disorders, such as scarlet fever, measles, smallpox, diphtheria,
&c., but is most frequently the result of exposure to cold and damp,
when the body is heated. It may be confined to the parts situated at
the back of the mouth, i.e. the tonsils, palate, and pharynx, or it
may extend a little further into the windpipe. The affection is an
inflammation of the mucous membrane of the parts enumerated. Many
cases speedily recover without any active treatment, provided the
invalid will have patience for a few days, confine himself to the
house, better to one apartment, and still better to bed, for a couple
of days; avoid all conversation; apply a warm poultice to the throat,
or a moist compress round the throat night and day. This last is made
by wringing a piece of lint, or a pockethandkerchief, out of water
sufficiently so that it does not drip, and it is of small moment
whether the water be cold or warm; it is now applied to the throat,
and covered with a piece of macintosh, and then a woollen comforter
is put over all. Ice may be sucked continuously, if agreeable to the
patient. If it be not, then a gargle of warm milk and water should be
employed every hour. A smart aperient dose of Epsom salts or castor
oil should be taken in the morning before breakfast, 1 tablespoonful
salts in a tumblerful of hot water. If, under this treatment, the
throat do not improve in 2 days, it has ceased to be a minor ailment,
and the physician must be sent for.
A very painful form of sore throat is that called quinsy. It is
inflammation of the tonsils, two glands situated at the back of
the mouth. This inflammation is principally observed in changeable
climates; and seems to attack, by preference, young adults. Children
rarely suffer from quinsy. Persons who have once been the subjects
of this ailment are very liable to a recurrence of the disorder. The
most common exciting cause is exposure to wet and cold, with a chilly
east wind.
Those who are liable to this form of sore throat, and know from
the premonitory symptoms what is impending, ought at once to adopt
preventive measures. These consist in using strong astringent
gargles; in the administration of single drop doses of tincture of
aconite, every hour, for half a day, and a brisk saline purgative
in the morning, such as a dose of Rochelle salts. For gargle, one
of the best is the old-fashioned homely mixture, consisting of 3
tablespoonfuls red wine (port or claret), 1 of vinegar, ½ teaspoonful
powdered alum, and a little sugar, in a tumbler of cold water. This
to be used every hour. If, however, the affection has gone too far
for this abortive treatment, then the patient must be confined to
bed; hot poultices must be kept constantly applied to the throat;
steam from hot water should be inhaled often; a gargle of hot milk
and water should be used hourly; and ice, if grateful, may be
constantly sucked. A sal prunelle ball may be allowed slowly to
dissolve in the mouth. The diet should be in semi-solid form, e.g.
arrowroot made with milk, soup thickened with rice-flour, or better
still, beef-jelly, if the patient can be persuaded to swallow at all.
If the abscess do not speedily rupture, and more particularly if both
tonsils be simultaneously affected, then it may be necessary to call
in the aid of the surgeon to lance it. The necessity for this will be
evident by continued and increasing distress of the sufferer, great
difficulty in breathing, and extreme restlessness and feverishness.
In a first attack, too great delay ought not to be allowed to take
place before getting professional assistance.
Every one has a cure for sore throat, but simple remedies appear to
be most effectual. Salt and water is used by many as a gargle, but a
little alum and honey dissolved in sage tea is better. An application
of cloths wrung out of hot water and applied to the neck, changing
as often as they begin to cool, has the most potency for removing
inflammation. It should be kept up for a number of hours; during the
evening is the usually most convenient time for applying this remedy.
For loss of voice in singers and speakers, Dr. Corson recommends the
patient to put a small piece of borax (2-3 gr.) into the mouth and
let it dissolve slowly. An abundant secretion of saliva follows.
Speakers and singers about to make an unusual effort should the night
before take a glass of sugared water containing 2 dr. potassium
nitrate (saltpetre) in order to induce free perspiration. In similar
circumstances this gargle may also be used:--6 oz. barley water,
1-2 dr. alum, ½ oz. honey. Mix, and use as a gargle. Or an infusion
of jaborandi, made by putting 2 scr. of the leaves in a small cup
of boiling water, drunk in the morning before getting up. The free
sweating is said very quickly to restore the strength of the voice.
_Constipation._--Short of mechanically obstructive disease, there
are many states in which constipation is the most marked feature. On
the nature of these, apart from the mere symptom, the possibility
of permanent relief by treatment must of course largely depend. We
may procure comfort with a pill, but often we cannot retain it with
many. Habit cannot be reformed or expelled by purges. Accordingly,
when we proceed against the fault of habit, now under notice, we must
take account of the constitution and circumstances in which it is
formed. By so doing we do much to ensure the desired relief, though
it may be that even then we fail somewhat of complete success. A
bowel long deficient in activity, dilated irregularly, with torpid
though thickened walls, does not soon, if ever, renew its original
tone and contractility. The difficulty is a pathological one, and
arises from structural as well as functional perversion. The natural
efforts to obtain relief are hindered and enfeebled by the effects
of some cause which may still be operative. If we would undo the
past or prevent further mischief, we must seek and treat that cause.
Aperients of different kinds, however potent at the time, are but
temporary palliatives of discomfort so long as no pains are taken
to trace the trouble to its origin. Whether it be a sedentary
habit of life, an excess of food overloading and overworking the
viscus, purgation draining and depleting it, gout, diabetes, struma,
chlorosis, altering either the structure of the intestinal wall or
the consistence of its contents, it must be sought for as a chief
guide to the means of cure. It is not likely that constipation will
ever form the chosen hobby of a specialist. A far too general view
of medicine and its adjuvant sciences is necessary for successful
treatment to encourage such appropriation. We are not, however,
outside the sphere of nostrums. There is in our time, if anything too
much reliance on physic-taking for constipation. More might be done
by appropriate dieting and by inculcating active habits of life than
is customary. It may be noted, with regard to diet in particular,
that a free use of simple fluids, as water, or mild mineral waters,
is of distinct advantage in assisting both digestion and evacuation.
There are also many aperient vegetable foods which, with the same
end in view, we should like to see in daily use at the table. Almost
any kind of wholesome fruit and green vegetable might thus be made
serviceable. When, again, we come to medicines, we must remember that
the disorder which we have to combat is a complex one. We cannot in
this case, more than in any other morbid state, put a finger on one
tissue as alone or invariably at fault. Thus in the costiveness of
anæmia we have atony of the intestinal muscle combined with defective
secretion, and both but part of a general tissue starvation; in the
gouty disorder of elderly people the same conditions appear, though
due to a very different dyscrasia; and so on. We may say, therefore,
speaking generally, that no single drug can be relied on to meet the
intestinal difficulty. An agent which aids secretion either of bowel
or liver will not alone suffice. The long-inactive muscular coat
likewise requires assistance. A free purge may have its value now
and then, but when the object to be attained is the correction of
a habit, a milder remedy used regularly is much more effective. To
meet these various necessities, perhaps no combination is superior to
the time-honoured union of belladonna with the compound rhubarb pill
and nux vomica, or the most recent mixture of the fluid extract of
cascara with the last-named drug. An agreeable change of remedy is
afforded by many aperient mineral waters. The effect of these latter,
however, is unfortunately apt to pass off after a time, probably
from their causing a too copious intestinal secretion. The action of
saline or other enemata is not quite similar. More strictly local,
and exerted rather on the fæces than the bowel, it gives relief
without so much exhausting the latter by secretion or peristalsis;
while the very rest which the colon thus easily obtains is itself
a help to the recovery of normal nutrition and muscular tone. The
chief points which we would therefore bear in mind, whatever the
remedies used in combating the habit of costiveness, are the need for
recognition of its primary cause, and the fact that its proximate
condition is an atonic bowel. (_Lancet._)
Dr. Mortimer Granville gives 3 prescriptions for habitual
constipation. It is indispensable to regard persistent inactivity
of the bowels, when not demonstrably due to other causes, as the
result of, either defect of peristaltic action; deficient glandular
secretion; or interruption of the _habit_ of periodic evacuation.
When there is a lax and torpid condition of the muscular coat of the
alimentary canal, we get food retained in the stomach or intestines
until it ferments, or sometimes “decomposes,” with the result of
distension, pain mechanically induced, and either eructations
or incarcerated flatus. In a considerable number of cases this
last-mentioned trouble is so great, and at the same time so masked,
as to give rise to the impression that grave disease exists; whereas
every anomalous symptom has quickly disappeared as soon as the
muscular tone has been restored, and the contents of the bowels have
commenced to pass naturally on their course. The essential fault
is partial, in some instances almost complete, loss of the reflex
contractility of the muscular coat, so that the presence of ingesta
at any part of the canal does not excite the intestine to contract
and propel it onwards. It is worse than useless to employ ordinary
aperients in such a condition as this; they only irritate without
strengthening the nerves, on the healthy activity of which everything
depends. When, therefore, there is the form of “constipation” which
requires treatment, use a prescription something like the following;
and it is, in the majority of instances, successful:--
Sodæ valerianatis gr. xxxvi.; tincturæ nucis vomicæ ♏ lx.; tincturæ
capsici ♏ xlviii.; syrupi aurantii ℥iss.; aquâ ad ℥vj. Misce, fiat
mistura, cujus sumatur cochleare magnum ex aquâ ter die, semihorâ
ante cibum.
The second form of constipation, in which there is a deficiency of
glandular secretions generally throughout the intestine, manifested
by a peculiarly dry and earthy character of the dejecta when the
bowels _do_ act, may be treated by a mixture such as this:--
Aluminis ʒiij.; tincturæ quassiæ ℥j.; infusi quassiæ ℥vij. Misce,
fiat mistura, cujus sumantur cochlearia duo magna ter quotidie,
post cibum.
The third form, which depends chiefly on interruption of the natural
habit of periodic discharge, often results from repeated failure to
move the bowels, in consequence of one or other of the two preceding
forms of this trouble. This may generally be relieved by directing
a perfectly regular attempt to go to stool, and by the use of the
following draught, taken the first thing after _rising_ from bed--not
on awakening--in the morning, as nearly as possible at the same hour.
It will be observed that it is not an aperient in the ordinary sense
of the term. It is, as a rule, neither necessary nor desirable to
continue it for longer than a fortnight. In most instances, it will
be found to re-establish the normal habit in a week or less.
Ammoniæ carbonatis ʒj., tincturæ valerianæ ℥j.; aquæ camphoræ ℥v.
Misce, fiat mistura; capiat partem sextam in modo dicto. (_Brit.
Med. Journ._)
The value of castor oil as a family aperient is undoubted.
Referring to its use, Dr. Soper enlarges on the great advantages
of a combination of castor oil and glycerine in equal proportions
to act as a purgative. Glycerine has great therapeutic value,
especially in its solvent properties, and this combination renders
it especially valuable. In regard to castor oil, a great mistake is
often made in the largeness of dose administered; in this mixture,
only ½ teaspoonful is required combined with an equal bulk of
glycerine. In all cases of chronic constipation, piles, &c., it has
proved most useful. Also ½ teaspoonful doses in the early stages of
bronchitis seem to promote exudation from the tubes, and is certainly
expectorant. The great difficulty is the obstinacy with which the
mixture becomes a mixture, as it can only be made by placing the
bottle in hot water and violently agitating. By adding the oil to the
glycerine gradually, and mixing the two in a mortar, the taste of the
oil completely disappears. The following is recommended as a pleasant
form for children:--1 dr. castor oil, 1 dr. glycerine, 20 drops
tincture orange peel; 5 drops tincture senega; cinnamon water to make
up ½ oz. mixture.
_Consumption._--It is highly probable that adult mortality from
phthisis might be considerably reduced, if members of phthisical
families, and persons of phthisical habit and tendency, could be
induced to pursue an intelligent course of life. In wisely-chosen
food, suitable exercise, well-adapted clothing, and pure air, are
four distinct and potent details of every-day life, well within
control, which may be turned to efficient account in the prevention
of phthisis. Precautions, if they are to be effectual, must not be
put off until signs of lung mischief become manifest. Then the evil
can only be mitigated, not avoided. If consumption be apprehended,
the daily diet should be rich both in nitrogenous flesh-forming and
fatty constituents. The especial nutritive value of milk in such a
case is universally recognised. Next to well-arranged daily food,
exercise in the open air is of the greatest importance. On this point
the late Dr. Parkes laid down the rule that “the best climates for
phthisis are perhaps not necessarily the equable ones, but those
which permit the greatest number of hours to be passed out of the
house.” By well-adapted clothing, many of the chills, catarrhs, and
pulmonary congestions which often lead up to consumption, might
be prevented. The rules in this respect are well established. The
feet should always be dry and warm; the covered parts of the body,
excepting the head, should be clothed in suitable woollen fabrics;
the underclothing should be kept of the same thickness all the year
round, and variations of apparel to suit the changes of season be
made only in the outer garments; and no constrictions or compressions
should be allowed to hamper the respiratory play of the chest and
abdomen, or to impede the circulation of blood through the lungs and
heart. With regard to the respiration of pure air, it may be said
generally that it is within doors that the breathing of vitiated air
is most likely to become dangerous, and is such a powerful excitant
of consumption. (_Brit. Med. Journ._)
No person, particularly if young, should be allowed to sleep in the
same bed, or even in the same room, with a consumptive. No person
should be allowed to remain for too long a time in too close or too
constant attendance on a consumptive. Ventilation as perfect as
possible should be secured. The expectoration of phthisical patients
should be carefully disinfected. Those phthisical patients who are
in the habit of mixing freely with other persons should wear one of
those antiseptic respirators which are now to be obtained for a few
pence.
_Corns._--(_a_) Salicylic plaster has recently been put upon the
market as a cure for corns, bunions, and thickened skins generally.
The price is reasonable enough, but some may prefer to make it
for themselves. Dissolve 2 dr. each of salicylic acid and common
yellow resin in 6 dr. sulphuric ether, and paint the solution over
belladonna or opium plaster spread on swan’s-down. The mixture dries
almost instantaneously, and the plaster is then ready for cutting up
into suitable sizes for corns. Considering that the whole does not
cost more than 3-4_s._ per yd., and that several thousand plasters
may be made out of that quantity, it is cheap.
(_b_) Some corns are so painful that neither paint nor plaster can be
endured, something of the nature of a shield alone giving relief. For
such cases as these, the following wrinkle may be appreciated: Take
a corn-shield, enlarge the diameter of the hole to a small extent by
means of a knife or scissors, and apply in the usual way. Then place
in the hollow thus formed over the corn, a small quantity of any of
the following solutions: Salicylic acid and extract cannabis indica
dissolved in ether; or ½ dr. extract cannabis indica dissolved in
2 dr. liquor potassæ; or a saturated solution of iodine, or iodide
of potash, in strong alcohol. The shield does the double service
of taking the pressure of the boot off the corn, and at the same
time preventing the liquid being rubbed off by the sock; while all
these solutions penetrate the skin with more rapidity than the usual
collodion preparation, and are consequently much more effective in
their operation. The saturated solution of iodine often succeeds
in removing corns and indurated epidermis when other remedies have
failed, and the well-known solvent action of liquor potassæ is a
sufficient credential to induce for it at least a trial.
(_c_) Many corns may be removed by a persevering application of the
ordinary shield, which, relieving the pressure of the boot, enables
nature to throw off the old skin. Acetic acid, too, is an excellent
remedy for corroding the indurated epidermis; but it is necessary to
protect the surrounding parts by means of a paper shield.
(_d_) Mix 16 fl. oz. collodion with 2 oz. (avoir.) salicylic acid,
and, when this is dissolved, add 1 oz. (avoir.) zinc chloride. Keep
it tightly stoppered and away from lights or fire.
(_e_) Three dr. euphorbium, 6 dr. powdered cantharides, 4 dr. Venice
turpentine, 4 oz. alcohol. Macerate the euphorbium and cantharides
with the alcohol for 48 hours, strain, and add the Venice turpentine;
spread on French tissue-paper with a soft brush--size of each sheet
about 18 by 24 in. This article is in much repute for the cure of
corns and bunions, and the relief of gout.
(_f_) Dissolve 1 part salicylic acid in 40 of collodion: apply
several times a week. The corn dissolves with little trouble.
(_g_) For hard corns apply at night a mixture of 1 part carbolic
acid, and 10 of distilled water, glycerine, and soap liniment.
Envelop with guttapercha tissue, and the corn may generally be
removed the next morning.
(_h_) Gezou’s remedy for corns and warts is prepared as follows:--30
gr. salicylic acid, 10 gr. ext. cannabis indica, ½ oz. collodion.
(_i_) Fasten a piece of lemon on the corn, and renew night and
morning. Simple but very effective.
_Diarrhœa and Dysentery._--Beyond everything stands a strict
regulation of the diet. When the intestinal canal is in a diseased
state almost any substance introduced into the stomach acts
mischievously, and it is not infrequently necessary to suspend all
food until the intestine is in a condition to bear it. Every solid
article is then mischievous, but even fluids, by reason of their
temperature, may act as prejudicially. In most cases taking a few
spoonfuls of warm soup, or drinking a mouthful of cold water will
immediately be followed by severe colics, and soon afterwards by
evacuations. Only allow lukewarm soups or other drinks, and only
by a spoonful at a time. Of course these stringent rules apply to
very obstinate diarrhœa, and especially dysentery, for there are
many cases of temporary diarrhœa in which the patients continue to
eat fruits and the like, and still soon get well. Such cases must,
however, not be taken into account, and it is always most prudent at
the commencement of diarrhœa to cut off the supply of food as far
as possible, and at all events to prohibit all articles likely to
augment the affection.
Opium is the most valuable medicine in diarrhœa, for it keeps the
sphincter in a state of permanent contraction, a contraction which
is often propagated to the large intestine, and the small intestine
is unable to propel its contents far enough to induce the irritation
which causes their expulsion. When, by reason of this contraction,
these contents are retained, their amount may become considerably
diminished by the absorption of the fluid. Frequently, however, there
is no spot of the canal which is not so diseased as to prevent such
absorption taking place, and then the diarrhœa will continue in spite
of the opium and of the contraction of the sphincter. It appears,
moreover, that opium, besides its action on the muscular portion of
the canal, exerts, by contact, a soothing effect upon the mucous
membrane. In consequence of the diminution of the irritation of this
membrane, its secretion is probably lessened, as are possibly those
of the liver and pancreas. However this may be, opium acts very
favourably in profuse secretion from the intestinal mucous membrane.
From ½-3 gr. may be given in the 24 hours, the best preparation being
the _ext. opii aquosum_.
If opium or morphia do not suffice, it must be aided by astringent
remedies, by far the best of which, and the most easily supported, is
zinc sulphate. One would have supposed that tannin in its separate
state would have proved more useful than zinc, but this is not the
case, and it is much less easily borne. It acts much better and
more energetically when employed as a household remedy (e.g. as a
decoction of sloe or wild pear tree) than in its separated form,
and is then of great service in practice among the poor. Alum is of
no use whatever in diarrhœa. Lead approaches zinc in efficacy, but
still it is less certain than it. The dose should not be greater than
¼ gr., and this may be repeated every 2-3 hours, and at most every
hour. If these means do not suffice, we must have recourse to enemata
of salep or starch (with which may be combined 1 gr. opium or ½ gr.
zinc) not throwing up more than 2 oz. at a time. If the clyster does
not cause pain in the rectum, and the disease continues obstinate,
the dose of zinc may be increased to 2 gr. Tannin may be added to the
enema, but the zinc is far more serviceable. In the most obstinate
cases we must have recourse to cauterisation; but this is only the
case when there is a diseased condition of the lower part of the
rectum. Very obstinate cases of blenorrhœa confined to the anus maybe
completely cured by the application of silver nitrate, in substance
as high as it can be passed. The injection of a strong solution does
not usually attain the same end. (Prof. Skoda.)
A case of chronic diarrhœa, which had lasted for nearly 40 years, was
cured by the administration of a saturated solution of salt in cider
vinegar, 1 dr. being taken 3 or 4 times a day; it always produces
good results.
For cholera, a ready remedy is Dr. Rubini’s tincture of camphor,
taken on sugar, not in water. Or 1 teaspoonful cayenne pepper in ½
wine glass brandy.
To stop violent diarrhœa, take 2 drops each brandy and laudanum in 1
teaspoonful water every 3 minutes; go up to 60 doses if necessary.
Dr. Christopher Elliott speaks strongly in favour of the use of
camomile tea in infantile diarrhœa. The dose for infants under 1 year
is ½-1 dr., and double that quantity for older children, given 2 or
3 times a day, or oftener. The _rationale_ of the action is the
power the drug possesses of subduing reflex excitability. This power
belongs especially to the volatile oil contained in the flowers.
_Dislocations._--These are distinguished from broken bones by
stiffness at the joint, intense pain and swelling. They demand
surgical skill and must not be touched by any one but a doctor.