disease of the
kidneys, or of the heart. The swelling ordinarily begins at the
feet and ankles in diseases of the heart, in the face in disease of
the kidneys. (Edema may be due to the same causes, or the
cause may be purely local, as when we see oedema happening if
a bandage be applied too tightly, or if swollen glands press
upon the main vein of a limb. We see oedema in venous inflam-
mation, in milk-leg, or as a sequel of typhoid fever, in conse-
quence of the blocking up of the femoral vein by coagulum. In
these cases, the oedema is one-sided. A circumscribed oedema,



156 A COMPENDIUM OF PRACTICAL MEDICINE.

also accompanies erysipelas of the .skin. Another source of
double-sided oedema is anaemia (DaCosta).

Causes of General Dropsy. — The most common are diseases of
the heart, of the kidneys, or of the liver. Cardiac dropsy begins in
the feet and ankles. Renal dropsy is usually much more general
than cardiac, and does not, like cardiac, begin in the most de-
pendent parts, but is often first noticed in the face and eye -lids.
The proof that dropsy is renal is furnished by the presence of
albumin and casts in the urine. The most usual kind of dropsy,
dependent upon an affection of the liver, is abdominal dropsy
(DaCosta).

Dropsies may be divided into three classes : Inflammatory,
mechanical, and cachetic or hydrsemic. Inflammatory dropsy is
due to a moderate degree of inflammatory alteration in the coats
of the blood vessels, and produces collateral oedema. Of this
nature are cases of oedema glottidis, of hydrocele, and of hydro-
cephalus.

Mechanical dropsy is the result of some obstruction to the
current of blood in the veins. The most frequent of the
mechanical causes of general dropsy is valvular diseases of the
heart.

Hydraemic or cachectic dropsy is the result of an impover-
ished and abnormally watery state of the blood. The most
important cause of hydraenric dropsy is Bright's disease.

PRESCRIPTIONS FOR DROPSY.

J& Spiritus chloroformi HI xx.

Tinctune digitalis ITC.x.

Infusi buchu Sj. — M.

Sig. : To be taken three or four times daily, and followed by a
good drink of water. (In renal dropsy.) — Fothergill.

Jfc Infusi digitalis si v.

Sig.: A tablespoonful two or three times daily. — Bartholow.

J& Potassii bicarbonatis gr. x.

Ferri et amnion, citrat gr. v.

Tincturas digitalis ITT x.

Infusi buchu sj. — M.

Sig.: To be taken three times daily. (In cardiac dropsy with
gouty tendency or debility. — Fothergill.



DYSENTERY.- 157

DYSENTERY.

Called also " bloody flux," is an ulcerative colitis. It is a
disease characterized by tormina, tenesmus, mucus, and mucus
and blood stools, burning pain, with more or less constitutional
disturbance (Bartholow).'

Causes. — It occurs in both sexes and at all ages. Sudden
arrest of perspiration by exposure to cold and dampness is one
of the. most common causes. It occurs in late summer and
autumn and in warm rather than in a cold climate. It is preva-
lent in malarious regions. Impure air and water, bad or insuffi-
cient food are causes (Bartholow).

Symptoms. — In the epidemic form, dysentery may begin
suddenly, but in the other forms it conies on gradually. There
is more or less catarrh of the intestines, diarrhcea, chilliness,
fever, and a feeling of malaise. In two or three days, pain in
the descending colon is felt. It is described by the term tor-
mina — "colicky pains." There is pain of a burning character in
the rectum, with the sense of the presence of a foreign body, and
with the desire to strain for its expulsion. Nothing comes away
but mucus, either alone or tinged with blood. The tenesmus con-
tinues. There may be ten to fifty stools daily. The patient
becomes weak early. His skin is dry, harsh and wrinkled, his
pulse small, quick and feeble. The discharges emit a horribly
fetid odor. In the severe cases, the patient passes into the stage
of collapse, the jmlse ceases at the wrist, hiccough comes on, the
skin is covered with a cold sweat, the hands become cold and
livid, the face is shrunken, the eyes deeply sunk, and the voice
husky. In mild cases convalescence is established about the
eighth day. In the more severe cases, the duration is more pro-
tracted (BartholoAv).

Prognosis. — Is good in mild cases, but in severe cases bad.

Treatment. — 1. Food. If the stomach is irritable, milk, with
one-fourth lime- water, is the best food. If the digestion remains
good, the patient can take milk, eggs, beef-juice, ice-cream,
boiled custard, oyster- soups, mutton, chicken and beef -broth.
Where there is much depression of the powers of life, egg-nog
may be freely given. 2. Medicine. According to Bartholow,.



158 A COMPENDIUM OF PRACTICAL MEDICINE.

the sulphate of magnesia in solution with dilute sulphuric acid
is entitled to the first j3lace as a remedy. It must be given in
laxative doses, early. It serves a triple purpose : it empties the
canal of retained faeces, it lessens hyperemia by setting up an
outward diffusion ; its after effect is astringent and sedative.
Ipecac is an excellent remedy, and must be given in the first
stage, before the mucous membrane is stripped off, and in scruple
to drachm doses, every four to six hours. The first doses empty
the stomach, and the following ones produce copious bilious
evacuations, called "ipecac stools.' 1 The utility of ipecac ceases
when these stools are produced. It is best given in milk in
twenty grain doses with aromatic powder added. Castor- oil, in
purgative doses, in the first stage is very efficient. After the first
stage is passed, an emulsion of oil (almond oil) and turpentine
combined with opium is very serviceable. When destruction of
the mucous membrane is beginning, the most effective remedies
are corrosive sublimate, sulphate of copper, sulphate and oxide
of zinc, acetate of lead, bismuth, arsenic, etc. Of this list, sul-
phate of copper and arsenic, combined with opium, are most
effective. One drop of Fowler's solution and five to twenty
drops of deodorized tincture of opium, every three hours, gives
excellent results. One-twentieth of a grain of sulphate of copper
with one- eighth of a grain of morphine every three hours is good
treatment (Bartholow). Bismuth in large doses (gr. xxx.-xl.)
every four hours with carbolic acid is 2-ood. Excellent results
are obtained by washing out the bowels with warm water. Very
great relief is affected by the injection of starch and laudanum.
Eight ounces of a strong solution of silver nitrate (gr. xx. to the
ounce), thrown into the sigmoid flexure, is effective. Morphine
hypodermically is effective.

External Applications. — The cold, wet jDack, the ice-bag, but
generally hot applications afford more relief. The turpentine
stupe is useful. If collapse comes on, active stimulation is neces-
sary.



DYSE^TEEY DYSMEISTOREHCEA. 159

PRESCRIPTIONS FOR DYSENTERY.

Jfc- Tinctura? opii deodorat 3ss.

Bismuth subnitrat 3ij.

Aquse mentbse pip

S yrupi zingiberis — aa §j . — M.

Sig. : Shake bottle. Give one teaspoonful every two to four
hours, to a child five years old. Half dose for a child one year old.

— Smith.

J£ Vini ipecac §ss.

Sig. : One drop every hour. (In acute or chronic form of chil-
dren, with slimy stools.) — Ringer.

{$r Piumbi acetat gr. xxiv.

Pulv. ipecac gr. iij.

Pulv. opii gr. iij. — M.

Ft. massa et in pil. no. xii. div.
Sig. : One pill every two hours until blood ceases, then at longer
intervals. — DaCosta.

Jfc Hydrargyri chloridi mitis..., 3j.

In pulv. no. vii. div.
Sig.: A powder two or three times daily. (In epidemic form.)

—Hull.

Jfr Cupri sulphatis gr. ss.

Magnesii sulphatis sj .

Acidi sulphurici dil 3j.

Aqua? §iv. — M.

Sig. : A tablespoonful every four hours. (In acute form.)

— Bartholow.

DYSMENORRHCEA.

Is painful menstruation. At the menstrual period women
normally feel unwell, have a few vague pains in the loins, and
an irritable temper.

Varieties and Causes. — 1. Neuralgic or sympathetic dysrnen-
orrhoea is seen in nervous or hysterical women, and is accom-
panied by neuralgia in other localities. 2. Congestive or inflam-
matory dysmenorrhea occurs where there is excessive congestion
of the uterus and ovaries from any cause. 3. Mechanical or
obstructive dysrnenorrhcea is due to some cause which mechani-
cally obstructs the outflow of blood, as stenosis of the os uteri,



160 A COMPENDIUM OF PRACTICAL MEDICINE.

or sharp flexions. 4. Membranous dysmenorrhea is sometimes
associated with endometritis. 5. Ovarian (Pozzi).

Symptoms. — Pain occurs preceding, during, or following the
menstrual flow. In the mechanical, the pain occurs with the
appearance of the flow, and consists of a series of uterine cramps
due to the effort of the uterus to expel blood clots from its in-
terior. In the congestive, the pain precedes the flow, and is re-
lieved when the latter becomes free. In the neuralgic, the pain
is referred to the hypogastrium, left ovarian, and intercostal
regions. It often occurs in the intermenstrual period, but is
always aggravated at the time of the sickness. In the membran-
ous, the pain lasts throughout the period, and until the expulsion
from the uterus of the more or less complete membranous cast.

Treatment.. — In the mechanical or obstructive, dilate the sten-
osis, correct the flexion, and prevent its recurrence. In the con-
gestive, give saline laxatives, hot foot- and sitz-baths, vaginal in-
jections, and ergot, with bromide of potassium. Instead of the
ergot and bromide, fifteen to twenty grain doses of phenacetine
every six to eight hours may be given. In the neuralgic, let the
patient exercise in the open air, and give, iron, quinine, and
other tonics. Pozzi has found the tincture of pulsatilla, given
some days before the period, in five -drop doses, three times daily,
quite efficient in the neuralgic form of young women. In the
membranous, dilatation of the cervix just before the menstrual
period, is sometimes effective. In the ovarian type, the bromides
are the most serviceable. In any variety, where the pain re-
quires it, potassium bromide and chloral may be given, with
mustard plasters applied. As palliative treatment for the pain,
give asafceticla, musk, tincture of cannabis indica, belladonnae or
hyoscyamus. Oxalate of cerium has been extolled. Wylie
praises electricity, he inserts the positive pole in the cervix.
Laudanum and valerian douches often afford relief when all
other remedies fail. Nitro- glycerine and amyl nitrite are excel-
lent for spasmodic cases (Pozzi).



DYSMENORRHEA DYSPEPSIA. 161

PRESCRIPTIONS FOR DYSMENORRHEA,

R Tincturse cardamonii comp 5ss.

Spiritus chloroformi ZTT.xx.

Liq. ammonii acetatis ^ss.

Tincturse belladonna? ITC.x.

Aquse cinnamomi q. s., ad oj- — M.

Sig. : For one dose. (In congestive and spasmodic). — Pozzi.

R Liq. ammonii acetatis £iv.

Sig. : A tablespoonful every two or three hours, with the fol-



lowing:

R Pulv. ipecac gr. iv.

In pil. no. xii. div.
Sig. : One every two or three hours. — Emmet.

R Extracti opii gr. v.

Extracti cannabis indica

Extracti byoscyami aa gr. x.

Pulv. Camphora? gr. xxv. — M.

Ft. massa et in pil. no. x. div.
Sig.: A pill two or three times daily. — McLane.

DYSPEPSIA.

Is difficult or painful digestion. It is usually chronic. A
disordered digestion, lasting for a short time, is called indiges-
tion.

Causes. — Dyspepsia is often an inherited condition. It may
result from a deficiency in the quantity of gastric juice secreted,
due to exhausting discharges, venereal excesses/ masturbation,
leucorrhoea and phthisis, and from the excessive use of narcotics,
the tannin of tea, and the nicotine of tobacco. It may result
from an excess in the gastric secretion, due to chronic hepatic
and cerebral diseases, and to gout. It may result from a change
in the quality of the gastric juice, due to ulcer and cancer of the
stomach, gout, rheumatism, diseases of the kidneys, uterus and
gall-bladder. Dyspepsia may result from pressure on the stom-
ach by tight lacing, from positions assumed by shoemakers,
needlewomen, writers, etc. It may result from mental emotion,



162 A COMPENDIUM OF PRACTICAL MEDICINE.

prolonged mental labor, anxiety, deficient or excessive physical
labor, excess of starchy food, or from deficiency of meats, badly
cooked food, too rapid eating, etc. (Loomis).

Symptoms. — The most constant s}'mptom is an abnormal
appetite; it may be lost, increased, or perverted. There is a
weight, dull pain, and a sense of burning in the epigastrium
after the ingestion of food, accompanied by flatulence, heartburn,
gastralgia, constipation or diarrhoea, a dull headache, and languor.
Indiscretion in eating or drinking is apt to bring on an attack of
sick headache. There is frequently a bitter taste in the mouth.
In some dyspeptics the breath has a very offensive odor. Py-
rosis, palpitation, dyspnoea and a severe pain referred to the
heart (which makes the patient think he has heart disease), may
be present. In some cases there is ringing in the ears, spots
before the eyes, and vertigo. When in any case the dyspepsia
has lasted a long time, chronic gastric catarrh will almost always
be developed (Loomis).

Prognosis. — Dyspepia in most cases can be cured, but the
cure depends for the most part on the will of the patient.

Treatment. — First, if possible, remove the cause. When the
gastric juice is deficient in quantity, hydrochloric acid and pepsin
are indicated. The vegetable bitters are efficient in these cases,
and may be combined with alcoholic stimulants. When acid
risings occur after ingestion of food, and are due to active fer-
mentation, the sulphite of soda, or salicylic acid immediately
after meals may prevent such changes. Saline waters will aid.
When there is great irritability of the stomach, bismuth acts
almost as a specific, and should be given in twenty grain doses
before eating. Creosote, codeia, oxalate of cerium, and morphia
may be employed to arrest vomiting. Dyspeptics should never
wear corsets or belts about the abdomen. They should retire
and rise early, eat slowly, and masticate well. No mental or
phvsical work should be performed directly after or before
eating. Horseback riding and walking in the open air should
be insisted upon. A change of scene and climate works rapid
cures in many instances. Dyspeptics should take a cold sponge -
bath morning and evening (Loomis). A small quantity of acid
wine at dinner is a good stimulant to the digestive function. A



DYSPEPSIA. 163

moderate dose of whiske} T , taken before nieals, is a capital remedy
to promote the appetite and the digestion (Bartholow).

PRESCRIPTIONS FOR DYSPEPSIA.

R Ammonii salicylates 5ij-

Syrupi aurantii cort §j.

Aquae mentha? pip ad 5iv. — M.

Sig. : A tablespoonful half an hour before meals. (In fermentative
dyspepsia.) — Sullivan.

R Tincturse capbici IH.xvj.

Tinctura? nucis vomica? •■3 1 j-

Tinctura? gentiana? comp ad...3ij. — M.

Sig. : A teaspoonful in water three times daily, with i gr. aloin
at bedtime, avoiding starchy diet. (For aggravated dyspepsia with
constipation.) — DaCosta.

R Bismuthi subnitratis

Sodii bicarbonatis

Pul v. cubebse — aa 3j .

Pulv. zingiberis gr. xx. — M.

In pulv. no. xii. div.
Sig. : A powder in a wineglassful of water before each meal.

—Clark.

R Tincturse opii deodorat gtt. xij.

Magnesii calcinat gr. xij.-xxiv.

Sacchari albi oj-

Aqua? anisi §iss. — M.

Sig.: Shake bottle. One teaspoonful every two hours to a child
one year old, until relieved. — J. Lewis Smith.

R Bismuthi subnitratis...., ^iss.

Mucil acacia? §j.

Sodii bicarbonatis giss.

Infusi calumba? ad oviij. — M.

Sig.: Two tablespoonfuls before meals. (Irritative dyspepsia
with raw tongue.) — Fothergill.

Buttermilk- cure may be substituted for the milk- cure in
cases of stomach disease (Bartholow).

Actaea (cimicifuga) is recommended for the dyspepsia of
drunkards.



164 A COMPENDIUM OF PRACTICAL MEDICINE.

DACTYLITIS. (Syphilitic).

Is guininy in character, and hence belongs to the later stages
of syphilis. It is a rare affection. The swelling usually termin-
ates abruptly, and is sometimes very great. There is no com-
plaint of pain. The skin is natural or bluish from venous
obstruction.

Treatment. — Is that of tertiary syphilis.

DANDRUFF. (See Pityriasis).

DERBYSHIRE NECK. (See Goitre.)

DROWNING.

Remove from the mouth and nostrils all obstructions to the



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