bulging out of the ribs that you have just now described, arise either
from delicacy of constitution, from the want of proper exercise, from
too much learning, or from too little play, or from not sufficient or
proper nourishment for a rapidly-growing body. I am happy to say that
such a case, by judicious treatment, can generally be cured—namely, by
gymnastic exercises, such as the hand-swing, the fly-pole, the patent
parlor gymnasium, the chest expander, the skipping-rope, the swimming
bath; all sorts of out-door games, such as croquet, archery, etc.; by
plenty of good nourishment, by making her a child of Nature, by letting
her almost live in the open air, and by throwing books to the winds. But
let me strongly urge you not, unless ordered by an experienced surgeon,
to allow any mechanical restraints or appliances to be used. If she be
made strong, the muscles themselves will pull both the spine and the
ribs into their proper places, more especially if judicious games and
exercises (as I have before advised), and other treatment of a
strengthening and bracing nature, which a medical man will indicate to
you, be enjoined. Mechanical appliances will, if not judiciously
applied, and in a proper case, waste away the muscles, and will thus
increase the mischief; if they cause the ribs to be pushed in in one
place, they will bulge them out in another, until, instead of being one,
there will be a series of deformities. No, the giving of strength and
the judicious exercising of the muscles are, for a lateral curvature of
the spine and the consequent bulging out of one side of the ribs, the
proper remedies, and, in the majority of cases, are most effectual, and
quite sufficient for the purpose.
I think it well to strongly impress upon a mother’s mind the great
importance of early treatment. If the above advice be followed, every
curvature in the beginning might be cured. Cases of several years’
standing might, with judicious treatment, be wonderfully relieved.
Bear in mind, then, that if the girl is to be made straight, she is
first of all to be made strong; the latter, together with the proper
exercises of the muscles, will lead to the former; and the _earlier_ a
medical man takes it in hand, the more rapid, the more certain, and the
more effectual will be the cure.
An inveterate, long-continued and neglected case of curvature of the
spine and bulging out of the ribs on one side might require mechanical
appliances, but such a case can only be decided on by an experienced
surgeon, who ought always, _in the first place_, to be consulted.
360. _Is a slight spitting of blood to be looked upon as a dangerous
symptom?_
Spitting of blood is always to be looked upon with suspicion, even when
a youth appears in other respects to be in good health; it is frequently
the forerunner of consumption. It might be said that, by mentioning the
fact, I am unnecessarily alarming a parent, but it would be a false
kindness if I did not do so:
“I must be cruel only to be kind.”
Let me ask when is consumption to be cured? Is it at the onset, or is it
when it is confirmed? If a mother had been more generally aware that
spitting of blood was frequently the forerunner of consumption, she
would, in the management of her offsprings, have taken greater
precautions; she would have made everything give way to the preservation
of their health; and, in many instances, she would have been amply
repaid by having the lives of her children spared to her. We frequently
hear of patients in _confirmed_ consumption being sent to Menton, to
Madeira, and to other foreign parts. Can anything be more cruel or
absurd? If there be any disease that requires the comforts of home—and
truly may an Englishman’s dwelling he called _home_!—and good nursing
more than another, it is consumption.
361. _What is the death-rate of Consumption in England? At what age does
Consumption most frequently occur? Are girls more liable to it than
boys? What are the symptoms of this disease?_
It is asserted, on good authority, that there always are, in England,
78,000 cases of consumption, and that the yearly death-rate of this fell
disease alone is 39,000! Consumption more frequently shows itself
between the ages of fourteen and twenty-one: after then, the liability
to the disease gradually diminishes, until at the age of forty-five it
becomes comparatively rare. Boys are more prone to this complaint than
girls. Some of the most important symptoms of pulmonary consumption are
indicated by the stethoscope; but, as I am addressing a mother, it
would, of course, be quite out of place to treat of such signs in
Conversations of this kind. The symptoms it might be well for a parent
to recognize, in order that she may seek aid early, I will presently
describe. It is perfectly hopeless to expect to cure consumption unless
advice be sought at the _onset_, as the only effectual good in this
disease is to be done _at first_.
It might be well to state that consumption creeps on insidiously. One of
the earliest symptoms of this dreadful scourge is a slight, dry, short
cough, attended with tickling and irritation at the top of the throat.
This cough generally occurs in the morning; but, after some time, comes
on at night, and gradually throughout the day and the night. Frequently
during the early stage of the disease _a slight spitting of blood
occurs_. Now this is a most dangerous symptom; indeed, I may go so far
as to say that, as a rule, it is almost a sure sign that the patient is
in the _first_ stage of a consumption.
There is usually hoarseness, not constant, but coming on if the patient
be tired, or toward the evening; there is also a sense of lassitude and
depression, shortness of breathing, a feeling of being quickly
wearied—more especially on the slightest exertion. The hair of a
consumptive person usually falls off, and what little remains is weak
and poor; the joints of the fingers become enlarged, or clubbed as it is
sometimes called; the patient loses flesh, and, after some time,
night-sweats make their appearance; then we may know that hectic fever
has commenced.
Hectic begins with chilliness, which is soon followed by flushings of
the face, and by burning heat of the hands and feet, especially of the
palms and the soles. This is soon succeeded by perspirations. The
patient has generally, during the day, two decided paroxysms of hectic
fever—the one at noon, which lasts about five hours, the other in the
evening, which is more severe, and ends in violent perspirations, which
perspirations continue the whole night through. He may, during the day,
have several attacks of hectic flushes of the face, especially after
eating; at one moment he complains of being too hot, and rushes to the
cool air; the next moment he is too cold, and almost scorches himself by
sitting too near the fire. Whenever the circumscribed hectic flush is on
the cheek, it looks as though the cheek had been painted with vermilion,
then is the time when the palms of the hands are burning hot.
The expectoration at first is merely mucus, but after a time it assumes
a characteristic appearance; it has a roundish, flocculent, wooly form,
each portion of phlegm keeping, as it were, distinct; and if the
expectoration be stirred in water, it has a milk-like appearance. The
patient is commonly harassed by frequent bowel complaints, which rob him
of what little strength he has left. The feet and ankles swell. The
perspiration, as before remarked, comes on in the evening, continues all
night, more especially toward morning and while the patient is asleep;
during the time he is awake, even at night, he seldom sweats much. The
thrush generally shows itself toward the close of the disease, attacking
the tongue, the tonsils, and the soft palate, _and is a sure harbinger
of approaching death_. Emaciation rapidly sets in.
If we consider the immense engines of destruction at work—viz., the
colliquative (melting) sweats, the violent bowel complaints, the vital
parts that are affected, the harassing cough, the profuse expectoration,
the hectic fever, the distressing exertion of struggling to breathe,—we
cannot be surprised that “consumption had hung out her red flag of no
surrender,” and that death soon closes the scene. In girls, provided
they have been previously regular, menstruation gradually declines, and
then entirely disappears.
362. _What are the causes of Consumption?_
The _predisposing_ causes of consumption are the scrofulous habit of
body, hereditary predisposition, narrow or contracted chest, deformed
spine, delicacy of constitution, bad and scanty diet, or food containing
but little nourishment, impure air, close in-door confinement in
schools, in shops, and in factories, ill-ventilated apartments,
dissipation, late hours, over-taxing with book learning the growing
brain, thus producing debility, want of proper out-door exercises and
amusements, tight lacing—indeed, anything and everything that either
will debilitate the constitution, or will interfere with or will impede
the proper action of the lungs, will be the predisposing causes of this
fearful and lamentable disease.
An ill, poor, and insufficient diet is the mother of many diseases, and
especially of consumption: “Whatsoever was the father of a disease, an
ill diet was the mother.”
The most common _exciting_ causes of consumption are slighted colds,
neglected inflammation of the chest, long continuance of influenza,
sleeping in damp beds, allowing wet clothes to dry on the body,
unhealthy employments—such as needle grinding, pearl-button making, etc.
363. _Supposing a youth to have spitting of blood, what precautions
would you take to prevent it from ending in Consumption?_
I should let his health be the first consideration; I should throw books
to the winds; if he be at school, I should advise you to take him away;
if he be in trade, I should cancel his indentures; if he be in the town,
I should send him to a sheltered healthy spot in the country, or to the
south coast; as, for instance, either to St. Leonards-on-Sea, or to
Torquay.
I should be particular in his clothing, taking especial care to keep his
chest and feet warm. If he did not already wear flannel waistcoats, let
it be winter or summer, I should recommend him immediately to do so; if
it be winter, I should advise him also to take to _flannel_ drawers. The
feet must be carefully attended to; they ought to be kept both warm and
dry, the slightest dampness of either shoes or stockings should cause
them to be immediately changed. If a boy, he ought to wear
double-breasted waistcoats; if a girl, high dresses.
The diet must be nutritious and generous; he should be encouraged to eat
plentifully of beef and mutton. There is nothing better for breakfast,
where it agrees, than milk; indeed, it may be frequently made to agree
by previously boiling it. Good home-brewed ale or sound porter ought, in
moderation, to be taken. Wine and spirits must on no account be allowed.
I caution parents in this particular, as many have an idea that wine, in
such cases, is strengthening, and that _rum_ and milk is a good thing
either to cure or to prevent a cough!
If it be summer, let him be much in the open air, avoiding the evening
and the night air. If it be winter, he should, unless the weather be
mild for the season, keep within doors. Particular attention ought to
be paid to the point the wind is in, as he should not be allowed to go
out if it is either in the north, in the east, or in the northeast;
the latter is more especially dangerous. If it be spring, and the
weather be favorable, or summer or autumn, change of air, more
especially to the south coast—to the Isle of Wight, for instance—would
be desirable; indeed, in a case of spitting of blood, I know of no
remedy so likely to ward off that formidable, and, generally,
intractable complaint—consumption—as change of air. The beginning of
the autumn is, of course, the best season for visiting the coast. It
would be advisable, at the commencement of October, to send him either
to Italy, to the south of France—to Mentone—or to the mild parts of
England—more especially either to Hastings, or to Torquay, or to the
Isle of Wight—to winter. But remember, if he be actually in a
_confirmed_ consumption, I would not, on any account whatever, let him
leave his home; as then the comforts of home will far, very far
outweigh any benefit of change of air.
364. _Suppose a youth to be much predisposed to a Sore Throat, what
precautions ought he to take to ward off future attacks?_
He must use every morning thorough ablution of the body, beginning
cautiously; that is to say, commencing with the neck one morning, then
by degrees, morning after morning, sponging a larger surface, until the
whole of the body be sponged. The chill at first must be taken off the
water; gradually the temperature ought to be lowered until the water be
quite cold, taking care to rub the body thoroughly dry with a coarse
towel—a Turkish rubber being the best for the purpose.
He ought to bathe his throat externally every night and morning with
lukewarm salt and water, the temperature of which must be gradually
reduced until at length no warm water be added. He should gargle his
throat either with barm, vinegar, and sage tea, or with salt and
water—two teaspoonfuls of table salt dissolved in a tumbler of water. A
wineglassful of barm, a wineglassful of vinegar, and the remaining sage
tea, to make a half-pint bottle of gargle. He ought to harden himself by
taking plenty of exercise in the open air. He must, as much as possible,
avoid either sitting or standing in a draught; if he be in one he should
face it. He ought to keep his feet warm and dry. He should take as
little aperient medicine as possible, avoiding especially both calomel
and blue-pill. As he grows up to manhood he ought to allow his beard to
grow, as such would be a natural covering for his throat: I have known
great benefit to arise from this simple plan. The fashion is now to wear
the beard, not to use the razor at all, and a sensible fashion I
consider it to be. The finest respirator in the world is the beard. The
beard is not only good for sore throats, but for weak chests. The
wearing of the beard is a splendid innovation; it saves no end of
trouble, is very beneficial to health, and is a great improvement “to
the human face divine.”
365. _Have you any remarks to make on the almost universal habit of boys
and of very young men smoking?_
I am not now called upon to give an opinion of the effects of tobacco
smoking on the middle-aged and on the aged. I am addressing a mother as
to the desirability of her sons, when boys, being allowed to smoke. I
consider tobacco smoking one of the most injurious and deadly habits a
boy or a young man can indulge in. It contracts the chest and weakens
the lungs, thus predisposing to consumption. It impairs the stomach,
thus producing indigestion. It debilitates the brain and nervous system,
thus inducing epileptic fits and nervous depression. It stunts the
growth, and is one cause of the present race of pigmies. It makes the
young lazy and disinclined for work. It is one of the greatest curses of
the present day. The following cases prove, more than any argument can
prove, the dangerous and deplorable effects of a boy smoking. I copy the
first case from _Public Opinion_. “The _France_ mentions the following
fact as a proof of the evil consequences of smoking for boys: ‘A pupil
in one of the colleges, only twelve years of age, was some time since
seized with epileptic fits, which became worse and worse in spite of all
the remedies employed. At last it was discovered that the lad had been
for two years past secretly indulging in the weed. Effectual means were
adopted to prevent his obtaining tobacco, and he soon recovered.’”
The other case occurred about five years ago, in my own practice. The
patient was a youth of nineteen. He was an inveterate smoker. From being
a bright, intelligent lad, he was becoming idiotic, and epileptic fits
were supervening. I painted to him, in vivid colors, the horrors of his
case, and assured him that if he still persisted in his bad practices,
he would soon become a driveling idiot! I at length, after some trouble
and contention, prevailed upon him to desist from smoking altogether. He
rapidly lost all epileptic symptoms, his face soon resumed its wonted
intelligence, and his mind asserted its former power. He remains well to
this day, and is now a married man with a family.
366. _What are the best methods to restrain a violent Bleeding from the
Nose?_
Do not interfere with a bleeding from the nose unless it be violent. A
bleeding from the nose is frequently an effort of Nature to relieve
itself, and therefore, unless it be likely to weaken the patient, ought
not to be restrained. If it be necessary to restrain the bleeding, press
firmly for a few minutes the nose between the finger and the thumb—this
alone will often stop the bleeding; if it should not, then try what
bathing the nose and the forehead and the nape of the neck with water
quite cold from the pump will do. If that does not succeed, try the
old-fashioned remedy of putting a cold large door-key down the back. If
these plans fail, try the effects either of powdered alum or of powdered
matico, used after the fashion of snuff—a pinch or two, either of the
one or the other, or of both, should be sniffed up the bleeding nostril.
If these should not answer the purpose, although they almost invariably
will, apply a large lump of ice to the nape of the neck, and put a small
piece of ice into the patient’s mouth for him to suck.
If these methods do not succeed, plunge the hand and the forearm into
cold water, keep them in for a few minutes, then take them out, and
either hold or let be held up the arms and hands high above the head;
this plan has frequently succeeded when others have failed. Let the room
be kept cool, throw open the windows, and do not have many in the room
to crowd around the patient.
Doubtless, Dr. Richardson’s local anæsthetic—the ether spray—playing
from a few seconds to a minute _on_ the nose and _up_ the bleeding
nostril, would act most beneficially in a severe case of this kind, and
would, before resorting to the disagreeable operation of plugging the
nose, deserve a trial. I respectfully submit this suggestion to my
medical brethren. The ether—rectified ether—used for the spray ought to
be perfectly pure, and of the specific gravity of 0.723.
If the above treatment does not soon succeed, send for a medical man, as
more active means, such as plugging of the nostrils—_Which is not done
unless in extreme cases_—might be necessary.
But before plugging of the nose is resorted to, it will be well to try
the effects of a cold solution of alum:
Take of—Powdered Alum, one drachm;
Water, half a pint;
To make a Lotion.
A little of the lotion should be put into the palm of the hand and
sniffed up the bleeding nostril; or, if that does not succeed, some of
the lotion ought, by means of a syringe, to be syringed up the nose.
367. _In case of a young lady Fainting, what had better be done?_
Lay her flat upon her back, taking care that the head be as low as or
lower than the body; throw open the windows; do not crowd around her;
unloose her dress as quickly as possible; ascertain if she have been
guilty of tight lacing, for fainting is sometimes produced by that
reprehensible practice. Apply smelling salts to her nostrils; if they be
not at hand, burn a piece of rag under her nose; dash cold water upon
her face; throw open the window; fan her; and do not, as is generally
done, crowd round her, and thus prevent a free circulation of air.
Shakspeare knew the great importance of not crowding around a patient
who has fainted. He says:
“So play the foolish throngs with one that swoons;
Come all to help him, and so stop the air
By which he should revive.”
_Measure for Measure_, Act ii. sc. 4.
As soon as she can swallow, give her either a draught of _cold_ water,
or a glass of wine, or a teaspoonful of sal-volatile in a wineglassful
of water.
_To prevent fainting for the future._—I would recommend early hours;
country air and exercise; the stays, if worn at all, to be worn slack;
attention to diet; avoidance of wine, beer, spirits, excitement, and
fashionable amusements.
Sometimes the cause of a young lady fainting is either a disordered
stomach or a constipated state of the bowels.
If the fainting have been caused by _disordered stomach_, it may be
necessary to stop the supplies, and give the stomach, for a day or two,
but little to do; a fast will frequently prevent the necessity of giving
medicine. Of course, if the stomach be _much_ disordered, it will be
desirable to consult a medical man.
If your daughter’s fainting have originated from a _costive state of the
bowels_ (another frequent cause of fainting), I beg to refer you to a
subsequent Conversation, in which I will give you a list of remedies for
the prevention and the treatment of constipation.
A young lady’s fainting occasionally arises from debility—from downright
weakness of the constitution; then the best remedies will be change of
air to the coast, good nourishing diet, and the following strengthening
mixture:
Take of—Muriated Tincture of Iron, one drachm and a half;
Tincture of Calumba, six drachms;
Distilled Water, seven ounces.
Two tablespoonfuls of this mixture to be taken three times a day.
Or, for a change, the following:
Take of—Wine of Iron, one ounce and a half;
Distilled Water, six ounces and a half:
To make a Mixture. Two tablespoonfuls to be taken three times a day.
Iron medicines ought always to be taken _after_ instead of _before_ a
meal. The best times of the day for taking either of the above mixtures
will be eleven o’clock, four o’clock, and seven o’clock.
368. _You had a great objection to a mother administering calomel either
to an infant or to a child, have you the same objection to a boy or a
girl taking it when he or she requires an aperient?_
Equally as great. It is my firm belief that the frequent use, or rather
the abuse, of calomel and of other preparations of mercury, is often a
source of liver disease, and an exciter of scrofula. It is a medicine of
great value in some diseases, when given by a _judicious_ medical man;
but, at the same time, it is a drug of great danger when either given
indiscriminately, or when too often prescribed. I will grant that in
liver diseases it frequently gives temporary relief; but when a patient
has once commenced the regular use of it, he cannot do without it,
until, at length, the _functional_ ends in _organic_ disease of the
liver. The use of calomel predisposes to cold, and thus frequently
brings on either inflammation or consumption. Family aperient pills
ought never to contain, in any form whatever, a particle of mercury.
369. _Will you give me a list of remedies for the prevention and for the
cure of Constipation?_
If you find it necessary to give to your son or to your daughter
aperient medicine, the mildest ought to be selected; for instance, an
agreeable and an effectual one is an electuary composed of the following
ingredients:
Take of—Best picked Alexandria Senna, one ounce;
Best Figs, two ounces;
Best Raisins (stoned), two ounces:
All chopped very fine. The size of a nutmeg or two to be occasionally
eaten.
Or, one or two teaspoonfuls of compound confection of senna (lenitive
electuary) may occasionally, early in the morning, be taken. Or, for a
change, a teaspoonful of Henry’s magnesia, in half a tumblerful of warm
water. If this should not be sufficiently active, a teaspoonful of Epsom
salts should be given with the magnesia. A Seidlitz powder forms another
safe and mild aperient; or one or two compound rhubarb pills may be
given at bedtime. The following prescription for a pill, where an
aperient is absolutely necessary, is a mild, gentle, and effective one
for the purpose:
Take of—Extract of Socotrine Aloes, eight grains;
Compound Extract of Colocynth, forty-eight grains:
Hard Soap, twenty-four grains;
Treacle, a sufficient quantity:
To make twenty-four Pills. One or two to be taken at bedtime
occasionally.