diarrhoea, or where the urine is irritating, the following lotion is useful: R-Pulv. calaminæ, Glycerini Alcoholis Aquæ ää 3ij (8.0). q. s. ad Oj (480 c.c.).-M. S.—Apply with a mop after each removal of the diaper. ZINC CHLORIDE. Chloride of Zinc (Zinci Chloridum, U. S. and B. P.) is a white, crystalline, deliquescent powder, of caustic taste and acid reaction, possessing considerable disinfectant power. It has been used as an eye-wash in the strength of 1 to 2 grains to the ounce (0.06-0.12: 30.0), but is rarely so employed at present. The same solution may be used as an injection in the second stage of gonorrhea. Small cutaneous cancers, particularly if near blood vessels, may be advantageously treated by the following salve, which is efficacious and mummifies the tissues so that hemorrhage is prevented: R-Zinci chloridi Cocaina hydrochlorat. S.-Apply as a paste. 3j (4.0). Under the name of Liquor Zinci Chloridi, U. S. and B. P., is prepared a solution of the salt for disinfecting purposes of the strength of about 50 per cent. ZINC SULPHATE. Zinci Sulphas, U. S. and B. P., is a white, somewhat efflorescent salt, of a sharp, acid taste, and soluble in water. In large amounts it acts as an irritant, and is employed as an irritant peripheral emetic in the dose of 10 to 30 grains (0.60-2.0). It is not so severe as sulphate of copper in its emetic and poisonous properties, and may be repeated if the first dose does not produce vomiting. In weak solutions it may be used as an astringent application by injection in gonorrhea and other affections of the urethral mucous membrane. In 2-grain (0.12) pills it is sometimes given in serous diarrhæas, particularly if it be combined with opium or minute doses of podophyllin (o grain [0.001] at a dose). In conjunctivitis and other eye affections the drug is used in the form of a wash. (See Conjunctivitis.) PART III. REMEDIAL MEASURES OTHER THAN DRUGS.- ACUPUNCTURE. ACUPUNCTURE is a term applied to the insertion of a small pointed instrument into the tissues of any part of the body for the purpose of relieving pain, swelling, or dropsies. When used in painful affections it accomplishes its best results in lumbago and sciatica, particularly in the former. When treating lumbago in this manner the writer places two darning-needles in boiling water to render them aseptic, inserts them at right angles to the skin to the depth of one to one and a half inches, and allows them to remain in place for several minutes. They are then slowly withdrawn, care being taken to prevent their breaking. Often after this treatment the patient can at once move more freely, to his great delight. Ringer, with his usual clear clinical insight, has noted that this procedure is more successful in those who have bilateral pain than in those who have unilateral pain, and the writer has found this invariably true. In sciatica acupuncture is less successful than in lumbago, but should always be tried. The needle should be inserted until it reaches the nerve, and perhaps pierces its sheath, and it must be absolutely aseptic. Bartholow has recommended the use of a hypodermic needle for the simultaneous injection of a few minims of chloroform or morphine. Sometimes the best results follow from inserting the needle immediately below where the nerve finds exit from the pelvis. In other cases it is asserted that the insertion of a needle on the sound side over a spot corresponding to that which is painful may be beneficial. Acupuncture is useless in acute rheumatism and for the lumbar pain accompanying fevers. Sometimes a rhigolene spray may be used to freeze the skin over the parts with advantage in lumbago or sciatica. Acupuncture is occasionally resorted to for the relief of dropsy, but it is not commonly employed, although it is often a useful measure in this condition. When the skin of the limbs becomes so tense with an effusion as to endanger its life, the tension should be relieved by incisions, not punctures; but saline purges are better for the re ( 461 ) moval of dropsy, if they can be used. Punctures rapidly close and cause local indurations, while incisions remain open and permit free drainage. Immediately after the incisions are made the parts are to be dressed with cotton previously saturated with boric-acid solution and dried, or with absorbent cotton sterilized by baking in an oven. It is hardly necessary to point out that the incisions must be made with antiseptic precautions. (See Antiseptics.) ANTISEPTICS. The term "antiseptic," as generally used, does not necessarily imply the power to destroy pathogenic germs. Any substance which inhibits the growth of micro-organisms, which destroys or renders innocuous the poisonous products of their action upon the tissues of the body, or which retards or prevents the absorption of such products, is properly termed antiseptic. Since germicides necessarily possess antiseptic attributes, they should, strictly speaking, be classed with antiseptics; in this portion of the work, however, only such drugs as are sufficiently innocuous to allow of their use in the human body or upon its surface will be considered. Some of these-as, for instance, carbolic acid and bichloride of mercury-are efficacious solely from their germicidal properties. Others, and of this class iodoform is the most important and typical example, exert their influence, not upon 'the micro-organisms, but upon the toxic substances produced by these organisms. Of the long list of antiseptics which have within recent years received warm commendation at the hands of individual writers, comparatively few have retained the confidence of the profession after prolonged trial. Only these few well-proved drugs will be discussed in this section. Heading the list, and in its germicidal power surpassing all others, is Bichloride of Mercury. Long since, the researches of Koch have shown that this salt is efficacious as a germicide in a watery solution of 1: 50,000. He states, however, that where albumin is present the bichloride is decomposed and rendered inert. The same change is observed when solutions are allowed to stand for some length of time, even when distilled water is used as a solvent. By the addition of either sodium chloride or a weak acid such decomposition is prevented. From this it follows that under ordinary circumstances solutions of bichloride should be freshly prepared, or, if it is desirable to keep them for a long time, a sufficient amount of sodium chloride should be added to prevent precipitation of the sublimate. Koch advised that as much salt should be added as would equal the weight of the sublimate. Other observers, however, have advised ten times this weight of sodium chloride. Since whenever bichloride solutions are used in wounds or in cavities of the body they are brought in contact with blood-serum or other albumin-bearing substances, care must be taken that the antiseptic powers of the mercury lotion are not destroyed by the decomposition of its active principle. The power of the solution may be preserved by using it in such excess that the chemical change has practically no effect, or by combining with it, as stated above, an acid which will not in itself be unduly irritating to raw surfaces. This end is accomplished by tartaric acid. In making up a solution, 1 part of bichloride and 5 parts of tartaric acid are added to as much water as is needed. Thus, in making up a solution of 1 : 1000 for surgical purposes, the following prescription may be employed: R-Hydrarg. chlorid. corros. Acid. tartaric. gr. xv (1.0). In the treatment of ordinary wounds bichloride solutions are used in the strengths of 1:500, 1: 1000, 1: 2000, and 1: 4000. For the irrigation of large cavities solutions of a strength greater than 1: 10,000 should rarely be employed; and even these dilute lotions have, when used in the peritoneal cavity, caused toxic symptoms. The 1:2000 solution is the one generally employed for sterilizing wounds and irrigating during operations. Solutions of 1:500 or 1: 1000 are used in cleansing the surface of the body. The ordinary method of preparing the surface of the body for operation is as follows: The part is first thoroughly scrubbed with green soap and warm water, is shaved, and is washed as before. It is then cleansed with alcohol or ether, after which a scrubbing with bichloride solution of 1: 1000 should follow. If no surgical interference is immediately indicated, the whole operative region should be enveloped in towels wrung out in a solution of 1: 2000, and kept thus protected until the surgeon is prepared to operate. The moment the skin is incised no lotion stronger than 1: 2000 should be employed; or if the more powerful solutions are used they should immediately be flushed out with one of less strength. The dressings, unless some particular form is used, may consist of boiled, bleached, and sun-dried gauze, soaked in a 1:500 bichloride solution and subsequently washed and wrung out in a 1: 4000 dilution of the same antiseptic. Next in popularity among the antiseptic preparations is Carbolic Acid and its solutions. The particular value of this drug lies in the fact that its potency is equally developed in both albuminous and non-albuminous solutions. Like the mercury salts, its disadvantage lies in its toxic properties. It is usually used in solutions of 1:20 and 1: 40. The carbolic acid of commerce is found in liquid form. In making solution for surgical purposes an ounce of this liquid is added to 20 or 40 ounces of water, according to the strength of the solution desired. Although carbolic acid is soluble in 15 parts of water, solution does not take place immediately, and in making solutions of a strength of 1:20 either the water must be hot or a certain amount of time and considerable agitation of the |