to INCLUDING ALL THE WORDS AND PHRASES GENERALLY BASED ON RECENT MEDICAL LITERATURE. BY GEORGE M. GOULD, B.A., M.D., OPHTHALMIC SURGEON TO THE PHILADelphia hospITAL AND CLINICAL CHIEF WITH ELABORATE TABLES OF THE BACILLI, MICROCOCCI, LEUCOMAÏNES, PTOMAÏNES, WEIGHTS AND MEASURES, THERMOMETERS, ETC.; AND APPENDICES AND TABLES OF VITAL STATISTICS. PHILADELPHIA: P. BLAKISTON, SON & CO. 1012 WALNUT STREET. Full page reduced about one-half. aces of malle the direct pulmonary ing-mischief chronic dys 1 a lowered disease, and peutic, and onsumption dual shows ution, espeof unusual t in caseous r influences extinguish hich a liabicongenital ufficient or insufficient G Besides potatoes, he excludes carrots, turnips, parsnips, and beetroot; but allows asparagus, spinach, cabbage, and the leguminose vegetables freely. No sort of meat is prohibited, and he allows the fat as well as the lean to be eaten. Professor Ebstein does not set strict limits to the quantity of liquid consumed, and he believes that the rules are better kept in the main, and in the most important points, if some articles of diet which strictly would be forbidden-for example, potatoes-are allowed in very moderate quantities. The diet is thus kept from being so irksome, and the patient is able to persevere longer with it than he could otherwise do. It will be observed that in this plan, while the fats are not excluded, the rule against the carbo-hydrates is very strict. Gradual Change. In most cases it will be well not to be too rigid, for the reasons already mentioned, and it cannot be too strongly insisted upon that the change of diet should be made gradually. Sugar, sweets, puddings, pastry, cakes, cream, sweet wines, stout and beer, should all be cut off. All farinaceous articles should be gradually reduced. Brown bread and toast in limited quantities should be substituted for ordinary bread, or its place may be partially taken by gluten bread. Lean meats, including poultry and game, also eggs, should be taken in moderation. Fish may enter largely into the dietary, and all green vegetables, salads, and cooked fruits may also be allowed. As already said, all malt liquors and sweet wines must be excluded. Hock, claret, or other light wine may be allowed to the extent of three or four glasses a day, or a small quantity of spirits in water may be permitted; but the total quantity of liquid taken in the twenty-four hours should not exceed two and a half or three pints. The corpulent should be encouraged to take exercise, and especially exercise in the open air; but any violent exertion is most undesirable, from the strain it would put on the heart and blood vessels. CHAPTER XI. DISEASES OF THE LUNGS AND PLEURÆ. GENERAL CONTENTS: Pulmonary Phthisis-Asthma-Pulmonary Emphysema -Chronic Bronchitis-Pleurisy with Effusion. PULMONARY PHTHISIS. As in struma, digestive disturbances, with evidences of malassimilation and mal-nutrition, frequently precede the direct manifestations of the diathesis; so in cases of pulmonary phthisis, we are accustomed to see the signs of lung-mischief preceded, often for some considerable time, by chronic dyspepsia, with a disordered state of system and a lowered standard of health. Wasting. Phthisis is essentially a wasting disease, and the great object of all treatment, dietetic, therapeutic, and climatic, is to raise the standard of nutrition. Niemeyer puts it thus: "Prophylaxis against consumption requires, in the first place, that when an individual shows signs of defective nutrition and a feeble constitution, especially if already he have given positive evidence of unusual delicacy, with a tendency to diseases which result in caseous products, he should be placed, if possible, under influences calculated to invigorate the constitution and to extinguish such morbid tendency." Insufficient Diet.-"Among the influences by which a liability to consumption is acquired, or by which a congenital predisposition to it is aggravated, that of an insufficient or improper diet stands first.” Impaired Nutrition.-Where the difficulty of insufficient Besides potatoes, he excludes carrots, turnips, parsnips, and beetroot; but allows asparagus, spinach, cabbage, and the leguminose vegetables freely. No sort of meat is prohibited, and he allows the fat as well as the lean to be eaten. Professor Ebstein does not set strict limits to the quantity of liquid consumed, and he believes that the rules are better kept in the main, and in the most important points, if some articles of diet which strictly would be forbidden-for example, potatoes-are allowed in very moderate quantities. The diet is thus kept from being so irksome, and the patient is able to persevere longer with it than he could otherwise do. It will be observed that in this plan, while the fats are not excluded, the rule against the carbo-hydrates is very strict. Gradual Change.-In most cases it will be well not to be too rigid, for the reasons already mentioned, and it cannot be too strongly insisted upon that the change of diet should be made gradually. Sugar, sweets, puddings, pastry, cakes, cream, sweet wines, stout and beer, should all be cut off. All farinaceous articles should be gradually reduced. Brown bread and toast in limited quantities should be substituted for ordinary bread, or its place may be partially taken by gluten bread. Lean meats, including poultry and game, also eggs, should be taken in moderation. Fish may enter largely into the dietary, and all green vegetables, salads, and cooked fruits may also be allowed. As already said, all malt liquors and sweet wines must be excluded. Hock, claret, or other light wine may be allowed to the extent of three or four glasses a day, or a small quantity of spirits in water may be permitted; but the total quantity of liquid taken in the twenty-four hours should not exceed two and a half or three pints. The corpulent should be encouraged to take exercise, and especially exercise in the open air; but any violent exertion is most undesirable, from the strain it would put on the heart and blood vessels. CHAPTER XI. DISEASES OF THE LUNGS AND PLEURÆ. GENERAL CONTENTS: Pulmonary Phthisis-Asthma-Pulmonary Emphysema -Chronic Bronchitis-Pleurisy with Effusion. PULMONARY PHTHISIS. As in struma, digestive disturbances, with evidences of malassimilation and mal-nutrition, frequently precede the direct manifestations of the diathesis; so in cases of pulmonary phthisis, we are accustomed to see the signs of lung-mischief preceded, often for some considerable time, by chronic dyspepsia, with a disordered state of system and a lowered standard of health. Wasting. Phthisis is essentially a wasting disease, and the great object of all treatment, dietetic, therapeutic, and climatic, is to raise the standard of nutrition. Niemeyer puts it thus: "Prophylaxis against consumption requires, in the first place, that when an individual shows signs of defective nutrition and a feeble constitution, especially if already he have given positive evidence of unusual delicacy, with a tendency to diseases which result in caseous products, he should be placed, if possible, under influences calculated to invigorate the constitution and to extinguish such morbid tendency." Insufficient Diet." Among the influences by which a liability to consumption is acquired, or by which a congenital predisposition to it is aggravated, that of an insufficient or improper diet stands first." Impaired Nutrition.-Where the difficulty of insufficient |