also well to take four grains of quinine night and morning. Instead of laudanum, one-sixth of a grain of morphine, or a full dose of Dover's powder, will serve the purpose equally well. Treated in the beginning, nothing is surer than a perfect cure in from twenty-four to forty-eight hours, but if not effectually treated, it is apt to extend to the larynx and become a severe bronchitis, or eventuate in a chronic, low-grade inflammation of the nasal membrane, called catarrh.

CATARRH.

Catarrh is a name that properly applies to all inflammations or any part of the mucous membrane, such as catarrh of the stomach or of the bladder, but by common usage, unless qualified by another word, has come to mean a chronic inflammation of the nasal mucous membrane. It is a very troublesome disease, and is often very difficult to treat. Patients are frequently seen who have suffered from the disease for years. The inflammation is apt to extend through the eustachian tube to the ears, and sometimes with not only the effect to impair the hearing, but to quite destroy it. The odor is, in bad cases, most penetrating, rendering the patient very offensive to his associates.

Treatment. In the beginning the most effective treatment is that recommended for coryza. Later, tonics should be given. Quinine in two-grain doses, three times a day; laudanum in small doses and iodide of potassium in five-grain doses three times a day. In the beginning powders and solutions snuffed up the nose usually do harm, and it is a question whether they ever do good in any stage. The most effective treatment for a chronic case is, perhaps, a change of climate. Some excellent cures have been known to result from a residence in Northern Wisconsin, or in the region of Lake Superior.

BRONCHITIS.

Bronchitis is an inflammation of the lining membrane of the trachea and bronchial tubes. It may be either acute or chronic. If acute, there will be a slight fever and considerable cough. The treatment should be the same as that advised for coryza.

Chronic Bronchitis usually eventuates from an acute attack. The disease may be of years' standing. Those cases of death of elderly people from exhaustion, attended by cough and expectoration, and accredited to consumption, may usually be put down as bronchitis. Consumption rarely attacks persons after 40 or 45 years of age.

Treatment should consist partly in good living and warm dressing. Any of the bitter tonics, with iron, may be taken, together with some form of opium to relieve the cough. Iodide of potassium in five-grain doses, with two grains of carbonate of ammonia, taken after meals, will be found very useful.

TYPHOID FEVER.

Typhoid Fever is a disease caused by bad sewerage, the odor from old privy vaults, or drinking water contaminated with human excrement, especially from typhoid-fever patients. It is a low grade of fever, which attacks a person but once. It comes on so gradually that it is hard to say when the disease began. It generally runs its course in spite of treatment. Treatment may save a case from a fatal termination, or

reduce its duration to the minimum, which is three weeks. At first the patient complains of fatigue, loss of appetite, mental dullness and lack of interest in his work. There may be diarrhoea. Pulse ranges from 90 to 110 per minute; temperature from 100 to 104 degrees. The skin is dry and of a bronze hue. There may be bleeding from the nose. The tongue will have a brown coat, which, if the patient is not given an abundance of water, will become very dry. The lips and teeth collect a dark brown or blackish, gum-like matter, called sordies. In the second week the patient may become more or less delirious, and, if not closely watched, may get out of bed, in consequence of delusions. It is a common thing for the patient to imagine himself away from home. Little red spots, like fleabites, may make their appearance upon the abdomen. If there has been diarrhoea, the abdomen may become distended with gas. Hemorrhage from the bowels may take place. During the third week any or all of these symptoms may become aggravated.

If the patient does well at the end of the third week, he will begin to improve, the tongue will clean, the skin become moist or wet with perspiration, and the mind perhaps become clear. He has not asked

for anything, but now he may express a desire for food or drink.

The treatment for this disease, in a mild case, is simply good hygienic surroundings and care. On account of the low mental condition, he may not be conscious of his wants. Hence he may never call for water or food.

He should have milk and other nutritious food in such quantities as he can digest, at short but regular intervals.

The bowels will need attention. If there be diarrhoea, some mild astringents may be given, as fluid extract of logwood. If the bowels are distended by gas, spirits of turpentine may be given. If constipation ensue, some mild laxative, as castor-oil, syrup or tincture of rhubarb, or an enema of tepid water, will relieve the symptoms. The temperature and circulation can be controlled, as laid down under the head of fevers in general.

In bad cases any or all of the symptoms may be aggravated, and will need special attention.

Young persons are more likely to recover than persons advanced in life. They are also more liable to contract the disease.

LEAD COLIC.

The lead may be

Lead colic is caused by the poison from lead. taken into the system by many different ways, without the knowledge of the patient. Persons manufacturing paints or working in shot factories or other places where lead is used may be poisoned. Painters are very liable to lead poisoning. Persons have been poisoned by sleeping in a newly painted room, or by using certain face washes and hair dyes which contain lead, or by drinking water which has stood in lead pipes, or beer or cider which has been for some time in contact with a lead faucet, and by many accidental or intentional adulterations of food. Lead poisoning is manifested by various affections of the nervous system, such as paralysis, as of the extensor muscles of the hand, and neuralgias, of which colic, or neuralgia of the intestines, is one.

The bowels are usually constipated. The pain is sometimes dull and heavy, and sometimes sharp and cutting. It usually comes on very gradually, beginning with slight pain, and grows worse until it may be

come very severe. There is seldom entire relief from pain, but there are periods of great increase, when the paroxysms are excruciating. If not relieved by treatment, the pain is likely to continue for days, and perhaps for weeks, and attacks will frequently occur. Persons do not die from lead colic, although they may from other effects of lead poisoning. A blue line along the gums next the teeth is usually present in these

cases.

Treatment should first be given as in ordinary colic. When the pain is relieved and the bowels moved, the following prescription should be taken, which will produce a permanent cure:

Mix.

Iodide of potassium......
Distilled water, ad...............

Dose: As directed.

..1 ounce.

..1 ounce.

The above is a saturated solution. Begin with five drops in a wine glass of water three times a day after meals, and increase one drop each day until the patient is taking twenty-five to thirty drops three times a day.

RHEUMATISM.

Rheumatism is a constitutional disease, characterized by certain local manifestations. These manifestations are due to inflammation, acute or chronic, of the synovial membrane lining the joints, of certain serous membranes, particularly those of the heart, and of fibrous tissue elsewhere in the body. Rheumatism is classified as acute articular rheumatism and chronic rheumatism.

In acute articular rheumatism the lining membranes of the

joints are inflamed. In the course of the disease certain complications involving internal organs are liable to arise. The parts more likely to become affected are the serous membranes, the endocardium and pericardium lining and surrounding the heart.

The attack usually begins suddenly. Sometimes there is a slight amount of fever for a day or two preceding the joint affection; sometimes the pain and tenderness of the joints precede the fever, but usually these symptoms appear together. The disease may attack any joint of the body, and is indeed very seldom confined to one or two. The affected joints are swollen, red and extremely tender. Pain is not so great except when attempting to move, or when disturbed or jarred. The slightest movement causes the most excruciating pain. Swelling is most apparent when the knees, ankles or wrists are the joints involved. The swelling is usually in proportion to the severity of the inflammation. One joint after another generally becomes involved. Sometimes upon attacking a new joint all tenderness and swelling disappear from the joints first involved. The fever ranges in this disease between 102 and 108 degrees. Profuse sweating is a common symptom.

The disease very rarely proves fatal. When it does it is due to the extension of the inflammation to the heart, and the development of pericarditis. Even then the number of deaths during the acute attack is very small, but in the fact that the heart is so frequently attacked lies the danger of the disease, for, as explained under the head of diseases of the heart, the great majority of valvular diseases of the heart are due to endocarditis developed during an attack of acute rheumatism. Usually, however, the lesion of the valves causes no inconvenience until a number U. I.-26

The

of years afterward. The heart is more likely to become involved the more intense the disease. Other organs, such as the pleura, the peritoneum and the membranes enveloping the brain, have been known to suffer inflammation during the attack, but it is extremely rare. head is usually free from pain. The duration of the attack varies from ten days to five or six weeks. There are sometimes relapses. One who has once suffered from acute rheumatism is more liable to subsequent attacks.

Treatment: Nothwithstanding the popularity of salicylic acid, or the salicylate of soda, in the treatment of rheumatism during the last few years, we believe that as much or more may be accomplished by the use of what has been known as the alkaline treatment. The alkali, either bicarbonate of potassa or soda, should be given in full doses, every three or four hours. Lemon juice may be added to the dose and taken while effervescing. As soon as the urine is rendered alkaline (which may be told by testing with litmus paper, which turns to blue if dipped into an alkaline fluid), the dose should be greatly diminished, and taken thereafter only once or twice a day. Tonics are useful. Quinine in two-grain doses may be given. Tincture of aconite applied to the swollen joints often affords relief. Chloroform liniment or soap liniment is used for this purpose. The salicylate of soda is much employed-perhaps at this time more than any other remedy.

Chronic rheumatism differs from the acute variety in the degree of severity of the symptoms, and in their duration. In mild cases the patients are able to go about their work, but suffer more or less pain in the affected joints. In other cases, more severe, the patient is confined to his bed, and frequently, with those about their avocations, there is more or less deformity of the joints.

Treatment: The alkalies may be used in small doses; also the salicylate of soda. Iodide of potassium is sometimes very useful, and in malarious districts quinine is to be employed.

The local applications to the joints here are of more importance than in the acute variety. Tincture of aconite, tincture of iodine and chloroform liniment are very useful.

MALARIAL FEVER.—AGUE.

Intermittent fever is one form of malarial fever. It has cold, hot and sweating stages, with a normal interval following. The patient may go through these stages every day, every other day, or every third day. This disease is caused by decaying vegetable matter. It prevails in new countries, river bottoms, districts which overflow, or in the neighborhood of canals or mill-ponds. It may prevail in houses with bad cellars, or where the sills and floors are in a state of decay. It does not make its appearance while the land is under water, but when the water recedes and exposes the half rotten vegetable matter to the sun. Some physicians suppose this disease to be caused by a microscopic vegetable germ which enters the system, contaminating the blood.

Intermittent fever is not self-protecting nor self-limiting. Some persons are never free from it while they reside in a malarial district. It runs an indefinite course if not checked by remedial agents. If not treated, the blood of the patient becomes impoverished, the lips pale, the skin sallow, the muscles weak and the body emaciated. The spleen becomes large, vulgarly called an ague cake. Some persons may become acclimated, improve, and finally get well without medicine, but the ma

jority would go from bad to worse and die, or become so weak as to have no physical endurance or resistance, and would finally succumb to some other disease which they, in the depraved state of the system, are not able to withstand. The system may become so surcharged with the poison as to cause death from the severity of the chill before reaction or the fever stage comes on. This is what is called a "congestive chill." Every chill is in reality a congestive chill-that is, during the chill some internal organ is congested, or contains an abnormal amount of blood; hence the variety of symptoms during this stage. One may have difficulty of breathing because of congestion of the lungs; another may have pain in the head; another, in the stomach or heart.

Instead of the cold, hot and sweating stages, the patient may have severe periodical pains along the course of a nerve. This constitutes one form of neuralgia. At another time, or another patient, instead of suffering from either chills or neuralgia, may have a periodical diarrhœa, or there may be hemorrhage from some part of the mucous membrane.

Treatment. The night-air contains the malarial poison in greater abundance than that of the day, so that if persons must live in a malarial region, they can lessen the liability to contract disease by being in the house before sunset, and remaining there until after sunrise in the morning. An attack may be induced in some persons by eating anything which is difficult to digest. It becomes those who are susceptible to the influence of this virus to look well to their food.

Some preparation of Peruvian bark enters into almost every formula for the cure of intermittent fever. Sulphate of cinchona is the cheapest, but it is more likely to disturb the stomach. Cinchonidia is cheaper than quinine, and is like it in appearance. It is not as likely to disturb the stomach as the sulphate of cinchona, but more so than quinine. Quinine is more used because it is less irritating to the stomach, though it is of a higher price. Quinine is the king in this realm of remedies. If the interval between the paroxysms is short, we must give larger doses, and closer together. When the paroxysms are farther apart, we can give smaller doses-three or four grains every two hours. We believe we shall have better effect from small doses close together than by giving doses of five or ten grains, four or five hours apart. We need, in ordinary cases, to administer from twenty to thirty grains between the paroxysms. The taste of quinine can be disguised by putting it in cold coffee or tea. few doses of bromo-hydric acid will prevent the disagreeable effects and the ringing in the ears produced by quinine.

A

Occasionally we meet with persons who cannot take quinine. We can use salicine in the same doses as quinine, or a little larger doses even. Arsenic is used in chronic forms of the disease and may be used where quinine cannot be employed.

Nux vomica or strychnine may be used in combination with other remedies.

TYPHUS FEVER.

Typhus fever is a disease arising from the crowding of human beings into a small space, as in emigrant ships, in prisons and in the poorer quarters of large cities. Typhoid fever is produced from human effete matter thrown off from the bowels. Typhus is liable to become epidemic after famine or excessive privation of any kind. When once originated, it is contagious in densely populated districts; thence it may spread to cleaner and more healthy parts of the city.