acid (a teaspoonful of boric acid in a glass of hot water). If the mouth becomes sore, this solution should be used frequently, and especially after each meal. If the inflammation is severe, the mouth should be carefully swabbed out with a solution of nitrate of silver (silver nitrate, 1 grain; water, 1 ounce) or with a solution of carbolic acid (carbolic acid, 1 grain; water, 1 ounce). Only a small amount of either solution-just enough to wet the swab-should be employed. The swab is best made by tying a little absorbent cotton on a small stick. Ulcers will often heal if touched with a piece of lunar caustic after carefully drying the surface. Spongy gums may be relieved by the application of tincture of myrrh diluted with equal parts of water.

SORE THROAT (TONSILLITIS, QUINSY).

Sore throat is a common disease. It is usually the result of exposure to wet and cold. Talking, laughing, or shouting in a damp, cold atmosphere is sometimes the cause of it. It may accompany or be an extension from an ordinary "cold in the head." It is a complication of diphtheria, scarlet fever, smallpox, tuberculosis, and syphilis. It is caused also by drinking milk drawn from cows with sores on their teats. Sometimes the inflammation is limited to the mucous membrane of the pharynx and soft palate; it is then known as pharyngitis or acute catarrhal sore throat. More frequently the tonsils are affected, and the inflammation is then called tonsillitis. When the inflammation is more deeply seated behind the tonsil and tends to suppurate or form an abscess, the term "quinsy" is applied. An attack of sore throat may last from 2 to 10 days, or longer.

Symptoms of acute sore throat are chilliness and feverishness, pain or soreness on swallowing, dryness, or a tickling or scratching sensation in the throat.

There is liable to be stiffness and some tenderness along the side of the neck. If one or both tonsils are involved, as they usually are to a greater or less extent, the symptoms are more severe. In marked cases examination shows redness and swelling of the parts affectedswollen tonsils (tonsillitis) and white or cream-colored spots may be seen on the surface of one or both tonsils. (This form of the disease is frequently mistaken for diphtheria.) There may be high fever and great prostration.

In the severest form of tonsillitis (quinsy) the tonsil is hard and swollen to twice or three times its natural size, and the patient is unable to swallow or to open his mouth beyond a fraction of an inch. The saliva dribbles away; if suppuration occurs the tonsil gradually softens until the abscess breaks. With the discharge of pus the severe pain is relieved and the patient rapidly recovers.

If the abscess is large, and if the pus is discharged in a backward direction there is danger from suffocation, particularly if the abscess break during sleep. Fortunately the abscess usually points toward the mouth, and the pus runs out.

Treatment.-Persons who are subject to attacks of sore throat should keep their feet dry and be careful not to catch cold. If a case develop, give a gargle of salt water or potassium chlorate and water (saturated solution), or boric acid and water may be applied to the tonsil. Dry bicarbonate of soda (baking soda) is highly recommended as a local application, a small quantity to be applied every hour. Apply cold water or a light ice bag to the neck, or a thick piece of flannel saturated with ice water may be placed around the neck and covered with muslin. Small pieces of ice placed in the mouth are usually agreeable. The bowels should be kept open by means of Epsom salts.

If the cold applications to the neck do not give relief, or if they are not agreeable to the patient, apply hot water or poultices and give hot gargles, or let the patient gargle with hot tea. If the swelling is very great, he can not gargle. If practicable, send for a physician.

DYSPEPSIA.

Dyspepsia is only a symptom of disease, and is often not due to the disease of the stomach itself. There are only two serious diseases of the stomach, ulcer and cancer, neither of which is a common complaint. Dyspepsia may result from nervousness. Emotional dyspepsia is very common. Everyone knows how bad news or worry will interfere with digestion and be followed by distress after a meal. Consumption is often accompanied by stomach trouble; in fact, this may be the only complaint made by a patient suffering from this disease. Disease of the heart, especially such as causes stagnation of blood in the abdominal organs; of the liver, such as is produced by alcohol or gallstone; of the intestines, particularly if there is constipation or obstruction of the free passage of the bowel contents; of the kidneys, as in chronic inflammation of those organs, where the waste products of the body are not fully eliminated; of the brain, as where there is a tumor or inflammation of the cerebral membranes-all give rise to stomach symptoms.

Symptoms.-There may be only a sense of fullness or distress after eating; there may be a burning or gnawing sensation in the center of the upper part of the abdomen or severe paroxysms of pain which double the patient up. These symptoms may be accompanied by nausea and vomiting or the eructation of gas or sour liquid. Gas may be passed from the intestines. The patient is inclined to be despondent and take a gloomy view of things in gen

eral. There may be an absence of appetite, with weakness and loss of weight, resulting from the taking of an insufficient amount of food.

Prevention. If a person has no serious disease he should be able to digest without distress nearly all classes of food. The cutting out from a diet of certain substances, such as fats, starches, or meats, may give rise to constipation and intestinal fermentation, which result in dyspepsia. It is not a good practice, therefore, to limit oneself to certain foods unless it is done under the order of a physician or until, after repeated trials, it is found that certain articles always disagree. Very often the fault is not in the food but in the state of mind of the eater. The simplest articles of food will sometimes cause dyspepsia if one is subject to worry of any sort. Constipation is one of the chief causes of dyspepsia, and its avoidance will often prevent this condition arising.

Treatment.-A teaspoonful to a tablespoonful of milk of magnesia taken every three hours will often allay dyspeptic symptoms. This medicine neutralizes the increased acidity of the stomach contents and also opens the bowels. A teaspoonful of bicarbonate of soda in a glass of water one hour after meals frequently acts as a preventive. Twenty grains of subcarbonate of bismuth taken with this soda is of value, but it may increase the tendency to constipation. A good plan is to alternate them; when the bowels are too loose, take bismuth; when constipated, use magnesia. A little peppermint added to these mixtures makes them more palatable. During an acute attack of dyspepsia it may be necessary to reduce the diet and only take a little milk or thin soup, but no permanent change in the diet should be made without the advice of a physician, as the dyspepsia may not only not be diminished thereby but it may even be increased by such a course. Great care should be taken to keep the bowels open by going to the closet at a regular time each day, even if there is no disposition for the bowels to move, by eating articles containing plenty of cellulose, such as coarse bread, wholewheat bread, oatmeal, etc. This substance forms part of the residue remaining after digestion and stimulates the intestines to contract, thus pushing the contents along. Fats, especially in children, tend to prevent constipation, and their absence from the diet will often cause this condition. Olive oil used in the form of salad dressing is one of the best means of correcting constipation. Fruits will often act in the same way. Cooked fruit, although not as efficacious as raw fruit in its action on the bowels, is less liable to disagree. Laxatives such as licorice powders, cascara, aloin, agar-agar, and Russian oil are often employed, but it is best not to use laxatives if the bowels can be regulated by the eating of a proper diet. Purgatives

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such as salts, calomel, and jalap, which are somewhat violent in their action, should be rarely used, and then only when their need is clearly indicated.

DIARRHEA.

Acute diarrhea is caused by acute inflammation or by irritation of the intestines. It may occur as a complication in many different diseases. It is usually one of the symptoms of typhoid fever. It is not infrequently met with in severe cases of malaria. It is called functional or simple diarrhea when it occurs independently of any other appreciable disease. It may be caused by exposure to cold or by errors in diet.

In simple diarrhea there may or may not be griping and colicky pains. In the more severe forms the tongue is coated and there is some fever. Thirst is marked in proportion to the size and frequency of the thin or watery discharges. If the rectum is affected, there is a constant desire to go to stool, and a burning sensation and bearingdown pain, as in dysentery.

Diarrhea may last from a few hours to as many days, or longer. It may become chronic.

Treatment. In all cases, rest and light diet. In the milder forms nothing further may be required. Twenty grains of bismuth subnitrate with 5 grains of salol may be given every three hours. In the more severe forms it is a good plan to begin with a dose of 1 or 2 tablespoonfuls of castor oil, to which 10 or 12 drops of laudanum may be added, or in place of the oil and laudanum Epsom salt may be given. The diet should be limited to light articles, such as cornstarch, gruel, weak broths, soft-boiled eggs, milk, and thoroughly toasted bread. As a rule, in very acute cases, the less food and drink taken the better. The patient should rest in bed and keep his body warm.

After the bowels have been freely moved by the oil or salts, if the diarrhea or pain continues, give one camphor and opium pill, and, if necessary, repeat the dose after an interval of three or four hours. If nausea and vomiting occur, apply mustard to the region of the stomach and give tablespoonful doses of equal parts of milk and limewater.

In chronic diarrhea careful attention to diet is of the greatest importance. The treatment is about the same as for chronic dysentery.

CHOLERA MORBUS (SPORADIC CHOLERA).

Cholera morbus is an affection of the stomach and intestines, attended by vomiting, purging, and cramps. It comes on suddenly, and may begin by vomiting or purging. It is usually met with during the hot months of summer. It is frequently caused by eating

unripe and indigestible fruits and vegetables, decomposed or improperly cooked fish, shellfish, or salad mixtures. Drinking large quantities of ice water and sudden checking of the perspiration, or irritants of any kind, may set up the trouble. The disease usually begins suddenly, often at night, with vomiting, after a feeling of uneasiness, nausea, or a severe cramp. The contents of the stomach are first thrown up, then a bilious matter. The stools are at first

solid or semisolid, but they soon become more watery, lose their color, and sometimes appear not unlike the rice-water stools of genuine Asiatic cholera. The patient soon has a wasted look. His thirst is unquenchable. His skin may become cold and clammy and the pulse very weak. Cramps may occur in the feet and in the calves of the legs. The disease runs a rapid course. The acute symptoms may subside in a few hours. The attack seldom lasts more than 12 hours. Recovery is the rule, but treatment should be promptly applied.

Treatment. Apply a large mustard plaster to the abdomen. Give 15 drops of laudanum. If the dose is rejected (immediately vomited), try it again. One-quarter grain of morphine sulphate may be given instead of the laudanum. If it is still not retained, then try 2 tablets of Sun Cholera Mixture. If vomiting quickly occurs, then inject into the rectum by means of a glass or rubber syringe about 20 drops of laudanum mixed with a little thin starch or a little water. The rectal injection should be given immediately after an evacuation, and the patient should be instructed to hold it as long as possible. In whatever way the remedy is given, the dose should be repeated in about one hour if the vomiting and purging continue.

It must not be forgotten, however, that all these remedies contain opium, and that if the patient is inclined to sleep or shows other constitutional effect of the drug the dose must not be repeated.

The nausea and thirst may be controlled by cracked ice placed in the mouth. Small quantities of carbonated water may be allowed. If the thirst is very urgent a tablespoonful of iced water may be given at short intervals.

COLIC.

Intestinal or spasmodic colic.—These terms are applied to abdominal pain occurring in paroxysms of different degrees of severity. The pain is usually referred to the region of the navel or middle of the belly. It may be due to indigestible food, cold or acid drinks, poisons, gases, or any irritating substance. It is often preceded by obstinate constipation. Vomiting frequently occurs.

Another variety of colic, called lead colic or painter's colic, is caused by lead poisoning. It is not uncommon in painters or workers in lead. It may be caused by drinking water taken from lead