The practice of medicine

Front matter

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Preface

The aim of this book is to present to the physician the most practical way of treating disease by medicinal and hygienic methods. To do this I have drawn upon my experience as a general practitioner for forty years : and upon the experience and observation of my colleagues of all schools of practice, so far as I believed them trustworthy. I entertain the broad belief that while the law of Similia is the chief guide in the selection of drugs, there are other methods of cure which should not be neglected. TThile I believe the application of the law of Similars is very wide, I know that it has its limitations ; that remedial medicaments which act chemically and physiologically cure some diseases promptly and safely. In the light of our present knowledge of ferments and micro-organisms, we know that many diseases require medicines which destroy the germs which are the cause of diseases ; and that unless such agents are used conjointly with strict aseptic measures the most carefully chosen medicines are powerless to cure.

It is my conviction that the physician who selects his remedies in accordance with the law of Similia, and by their primary symptoms alone, narrows his therapeutic resources, and deprives his patients of means of cure which it is his duty to apply. By clinging to one and rejecting all other methods of cure, the physician fails in his duty to his patients.

If I have quoted freely from writers of all systems of practice, I have done so because I have desired to give the best information at present attainable, and I have been careful to give due credit to all authorities.

This is an era of preventive medicine. The physician who previii. PREFACE.

vents disease is worthy of equal, if not more, honor than one who

cures. Therefore I have made hygiene as prominent as medicinal

therapeutics. In relation to dose, I have left the size and repetition

to the individual experience and observation of the practitioner,

except in cases where my own experience warranted me in giving

explicit directions. My conviction is that any dose, from the crude

drug to the most minute particle of a drug, may prove curative.

There is no fixed law regulating dose, and there never will be.

The best criticism I desire for this book and myself is that I

have been honest, liberal, and conscientious.

E. M. H.

Chicago, March 1, 1894.

No. 65 East Twenty-second street.

CONTENTS,

PAGE.

Chapter I. Fevers

Ephemeral Fevers 1

Malarial Fevers 2

Simple Intermittent 2

Remittent 10

Pernicious 11

Typho-malarial 14

Typhus Fever 15

Relapsing Fever 16

Dengue Fever 16

Typhoid Fever 17

Sewer-gas Fever 28

Rocky-Mountain Fever 32

Yellow Fever 35

Chapter II. Infectious Eruptive Fevers

Small-pox (Variola) 37

Varioloid . 39

Varicella (Chicken-pox) 39

Scarlet Fever 40

Rubeola (Measles) 46

Epidemic Roseola 51

Chapter III. Specific Infectious Diseases

Diphtheria 53

Erysipelas 63

La Grippe 67

Whooping-cough 72

Parotitis 76

Idiopathic Parotitis (Mumps) 76

Symptomatic Parotitis 78

Carbuncle 78 x. CONTENTS.

Tetanus 80

Syphilis • 83

Dysentery 85

Cholera Asiatiea ' 95

Tuberculosis, Scrofula, Phthisis 107

Acute Tuberculosis 110

Scrofula (Tuberculosis of the Lymph Glands) 110

Pulmonary Tuberculosis Ill

Gonorrhoea 135

Chapter IV. Constitutional Diseases

Rheumatism 139

Anaemia 146

Primary Anaemia 147

Secondary Ansemia 148

Corpulency 162

Mal-nutrition, Emaciation, Leanness 171

Diabetes Mellitus 174

Diabetes Insipidus 191

Myalgia 194

Gout 196

Diseases of the Thyroid Gland . » 201

Acute Inflammation 201

Congestion or Engorgement 201

Goitre (Bronchocele) 202

Myxcedema 207

Septicaemia 209

Pyaemia 210

Purpura 212

Haemophilia 216

Scurvy (Scorbutus) 217

Infantile Scurvy 218

Osteomalacia 223

Rickets 227

Furuncle 237

Chapter V. Diseases Of The Respiratory System

Acute Coryza 239

Chronic Coryza 242

Hay Fever 254

CONTENTS. xi.

Cough 258

Hypersesthetic Pharyngitis 268

Acute Laryngeal (Edema 271

Nasal Stenosis 273

Epistaxis 276

Laryngitis Stridulosa 277

Acute Catarrhal Laryngitis 280

Chronic Laryngitis 282

Membraneous Laryngitis 284

Bronchial Spasmodic Asthma 292

Bronchitis 305

Acute Catarrhal Bronchitis 306

Chronic Bronchitis 307

Diseases of the Ltfngs 325

Congestion of the Lungs 325

(Edema of the Lungs 328

Hemorrhage from the Lungs 330

Broncho-pneumonia (Capillary Bronchitis) ......... 336

Pneumonia 342

Gangrene of the Lungs 349

Emphysema 350

Abscess of the Lungs 352

Diseases of the Pleura 353

Chapter VI. Diseases Of The Digestive System

Diseases of the Mouth 361

Stomatitis • 361

Diseases of the Salivary Glands 364

Diseases of the Tonsils 365

Diseases of the (Esophagus 369

Diseases of the Stomach 370

Acute Gastritis 370

Chronic Gastritis 372

Dilatation of the Stomach 382

Neurosis of the Stomach (Gastralgia) 384

Hemorrhage from the Stomach 387

Ulcer of the Stomach and Duodenum 389

Cancer of the Stomach 394

Diseases of the Intestines 396

Catarrhal Enteritis (Diarrhoea) 396

Diarrhoea of Children 401 xii. CONTENTS.

Diseases of the Intestines — Continued.

Acute Dyspeptic Diarrhoea 401

Cholera Infantum 405

Appendicitis 408

Membraneous Colitis 416

Constipation 418

Intestinal Obstruction 424

Diseases of the Rectum — Non-surgical 426

Hygiene of the Rectum 427

Hemorrhoids, Piles 432

Internal Hemorrhoids 434

Procidentia Recti 437

Fissure and Ulcer of the Rectum 440

Diseases of the Sacculi Horneri 444

Diseases of the Rectal Papillae 447

Proctitis 447

Proctalgia • 450

Pruritus Ani 450

Diphtheria of the Rectum 453

Peritonitis 453

Ascites 456

Diseases of the Liver 458

Functional Disorders 458

The Action of Medicinal and Other Substances on the Liver . . . 464

Lithsemia 474

Increased Secretion and Expulsion of Bile 487

Biliousness 490

Congestion of the Liver . . . , 505

Hepatic Congestion in Children 511

Jaundice without Obstruction 512

Icterus (Jaundice) 518

Gall-stones 526

Acute Hepatitis 547

Cirrhosis of the Liver 550

Fatty Liver 552

Cancer of the Liver 553

Diseases of the Pancreas 553

Acute Pancreatitis . . , 554

Suppurative Pancreatitis 555

Diseases of the Spleen 560

Congestion 560

Inflammation 563

Splenalgia 565

Hypertrophy of the Spleen 566

CONTENTS. xiii.

Chapter VII. Diseases Of The Urinary System

Diseases of the Kidneys 569

Nephralgia 569

Congestion of the Kidneys 570

Hematuria 571

Hemoglobinuria 575

Nephrolithiasis (Renal Calculus) 576

Nephritis (Bright 's Disease) 585

Acute Diffuse Nephritis 585

Chronic Parenchymatous Nephritis 589

Chronic Interstitial Nephritis 591

Pyelitis 619

Uramiia 622

Diseases of the Bladder 624

Acute Cystitis 624

Chronic Cystitis 628

Vesical Disorders of Women 638

Irritable Bladder and Urethra 642

Incontinence of Urine 647

Retention of Urine 654

Acute Inflammation of the Prostate Gland 656

Chronic Inflammation of the Prostate Gland 661

Hypertrophy of the Prostate Gland 666

Atrophy of the Prostate Gland 676

Chapter VIII. Diseases Of The Circulatory System

Inflammations of the Heart 680

Pericarditis, Endocarditis, Myocarditis 680

Chronic Valvular Diseases 683

Aortic Incompetency 684

Aortic Stenosis 687

Mitral Stenosis 689

Hypertrophy and Dilatation 690

Essential Paroxysmal Tachycardia 691

Persistent Tachycardia 701

Bradycardia 724

The Senile Heart . 731

Pain in the Heart 746

Angina Pectoris 749

The Heart in Pneumonia 756 xiv. CONTENTS.

High Arterial Tension 768

Low Arterial Tension 779

The Pulse 787

What the Pulse Really Is 788

The Action of the Heart 791

Mode of Feeling the Pulse 793

Irregular Pulse 799

Intermittent Pulse 801

Diseases of the Veins 803

Phlebitis 803

Thrombosis of the Veins 804

Dilatation of the Veins (Varix) 807

Embolism , 812

Thrombosis of the Heart and Arteries 813

Arterio-Sclerosis 814

Geography of Heart Disease 821

!Non-medicinal Methods of Treating Diseases of the Heart 826

Sehott's Method of Treatment of Chronic Diseases of the Heart .... 828

Chapter IX. Diseases Of The Nervous System

Laryngismus Stridulus 832

Paralysis Agitans 834

Chorea 837

Cardiac Chorea 847

Chorea in Pregnancy 847

Epilepsy 850

Hysteria 857

Neurasthenia 862

Insomnia 871

Sunstroke 880

Diseases of the Brain and Nerves 884

Irritation of the Brain 884

Cerebral Hyperemia 886

Cerebral Anaemia 891

Headache 896

From Cerebral Hyperemia 901

Sympathetic Headache 902

Bilious Headache 905

From Eye Strain 907

Nervous Headache 909

Toxsemic Headache 912

Cerebral Hemorrhage 915

CONTEXTS. xv.

Diseases of the Brain and Nerves — Continued.

Tumors of the Brain 917

Meningitis, Acute-Simple 919

Meningitis, Cerebro-Spinal 922

Spinal Hypereemia 929

Spinal Anaemia , . 931

Neuralgia 936

Cervico-occipital ' 944

CerYico-brachial 944

Intercostal 946

Lumbar 949

Sciatic 951

Neuritis 958

Localized Neuritis 959

Multiple Neuritis (Polyneuritis) 960

Alcoholic Neuritis 964

Lead and Arsenic Neuritis 965

Endemic Neuritis (Beri-Beri) 966

Neuromata 967

Myelitis 967

Myelitis, Acute, of the Anterior Horns 969

Multiple Sclerosis of the Brain and Spinal Cord 973

Chronic Diffuse Meningo-Encephalitis 974

Chronic Degenerations of the Spinal Cord 978

Locomotor Ataxia (Tabes Dorsalis) 978

Primary Spastic Paraplegia 984

Ataxic Paraplegia 985

Hereditary Ataxia 987

Pellagra 988

Progressive Spinal Muscular Atrophy 989

Bulbar Paralysis 992

Pseudo-Hypertrophic Muscular Paralysis 993

Syringo Myelia 996

Tumors of the Spinal Cord 997

Spina Bifida 997

Nerve Vibration 998

Chapter X. Intestinal Parasites

Ascaris Lumbricoides 1004

Oxyuris Veraiicularis 1008

Tape- Worms and Cyst "Worms 1012

THE

PRACTICE OF MEDICINE.

Chapter I Feyers

EPHEMERAL FEVER.

This fever, sometimes called " simple," is a non-specific fever, either remittent or continuous, which runs its course in a few days, and terminates in a rapid convalescence ; presenting no characteristic lesion, and seldom any premonitory symptoms, its access being sudden. It may be caused by mental emotions, by extremes of heat and cold, by excessive mental and physical fatigue. It may last a few days, or a few weeks ; and it is impossible to predict, in the beginning, whether the fever is simple, or has a specific cause. Not until indications of some local lesion occur, can we make a diagnosis. It is often remittent, the temperature being nearly normal in the morning, and rising to 103° or 105° F. in the evening. If it occurs in a malarial region, and during the months when malaria obtains, it may be confused with miasmatic fever.

Treatment. — If the patient is robust and strong, little or no food is necessary ; only plenty of cool pure water, a cool well- ventilated room, and cool or warm sponging. To weakly patients, gruels, broths, fresh milk, or wine-whey, may be given. If there is a suspicion of noxious matter in the digestive tract, it should be removed by an enema, aided by a simple laxative, like seltzer aperient, congress water, or phosphate of soda.

Aconite is sufficient in nearly all cases, particularly if there is anxiety, dry heat, and a small hard pulse ; or if the fever is due to fright or mental excitement.

Gelsemium is equally efficacious if the fever occurs from exposure to rapid changes of cold or heat, and especially if the febrile movement tends towards a distinctly remittent type. Other indications are a flushed, bright-red face, a hot but moist skin, and a quick, but soft, large pulse. Even if decidedly miasmatic in origin, this drug will modify or arrest it.

Veratrum viride is a potent remedy in robust persons, when the temperature reaches 104° or 105° F., and the pulse is large, hard, and bounding.

Bryonia is adapted to those cases which seem bilious or rheumatic, with acute pains all over, worse on movement, with dull, stupefying headache, but with a temperature rarely above 103° F.

Phenacetin, in doses of two or three grains, will relieve the aches and pains sooner than any other remedy.

Eupatorium perfoliatum is an excellent remedy when the fever assumes a decidedly bilious character, such as is commonly called " bilious fever," occurring in the summer and autumn months, remittent in character, with vomiting and purging of acrid green matter, violent aching, apparently " in the bones." If the fever is miasmatic, it acts equally well.

Mercurius and ipecac, for many years a very successful remedy in my practice, has been a combination of the 2x trituration of these two drugs, especially when the tongue is foul, brown, or "pasty," the breath offensive, the bowels confined or loose, and when there is great nausea or vomiting, but only a moderate fever ; then a few grains every two hours will soon effect a favorable change. These remedies can be used in alternation, if that method be preferred.

MALARIAL FEVERS.

I.— SIMPLE INTERMITTENT FEVER.

A paroxysmal disease, due to the action of a malarial poison, supposed to be a bacillus, characterized by the occurrence of febrile paroxysms, consisting of a succession of definite stages, namely, the cold, the hot, and the sweating stage, separated by an apyrexia, or intermission of variable length. According to the length of the interval, the fever may be of different types, hence the names : Quotidian, tertian, or quartan, i. e., a fever every day, every second day, or every fourth day. These are typical forms, but there are many atypical forms ; I have seen the paroxysms occur twice a day, every three days, every fifth, sixth, and seventh day, and even every fourteenth day. More singular still are those forms termed " masked ague," when the paroxysms may assume as many forms as the transformations of the fabled Proteus, forms in which there is no chill, fever, or sweat, but instead, periodical attacks of headache, eyeache, earache, neuralgia of any organ, gastralgia, cardiac disorder, diarrhoea, dysentery, swelling of a joint, imitating rheumatism, ovarian pain, hemorrhages from various organs, and even paroxysmal insanity ; all these manifestations, and many more, I have seen occur ; not only have I seen them occur uncomplicated with other diseases, but I have seen non-malarial disorders change to malarial, and have seen the malarial paroxysms engrafted upon, and mix and mingle with, non-malarial disorders. There is no form of disorder that it may not assume or imitate.

Why the malarial should cause this periodicity, — varying in different cases, — or why it should assume so many different forms, has not been satisfactorily answered. Laveran's hypothesis is that the paroxysms coincide with the development of the bacillus malarise, but he does not explain why the paroxysms occur without fever or chill, or why these manifestations are often located in some particular nerve, or joint, or organ of the body. What, for example, has the bacillus to do with an attack of hematuria, hysteria, or paroxysm of mania? Again, why do these paroxysms persist long after the bacilli are supposed to have left the system? No fact is better known than that malarial fever is not contracted after the occurrence of frost, or after the temperature remains constantly below 50° F. ; yet patients that have been the victims of ague, often continue to have paroxysms similar to genuine ague, all through the winter ; these attacks are commonly called dumb-ague. My explanation is that the nervous system is naturally prone to paroxysmal manifestations, as in periodic neuralgia not due to malaria, and that the post-malarial paroxysms are kept up by a habit into which certain nerves have fallen. There is a peculiarity of these post-malarial paroxysms that has created an element of great uncertainty in the therapeutics of ague, namely, that the paroxysms can be arrested by suggestion, by mental shock, change of environment, etc. This accounts for the multiplicity of remedies which are supposed to cure or to arrest the paroxysms ; many of these are as absurd as are the alleged " cures " for warts.

I have known the setting back the hour-hand of the clock prevent the access of the paroxysm ; the belief of the patient that he has passed the hour of his chill is often sufficient to prevent a paroxysm of " ague from habit." Treatment. — The treatment of Intermittent Fever has been a bone of contention in the homeopathic school, the extremists contending that we should select medicines according to the totality of the symptoms, ignoring altogether the element of periodicity. These physicians claim success, even in pernicious cases ; but I cannot believe it, because for several years I tried faithfully, with painful study, to treat ague after that plan. I did not succeed ; sometimes the paroxysms ceased on the seventh or fourteenth day, as they will do even if left to nature ; often they assumed a remittent character, but oftener my patients took the case into their own hands, and swallowed quinine ad libitum, or employed another physician, who prescribed quinine ad libitum. Dr. Kippax (" Lectures on Fevers ") gives indications for more than fifty remedies ; Bcenninghausen, over one hundred ; Allen, many more. This is absurd. Of all these, only ten are of any special practical value ; the dogma that any remedy, the symptoms of which possess those of intermittent (excepting the periodicity^), will cure ague, is an illusion. I shall not attempt to argue the question ; this opinion is the result of experience and observation ; if the individual experiences of others are to the contrary, I shall not try to controvert such experience. Kippax says : " Our sheet anchor in the treatment of simple intermittent is quinine." But when he says that it is " for no other reason than that this remedy is so frequently the similimum in cases of ague," I cannot agree with him. I admit that it has a few febrile symptoms which appear to be periodical, but the fact that its chief indication is periodicity, is a fact from empirical, not pathogenetic, data, and cannot be disputed. This fact, and why it is a fact, was demonstrated by the experiments of Laveran, Crudelli, and Tomasi, who examined the blood of patients suffering from malarious fever, and found that when quinine was taken into the system, it destroyed the bacillus malariae ; this destruction of the bacillus arrested the paroxysms ; but it seems that when it does not destroy them all, then the fever may recur every seven or fourteen days. In a late paper Laveran says that the bacilli begin to accumulate again in the blood within four days, and in seven or fourteen days are in sufficient number to cause a relapse. For this reason he advises to begin the use of

FEVERS. o

quinine four days after a paroxysm, and its continuance until the time of the next one. This plan is not new or original with Laveran, but was adopted many years ago by all observant and practical physicians, though they knew nothing of the bacillus. That they were not always successful in preventing a relapse, was due to the fact that they gave too much quinine, and caused a condition of the nervous system and liver which led to the habit above alluded to, — a habit of periodical paroxysms simulating ague. I quote from Manquat's summary of the indications for quinine (" Merck's Bulletin," March, 1892). In malaria it is efficacious in all types, besides being a preventive. Laveran shows that malarial microbes disappear from the blood after quinine has been taken for a certain time, and that the addition of a minute quantity of a weak solution to malarial blood destroys them. He believes the white blood-corpuscles are not directly influenced, but enabled more easily to subdue and seize upon the micro-organisms rendered torpid or moribund by the drug. If given during or just before the onset of an attack, quinine has no power to check it, while this may be prevented if taken at a sufficient interval beforehand. Baccelli (according to the " British Medical Journal ") made intravenous injections of fifteen grains during the onset, but during the first six hours could recognize no modification in form, number, or movement of the microbes.

As the largest part of a given dose of quinine is eliminated during the sixth hour after injection — while according to Laveran it is during the onset that the microbes are present in blood in gTeatest number — the drug should be given at an interval of about six hours before an attack. Quinine should be taken eight hours before shivering appears in quotidian ague, twelve hours before in tertian, and from eighteen to twenty-four hours beforehand in the quartan variety. To these figures, however, another hour should be added ; half an hour on account of the tendency of the onset of successive attacks to be antedated to that extent, and half an hour as allowance for imperfect absorption from impaired gastric action. For the last reason also, and to obviate its reaction, the required quantity should be given in two or three divided doses at half-hour intervals. Two doses, eight to ten hours before the expected onset of shivering, are almost always effectual. If the result be unsatisfactory, an aperient should be given.

Laveran states that no microbes are found in the blood of malarial patients after quinine sulphate has been taken for eight days in doses of nine to twelve grains, but that if after three or four doses it be discontinued the microbes reappear, and a relapse occurs. Upon this is based his scheme of treatment, namely : During the first three days twelve to fifteen grains of quinine hydrochlorate daily. No quinine during the fourth, fifth, sixth, and seventh days. On the eighth, ninth, and tenth days, nine to twelve grains. None from the eleventh to the fourteenth days. On the fifteenth and sixteenth days, nine to twelve grains. None from the seventeenth to the twentieth days. On the twenty-first and twenty-second days, nine to twelve grains.

In very severe cases recourse should be had to hypodermic medication ; fifteen grains of a salt of quinine may be injected subcutaneously, and repeated after a short interval ; as a rule, twenty to thirty grains are sufficient. The injection should be made into the deep subcutaneous tissue to avoid complications. The following formula may be used :

R Quinine sulphate gr. xv.

Tartaric acid gr. viiss.

Distilled water drm. iiss.

Antipyrine greatly enhances the solubility of quinine; fifteen grains of quinine hydrochlorate with seven and one-half grains of antipyrine will dissolve in one-half fluid drachm of water. When with severe depression there is reason to believe no absorption has taken place, the solution may be injected into the trachea through the cricothyroid membrane.

In continued malarial fevers quinine must be given in larger doses. Laveran advises twenty to thirty grains daily, nine grains morning, fourteen grains evening, till the fever disappears. This nearly always happens by the second or third day. If fever persists with four days' treatment, it may be assumed to be non-malarial. When the temperature falls, nine to twelve grains should be given daily for a short time. In malarial cachexia quinine wine (Laroche) may be taken with meals, but not fasting or long before food ; otherwise gastralgia and dyspepsia ensue.

As a preventive quinine is not effective in smaller doses than two to four grains three times a day. It should be given also in all malarial complications and incidental affections (for example, neuralgia, hemorrhage, pneumonia).

There are some rules relating to the administration of quinine that are important : (1) It does not act favorably if it is given when the tongue is coated, foul, and dry ; nor if the bowels are constipated. In such cases the liver is generally congested, and the elimination of bile not normal. If you desire quinine to act promptly, and not to derange the gastric functions, give some chologogue, followed by a saline laxative. In most cases one or two grains of blue mass (if the patient has not been salivated) acts well. If this is not desirable, give one grain of euonymin, irisin, or one-fourth grain of podophyllin in the evening, and the next morning give a glass of rubinat water, or hunyadi-janos ; this will carry off the unhealthy secretions liberated by the drugs recommended. If these bitter waters are objectionable use the citrate of magnesia, or congress water. You may go on day after day giving quinine or other remedies for the fever, but unless the tongue is clean and moist they will not arrest it. Our school have not realized the importance of removing morbid fermenting matters from the bowels in the beginning of malarious fevers.

Ipecac, in certain epidemics of malarial fever, in which the type is sometimes remittent, sometimes intermittent, or when the two are mixed, seems to be all that is required. When it fails — although seemingly indicated by the symptoms, — I think it is because the tincture is used. Ipecac does not give up all its virtues to alcohol. The trituration of the root is better. Many physicians use a trituration of nux vomica and ipecac mixed, the lx of each, with good results. As in remittent, I like the action of the double remedy — ipecac and mercurius dulc. It also acts well alternated with gelsemium.

Eupatorium perf. resembles ipecac in its gastric symptoms, but is chiefly indicated by the bone pains, so called. These pains are, however, muscular, and resemble those of baptisia and gelsemium. The " soreness " of the whole body, of the eyeballs, head, and chest, call for it. No remedy is in more common use among the people ; and it is probably most effectual, when used in a primative manner in infusion. I found that when the tincture or dilutions failed, a weak infusion seemed to act promptly.

Cedron, said to be better adapted to the intermittents of the tropics, I have often found useful in the north. It is indicated by the exact regularity of the paroxysms, and violent symptoms, such as headache, neuralgia, and local pains, which attend the attacks. In masked ague it is of great value, and in chronic cases particularly, where quinine has been used.

Gelsemium certainly possesses some anti-periodic quality. It differs greatly from ipecac and eupatorium, in that the paroxysms are not attended by gastric, hepatic, or intestinal derangements. The fever has a quick, soft pulse, a scarlet redness of the face, and a soporose condition. It is particularly indicated in the quotidian fevers of children, and in fevers excited by a chill in hot weather.

Arsenicum has a high reputation in both schools as a remedy for malarial fever, but I never attained with it the success I was led to expect by the encomiums heaped upon it ; it never cured for me a single typical case of intermittent fever of any variety, i. e., when the paroxysms were regular, and consisted of the distinct chills, fever, and sweat. This seems to be the experience of others, for Hughes, Kippax, and Morse say the more widely the paroxysms vary from the typical, the better it is indicated. The chill or sweat may be absent, and the apyrexia of uncertain duration. This means that the development of the bacilli is irregular, and that the malarial poison has a special tendency to attack vital organs. I do not doubt the homeopathic ity of arsenic to malarial fevers, or rather to the pathological condition of the vital fluids and nervous system caused by malaria. This is the reason why it is not useful in acute typical cases, or when the malaria is engrafted on a cachetic state. But it is the chief remedy in typho-malarial fevers, in chronic cases of intermittents, — that persist after several weeks' duration, when the general health begins to decline, — or in patients who have contracted malaria, have partially recovered after leaving the malarious region, but cannot entirely shake off the disease. During our civil war it was found useful in the malarial disorders of returned soldiers. The impoverished blood, sallow skin, gastric irritations, and tendency to oedema, are the chief indications for it. Good results have been obtained from the 3 Ox, and even 20 Ox, according to apparently trustworthy testimony, but I have not been so fortunate, nor have I succeeded so well with the triturations of arsenious acid, as with Fowler's solution, which I have prescribed in the following manner : One drop after each meal in chronic cases, or in the malarial cachexia. If the patient is confined to his house, ten drops in half a glass of water, a spoonful every two hours. The lx and higher dilutions can be made from this preparation and prescribed on discs. In some cases of chronic ague and malarial cachexia, the salts of arsenic act admirably. The arseniate of quinine is a favorite with many practitioners, when both arsenic and quinine seem indicated ; dose, two to three grains of the lx ; arseniate of iron 2x when the anaemia is great, the lips and gums bloodless, the feet cedematous, and sometimes a general anasarca. Arsenite of strychnine, 2x when the spinal and sympathetic nervous systems seem greatly depressed in vitality, and when a general paresis, with complete absence of food assimilation is present.

Natrum muriaticum comes next to arsenic in usefulness in chronia irregular intermittents, with a cachectic condition. It is indicated in morning chills (11 to 12 a. m.) followed by violent, hammering, frontal headache. Herpes of the lips appears on the third or fifth day. Salt is an old and common domestic remedy, but the people have a strange way of using it. A saturated solution of common salt in vinegar is prepared ; it is taken in doses of one or two teaspoonfuls just before the chill. I have known from observation that it is often curative. In an epidemic of intermittent fever that occurred in 1858, along the south shores of the great lakes, a physician in western New York found that the lx trituration of mix vomica in salt (instead of sac. lac), cured nearly every case. In later epidemics it was not so useful. In " dumb ague " and masked intermittents it will cure even in the 3 Ox. This and arsenic are the only two drugs that are effective in that dose, so far as I have observed.

Eucalyptus globulus seems to me to act like quinine on the bacilli in the blood of malarial patients. Probably next to corrosive sublimate it is the most powerful destroyer of bacterial life now known. It is also a powerful disinfectant and antiseptic. The great success that attended its use in the hospitals of Australia, California, and Algeria proves it to be a rival of quinine, with none of its deleterious effects. In the reports that I collected and published in the last edition of " New Remedies," it cursd three-fourths of all cases of quotidian, tertian, or remittent malarial fevers. In those cases that resisted the drug, while the periodic paroxysm remained, it was much milder ; the tongue cleaned, the secretions became healthy, and the remaining symptoms were readily removed by small doses of quinine. The excessive colliquative night-sweats during the apyrexia also ceased. The dose usually prescribed is one drachm of the tincture every three or four hours, or three times a day, during the apyrexia and paroxysm. I have tested its value in Michigan, also in Chicago, where malarial fevers do not originate, but are contracted in the suburban regions, and I find that less than five drops of the mother tincture every two hours does not suffice, and larger doses are often required. It is said on high medical authority that when the trees are planted on the malarial lands of Algeria, France, Italy, and Mexico, their influence prevents the fever of those regions. In the United States, except southern California, New Mexico and southern Texas, the eucalyptus will not grow north of 28° ; even in Florida it cannot resist the frosts that occur there every winter north of Tampa.