Potassium bicarbonate, 15 grains.
Potassium tartrate, 10 grains.
M. Sig.: To be taken with water twice daily, three hours after meals. The second dose may be taken with ad vantage on going to bed.
This must be persevered in for at least ten days in order to properly test its efficiency.
The Aliinghams found that when gout, active or latent, was the cause of pruritus ani, the irritation was best al layed by the local use of a strong solution of sodium bicarbonate or of sodium di sulphite (1 drachm to the fluidounce of water) frequently applied in a poultice.
In functional derangement of the liver, if dependent upon a gouty diath esis, the diet should be carefully regu lated. The use of alcohol should be re stricted. Considerable benefit is to be derived from the use of aperient medi cines, of which the salines are the best, as sodium phosphate or the sulphate or the natural mineral waters. In some cases marked improvement results from the use of mercury in some form, such as the fractional closes of calomel or blue mass in 5- or 10-grain doses. Ammo nium chloride in 10- to 15-grain doses, four times daily, is a useful remedy in hepatic congestion. Nitrohydrochloric acid in combination with nux vomica and compound tincture of gentian or of cardamom often proves of value.
When chronic constipation is present the first step in correcting this condition is to instruct the patient to go at a certain hour every day to the closet, whether the desire exists or not. In most instances a morning hour will prove best, either before or after breakfast. Physical exercise is another important factor.
Certain articles of food are often of value, such as the fruits, of which apples. prunes, and oranges are the best.
No one plan can be outlined that will benefit all, or even the majority of per sons afflicted with constipation. The in dividual indications are the only means by which we can successfully gauge the remedies required. Some authorities are strongly opposed to the continual use of laxatives in eases of obstinate constipa tion, but without their employment some patients would never have a bowel move ment. Many inordinately use cathartics and laxatives, but this fact offers no valid objection to their employment by the physician when other means have been fruitlessly tried. Sometimes a tumblerful of hot or cold water taken before breakfast will regulate the bowels. If this should fail, the mineral waters may be tried, especially the Hunyadi Janos, a wineglassful of which, followed by a half-tumblerful of hot water, may be taken. Fluid extract of cascara sa grada, with equal parts of glycerin, in doses of 30 to 60 drops at bed-time, will , often prove useful. (See also CONSTIPA
TION, volume ii.) In intractable cases of pruritus ani the urine should be examined for sugar.
The Allinghams state that when pru ritus is of neurotic origin, as they think it frequently is, particularly in spare and delicate, excitable people, arsenic and quinine should be freely given, sepa rately or combined. They should be pushed to their physiological effects. The internal use of opium in any form is contra-indicated. Most authorities agree that though a night's rest may be procured by its employment, its use aggravates the disorder.
—The pruritus in duced by uterine catarrh can only be per manently removed by the cure of the prime factor in its causation. Relief from the itching can be afforded by cleanliness, frequent washing of the parts, and by the use of vaginal douches. Various sedative applications may be tried, such as 1 part of the officinal solu tion of plumbic subacetate to 4 parts of water, applied three or four times daily by means of cotton pledgets; or a lotion composed of 1 ounce each of chloroform, tincture of aconite, and tincture of opium and G ounces of olive- or linseed oil, which is to be shaken well before using and is to be smeared over the parts whenever the pruritus becomes annoy ing.
The elimination of Oxyuris vermicu laris and the relief of any cutaneous in flammation about the anus which their presence has occasioned will materially assist the cure of the pruritus. To de stroy the worms it is not sufficient to rely entirely on rectal medication, such as enemas of lime-water, weak solutions of quinine (20 grains to the pint of water), or of corrosive-sublimate solu tions (1 part to 4000), for these only ac complish the deStruction of the parasites in the rectum. In addition, it is essen tial for their complete eradication to acid internal medication, so as to reach the seat of their propagation in the small intestine. (See PA RASIT ES, INrEs.ri.NAL.) When pruritus is caused by animal or vegetable parasites, it is readily cured by the application of the sulphur ointment, gently rubbed over the affected area at bed-time. The ointment should contain from to 1 drachm of sulphur to the ounce of benzoated lard, and it should be employed every night for a week or ten days. The use of strong sulphur ointment for any great length of time is injudicious, as the cutaneous surface of the parts is apt to become irritated. A cleaner and an equally efficient remedy advised by Messrs. Allingham is a lotion of sulphurous acid of the strength of 1 part to G of water.