everted lids, which should be washed with a solution of common salt, and then with water before being replaced (C.); in solution, gr. v ad 3j aquæ destillatæ locally once a day in purulent ophthalmia of the new-born, washed off with a weak solution of common salt (Noyes); in solution, gr. iij to the 3 to abort the discharge in catarrhal ophthalmia (Fox). Boro-Glyceride, in many catarrhal affections, especially ophthalmia neonatorum, is a most efficacious application, the solutions used being of 10, 25 and 50 per cent. strength (Fox). Alum, gr. viij ad 3j aquæ, applied every 4 or 1⁄2 hour in purulent ophthalmia of children; success depends on the frequency of the application (R.); a crayon formed of a crystal of alum, a mild and occasionally useful application (C.). Mercury. Calomel dusted over membrane in phlyctenular ophthalmia; or after detaching scales rub in brown citrine ointment every night for eczema of margin of lids (B). Pulsatilla, as a lotion to conjunctiva 8 or 10 times in 24 hours, also internally (P.); much used by homoeopaths (B.). Spigelia, useful in rheumatic ophthalmia (P.). Antimony. Tartar emetic, gr. to, three or four times a day in strumous ophthalmia, with sharp purgation at commencement (R.). Belladonna, or Atropine, locally, of great service in strumous ophthalmia to relieve pain; constitutional treatment also required (Wa.) Atropine, gr. ij of neutral sulphate to the 3 of aqua destillata, twice or thrice daily, as soothing application (C.). Arsenic, invaluable in inveterate cases of strumous ophthalmia, especially when complicated with cutaneous eruptions (Wa.). Copper Sulphate, gr. j ad 3j aquæ camphora as collyrium in purulent ophthalmia of infants; in substance to inner part of lids in granular conjunctivitis (Wa.). Tannin, powdered (or in solution gr. j-x ad 3) produces remarkable results (B.). Lead Acetate, gr. j ad 3j aquæ destillatæ, applied by camel's-hair pencil to surfaces of everted lids, washed away before the lid is replaced. Or the Tannate of Lead 11⁄2 ad 3 parts fine oil, and 1 of fresh lard, a very small piece as ointment to lid (C.). Carbonic Acid Gas, said to relieve the pain and photophobia of strumous ophthalmia when locally used (R.). Physostigma, to reduce pupil and shut out the light (P.). Iodine, is employed in scrofulous ophthalmia, locally for its alterative stimulation (W.). Iodoform, in gonorrhoeal ophthalmia, and purulent conjunctivitis, of very great value locally, but should be pulverized very finely (Grossmann); does not bear out the claims made for it (Keyser). Zinc Chloride, gr. j ad 3j aquæ as collyrium, in gonorrhoeal ophthalmia, used with marked benefit; also a stronger solution (gr. ij-iv ad 3j), effectually arrests the muco-purulent discharge remaining atter subsidence of purulent ophthalmia, and has succeeded admirably in diphtheritic conjunctivitis and pustular ophthalmia (Wa.). Zinc Sulphate, as collyrium, gr. j-iv ad 3j, is very serviceable in ophthalmia of infants or adults; liquor plumbi added improves (Wa.). Staphisagria, especially in tarsal ophthalmia (P.). Colchicum, when gouty diathesis (P.). Cod-liver Oil, in strumous subjects, tends to remove the manifestations of the disease (R.). Cold Wet Compresses, or iced, are held to be essential in early stage of acute purulent and gonorrhoeal ophthalmia (C.). [Compare BLEPHARITIS, CONJUNCTIVITIS, KERATITIS.]

Opium Habit.

Capsicum, very serviceable from its power as a stimulant to the stomach, and its sedative action on the cerebrum (B.); removes the sinking sensation at the pit of the stomach experienced by alcoholics, when trying to break off that habit (R.). Bromide of Sodium, in large and increasing doses, 3j twice daily, increased by 20 grains each day, to a maximum of 100 to 120 grains twice in twenty-four hours, with simultaneous gradual reduction of the opiate dose, so that from the 8th to the 10th day it is entirely abandoned. Each dose of the salt should be given in 6 or 8 fluid ounces of cold water (Mattison). A combination of bromides (see formula below), commencing with 40 grains twice daily, increasing to 100 grains twice daily, at 10 A. M. and 4 P. M., freely diluted with water, does not depress vitality, or produce the injurious results of the bromides as commonly administered. This, with 3j of Warburg's tincture before breakfast each morning, with the use of Spt. Etheris Nitrosi to eliminate the bromides

rapidly, electricity, a mixture of iron and strychnine, and an occasional hypodermic of 5 or 10 minims of a 4 per cent. solution of Cocaine for nervous restlessness, is the general line of my treatment (Mann). Bromides may do great harm, if recklessly administered, paralyzing the muscular system and causing prolonged delirium. Cocaine, or the fluid extract of Coca (Erythroxylon), has been used to relieve the depression caused by the withdrawal of the drug (B.); has been, by many careful observers, pronounced of great benefit, restoring appetite, inducing sleep, promoting digestion, while soothing the brain and inducing a feeling of contentment and calm (R.). Should never be entrusted to the patient, lest he jump out of the frying-pan into the fire. Gelsemium, subdues the restlessness and motor excitement; proved of great value in one case where 30 grains of morphine were used daily; mj of tincture every hour (Pennoyer). Conium, in 10-drop doses of a good fluid extract, to check motor activity and relieve the wandering pains. Sparteine, in doses of gr. to hypodermically, at moment of systolic cardiac depression which answers to the period of craving, and corresponds to the truncated curve of the sphygmographic trace, which is characteristic of the period when the stimulant effect of morphine has passed (Jennings). Nitroglycerin acts in the same manner, but its effect is more rapid and more ephemeral (Idem). Cannabis Indica, may be required in full doses, for restlessness after withdrawal of the opiate, 3-doses of Squibb's fluid extract, repeated every hour or two, as required (M.). Galvanism, is very efficient for the neuralgic pains in various parts; a strong faradic current sometimes acting better (M.). Baths, if hot, 105° to 112° F., are of great value to relieve disquiet; warm baths are worthless (M.). Chloral, as a hypnotic, fails in the first few days of abstinence; later in full doses, 45 grains at once, rather than three 15-grain doses, alone or with a bromide, it can be relied on (M.). Hyoscyamine, Merck's amorphous, gr. to hypodermically, or more, is useful as a hypnotic, and perfectly safe, in patients of good general condition, in whom the disuse of Opium produces unusual insomnia and motor activity (M.). Lupulin, with Phosphoric Acid (see formula below), helps to sustain the patient, lessens the force of his suffering, and shortens its duration (Fleming). Zinc and Iron as blood tonics, given for a month at least, are valuable, and are best given on alternate days (see formula below) (Fleming). Piscidia Erythrina, has been proposed as a substitute, and highly commended, but is worthless, as are also Avena sativa and many other falsely termed substitutes (M.); there is no remedy for the opium-habit (Da Costa). Zinc Oxide, for the vomiting and diarrhoea, beginning with gr. j once daily and increasing to tolerance (Da C.). Withdrawal of the drug suddenly and completely, is the method of Levinstein and other Germans, and is preferred when we can have absolute control and surveillance of the patient (Da C.); entails horrible suffering, and is utterly inexcusable (M.). A more gradual reduction is the method usually employed, taking off one-third the first day, one-fourth the second day, and then gradually reducing the amount until the sixth or seventh day, when it is entirely withdrawn. No agent is of any value unless strengthened by moral courage and perseverance on the part of the patient (Squibb). Useless to try to cure a patient while he is pursuing his ordinary avocations. Failure will result unless there is complete seclusion and entire giving up to the treatment (Mann).

Pulsatilla, mj or less, every hour, relieves pain rapidly, though not the oedema (St.). Belladonna, int., and as oint. (extract j ad iij adipis) when inflammation has subsided (Wa.). Sodium Salicylate, in gonorrhoeal orchitis, subdues pain in a few hours. Iodine, tinct. locally to remove swelling after the acute stage has passed (B.). Mercury, the oleate locally (B.); Calomel gr. iij with Ipecac, gr. x at once, followed by a saline next morning, and smaller doses of calomel and ipecac, every 6 hours, with morphine hypodermically, gr. into cellular tissue of scrotum (McElroy). Ammonium Chloride, makes a good evaporating lotion, in solution with alcohol and water (R.). Silver Nitrate, a strong solution to the scrotum, with gentle pressure (Wa.). Tartar Emetic, in acute orchitis (R.). Digitalis, locally, is found most useful (P.). Alcohol, with equal quantity of water, as evaporating lotion (B.). Ice, benefits and relieves pain (B.). [Compare EPIDIDYMITIS.]

Aconite and Opium, equal parts of the tinctures, a few drops well down the external meatus, will often subdue the pain. Blistering Fluid, or Croton Oil Liniment, behind the ear often relieves earache (R.). Glycerin, for dryness of meatus (R.); or oil for accumulation of wax in external meatus dropped in every night, gentle syringing in the morning with warm water (Cl.). Opium, Morphine in solution, gr. iv to the 3, with gr. j-ij of Atropine, is an excellent application (B.). Atropine, gr. in 3xx of water, a teasp. every three hours for a child in the acute otitis media of children from coryza, very successfully used to abort the otitis, and relieve the earache (Miot); a solution locally is especially applicable in the earache of children from whatever cause ;—gr. j to the oz., of which gtt. iv dropped into ear to remain for 10 or 15 minutes. Pulsatilla, internally and externally, is often used with advantage (P.). Cocaine, a 4 per cent. solution sprayed over the tympanic membrane through the external meatus, and forced into the Eustachian tubes by inhaling the vapor and then expanding the tubes by Valsalva's method; this repeated every three minutes is a very sure method of curing otalgia (R.).

Otitis.

Pulsatilla, in inflammation of external auditory canal; in otitis, as lotion warmed and applied by syringe, three or four times a day (P.). Aconi quickly relieves the pain (R.); should be used internally and locally. Cart Acid, a 20 per cent. solution instilled into ear in moderate otitis, reliev

pain at once and checks progress. A solution in glycerin is best (Rohrer). Atropine, in the acute otitis media of children, is very efficient. See OTALGIA, above. Blisters, behind ears, either kept discharging or repeated, often very useful (Wa.). Leeches, behind the ear, afterwards a small blister upon the same place, when leech-bites have healed (H.). Warm Douche frequently, to the ear, to secure cleanliness, then drying the parts (Roosa).

Otorrhoea.

Mercury, in chronic cases, the brown citrine ointment (B.). Lead lotions much employed (B.). [See GONORRHOEA, for formula.] Potassium Permanganate, as injection or spray, gr. j-3j aq. destil. (B.). Silver Nitrate, locally, a solution of gr. iv to the 3 (B.); gr. x to the 3 (Roosa). Copper Sulphate, gr. j-v to the 3 (Roosa). Tannin, the glycerite, locally, is successful (B.); especially in children (Wa.). Zinc Sulphate, locally, in solutions of gr. ij-viij to the 3 (B.); gr. j-v to the 3 (Roosa). Cadmium, gr. ij-3j rose-water (B.). Liquor Soda Chloratæ, mxv xxx ad 3j aquæ when discharge fetid; is highly useful as injection (Wa.). Quinine, with sulphuric acid, advisable in otorrhoea after scarlatina (Wa.). Boracic Acid, finely pulverized, as astringent and disinfectant application; may be mixed with pulv. Alum, and just enough powdered Lycopodium to keep it dry;—this packed carefully through speculum, after washing with a weak and tepid alkaline solution. Absorbent Cotton, on holder, may be used every few hours by patient to keep pus removed from the canal. Syringing with warm salt water, once daily, as absolute cleanliness is essential in the treatment. Politzer Bag is a useful adjunct in keeping secretions out of tympanum and breaking up adhesions (Roosa). [Compare OTITIS.]

Ovarian Neuralgia.

Atropine, subcutaneously, the best remedy for pain in the pelvic viscera (Wa). Ammonium Chloride, gr. xxx with gtt. ij-v tinct. aconiti, repeated in 2-hour if necessary to remove pain (W.). Camphor, with Cannabis Indica, of great service in relieving ovarian pain, especially when spasmodic in character (Wa.). Opium, often the cause; if use stopped entirely improvement may ensue (E.); one of the best remedies in ovarian pain of non-inflammatory character (Graily Hewitt). Codeine, has especial value against ovarian pain (Freund), whether of inflammatory or neuralgic origin, in dose of gr. 4 at least. Conium, or, better still, its alkaloid, used as a vaginal pessary, in all cases of ovarian pain, whether neuralgic or inflammatory, is quite a specific (Meadows). Hot Water, vaginal injections, night and morning; sunlight baths, fresh air (E.). Ether, the compound spirit, in doses of mxxx-xl as a palliative (Anstie). Gelsemium, deserves a trial; its power is great but not certain (Wa.). Leeches over the groin, or inside the thigh, where ovarian pain persistent, or tenderness and aching (Wa.). Surgical, Battey's operation as a last resort (E.). [Compare DYSMENORRHOEA.]

Ovaritis.

Turpentine Epithems, may be applied hot over the seat of the disease (Wa). Tartar Emetic, as ointment for counter-irritation over seat of disease, in subacute ovaritis; at same time a pill of opium, hemp and camphor. See formula below (Hewitt). Opium, in suppository or enema, more effectual than internally (Tilt). Mercurial Ointment, combined with camphor and belladonna, over the seat of the disease by friction (West). Blisters, in subacute ovaritis are often of great service, placed over the region or to the cervix uteri (Wa.). Enemas, of warm water, simple or medicated, in subacute ovaritis, are warmly recommended; they should be retained as long as possible (Wa.). Salix Nigra, the "pussy willow," in doses of mxxx of the fluid extract thrice daily, of decided benefit in ovarian hyperesthesia, etc., of highly nervous women. Ergot, is valuable in chronic ovaritis, with rest and Potassium Bromide (Tait). Ice, in bag, over seat of pain, when intolerable, and patient too

OXALURIA-OZENA-PAIN.

643

much reduced to bear leeches; is often of benefit (Wa.). Poultices of Linseed meal, as light as possible, often produce great benefit in ovarian inflammation.

Mineral Acids, when eructations of sulphuretted hydrogen (R.). Nitromuriatic Acid, is of important service (B.); especially in the condition showing general malaise, weakness, and depression of spirits, with oxalate crystals in the urine (W.); also in sciatica and other forms of neuralgic rheumatism accompanied with oxaluria, full doses (mvj-x) of this acid, with an occasional brisk purgative, and cold douche, followed by friction (Wa.). Zinc Sulphate, often very serviceable in irritability of the nervous system, associated with dyspepsia and oxaluria (Bird). Lactic Acid, aids imperfect digestion (B.).

Ozæna.

Gold, the auric salts are very serviceable in syphilitic ozæna (B.). Mercury, ointment of the nitrate in syphilitic form; the white or red precipitate with 58 times its weight of sugar snuffed after clearing the nose in non-syphilitic forms (R.). Potassium Permanganate, 3j-Oj solution as an injection or spray (B.). Hydrastis, the fluid extract locally (B.); 3j-3viij solution as lotion with mv of the tincture thrice daily internally (P.). Bromine, as inhalation (see formula below); or Iodine with Carbolic Acid, or the latter in one per cent. solution, as inhalations (B.). Carbolic Acid, inhaled, I per cent. solution (B.). Silver Nitrate, applied behind veil of palate;--gr. v-xx ad 3j (B.). Alum, solution (3j-Oj) for irrigation (R.). Glycerite of Tannin, by irrigation (R.). Salicylic Acid, in very weak solution (1 to 500), as cleansing, astringent, and disinfectant wash, used by retro-pharyngeal syringe, and followed by applications of Calomel, in powder, to the ulcerated portions of the mucous membrane (Massei). Cubeba, the oleo-resin, gtt. xv-xx on sugar after each meal, to restrain the secretion and perhaps modify its character (Cohen). Chloride of Lime, gr. xxx-lx with 3j decocti krameria; of which 3ij-iij, diluted with an equal quantity of water, should be injected twice daily after cleansing with salt and water (Cohen). [Compare CATARRH, CHRONIC NASAL.]

M. Sig.-Use as wash or spray.

Opium, is universally used to quiet pain. Morphine, hypodermically, in vicinity of nerve, is curative when not so by stomach. Morphintas vel sulphas gr. 6-2, with atropinæ gr. o. Caution, morph 11787