CROUPOUS AND DIPHTHERITIC INFLAMMATION . 729 



because in the majority of cases none better fulfils the causal indica- 

 tions. If the circumstances of the patient do not allow of his being 

 sent to a watering-place, we may let him use the " Karlsbad diet " at 

 home, and order soda-water or artificial Marienbad or Karlsbad water. 

 From this treatment alone we shall see the most favorable and speedy 

 results in catarrhal jaundice. 



In some cases the indications from the disease may be fulfilled by 

 the administration of an emetic. During the act of vomiting, the bile 

 is forced out of the gall-ducts and bladder, toward the mouth of the 

 ductus choledochus, and an obstructing plug of mucus may thus be 

 pressed out of the latter. We might give emetics far more frequently, 

 if the obstruction of the ductus choledochus were not more frequently 

 caused by the swelling of the mucous membrane than by mucous 

 plugs, and if we did not fear that the untimely use of an emetic 

 might render worse the gastro-intestinal catarrh. Nitro-muriatic acid 

 has a great reputation in the treatment of catarrhal jaundice ; it is 

 used externally, in the form of foot-baths ( | ss j. to a foot-bath) and 

 as fomentations over the liver, or internally ( 3 ss j. to vj. of muci- 

 lage, a tablespoonful every two hours). The internal administration 

 might possibly have a favorable influence on the intestinal catarrh ; 

 perhaps it might also excite contractions in the excretory bile-ducts, 

 and thus cause the expulsion of obstructing coagula. The external 

 use of aqua regia would scarcely be of any benefit. The action of the 

 drastics is explained by the effect they have of increasing the peristaltic 

 action of the intestines, which extends to the ductus choledochus 

 But generally these have no favorable influence on the catarrhal jaun- 

 dice, for which they are given so much. The exhibition of calomel 

 (gr. j every evening), and of the Vienna decoction (two tablespoon- 

 fuls every morning), according to the so-called English method, is ob- 

 jectionable, although many patients with catarrhal jaundice recover 

 in spite of this treatment. Slight laxatives are only advisable when 

 there is obstinate constipation. Then we may use some one of the 

 tartrates, particularly tartrate of potash, or a decoction of tamarinds 

 ( 1 j ij to i V J viij) with acid, tartar. (&] 3 ss.) and syrup, sennas c. 

 mannae ; or we may prescribe infusum sennas compositum or lenitive 

 electuary. 



CHAPTER II. 



CROUPOUS AND DIPHTHERITIC INFLAMMATION OF THB GALL-DUCTS. 



INFLAMMATIONS of the gall-ducts with fibrinous exudations are ex 

 eeedingly rare, and when they do occur it is only in the course of 

 severe diseases, such as protracted typhus, septicaemia, cholera, eta 



