300 THE TREATMENT OF DISEASES. 



often placed in circumstances in which it would be impossible to obtain skilled 

 medical assistance, and yet it is felt that something must be done to relieve the 

 pain. 



The inhalation of a little ether or chloroform will, even in very severe cases, 

 afford almost immediate relief. We prefer ether to chloroform. About twenty 

 drops should be placed on a piece of lint or on a handkerchief, which should 

 be held some three or four inches from the nose, and the vapour gently inhaled ; 

 it may be repeated after a short interval. The object is not to render the patient 

 insensible, or to get him under the influence of the anaesthetic that should be 

 carefully avoided but simply to relax the spasm and ease the pain. The patient 

 is not to use the ether or chloroform himself, but some one is to do it for him. 

 Four or five drops of nitrite of amyl inhaled in a similar way will often prove 

 efficacious. "When the patient flushes in the face, he is under the influence of the 

 amyl, and requires no more. It often produces a peculiar sensation of pulsation in the 

 head, but never insensibility. At first there will be no occasion to check vomiting if 

 present, but when there is frequent and severe retching attended with pain, it will 

 have to be stopped. The bismuth mixture (Pr. 18), with or without the addition 

 of three minims of dilute hydrocyanic acid to each dose, soda water, or sucking ice 

 will often succeed. Purgatives are of little use in expelling the stone, and simply 

 exhaust the patient. 



What means must you take to dissolve or prevent this formation of gall-stones 1 

 What are you to do when your attack is over to guard against another? The 

 great thing is to take saline purgatives and alkalies dissolved in large quantities 

 of water. If you can afford it and spare the time, go to Carlsbad, Marienbacl, 

 Homburg, or Yichy, and drink the waters there \ if you cannot get away you 

 must use the Carlsbad salts at home. They should be dissolved in a large quantity 

 of water two or three pints and taken tepid ; you will soon be able to deter- 

 mine the dose for yourself. It should be taken in the morning before breakfast, 

 "ilie drinking being prolonged over an hour or more, and if possible combined 

 with out-door exercise. It is very essential to adopt a dietary similar to that 

 in use at Carlsbad. Breakfast, which is taken about an hour after the waters,, 

 consists merely of weak tea or coffee, with milk and a little sugar, and small, 

 well-baked rolls, or stale bread. Dinner is taken at one, and consists of soup free 

 from fat or spices, and thickened with barley, rice, or vermicelli ; meat, such as beef, 

 mutton, lamb, poultry and game, with boiled fresh vegetables ; and a light, simple 

 pudding, or compote of stewed fruit. A cup of coffee may be taken in the 

 afternoon, or a light supper at eight. The following articles of diet are forbidden : 

 fat, butter, cream, pastry, cheese, pork, goose, sausages, salmon, mackerel, herrings, 

 anchovies, entrees of all kinds, spices, pepper, onions, garlic, dressed salads, 

 cucumber, uncooked fruit, and spirits. Nothing stronger than light claret is to 

 be taken to drink, and even this should be avoided if possible. Smoking is 

 allowed, but in the strictest moderation. The treatment is to be continued for 

 thirty days. This plan can be carried out just as well in England as in Bohemia, 

 although there are of course decided advantages in obtaining change of air and 

 scene. 



