=Headaches=
_Treatment of Sick Headache--Effects of
Indigestion--Neuralgia--Headaches Occasioned by Disease--Other
Causes--Poisoning--Heat Stroke._
Headache varies according to its nature and causes. The first variety
to be considered is "sick headache" or migraine.
=SICK HEADACHE.=--This is a peculiar, one-sided headache which takes
the form of severe, periodic attacks or paroxysms, and is often
inherited. It recurs at more or less regular intervals, as on a
certain day of each week, fortnight or month, and the attacks appear
and disappear at regular hours. The disorder generally persists for
years and then goes away. If it begins in childhood, as it frequently
does between the years of five and ten, it may stop with the coming of
adult life, but if not outgrown at this time it commonly vanishes
during late middle life, about the age of fifty-one in a man, or with
the "change of life" in a woman. While in many instances arising
without apparent cause, yet in others sick headache may be
precipitated by indigestion, by eye-strain, by enlarged tonsils and
adenoids in children, or by fatigue.
There may be some warning of the approach of a sick headache, as
mental depression, weariness, disturbances of sight, buzzing in the
ears, or dizziness. The pain begins at one spot on one side of the
head (more commonly the left), as in the eye, temple, or forehead, and
later spreads over the whole side of the head and, in some cases, the
neck and arm. The face may be pale, or pale on one side and red on the
other. The headache is of a violent, boring nature, aggravated by
light and noise, so that the patient is incapacitated for any exertion
and is most comfortable when lying down in a quiet, dark room.
Vomiting usually comes on after a while, and often gives relief. The
headache lasts several hours or all day, rarely longer. The duration
is usually about the same in the case of any particular individual who
is suddenly relieved at a certain hour generally after vomiting, a
feeling of well-being and an enormous appetite following often.
Patients may feel perfectly well between the attacks, but if they
occur frequently the general health suffers.
In the majority of cases there is no apparent cause discoverable save
heredity, and for these the following treatment is applicable. Each
case should, however, be carefully studied by a physician, if
possible, as only in this way can any existing cause be found and
removed.
=Treatment.=--Any article of diet which experience has shown to
provoke an attack should naturally be avoided. A Seidlitz powder, or
tablespoonful of Epsom salts in a glassful of water, is advisable at
the onset of an attack. Rubbing the forehead with a menthol pencil
will afford some relief. Hot strong tea with lemon juice is sometimes
of service. To actually lessen the pain _one_ of the following may be
tried: phenacetin (eight grains) and repeat once in an hour if
necessary until three doses are taken by an adult; or, migraine
tablets, two in number, and do not repeat; or fluid extract of
cannabis indica, two drops every half hour until relieved, or until
six doses are taken.
=HEADACHE FROM VARIOUS CAUSES.=--It is impossible to decide from the
location or nature of the pain alone to what variety of headache it
belongs, that is, as to its cause. It is only by considering the
general condition of the body that such a decision can be attained.
=Headache from Indigestion.=--The pain is more often in the forehead,
but may be in the top or back of the head. The headache may last for
hours, or "off and on" for days. Dull headache is seen in
"biliousness" when the whites of the eyes are slightly tinged with
yellow and the tongue coated and yellowish, and perhaps dizziness,
disturbances of sight and a feeling of depression are present. Among
other signs of headache due to indigestion are: discomfort in the
stomach and bowels, constipation, nausea and vomiting, belching of
wind, hiccough, and tender or painful eyeballs.
In a general way, treatment for this sort of headache consists in the
use of a cathartic, such as calomel (three-fifths of a grain) at
night, followed by a Seidlitz powder or a tablespoonful of Epsom salts
in a glass of cold water in the morning. A simple diet, as very small
meals of milk, bread, toast, crackers with cereals, soups, and perhaps
a little steak, chop, or fresh fish for a few days, may be sufficient
to complete the cure.
=Sympathetic Headaches.=--These are caused by irritation in various
parts of the body, which is conveyed through the nervous system to the
brain producing headache. Headache from eye-strain is one of this
class, and probably the most common, and, therefore, most important of
all headaches. There is unfortunately no sure sign by which we can
tell eye-headaches from others, except examination of the eyes (see p.
29). Redness, twitching, and soreness of the eyelids, and watering of
the eyes, together with headache, after their excessive use may
suggest the cause in some cases. The pain may be occasioned or almost
constant, and either about the eyes, forehead, top or back of the
head, and often takes the form of "sick headache." The headache may at
times appear to have no connection with use of the eyes. When headache
is frequent the eyes should always be examined by a competent oculist
(a physician) not by any sort of an optician.
=Decayed Teeth.=--These not uncommonly give rise to headache.
=Disorders of the Nose and Throat.=--Such troubles, especially
adenoids and enlarged tonsils in children, enlarged turbinates, and
polypi (see Nose Disorders, p. 60) are fruitful sources of headache.
In nose-headaches there is often tenderness on pressing on the inner
wall of the bony socket inclosing the eyeball.
=Diseases of the Maternal Organs.=--These in women produce headache,
particularly pain in the back of the head. If local symptoms are also
present, as backache (low down), leucorrhea, painful monthly periods,
and irregular or excessive flowing, or trouble in urinating, then the
cause of the headache is probably some disorder which can be cured at
the hands of a skillful specialist in women's diseases.
=Nervous Headaches.=--These occur in brain exhaustion and anaemia, and
in nervous exhaustion. There is a feeling of pressure or weight at the
back of the head or neck, rather than real pain. This is often
relieved by lying down. Headache from anaemia is often associated with
pallor of the face and lips, shortness of the breath, weakness, and
palpitation of the heart. Rest, abundance of sleep, change of scene,
out-of-door life, nourishing food, milk, cream, butter, eggs, meat,
and iron are useful in aiding a return to health (see Nervous
Exhaustion, Vol. III, p. 17).
=Neuralgic Headaches.=--The pain is usually of a shooting character,
and the scalp is often exceedingly tender to pressure. They may be
caused by exposure to cold, or by decayed teeth, or sometimes by
inflammation of the middle ear (see Earache, p. 40).
=Headache from Poisoning.=--Persons addicted to the excessive use of
tea, coffee, alcohol, and tobacco are often subject to headache from
poisoning of the system by these substances. In tea, coffee, and
tobacco poisoning there is also palpitation of the heart in many
cases; that is, the patient is conscious of his heart beating,
irregularly and violently (see Palpitation, Vol. III, p. 171), which
causes alarm and distress. Cessation of the habit and sodium bromide,
twenty grains three times daily, dissolved in water, administered for
not more than three days, may relieve the headache and other trouble.
Many drugs occasion headache, as quinine, salicylates, nitroglycerin,
and some forms of iron.
The poisons formed in the blood by germs in acute diseases are among
the most common sources of headache. In these disorders there is
always fever and often backache, and general soreness in the muscles.
One of the most prominent symptoms in typhoid fever is constant
headache with fever increasing toward night, and also higher each
night than it was the night before. The headache and fever, together
often with occasional nosebleed and general feeling of weariness, may
continue for a week or two before the patient feels sick enough to go
to bed. The existence of headache with fever (as shown by the
thermometer) should always warn one of the necessity of consulting a
physician. Headache owing to germ poisons is also one of the most
distressing accompaniments of _grippe_, measles, and smallpox, and
sometimes of pneumonia.
The headache caused by the poison of the malarial parasite in the
blood is very violent, and the pain is situated usually just over the
eye, and occurring often in the place of the paroxysm of the chill and
fever at a regular hour daily, every other day, or every fourth day.
If the headache is due to malaria, quinine will cure it (Malaria, Vol.
I, p. 258). The headache of rheumatism is owing also to a special
poison in the blood, and is often associated with soreness of the
scalp. If there are symptoms of rheumatism elsewhere in the body,
existing headache may be logically attributed to the same disease (see
Rheumatism, p. 169).
The poison of gout circulating in the blood is sometimes a source of
intense headache.
The headache of Bright's disease of the kidneys and of diabetes is
dull and commonly associated with nausea or vomiting, swelling of the
feet or ankles, pallor and shortness of breath in the former; with
thirst and the passage of a large amount of urine (normal quantity is
three pints in twenty-four hours) in the case of diabetes.
The headaches of indigestion are also of poisonous origin, the
products of imperfectly digested food being absorbed into the blood
and acting as poisons.
Another variety of headache due to poisoning is seen in children
crowded together in ill-ventilated schoolrooms and overworked. Still
another kind is due to inhalation of illuminating gas escaping from
leaky fixtures.
=Headache from Heat Stroke.=--Persons who have been exposed to
excessive heat or have actually had a heat stroke (Vol. I, p. 40) are
very prone to headache, which is made worse by movements of the head.
Sodium bromide, twenty grains dissolved in water, may be given to
advantage three times daily between meals in these cases for not more
than two days. Phenacetin in eight-grain doses may also afford relief,
but should not be used more often than once or twice a day.
=Constant Headache.=--This, afflicting the patient all day and every
day, and increasing in severity at night, is suggestive of some
disease of the brain, as congestion, brain tumor, or meningitis, and
urgently demands skillful medical attention.
Part II
TUMORS
SKIN DISEASES
RHEUMATISM
BY
KENELM WINSLOW
AND
ALBERT WARREN FERRIS
CHAPTER I
=Growths and Enlargements=
_Benign and Malignant Tumors--Treatment of Rupture--Hernia in
Children--Varicocele--Causes of Varicose Veins--External and Internal
Piles._
=TUMORS.=--A tumor--in its original meaning--signifies a swelling. As
commonly used it means a new growth or enlargement of a part, which is
not due to injury or inflammation. Tumors occur at all ages, in both
sexes, and may attack any part of the body. Tumors are usually divided
into benign and malignant growths. In a general way the malignant
tumors are painful; they do not move about freely but become fixed to
the adjacent parts; their growth is more rapid; they often have no
well-defined borders; frequently they return after removal; the skin
covering them is often attached and cannot be moved readily without
also moving the tumor. Malignant tumors are divided into cancers
(carcinomata) and sarcomas (sarcomata). Cancer is much more frequent
than sarcoma. Cancer occurs more often in persons over thirty; there
appears to be a hereditary tendency to it in some families, and a
number of individuals in the same house or locality sometimes develop
cancer as if it were in some way communicated from one to another.
The common situations of cancer are the breast and womb in women, and
the lip and stomach of men. The neighboring glands become enlarged, as
are shown by the lumps which form under the jaw in cancer of the lip,
and which may be felt sometimes in the armpit in cancer of the breast;
these are, however, late signs, and the growth should never be
permitted to remain long enough for them to develop. Paleness,
weakness, and loss of strength often attend the development of cancer,
but many do not exhibit these symptoms.
Sarcoma is often seen in the young and well nourished; it grows very
rapidly; the skin is usually not adherent to the tumor; there is
generally no pain; heredity has no relation to its development;
paleness is absent in many cases; the favorite seats are the muscle,
bone, glands of neck, brain, and many other localities; it is not
nearly so common as cancer.
Cancer of the breast begins as a lump, occurring more often to the
outside of the nipple, but may develop in any part. It may or may not
be painful at first, but the skin becomes attached to it; and sooner
or later the nipple is drawn in. It is seen in women over forty, as a
rule. Lumps in the breast, occurring during the nursing period, are
often due to inflammation, but these generally have no relation to
cancer unless they persist for a long time. Any lump which appears in
the breast without apparent cause, or which persists for a
considerable time after inflammation ceases, should be promptly
removed by the surgeon, as without microscopic examination the most
skilled practitioners will be unable absolutely to distinguish between
a harmless and malignant tumor. As even so-called benign tumors often
become cancerous (e. g., inflammatory lumps in the breast, warts, and
moles), an eminent surgeon (Dr. Maurice Richardson) has recently
formulated the rule that all tumors, wherever situated, should if
possible be removed, whatever their apparent nature. Cancer of the
womb may be suspected in middle-aged women if flowing is more profuse
than is usual, or occurs at irregular times; if there is a discharge
(often of offensive odor) from the front passage; and sometimes pain,
as backache, and perhaps paleness. Early examination should be sought
at the hands of a physician; it is suicidal to delay.
Cancer of the stomach is observed more often in men over forty, and
begins with loss of appetite; nausea or vomiting; vomiting of blood;
pain in the stomach; loss of weight, and paleness. Some of these
symptoms may be absent. Improved methods of surgery have rendered
early operation for cancer of the stomach a hopeful measure, and if
cure does not result, the life will be prolonged and much suffering
saved.
Cancer of the lip arises as a small lump, like a wart generally, on
the lower lip in men from forty to seventy. Sometimes it appears at
first simply as a slight sore or crack which repeatedly scabs over but
does not heal. Its growth is very slow and it may seem like a trivial
matter, but any sore on the lower lip in a man of middle age or over,
which persists, should demand the immediate attention of a surgeon,
because early removal is more successful in cancer of the lip than in
any other form.
There are, of course, many comparatively harmless or benign forms of
tumors which will not return if removed and do not endanger life
unless they grow to a large size. Among these are the soft, flattened,
fatty tumors of the shoulders, back, buttocks, and other parts, and
the wen. This is often seen on the head and occurs frequently on the
scalp, from the size of a pea to an egg, in groups. Wens are elastic
lumps, painless and of slow growth, and most readily removed. Space
does not permit us to recount the other forms of benign tumors and it
would be impossible to describe how they could be distinguished from
malignant growths.
=Causes.=--The causes of tumors are almost wholly unknown. There is no
other branch of medicine which is receiving more scientific study the
world over than cancer, and some definite and helpful knowledge may
soon be expected. A cancer can be communicated by introduction of
cancerous material into healthy tissues. This and other reasons have
led many to believe that the disease was caused by a special germ; a
chemical cause is thought to be the origin of cancer by other
authorities. Neither of these theories has been substantiated and we
are still completely at sea in the matter. Cancer appears to be
excited sometimes by local irritation, as in the lip by the constant
irritation of the hard, hot stem of a clay pipe; cancer of the tongue
by the irritation of a rough, sharp tooth. Blows and injuries are also
occasional agencies in the development of cancer. Malignant growths
not rarely arise from moles and warts.
=Treatment.=--Early removal by the knife is the only form of treatment
which is to be considered in most cases. Delay and neglect are
suicidal in malignant disease. Cure is successful in just so far as
the operation is done early. If dread of surgical operation were not
so prevalent, the results of removal of cancer would be immeasurably
better. The common, bad results of operation--that is, return of the
disease--are chiefly due to the late stage in which surgeons are
compelled to operate through the reluctance of the patient and,
strangely enough, often of his family medical man. Cancer should be
removed in so early a stage that its true nature can often not be
recognized, except by microscopical examination after its removal. If
Maurice Richardson's rule were followed, many cancers would never
occur, or would be removed before they had developed sufficiently to
show their nature.
All treatment by chemical pastes and special remedies is simply
courting fatal results. Most special cures advertised to be performed
in sanitoriums are money-getting humbugs. Even the X-ray has proved
useless except in the case of most superficial growths limited to the
skin or when directed against the scar left by removal of a cancer;
and while the growth may disappear during treatment, in a large
proportion of cases there is a recurrence. But when tumors are so far
advanced that removal by the knife is inoperable, then other means
will often secure great relief from suffering and will prolong life
for a very considerable period in many cases.
=RUPTURE.=--Hernia or rupture consists in a protrusion of a portion of
the contents of the abdomen (a part of the bowel or its covering, or
both) through the belly wall. The common seats of rupture are at the
navel and in the groin. Rupture at the navel is called umbilical
hernia; that in the groin either inguinal or femoral, according to
slight differences in site. Umbilical hernia is common in babies and
occurs as a whole in only five per cent of all ruptures, whereas
rupture in the groin is seen to the extent of ninety-four per cent of
all ruptures. There is still another variety of hernia happening in
the scars of wounds of the belly after injuries or surgical
operations, and this may arise at almost any point.
=Causes.=--Rupture is sometimes present at birth. In other cases it is
acquired as a result of various causes, of which natural weakness of
the part is the chief. Twenty-five per cent of persons with rupture
give a history of the same trouble in their parents. Rupture is three
times more frequent in men than in women, and is favored by severe
muscular work, fatness, chronic coughing, constipation, diarrhea,
sudden strain, or blows on the abdomen.
=Symptoms.=--Rupture first appears as a fullness or swelling, more
noticeable on standing, lifting, coughing, or straining. It may
disappear entirely on lying down or on pressure with the fingers. In
the beginning there may be discomfort after standing or walking for
any length of time, and later there is often a dragging pain or
uneasiness complained of, or a sensation of weakness or griping at the
seat of the rupture. In case the rupture cannot be returned, it is
called irreducible and is a more serious form. The great danger of
hernias is the likelihood of their being strangulated, as the term is;
that is, so nipped in the divided abdominal wall that the blood
current is shut off and often the bowels are completely obstructed. If
this condition is not speedily relieved death will ensue in from two
to eight days. Such a result is occasioned, in persons having rupture,
by heavy lifting, severe coughing or straining, or by a blow or fall.
The symptoms of strangulated hernia are sudden and complete
constipation, persistent vomiting, and severe pain at the seat of the
rupture or often about the navel. The vomiting consists first of the
contents of the stomach, then of yellowish-stained fluid, and finally
of dark material having the odor of excrement. Great weakness,
distention of the belly, retching, hiccough, thirst, profound
exhaustion, and death follow if the condition is not remedied. In
some cases, where the obstruction is not complete, the symptoms are
comparatively milder, as occasional vomiting and slight pain and
partial constipation.
If the patient cannot return the protrusion speedily, a surgeon should
be secured at all costs--the patient meanwhile lying in bed with an
ice bag or cold cloths over the rupture. The surgeon will reduce the
protrusion under ether, or operate. Strangulation of any rupture may
occur, but of course it is less likely to happen in those who wear a
well-fitting truss; still it is always a dangerous possibility, and
this fact and the liability of the rupture's increasing in size make a
surgical operation for complete cure advisable in proper subjects.
=Treatment.=--Two means of treatment are open to the ruptured: the use
of the truss and surgical operation. By the wearing of a truss,
fifty-eight per cent of ruptures recover completely in children under
one year. In children from one to five years, with rupture, ten per
cent get well with the truss. Statistics show that in rupture which
has been acquired after birth but five per cent recover with a truss
after the age of fifteen, and but one per cent after thirty. The truss
must be worn two years after cure of the rupture in children, and in
adults practically during the rest of their lives. A truss consists of
a steel spring which encircles the body, holding in place a pad which
fits over the seat of hernia. The Knight truss is one of the best. The
truss is most satisfactory in ruptures which can be readily returned.
In very small or large hernias, and in those which are not reducible,
the action of the truss is not so effective. In irreducible ruptures
there is likely to be constipation and colic produced, and
strangulation is more liable to occur. A truss having a hollow pad may
prove of service in small irreducible ruptures, but no truss is of
much value in large hernias of this kind. Every person with a
reducible rupture should wear a proper truss until the rupture is
cured by some means. Such a truss should keep in the hernia without
causing pain or discomfort. It should be taken off at night, and
replaced in the morning while the patient is lying down. In cases
where the protrusion appears during the night a truss must be worn day
and night, but often a lighter form will serve for use in bed. To test
the efficiency of a truss let the patient stoop forward with his knees
apart, and hands on the knees, and cough. If the truss keeps the
hernia in, it is suitable; if not, it is probably unsuitable.
Operation for complete cure of the hernia is successful in 95 cases
out of 100, in suitable subjects, in the ruptures in the groin. The
death rate is but about 1 in 500 to 1,000 operations when done by
surgeons skilled in this special work. Patients with very large and
irreducible hernias, and those who are very fat and in advanced life,
are unfavorable subjects for operation. In young men operation--if it
can be done by a skillful surgeon and in a hospital with all
facilities--is usually to be recommended in every case of rupture.
Umbilical hernias and ventral hernias, following surgical operations,
may be held in place by a wide, strong belt about the body, which
holds a circular flat or hollow plate over the rupture. These have
been the most difficult of cure by operation; but recent improvements
have yielded very good results--thirty-five cures out of thirty-six
operations for umbilical rupture, and one death, by Mayo, of
Rochester, Minn.--and they are usually the very worst patients, of
middle age, or older, and very stout.
Umbilical rupture in babies is very common after the cord has dropped
off. There is a protrusion at the navel which increases in size on
coughing, straining, or crying. If the rupture is pushed in and the
flesh is brought together from either side in two folds over the
navel, so as to bury the navel out of sight, and held in this position
by a strip of surgeon's plaster, reaching across the front of the
belly and about two and one-half inches wide, complete recovery will
usually take place within a few months. It is well to cover the
plaster with a snug flannel band about the body. The plaster should be
replaced as need be, and should be applied in all cases by a physician
if one can be secured.
=VARICOSE VEINS.=--Varicose veins are enlarged veins which are more
commonly present on the legs, but are also seen in other parts of the
body. They stand out from the skin as bluish, knotty, and winding
cords which flatten out when pressure is made upon them, and shrink
in size in most cases upon lying down. Sometimes bluish, small, soft,
rounded lumps, or a fine, branching network of veins may be
seen. Oftentimes varicose veins may exist for years--if not
extensive--without either increasing in size or causing any trouble
whatsoever. At other times they occasion a feeling of weight and dull
pain in the legs, especially on long standing. When they are of long
duration the legs may become swollen and hard, and eczema, with
itching, is then not uncommon. This leads to scratching and sores, and
these may enlarge and become what are called varicose ulcers, which
are slow and difficult of healing. Occasionally an old varicose vein
may break open and give rise to profuse bleeding.
=Causes.=--Varicose veins are more frequent in women, especially in
those who stand much, as do cooks. Any obstruction to the return flow
of the blood from the veins toward the heart will produce them, as a
tight garter about the leg; or the pressure of the large womb in
pregnancy upon the veins, or of tumors in the same region. Heart and
lung diseases also predispose to the formation of varicose veins.
=Treatment.=--Varicose veins are exceedingly common, and if they are
not extensive and produce no discomfort they may be ignored.
Otherwise, it is well to have an elastic stocking made to come to, or
above, the knee. The stocking should be put on and removed while lying
down. Cold bathing, outdoor exercise, and everything which will
improve the general health and tone are desirable, also the avoidance
of constipation. In the most aggravated cases surgical operation will
cure varicose veins. Bleeding from a broken vein is stopped by
pressure of a bandage and lying on the back with the foot raised on a
pillow.
=VARICOCELE.=--This consists of an enlargement of the veins in the
scrotum above the testicle of the male, on the left side in most
cases. The large veins feel more like a bunch of earthworms than
anything else. If they cause no discomfort they may be entirely
neglected and are not of the slightest consequence. Even when they
produce trouble it is chiefly imaginary, in most instances, since they
are a common source of worry in young men in case of any
irregularities in the sexual functions. Advantage is taken of this
fact by quacks, who find it for their profit to advertise all sorts of
horrible and impossible results of the condition. The testicle on the
diseased side may become smaller than its fellow, but in few cases
does any serious consequence result from varicocele. Pain in the
hollow of the back may be the only symptom of varicocele in cases
where there are any symptoms. A dragging pain in the groin, a pain in
the testicles and about the rectum and in the bladder may cause
complaint.
=Causes.=--Varicocele occurs usually in young, unmarried men and often
disappears of itself in later life. Undue sexual excitement may
produce the condition.
=Treatment.=--When any treatment is necessary, the application of a
snugly fitting suspensory bandage--which can be procured at any good
drug shop--and bathing the testicles night and morning in cold water,
with the avoidance of constipation and of the cause noted, will be
generally sufficient to relieve any discomfort arising from
varicocele. The enlargement of the veins will not, of course, be
altered by this treatment, and absolute cure can only be effected by a
surgical removal of the veins, which is not a serious undertaking, but
is rarely necessary.
=PILES--HEMORRHOIDS.=--Piles consist of enlarged, and often inflamed,
veins in the rectum, or lower part of the bowel.
=External Piles.=--These are bluish swellings or little lumps which
project from the bowel, interfering with walking or the toilet of the
parts, and are sometimes exquisitely tender and painful when inflamed.
In the course of time these become mere projections or fringes of
flesh and cause no trouble unless through uncleanliness or other
reasons they are irritated. The treatment of external piles may be
summed up in great cleanliness--washing the parts after each movement
of the bowels; rest in bed, if the soreness is great; the application
of cold water or powdered ice in a rubber bag, or of hot poultices,
and of various drugs. Among these are hamamelis extract, or
witch-hazel, with which the parts may be frequently bathed; an
ointment of nut-gall and opium; or extract of belladonna and
glycerin, equal parts. Sitting in cold water, night and morning, in a
tub also will prove serviceable. The more rapid and effectual method
of cure consists in opening of the recent pile by the surgeon, or
clipping off the fleshy projections. The bowels should always be kept
regular in any form of piles by small doses of Glauber's or Epsom
salts taken in a glass of hot water on rising, or some mineral water.
In case these do not agree, extract of cascara or compound licorice
powder may be taken at night. Equal parts of sulphur and cream of
tartar is an old-fashioned domestic cathartic of which a teaspoonful
may be taken each morning to advantage in piles.
=Internal Piles.=--In the beginning patients with internal piles feel
as if the bowels were not wholly emptied after a passage, and
sometimes there is difficulty in urinating and also pains in the
hollow of the back and in the thighs. There is often pain on movement
of the bowels, and blood follows the passage. Later, blood may be lost
at other times, and the loss may be so great as to cause pronounced
paleness and weakness. Itching is a frequent occurrence. Mucus and pus
(matter such as comes from an abscess) may also be discharged. Loss of
sexual desire and power is not uncommonly present. There may be no
external protrusions; but bleeding, itching, and pain during movement
of the bowels are the chief symptoms. If the pain is very severe
during and also after a passage, it is probable that there is also
present a fissure or crack in the flesh, or ulcer at the exit of the
bowel which needs surgical attention. It not infrequently happens that
the piles come out during the bowel movement, when they should be
thoroughly washed, greased, and pushed back. Sometimes this is
impossible, although after lying down for a while and applying ice or
cold water the mass may shrink so as to admit of its return. When a
large mass is thus protruded and cannot be returned, and becomes
nipped by the anus muscles, it undergoes inflammation and is very
painful, but a cure often results from its destruction. Such a mode of
cure is not a safe or desirable one, however.
=Treatment.=--The cold sitz baths in the morning or injections of a
half pint of ice water after a passage are useful. Ointments may be
introduced into the bowel upon the finger, or, better, with hard
rubber plugs sold for the purpose; or suppositories may be employed.
An ointment, containing sixty grains of iron subsulphate to the ounce
of lard (or, if there is much itching, an ointment consisting of
orthoform, thirty grains, with one-half ounce of lard), will prove of
value. Also the injection of one-half pint cold water, containing a
teaspoonful of extract of hamamelis, after a passage, affords relief.
Two or three grains of the subsulphate of iron may be employed in
suppositories, and one of these may be introduced three times daily.
The compound gall ointment or the glycerite of tannin will be found to
act successfully in some cases. When one remedy does not serve, try
another. The only positive cure for piles consists in surgical
operation for their removal. Self-treatment is not recommended, as the
physician can do better, and an examination is always advisable to
rule out other conditions which may be mistaken by the layman for
piles.
=Causes.=--Piles are seen chiefly in adults, in those in advanced
life, and in those who exercise little but eat much. Constipation
favors their occurrence, and the condition is commonly present in
pregnant women. Fatigue, exposure, horseback exercise, or an alcoholic
debauch will cause their appearance. Certain diseases also occasion
the formation of piles.
CHAPTER II
=Skin Diseases and Related Disorders=
_Household Remedies for Itching--Chafing and Chapping--Hives, Cold
Sores and Pimples--Ringworms, Warts and Corns--Eczema and other
Inflammatory Disorders._
No attempt will be made to give an extended account of skin diseases,
but a few of the commoner disorders which can be readily recognized by
the layman will be noticed. Although these cutaneous troubles are
often of so trivial a nature that a physician's assistance is
unsought, yet the annoyance is often sufficient to make it worth while
for the patient to inform himself about the ailment. Then the
affections are so frequent that they may occur where it is impossible
to procure medical aid. Whenever an eruption of the skin is
accompanied by fever, sore throat, headache, pains in back and limbs,
vomiting, or general illness, one of the serious, contagious, eruptive
diseases should be suspected, particularly in children, and the
patient must be removed from contact with others, kept in isolation,
and a physician immediately summoned.
=ITCHING= (_Pruritus_).--Itching is not a distinct disease by itself,
but a symptom or sign of other skin or general disorders.
Occasionally it must be treated as if it were a separate disease, as
when it occurs about the entrance to the bowel (_anus_), or to the
external female sexual parts (_vulva_), or attacks the skin generally,
and is not accompanied by any skin eruption except that caused by
scratching, and the cause be unascertainable. Itching, without
apparent cause, may be due to parasites, as lice and fleas, and this
must always be kept in mind; although debilitated states of the body
and certain diseases, as gout and diabetes, are sometimes the source.
Commonly, itching is caused by one of the many recognized skin
diseases, and is accompanied by an eruption characteristic of the
particular disorder existing, and special treatment by an expert,
directed to remedy this condition, is the only reasonable way to
relieve the itching and cure the trouble.
It may not, however, be improper to suggest means to relieve such a
source of suffering as is itching, although unscientific, with the
clear understanding that a cure cannot always be expected, but relief
may be obtained until proper medical advice can be secured. The
treatment to be given will be appropriate for itching due to any
cause, with or without existing eruption on the skin, unless otherwise
specified. If one remedy is unsuccessful, try others.
For itching afflicting a considerable portion of the skin, baths are
peculiarly effective. Cold shower baths twice daily, or swimming in
cold water at the proper time of year, may be tried, but tepid or
lukewarm baths are generally more useful. The addition of saleratus or
baking soda, one to two pounds to the bath, is valuable, or bran water
obtained by boiling bran tied in a bag in water, and adding the
resulting solution to the bath. Even more efficient is a bath made by
dissolving half a cupful of boiled starch and one tablespoonful of
washing or baking soda in four gallons of warm water. The tepid baths
should be as prolonged as possible, without chilling the patient. The
bran water, or starch water, may be put in a basin and sopped on the
patient with a soft linen or cotton cloth and allowed to evaporate
from the skin, without rubbing, but while the skin is still moist a
powder composed of boric acid, one part, and pulverized starch, four
parts, should be dusted on the itching area.
Household remedies of value include saleratus or baking soda (one
teaspoonful to the pint of cold water), or equal parts of alcohol, or
vinegar and water, which are used to bathe the itching parts and then
permitted to dry on them. Cold solution of carbolic acid (one
teaspoonful to the pint of hot water) is, perhaps, the most
efficacious single remedy. But if it causes burning it must be washed
off at once. Dressings wet with it must never be allowed to become
dry, as then the acid becomes concentrated and gangrene may result.
Calamine lotion (p. 145) is also a serviceable preparation when there
is redness and swelling of the skin. When the itching is confined to
small areas, or due to a pimply or scaly eruption on the skin, the
following ointments may be tried: a mixture of tar ointment and zinc
ointment (two drams each) with four drams of cold cream, or flowers of
sulphur, one part, and lard, twelve parts.
=CHAFING AND CHAPPING.=--Chafing occurs when two opposing skin
surfaces rub together and are irritated by sweat, as in the armpits,
under the breasts and beneath overlapping parts of the belly of fat
people, and between the thighs and buttocks. The same result is caused
by the irritation induced by discharges constantly running over the
skin, as that seen in infants, due to the presence of urine and bowel
discharges, and that irritation which arises from saliva when the lips
are frequently licked. The latter condition of the lips is commonly
called chapping, but it is proper to consider chafing and chapping
together as the morbid state of the skin, and the treatment is the
same for both.
Chafing occurs more often in hot weather and after violent exercise,
as rowing, riding, or running, and is aggravated by the friction of
clothing or of tight boots. It may, on the other hand, appear in
persons who sit a great deal, owing to constant pressure and friction
in one place. The parts are hot, red, and tender, and emit a
disagreeable odor when secretions are retained. The skin becomes
sodden by retained sweat, and may crack and bleed. The same redness
and tenderness are seen in chapping of the face and lips, and
cracking of the lips is frequent.
In chafing the first requisite is to remove the cause, and then
thoroughly wash the part with soap and water. Then a saturated
solution of boric acid in water should be applied with a soft cloth,
and the parts dusted with a mixture of boric acid and powdered starch,
equal parts, three times daily. If the lips are badly cracked,
touching them, once daily, with a stick of silver nitrate (dipped in
water) is of service.
=HIVES; NETTLERASH= (_Urticaria_).--Hives is characterized by the
sudden appearance of hard round or oval lumps in the skin, from the
size of a pea to that of a silver dollar, of a pinkish-white color, or
white in the center and often surrounded by a red blush. The rash is
accompanied by much itching, burning, or tingling, especially at night
when the clothes are removed. The peculiarity of this eruption is the
suddenness with which the rash appears and disappears; the itching,
the whitish or red lumps, the fact that the eruption affects any part
of the body and does not run together, are also characteristic.
Scratching of the skin often brings out the lumps in a few minutes.
The swellings may last a few minutes or hours, and suddenly disappear
to reappear in some other place. The whole trouble usually continues
only a few days, although at times it becomes a chronic affection.
Scratching alters the character of the eruption, and causes red, raw
marks and crusts, but the ordinary swellings can be seen usually in
some part of the body. Rarely, the eruption comes in the throat and
leads to sudden and sometimes dangerous swelling, so that suffocation
has ensued. With hives there are no fever, sore throat, backache,
headache, which are common to the contagious eruptive disorders, as
measles, scarlet fever, etc.
Indigestion is the most frequent cause. Certain articles of diet are
almost sure to bring on an attack of hives in susceptible persons;
these include shellfish, clams, lobsters, crabs, rarely oysters; also
oatmeal, buckwheat cakes, acid fruits, particularly strawberries, but
sometimes raspberries and peaches. Nettlerash is common in children,
and may follow any local irritation of the skin caused by rough
clothes, bites of mosquitoes and fleas, and the stings of jellyfish,
Portuguese man-of-war, and nettles.
=Treatment.=--Remove any source of irritation in the digestive canal,
or externally, and employ a simple diet for a few days, as bread and
milk.
A dose of castor oil, one teaspoonful for children; one tablespoonful
for adults, or some other cathartic is advisable. Locally we use, as
domestic remedies, a saturated solution of baking soda (or saleratus)
in water, or equal parts of alcohol or vinegar and water to relieve
the itching. The bath containing soda and starch (p. 141) is the most
useful treatment when the nettlerash is general. Calamine lotion is
one of the best applications which can be employed for this disorder.
It should be sopped on frequently with a soft cloth and allowed to dry
on the skin.
CALAMINE LOTION
Zinc oxide 1/4 ounce
Powdered calamine 1/4 "
Limewater 6 ounces
Mix and shake before applying to the skin.
If choking is threatened, give an emetic of mustard, one teaspoonful,
and warm water, half a pint.
=PIMPLES; BLACKHEADS= (_Acne_).--This eruption is situated chiefly on
the face, but often on the back, shoulders, and chest as well. It is a
disorder which is seen mostly in young men and women at about the age
of puberty. It consists of conical elevations of the skin, from a pin
head to a pea in size, often reddened and tender on pressure, and
having a tendency to form matter or pus, as shown by a yellow spot in
the center of the pimple. After three to ten days the matter is
discharged, but red elevations remain, which later become brown and
disappear without scarring, except in rare cases.
"Blackheads" appear as slightly elevated black points, sometimes
having a yellowish tint from which a little, thin, wormlike mass may
be pressed. Pimples and blackheads are both due to inflammation about
the glands of the skin which secrete oily material; the mouths of the
glands become plugged with dust, thus retaining the oily secretion and
causing blackheads. Then if these glands are invaded by germs
producing pus, we have a pimple, which usually results in the
formation of matter as described above. Constipation and indigestion
favor the occurrence of pimples and blackheads; also a poor state of
the blood, or anaemia.
=Treatment.=--Tea, coffee, tobacco, and alcohol should be avoided,
together with veal, pork, fats, and cheese. The bowels must be moved
daily by some proper cathartic, as cascara tablets containing two
grains each of the extract. The dose is one to two tablets at night.
The blackheads should be squeezed out with a watch key, or with an
instrument made for the purpose, not finger nails, and pimples
containing matter must be emptied after being pricked with a needle
(which has been passed through a flame to kill germs on it). If there
is redness of the skin and irritation associated with pimples, it is
sufficient to bathe the skin with very hot water and green soap three
times daily, and apply calamine lotion (see p. 145) at night. In other
cases, when the skin is not sensitive, and zinc or mercury has not
been used, the employment of sulphur soap and hot water at bedtime,
allowing the suds to dry and remain on the face during the night, is
to be recommended. An ointment consisting of half a dram of
precipitated sulphur with half an ounce each of powdered starch and
vaseline applied each night, and hot water used on the face three
times daily are also efficacious. Sulphur lotion is better than
sulphur ointment.
=COLD SORE; FEVER BLISTER.=--Cold sores occur usually about the lips
or at the angles of the mouth, although they may appear anywhere on
the face. Cold sore has a round, oval, or irregular outline, from the
size of a pea to that of a quarter of a dollar, and is seen as a
slightly raised patch on the skin on which is a group of very minute
blisters, three to twelve in number. Cold sore may be single or
multiple, and near together or widely separated on the face. Having
first the appearance of a red patch, it later becomes covered with a
brown crust from the drying of the contents of the tiny blisters. Cold
sore often gives rise to burning, itching, or tingling, the
disfigurement usually causing more annoyance, however, than the pain.
The duration of the trouble is from four to twelve days.
Cold sores are commonly induced by indigestion and fevers, and also
are occasioned by local irritation of any sort, as from nasal
discharge accompanying cold in the head (from which the name is
derived), by the irritation produced by a pipestem or cigar, and by
rubbing the skin.
=Treatment.=--Picking and scratching are very harmful, and cigar or
pipe smoking must be stopped. Painting the sore with collodion, by
means of a camel's-hair brush, is poor treatment in the early stages.
Better use spirits of camphor, and afterwards, if there is much
itching or burning, sopping the eruption with calamine lotion (p. 145)
will relieve the discomfort.
=PRICKLY HEAT= (_Miliaria_).--This is a common eruption of adults in
hot weather, and very frequently attacks children. It consists of
fine, pointed, red rash, or minute blisters, and occurs on parts of
the body covered by clothing, more often on the chest. The eruption is
caused by much sweating, leading to congestion and swelling of the
sweat glands. Burning, stinging, and itching accompany the disorder.
The condition must be distinguished from the contagious skin
eruptions. In the latter there are fever, sore throat, backache,
headache, and general sickness, while in prickly heat there is no
general disturbance of the system, or fever, unless the eruption comes
out in the course of fevers, when it is of no significance except as
one of the symptoms of fever.
=Treatment.=--The treatment of prickly heat, occurring in hot weather,
consists in avoiding heat as much as possible and sponging the surface
with cold water, and then dusting it with some simple powder, as
starch or flour, or better, borated talcum. To relieve the itching,
sponging with limewater or a saturated solution of baking soda (as
much as will dissolve) in water, or bran baths, made by tying one
pound of bran in a towel which is allowed to soak in the bath, are all
good remedies.
=RINGWORM OF THE BODY; RINGWORM OF THE SCALP.=--This skin disease is
caused by a vegetable fungus and not by a worm as the name suggests.
The disease on the body and scalp is caused by the same parasite, but
ringworm of the body may attack adults as well as children, and is
readily cured; ringworm of the scalp is a disease confined to
children, and is difficult of cure. Ringworm is contagious and may be
acquired from children with the disease, and therefore patients
suffering from it should not be sent to school, and should wear a
skull cap and have brush, comb, towels, and wash cloths reserved for
their personal use alone. Children frequently contract the disease
from fondling and handling cats and dogs.
=Symptoms.=--On the body, ringworm attacks the face, neck, and hands.
It appears first as small, red, scaly spots which may spread into a
circular patch as large as a dollar with a red ring of small, scaly
pimples on the outside, while the center exhibits healthy skin, or
sometimes is red and thickened. There may be several patches of
ringworm near each other and they may run together, or there may be
only one patch of the disease. Ringworm of the scalp occurs as a
circular, scaly patch of a dusty-gray or pale-red color on which there
are stubs of broken hairs pointing in different directions, and
readily pulled out. The disease in this locality is very resistant to
treatment. There are no crusts or itching as in eczema.
=Treatment.=--The application of pure tincture of iodine or carbolic
acid to the spots with a camel's-hair brush, on one or two occasions,
will usually cure ringworm on the skin. On the scalp the hairs should
be pulled out of the patch of ringworm, and each day it should be
washed with soap and water and a solution of boric acid (as much acid
as the water can dissolve), destroying the cloth used for washing. The
following ointment is then applied: sulphur, one part; tar, two parts;
and lard, eight parts. It is desirable to secure the services of a
physician in this disease, in which various remedies may have to be
tried to secure recovery. If untreated, ringworm is likely to last
indefinitely.
=FRECKLES, TAN, AND OTHER DISCOLORATIONS OF THE SKIN.=--Freckles
appear as small, yellowish-brown spots on the face, arms, and hands,
following exposure to the sun in summer, and generally fading away
almost completely in winter. However, sometimes they do not disappear
in winter, and do occur on parts of the body covered by clothing.
Freckles are commonly seen in red-haired persons, rarely in brunettes,
and never on the newborn. Their removal is accomplished by the
employment of agents which cause a flaking off of the superficial
layer of discolored skin, but after a few weeks the discolorations are
apt to return. Large, brown spots of discoloration appearing on the
face are observed more often in women, and are due to disorder of
digestive organs of the sexual organs or to pregnancy; they also
occur in persons afflicted with exhausting diseases. Tan, freckles,
and discolorations of the skin generally are benefited by the same
remedies.
=Treatment.=--Prevention of tan and freckles is secured through
nonexposure of the unprotected skin to the sun, though it is doubtful
whether the end gained is worth the sacrifice, if carried so far as to
the avoidance of the open air and sunlight whenever possible.
Boric acid (sixteen grains to the ounce of water) is an absolutely
harmless and serviceable agent for the removal of skin pigmentations.
The skin may be freely bathed with it night and morning. Corrosive
sublimate is the most effective remedy, but is exceedingly poisonous
if swallowed accidentally, and must be kept out of children's way, and
should not be applied over any large or raw surface of skin or on any
mucous membrane. Its application is inadvisable as soon as any
irritation of the skin appears from its use. The following preparation
containing it is to be painted on the skin with a camel's-hair brush,
night and morning:
POISONOUS SUBLIMATE SOLUTION
Corrosive sublimate 7 grains
Alcohol 1-1/2 ounces
Glycerin 1-1/2 "
Oil of lavender 10 drops
Mix.
The following lotion is also efficacious:
Zinc oxide 30 grains
Powdered starch 30 "
Kaolin 60 "
Glycerin 2 drams
Rose water 2 ounces
Mix.
DIRECTIONS.--Shake and paint on spots, and allow the preparation
to dry; wash it off before each fresh application.
It is best to use only cold water, rarely soap, on the healthy skin of
the face. Warm water favors relaxation of the skin and formation of
wrinkles.
=IVY POISON.=--The poison ivy (_Rhus toxicodendron_), poison sumach
(_Rhus venenata_), and poison oak (_Rhus diversiloba_ of the Pacific
Coast, U. S. A.) cause inflammation of the skin in certain persons who
touch either one of these plants, or in some cases even if approaching
within a short distance of them. The plants contain a poisonous oil,
and the pollen blown from them by the wind may thus convey enough of
this oil to poison susceptible individuals who are even at a
considerable distance. Trouble begins within four to five hours, or in
as many days after exposure to the plants.
The skin of the hands becomes red, swollen, painful, and itching. Soon
little blisters form, and scratching breaks them open so that the
parts are moist and then become covered with crusts. The poison is
conveyed by the hands to the face and, in men, to the sexual organs,
so that these parts soon partake of the same trouble. The face and
head may become so swollen that the patient is almost unrecognizable.
There is a common belief that ivy poison recurs at about the same time
each year, but this is not so except in case of new exposures.
Different eruptions on the same parts often follow ivy poisoning,
however.
=Treatment.=--A thorough washing with soap, especially green soap,
will remove much of the poison and after effects. Saleratus or baking
soda (a heaping tablespoonful of either to the pint of cold water) may
be used to relieve the itching, but ordinary "lead and opium wash" is
the best household remedy. Forty minims of laudanum[9] and four grains
of sugar of lead dissolved in a pint of water form the wash. The
affected parts should be kept continually wet with it. Aristol in
powder, thoroughly rubbed in, is almost a specific.
=WARTS.=--Warts are flattened or rounded outgrowths from the outer and
middle layers of the skin, varying in size from a pin head to half an
inch in diameter. There are several varieties.
_Seed Warts._--These have numerous, little, fleshy projections over
their surface, which are enlarged normal structures (_papillae_) of the
middle layer of the skin, together with the thickened, outer, horny
layer.
_Threadlike Warts._--These are seen along the edge of the nails, on
the face, neck, eyelids, and ears. They are formed by the great
prolongation and growth of the projections, or _papillae_ of the middle
layer of the skin just described.
_Flat Warts_, raised but slightly above the surface are more common in
old people.
_Moist Warts_ occur where they are softened by secretions of the body,
as about the sexual organs (in connection with diseases of the same),
and about the anus (or opening of the bowel). They are of a white,
pink, or red color, and consist of numerous, little, fleshy
projections, usually covered with a foul-smelling secretion.
Warts most commonly appear on the hands of children, but may appear on
any part of the body and at all ages. They may disappear quickly or
remain indefinitely. They are not communicable from one person to
another.
=Treatment.=--Warts may be removed by painting them frequently with
the fresh juice of the milkweed, or with acetic acid or tincture of
iodine. These remedies are all harmless, but somewhat slow and not
always effective. Application, morning and evening, of a saturated
solution of "washing soda" (impure bicarbonate of potash) will often
remove a wart.
=CORNS.=--Corns are local, cone-shaped thickenings of the outer layer
of the skin of the feet, due to pressure and friction of the shoes, or
opposed surfaces of skin between the toes. They are not in themselves
sensitive, but pain follows pressure upon them, as they act as
foreign bodies in bearing down upon the sensitive lower layers of the
skin. Continued irritation often leads to inflammation of the skin
around and beneath the corn with the formation of pus. Ordinarily,
corns are tough, yellowish, horny masses, but, when moistened by sweat
between the toes, they are white, and are called "soft corns."
=Treatment.=--Comfortable shoes are the first requisite; well-fitting
and neither tight nor loose. Pressure may be taken off the corns by
surrounding them with felt rings or corn plaster. To remove the corn
the foot should be soaked for a long time in warm water, in which is
dissolved washing soda, and then the surface of the corn is gently
scraped off with a clean, sharp knife. Another useful method consists
in painting the corn, night and morning for five days, with the
following formula, when both the coating and corn will come off on
soaking the same for some time in warm water:
Salicylic acid 30 grains
Tincture of iodine 10 drops
Extract of Cannabis Indica 10 grains
Collodion 4 drams
Mix.
When the tissues about the corn become inflamed the patient must rest
with the foot elevated and wrapped in a thick layer of absorbent
cotton saturated with a hot solution of corrosive sublimate (one
tablet to the pint of water) and covered with oil silk or rubber
cloth. Pus must be let out with a knife which has been laid in boiling
water.
If corns are removed by the knife the foot should be previously made
absolutely clean, the knife boiled, and the paring not carried to the
extent of drawing blood. The too-close removal of a corn may lead to
infection of the wounded tissues with germs, and in old people, and
those with feeble circulation, gangrene or erysipelas may result. Soft
corns are treated by removal of the surface layer, by soaking in
washing soda and hot water and scraping as above stated, and then the
corn should be dusted with a mixture of boric acid and zinc oxide,
equal parts, and the toes kept apart by pads of absorbent cotton.
=CALLUS AND CRACKS OF THE SKIN.=--Callus consists of round or
irregular, flattened, yellowish thickenings of the upper or horny
layer of the skin. The skin becomes hypertrophied and resembles a
thick, horny layer, caused by intermittent pressure of tools, shoes,
etc. The whole palm of the hand or soles of the feet may be the seats
of a continuous callus. Callus is not harmful, except in leading to
cracks of the skin near the bend of joints, and, rarely, in causing
irritation, heat, pain, and even the formation of pus in the skin
beneath. Callus usually disappears when the exciting cause or pressure
is removed.
=Treatment.=--The hands and feet should be soaked continuously in hot
baths containing washing soda, and then should be covered with
diachylon (or other) ointment. This may be done each night; or
collodion (one ounce containing thirty grains of salicylic acid) may
be painted, night and morning for several days, on the callus, and
then, after soaking for some time in hot water, the surface should be
scraped off with a dull knife and the process repeated as often as
necessary to effect a cure. Fissure or cracks of the skin caused by
callus are treated in the same manner: by prolonged soaking in hot
water, paring away the edges, and applying diachylon ointment or cold
cream to the part. Inflammation about callus must be cared for as
recommended above for inflamed corns.
=BOILS.=--A boil is a circumscribed inflammatory process, caused by
the entrance of pus-producing germs into the skin either through the
pores (the mouths of the sweat glands) or along the shafts of the
hair, and in this way invading the glands which secrete a greasy
material (sebaceous glands). In either case the pus germs set up an
inflammation of the sweat or sebaceous glands, and the surrounding
structures of the skin, and a small, red, itching pimple results.
Rarely, after a few days, the redness and swelling disappear, and the
pus, if any, dries and the whole process subsides. This is called a
"blind boil." But usually the boil increases in size for several days,
until it may be as large as a pigeon's egg. It assumes a bright-red
sharply defined, rounded shape, with a conical point, and is at first
hard and then softens as pus or "matter" forms. There is severe pain
of a throbbing, boring character, which is worse at night, and
destroys the patient's sleep and appetite. There may be some fever.
The glands in the neighborhood may be enlarged and tender, owing to
some of the pus germs' escaping from the boil and lodging in the
glands.
If the boil is not lanced, it reaches its full development in seven to
ten days with the formation of a central "core" of dead tissue and
some pus, which gives to the center of the boil a whitish or
yellowish-brown appearance. The boil then breaks down spontaneously in
one or more places (usually only one) and discharges some pus, and,
with a little pressure, also the white, central core of dead tissue.
The remaining wound closes in and heals in a week or two. Boils occur
singly or in numbers, and sometimes in successive crops. When this
happens it is because the pus germs from the previous boils have
invaded fresh areas of skin.
=Causes.=--Boils are thus contagious, the pus germs being communicated
to new points on the patient's skin, or to that of another person.
Local irritation of the skin, from whatever cause, enables the germs
to grow more readily. The existence of skin diseases, as eczema ("salt
rheum"), prickly heat, and other sources of itching and scratching, is
conducive to boils, as the pus germs contained in ordinary dirt are
rubbed into the irritated skin. Whenever the skin is chafed by rough
clothing, as about the wrists and neck by frayed collars and
sweaters, etc., boils are likely to occur. Also when the face and neck
are handled by barbers with dirty hands or instruments, a fruitful
field is provided for their invasion. While boils are always the
result of pus germs gaining entrance to the skin glands, and,
therefore, strictly due to local causes, yet they are more prone to
occur when the body is weakened and unable to cope with germs which
might do no harm under other circumstances.
The conditions favoring the occurrence of boils are: an impoverished
state of the blood, errors of diet and indigestion, overwork,
dissipation, and certain diseases, as typhoid fever, diabetes, and
smallpox. Boils are thought to occur more frequently in persons with
rough skin and with a vigorous growth of dark hair. They may be
situated on any part of the body, but certain localities are more
commonly attacked, as the scalp, the eyelids, cheeks, neck, armpits,
back, and buttocks. Boys and young men are generally the sufferers.
=Treatment.=--The importance of cleanliness cannot be overestimated in
the care of boils if we keep their cause in mind. Dirty underclothes
or fingers used in squeezing or otherwise handling the boil, may carry
the trouble to fresh parts. Any sort of local irritation should be
removed; also all articles of clothing which have come in contact with
the boils should not be worn until they have been washed in boiling
water. There is no single remedy of much value for the cure of boils,
although pills of calcium sulphide (each one-tenth grain) are
commonly prescribed by physicians, every three hours.
The most rational measure consists in removing the general causes, as
noted above, if this is possible. When the patient is thin and poorly
nourished, give food and cod-liver oil; and if the lips and skin are
pale, iron arsenate pills (one-sixteenth grain each) are to be taken
three times daily for several weeks. A boil may sometimes be arrested
by painting it with tincture of iodine until the boil is almost black,
or with a very heavy coating of collodion. If a boil continues to
develop, notwithstanding this treatment, one should either use an
ointment of vaseline containing ten per cent of boric acid spread on
soft cotton over the boil, or, if the latter is very painful, resort
to the frequent application of hot flaxseed poultices.
When the boil has burst, and pus is flowing out on the surrounding
skin, it should be kept very clean by frequent washing with hot water
and soap and the application of a solution of corrosive sublimate (one
part to 1,000) made by dissolving one of the tablets, sold everywhere
for surgical purposes, in a pint of warm water. This will prevent the
lodgment of the pus germs in the skin and the formation of more boils.
Poultices mixed with bichloride (corrosive sublimate) solution are
less likely to encourage inoculation of neighboring areas.
The poultices should be stopped as soon as the pain ceases, and the
boil dressed as recommended above, dusted with pure boric acid and
covered with clean absorbent cotton and bandage. After pus has begun
to form in a boil recovery will be materially hastened by the use of a
knife, although this is not essential. The boil should be thoroughly
cleaned, and a sharp knife, which has been boiled in water for five
minutes, is inserted, point first, into the center of the boil, far
enough to liberate the pus and dead tissue. By this means healing is
much more rapid than by nature's unassisted methods. Pure carbolic
acid, applied on the tip of a toothpick, thrust into the head of a
boil, is generally curative. When many boils occur, consult a
physician.
=CARBUNCLE.=--A carbuncle is similar to a boil in its causation and
structure, but is usually a much more serious matter having a tendency
to spread laterally and involve the deeper layers of the skin. It is
commonly a disease of old persons, those prematurely old or
debilitated, and occurs most frequently on the neck, back, or
buttocks. It is particularly dangerous when attacking the back of the
neck, upper lip, or abdomen.
Carbuncle often begins, with a chill and fever, as a pimple, and
rapidly increases in size forming a hot, dusky red, rounded lump which
may grow until it is from three to six inches in diameter.
Occasionally it runs a mild course, remains small, and begins to
discharge pus and dead tissue at the end of a week and heals rapidly.
More commonly the pain soon becomes intense, of a burning, throbbing
character, and the carbuncle continues to enlarge for a week or ten
days, when it softens and breaks open at various points discharging
shreds of dead tissue and pus. The skin over the whole top of the
carbuncle dies and sloughs away, leaving an angry-looking excavation
or crater-like ulcer. This slowly heals from the edges and bottom, so
that the whole period of healing occupies from a week to two, or even
six months. The danger depends largely upon blood poisoning, and also
upon pain, continuous fever, and exhaustion which follow it. Sweating
and fever, higher at night, are the more prominent signs of blood
poisoning.
Carbuncles differ from boils in being much larger, in having rounded
or flat tops instead of the conical shape of boils, in having
numerous, sievelike openings, in the occurrence of death of the skin
over the top of the carbuncle, and in being accompanied by intense
pain and high fever.
=Treatment.=--Carbuncle demands the earliest incision by a skilled
surgeon, as it is only by cutting it freely open, or even removing the
whole carbuncle as if it were a tumor, that the best results are
accomplished. However, when a surgeon cannot be obtained, the
patient's strength should be sustained by feeding every two hours with
beef tea, milk and raw eggs, and with wine or alcoholic liquors. Three
two-grain quinine pills and ten drops of the tincture of the chloride
of iron in water should be given three times daily.
The local treatment consists in applying large, hot, fresh flaxseed
poultices frequently, with the removal of all dead tissue with
scissors, which have been boiled in water for ten minutes. When the
pain is not unbearable, dressings made by soaking thick sheets of
absorbent cotton in hot solution of corrosive sublimate (1 to 1,000 as
directed under Boils, p. 161) should be applied and covered by oil
silk or rubber cloth and bandage. They are preferable to poultices as
being better germ destroyers, but are not so comfortable. When the
dead tissue comes away and the carbuncle presents a red, raw surface,
it should be washed twice a day in the 1 to 1,000 corrosive-sublimate
solution, dusted with pure boric acid, and covered with clean, dry
absorbent cotton and bandage.
=ECZEMA; SALT RHEUM; TETTER.=--Eczema is really a catarrhal
inflammation of the skin, with the exudate (fluid that escapes)
concealed beneath the surface, or appearing on the surface after
irritation has occurred. The many varieties are best classified as
follows:
(1) Eczema of internal origin, including cases due to morbid agencies
produced within the body, cases due to drugs, and possibly reflex
cases.
(2) Eczema of external origin, including cases caused by occupation,
by climate, or by seborrhea.
Eczema of internal origin almost invariably appears on both sides of
the body at once, as on both cheeks, or both arms, or both thighs. Its
border shades into the surrounding skin, it is dotted with papules
(or heads) filled with fluid, and its surface is clean and not greasy.
As it spreads, the symmetry of distribution is lost. Among the morbid
agencies producing this variety of eczema are the products of
indigestion. Among the drugs producing it is cod-liver oil.
Occupation eczema occurs first on exposed parts, as the hands, arms,
face, and neck, in those who handle irritant dyes, sugar, formalin,
etc.
Climatic eczema includes the "winter itch," common in this latitude,
appearing on wrists and ankles in the form of clean, scaly patches,
often ringed.
The seborrheic variety spreads from the scalp to the folds of the
skin. Its borders are sharply defined, and its crusts and scales
yellowish and greasy. It spreads from a center in all directions at
once.
=Treatment.=--The treatment of eczema puzzles a physician, and only
specialists in skin diseases are able easily to diagnose the subacute
or chronic forms. It may appear different, and need different
treatment almost from day to day, and consequently only general
suggestions can be made for home management of a case of this disease.
The outlook is always good; and even in the case of weak and
debilitated patients, there is excellent chance of cure.
The diet must be regulated at once. Meat should be eaten in small
quantities once a day only, and none but very digestible meats should
be eaten, as fowl, beef, and lamb. Sugar and sweet food need be cut
down only when there is indigestion with a production of gas. Fresh
air and exercise are imperative. Five grains of calomel, at night,
followed by one heaped tablespoonful of Rochelle salts dissolved in a
full tumbler of water the next morning before breakfast, should be
repeated twice a week till marked improvement is seen. Meanwhile,
external treatment must be pushed.
Generally speaking, ointments must not be used on weeping or exuding
surfaces; all scales and crusts must be removed from the surface; and
acute patches must be soothed, chronic patches stimulated. Water is
harmful and increases the trouble; but it is necessary to use it once,
in cleansing the affected area, in the form of soap and water. If
there are thick, adherent crusts, a poultice of boiled starch, covered
with a muslin cloth, will loosen them in a night. Thickened or horny
layers on the palms and soles may be covered with salicylic plaster
(ten per cent strength), which is removed after two days, and the
whole part soaked in warm water, when the horny layer is to be peeled
off. Thickened surfaces are best treated with wood tar, in the form of
oil of cade ointment, or the "pix liquida" of the drug shops mixed
with twice its amount of olive oil. This should be well rubbed into
the affected part.
Seborrheic eczema of the scalp and neighboring areas is best treated
with a four per cent ointment of ammoniated mercury, rubbed in once a
day for five days, followed by the application of a solution of
resorcin in water, four grains to the ounce. Weeping and exuding
patches should be treated with powdered stearate of zinc, or oleate of
bismuth, or aristol, either one dusted on till the area is fairly
covered. When the surface begins to dry up, the following paste may be
applied:
Salicylic acid 5 to 15 grains
Zinc oxide 2 drams
Powdered starch 2 drams
Vaseline 1 ounce
If weeping returns, stop the ointment and resume the powder treatment,
or use the following lotion:
Zinc oleate 1 dram
Magnesium carbonate 1 dram
Ichthyol 1/2 ounce
Lime water 4 ounces
When the skin after scaling off becomes thin, all swelling having
disappeared, lead plaster is of service, or diachylon ointment
twenty-five per cent, made with olive oil.
An eczema of moderate extent should recover after four to six weeks'
treatment, unless the soles or palms be attacked, when six or more
months of treatment may be necessary.
If itching is pronounced, remove crusts and scabs after soaking with
olive oil, dust borax, finely powdered on the surface. If the itching
is not controlled in twenty minutes, wipe off the borax with a very
oily cloth (using olive oil), and then apply a little solution of
carbolic acid (made by adding a half teaspoonful of carbolic acid to a
pint of hot water). If this does not allay the itching, wipe it off
thoroughly with the oiled cloth, and rub in the tar ointment made of
equal parts of "pix liquida" and olive oil. After the itching ceases,
treat as directed according to the variety existing. Itching often
disappears after a good saline cathartic has acted--Rochelle salts,
solution of magnesia citrate, or phosphate of soda. Scratching must be
avoided. In the case of children it is prevented by putting mittens of
muslin on the hands.
The best cathartic for young children is a teaspoonful of castor oil.
Carbolic-acid solution must not be used on them. The folds and creases
of their skin must be kept dry and powdered with borated talcum. A
great point in the treatment of all eczema is to avoid the use of
water, and to substitute oiling with olive oil and wiping off for the
usual washing of the affected area.
=BALDNESS AND DANDRUFF.=--Baldness is commonly caused by seborrhea of
the scalp, an affection probably due to a microbe, and consisting of
an inflammation of the skin, with great increase of dandruff of a
thick, greasy variety. Sometimes it appears as a thick film, not only
covering the scalp, but also the forehead and back of the neck. The
greasy substance should be removed with olive oil or vaseline, and the
scalp treated with ointment of ammoniated mercury, four per cent
strength. Shampoos with tar-soap suds should be given once in four or
five weeks, and the hair should not be wet with water between the
shampoos. The hair must be arranged by combing, the brush being used
to smooth the surface of the hair only. Deep and repeated brushing
does great damage, which is equalled only by the frequent washing some
ill-advised sufferers employ. Massage of the scalp is useless to
control seborrheic eczema, which is practically always present in
these cases.
Tight hats are sometimes a cause of baldness. The lead used in the
preparation of the "sweat leather" of hats is said to be a cause of
loss of hair over the temples. When once killed, hair can rarely be
made to grow again. Early treatment of seborrhea is the best
preventive of baldness.
The baldness occurring during an attack of syphilis, when the hair
falls out in round patches, is treated and often relieved by
antisyphilitic remedies (see p. 210).
FOOTNOTES:
[9] Caution. Poisonous.
CHAPTER III
=Rheumatism and Kindred Diseases=
_Causes of Rheumatic Fever--Relief of Pain in the
Joints--Lumbago--Stiff Neck--Gout--Symptoms and Cure of Scurvy._
=RHEUMATIC FEVER; INFLAMMATORY RHEUMATISM; ACUTE RHEUMATISM.=--This
variety of rheumatism is quite distinct from the other forms, being in
all probability due to some special germ. It occurs in temperate
climates during the fall, winter, and spring--less often in summer.
Persons more frequently suffer between the ages of ten and forty
years. It is rare in infants; their pain and swelling of the limbs can
be attributed more often to scurvy (p. 180), or to surgical disease
with abscess of joint or bone. Exposure to cold and damp, in persons
insufficiently fed, fatigued, or overworked, is the most common
exciting cause.
=Symptoms.=--Rheumatic fever may begin with tonsilitis, or other sore
throat, with fever and pains in the joints. The joints rapidly become
very painful, hot, red, swollen, and tender, the larger joints, as the
knees, wrists, ankles, and elbows, being attacked in turn, the
inflammation skipping from one joint to another. The muscles near the
joints may be also somewhat swollen and tender. With the fever, which
may be high (the temperature ranging from 102 deg. to 104 deg. F.), there are
rapid pulse, copious sweating, and often the development of various
rashes and minute blisters on the skin. There is also loss of
appetite, and the bowels are constipated. The urine is usually very
dark-colored. Altogether, victims of the disease are truly pitiable,
for they suffer agony, and are unable to move without increasing it.
The weakness and prostration are marked. Small, hard lumps, from the
size of a shot to that of a pea, sometimes appear on the skin of the
fingers, hands, wrists, knees, and elbows. These are not tender; they
last for weeks and months. They are seen more often in children, and
are most characteristic of rheumatic fever, but do not show themselves
till late in the disease.
Complications of rheumatic fever are many. In about half the cases the
heart becomes involved, and more or less permanent crippling of the
heart persists in after life. Unconsciousness and convulsions may
develop--more often when the fever runs high.
Lung trouble and pleurisy are not infrequent. Chorea or St. Vitus's
dance follows inflammatory rheumatism, in children, in some instances.
Repeated attacks at intervals, varying from one to four or five years,
are rather the rule--more particularly in young persons. Acute
rheumatism frequently takes a milder form, with slight fever (the
temperature running not over 100 deg. or 101 deg. F.) and slight pain, and
swelling of the joints. In children this is a common occurrence, but
heart disease is just as apt to follow, and, therefore, such cases
should receive a physician's attention at the earliest moment.
Recovery from rheumatic fever is the usual result, but with an
increased tendency to future attacks, and with the possibility of more
or less permanent weakness of the heart, for acute rheumatism is the
most common origin of chronic heart troubles. The milder form often
follows the more severe, and may persist for a long time. The duration
of rheumatic fever is variable; in severe cases the patient is
bedridden for six weeks or so.
Rheumatism may be named through a mistake in diagnosis. There are
numerous other febrile disorders in which inflammation of the joints
may occur. Among these are gonorrhea, pneumonia, scarlet fever, blood
poisoning, diphtheria, etc. The joint trouble in these cases is caused
by the toxins accompanying the special germ which occasions the
original disease, and the joint inflammation is not in any way
connected with rheumatism. The constant attention of a physician is
emphatically demanded in every case of rheumatic fever, since the
complications are so numerous, and since permanent damage of the heart
may be prevented by proper care. Only frequent examinations of the
heart by the medical man will reveal the presence or absence of heart
complications.
=Treatment.=--It appears extremely doubtful whether rheumatic fever
can be cut short by any form of treatment. The disease is
self-limited, that is, it will pass away of itself after a certain
time. The pain, however, can be rapidly abated by treatment. Warmth is
of great value. It is best for the patient to sleep between blankets
instead of sheets, and to wear flannel nightgowns, changing them as
often as they become damp with sweat. To facilitate the changing, it
is well to have the nightgowns slit all down the front, and also on
the outside of the sleeves. Wrapping the joints in cotton batting and
applying splints to secure absolute rest are great aids to comfort.
The diet should be fluid, consisting of gruels, milk, broths, and
soups. To relieve pain in the joints, cloths, wrung out of a saturated
solution of baking soda and very hot water, wrapped about the joint
and covered with oil silk will be found extremely serviceable. Oil of
wintergreen is another remedy which has proven of value when applied
to the joints on cloths saturated in the oil and covered with cotton
wool.
The bed must be smooth and soft, with good springs. High fever is
reduced by the employment of cold to the head and by sponging the body
with cool water at intervals of two hours or so.
The two drugs of most value are some form of salicylic acid and an
alkali. Sodium salicylate in solution in water should be given to the
adult in doses of ten to fifteen grains every two hours till the pain
is relieved, and then once in four hours as long as the fever lasts.
At the same time baking soda should be administered every three
hours, one-half a level teaspoonful dissolved in water, and this may
be continued as long as the fever persists. The patient must use a
bedpan in relieving the bladder and bowels, and should remain in bed
for a great while if the heart is damaged. It is a disease which no
layman should think of treating if it is possible to obtain the
services of a medical man.
=MUSCULAR RHEUMATISM= (_Myalgia_).--In this disease there is pain in
the muscles, which may be constant, but is more pronounced on
movement. Exposure to cold and wet, combined with muscular strain,
frequently excite an attack. On the other hand, it often occurs during
hot, dry, fine weather. Attacks last usually but a few days, but may
be prolonged for weeks. The pain may be dull, as if the muscle had
been bruised, but is often very sharp and cramplike. There is,
commonly, slight, if any, fever, and no general disturbance of the
health. The following are the most common varieties:
=LUMBAGO.=--This attacks the muscles in the small part of the back. It
comes on often with great suddenness, as on stooping or lifting. It
may be so severe that the body cannot be moved, and the patient may
fall in the street or be unable to rise or turn in bed. In less severe
cases the pain "catches" the patient when attempting to straighten up
after stooping. Pain in the back is often attributed by the laity to
Bright's disease, but is rarely seen in the latter disorder, and is
much more often due to rheumatism.
=STIFF NECK.=--This is a very common variety of muscular rheumatism,
and is seen more especially in young persons. It may appear very
suddenly, as on awakening. It attacks the muscles of one side and back
of the neck. The head is held stiffly to one side, and to turn the
head the body must be turned also, as moving the neck causes severe
pain. Sometimes the pain on moving the neck suddenly, or getting it
into certain positions, is agonizing, but when it is held in other
positions a fair amount of comfort may be secured.
=RHEUMATISM OF THE CHEST.=--In this form there is more or less
constant pain, much increased by coughing, sneezing, taking long
breaths, or by movements. It attacks usually one side, more often the
left. It may resemble neuralgia or pleurisy. In neuralgia the pain is
more limited and comes in sharper attacks, and there are painful
spots. The absence of fever in rheumatism of the chest will tend to
separate it from pleurisy, in which there is, moreover, often cough.
Examination of the chest by a physician, to determine the breath
sounds, is the only method to secure certainty in this matter.
Muscular rheumatism also affects the muscles about the shoulder and
shoulder blade and upper part of the back; sometimes also the muscles
of the belly and limbs.
=Treatment.=--Rest, heat, and rubbing are the most satisfactory
remedies. In stiff neck, rub well with some liniment, as chloroform
liniment, and lie in bed on a hot-water bag. Phenacetin or salophen in
doses of ten grains, not repeated more frequently than once in four
hours for an adult, may afford relief; only two or three doses should
be taken in all. In lumbago the patient should remain in bed and have
the back ironed with a hot flatiron, the skin being protected by a
piece of flannel. This should be repeated several times a day. Or a
large, hot, flaxseed poultice may be applied to the back, and repeated
as often as it becomes cool. At other times the patient may lie on a
hot-water bag. Plasters will give comfort in milder cases, or when the
patient is able to leave the bed. A good cathartic, as two compound
cathartic pills, sometimes acts very favorably at the beginning of the
attack. Salicylate of sodium is a useful remedy in many cases, the
patient taking ten grains three times daily, in tablets after eating,
for a number of days. In rheumatism of the chest, securing immobility
by strapping the chest, as recommended for broken rib (Vol. I, p. 84),
gives more comfort than any other form of treatment. Many other
measures may be employed by the physician, and are applicable in
persistent cases, as electricity and tonics. The hot bath, or Turkish
bath, will sometimes cut short an attack of muscular rheumatism if
employed at the onset of the trouble.
=CHRONIC RHEUMATISM.=--Chronic rheumatism is a disease attacking
persons of middle age, or after, and is seen more commonly in poor,
hard-working individuals who have been exposed to cold and damp, as
laborers and washerwomen. Several of the larger joints, as the knees,
shoulders, and hips, are usually affected, but occasionally only one
joint is attacked. There is little swelling and no redness about the
joint; the chief symptoms are pain on motion, stiffness, and
tenderness on pressure. The pain is increased by cold, damp weather,
and improved by warm, dry weather. There is no fever. The general
health suffers if the pain is severe and persistent, and patients
become pale, dyspeptic, and weak. The disease tends rather to grow
worse than recover, and the joints, after a long time, to become
immovable and misshapen. Life is not, however, shortened to any
considerable degree by chronic rheumatism. Heart disease is not caused
by this form of rheumatism, although it may arise from somewhat
similar tendencies existing in the same patient. It may be
distinguished from other varieties of rheumatism by the fact that the
larger joints are those attacked, and also by the age of the patients
and general progress of the disease. It very rarely follows acute
rheumatism.
=Treatment.=--The treatment of chronic rheumatism is generally not
very successful unless the patient can live in a warm, dry climate the
year round. Painting the joint with tincture of iodine and keeping it
bandaged in flannel affords some relief. The application of a cold,
wet cloth covered with oil silk and bandage, by night, also proves
useful. Hot baths at night, Turkish baths, or special treatment
conducted under the supervision of a competent medical man at one of
the hot, natural, mineral springs, as those in Virginia, often prove
of great value. Rubbing and movement of the joints is of much service
in all cases; any liniment may be used. Drugs are of minor importance,
but cod-liver oil and tonics may be required. These should be
prescribed by a physician.
=RHEUMATIC GOUT= (_Arthritis_).--Notwithstanding the name, this
disease has no connection with either gout or the other forms of
rheumatism described. It occurs much more frequently in women, with
the exception of that form in which a single joint is attacked. The
disease may appear at any age, but more often it begins between the
years of thirty and fifty-five. The cause is still a matter of doubt,
although it often follows, or is associated with, nervous diseases,
and in other cases the onset seems to be connected with the existence
of influenza or gonorrhea, so that it may be of germ origin. Constant
exposure to cold and dampness, excessive care and anxiety, and injury
are thought to favor the disease. The disease is sometimes limited to
the smaller joints of the fingers and toes, little, hard knobs
appearing on them. At times the joints may be swollen, tender, and
red, and are usually so at the beginning of the disease, as well as at
irregular intervals, owing to indigestion, or following injury. At
first only one joint, as of the middle finger, may be attacked, and
often the corresponding finger on the other hand is next affected.
The joints of the fingers become enlarged, deformed, and stiffened.
The results of the disease are permanent so far as the deformity is
concerned and the stiffness which causes interference with the
movement of the finger joints, but the disease may stop during any
period of its development, leaving a serviceable, though somewhat
crippled, hand. In these cases the larger joints are not generally
involved. There is some evidence to indicate that this form of the
disease is more commonly seen in the long-lived.
=General Form.=--In this type the disease tends to attack all the
joints, and, in many cases, to go from bad to worse. The hands are
usually first attacked, then the knees, feet, and other joints. In the
worst cases every joint in the body becomes diseased, so that even
movements of the jaw may become difficult. There are at first slight
swelling, pain and redness about the joints, with tenderness on
pressure. Creaking and grating are often heard during motion of the
affected joints. This condition may improve or subside for intervals,
but gradually the joints become misshapen and deformed. The joints are
enlarged, and irregular and stiff; the fingers become drawn over
toward the little finger, or bent toward the palm, and are wasted and
clawlike. The larger limbs are often bent and cannot be straightened,
and the muscles waste away, making the joints look larger. In the
worst cases the patient becomes absolutely crippled, helpless, and
bedridden, and the joints become immovable. The pain may be great and
persistent, or slight. Usually the pain grows less as the disease
advances. Numbness and tingling of the skin often trouble the patient,
and the skin is sometimes smooth and glossy or freckled.
The general health suffers, and weakness, anaemia, and dyspepsia are
common. Even though most of the joints become useless, there is often
sufficient suppleness in the fingers to allow of their use, as in
writing or knitting. In old men the disease is seen attacking one
joint alone, as the hip, shoulder, knee, and spine. Children are
occasionally sufferers, and in young women it may follow frequent
confinements or nursing, and often begins in them like a mild attack
of rheumatic fever. The heart is not damaged by rheumatic gout.
It is frequently impossible to distinguish rheumatic gout from chronic
rheumatism in the beginning. In the latter, creaking and grating
sounds on movement of the joints are less marked, the small joints, as
of the hand, are not so generally attacked, nor are there as great
deformity and loss of motion as is seen in late cases of rheumatic
gout.
=Outlook.=--It often happens that after attacking several joints, the
disease is completely arrested and the patient becomes free from pain,
and only a certain amount of interference with the use of the joint
and stiffness remain. Life is not necessarily shortened by the
disease. The deformity and crippling are permanent.
=Treatment.=--Rheumatic gout is a chronic disease in most instances,
and requires the careful study and continuous care of the medical man.
He may frequently be able to arrest it in the earlier stages, and
prevent a life of pain and helplessness. In a general way nourishing
food, as milk, eggs, cream, and butter, with abundance of fresh
vegetables, should be taken to the extent of the digestive powers.
Everything that tends to reduce the patient's strength must be
avoided. Cod-liver oil and tonics should be used over long periods.
Various forms of baths are valuable, as the hot-air bath, and hot
natural or artificial baths. A dry, warm climate is most appropriate,
and flannel clothing should be worn the year round. Moderate exercise
and outdoor life, in warm weather, are advisable, and massage, except
during the acute attacks of pain and inflammation, is beneficial.
Surgical measures will sometimes aid patients in regaining the
usefulness of crippled limbs.
=SCURVY.=--Scurvy used to be much more common than it is now. In the
Civil War there were nearly 50,000 cases in the Union Army. Sailors
and soldiers have been the common victims, but now the disease occurs
most often among the poorly fed, on shore. It is caused by a diet
containing neither fresh vegetables, preserved vegetables, nor
vegetable juices. In the absence of vegetables, limes, lemons,
oranges, or vinegar will prevent the disease. It is also thought that
poisonous substances in the food may occasion scurvy, as tainted meat
has experimentally produced in monkeys a disease resembling it.
Certain conditions, as fatigue, cold, damp quarters, mental depression
and homesickness, favor the development of the disease. It attacks all
ages, but is most severe in the old.
=Symptoms.=--Scurvy begins with general weakness and paleness. The
skin is dry, and has a dirty hue. The gums become swollen, tender,
spongy, and bleed easily, and later they may ulcerate and the teeth
loosen and drop out. The tongue is swollen, and saliva flows freely.
The appetite is poor and chewing painful, and the breath has a bad
odor. The ankles swell, and bluish spots appear on the legs which may
be raised in lumps above the surface. The patient suffers from pain in
the legs, which sometimes become swollen and hard. The blue spots are
also seen on the arms and body, and are due to bleeding under the
skin, and come on the slightest bruising. Occasionally there is
bleeding from the nose and bowels. The joints are often swollen,
tender, and painful. Constipation is rather the rule, but in bad cases
there may be diarrhea, nausea, and vomiting, and the victim becomes a
walking skeleton. Mental depression or delirium may be present.
=Treatment.=--Recovery is usually rapid and complete, unless the
disease is far advanced. Soups, fresh milk, beef juice, and lemon or
orange juice may be given at first, when the digestion is weak, and
then green vegetables, as spinach (with vinegar), lettuce, cabbage,
and potatoes. The soreness of the mouth is relieved by a wash
containing one teaspoonful of carbolic acid to the quart of hot water.
This should be used to rinse the mouth several times daily, but must
not be swallowed. Painting the gums with a two per cent solution of
silver nitrate in water, by means of a camel's-hair brush, twice
daily, will also prove serviceable. To act as a tonic, a two-grain
quinine pill and two Blaud's pills of iron may be given three times
daily.
=INFANTILE SCURVY.=--Scurvy occasionally occurs in infants between
twelve and eighteen months of age, and is due to feeding on patent
foods, condensed milk, malted milk, and sterilized milk. In case it is
essential to use sterilized or pasteurized milk, if the baby receives
orange juice, as advised under the care of infants, scurvy will not
develop.
Scurvy is frequently mistaken for either rheumatism or paralysis in
babies.
=Symptoms.=--The lower limbs become painful, and the baby cries out
when it is moved. The legs are at first drawn up and become swollen
all around just above the knees, but not the knee joints themselves.
Later the whole thigh swells, and the baby lies without moving the
legs, with the feet rolled outward and appears to be paralyzed,
although it is only pain which prevents movement of the legs.
Sometimes there is swelling about the wrist and forearm, and the
breastbone may appear sunken in. Purplish spots occur on the legs and
other parts of the body. The gums, if there are teeth present, become
soft, tender, spongy, and bleed easily. There may be slight fever, the
temperature ranging from 101 deg. to 102 deg. F. The babies are exceedingly
pale, and lose all strength.
=Treatment.=--The treatment is very simple, and recovery rapidly takes
place as soon as it is carried out. The feeding of all patent baby
foods--condensed or sterilized milk--must be instantly stopped. A diet
of fresh milk, beef juice, and orange juice, as directed under the
care of infants, will bring about a speedy cure.
=GOUT.=--Notwithstanding the frequency with which one encounters
allusions to gout in English literature, it is unquestionably a rare
disease in the United States. In the Massachusetts General Hospital
there were, among 28,000 patients admitted in the last ten years, but
four cases of gout. This is not an altogether fair criterion, as
patients with gout are not generally of the class who seek hospitals,
nor is the disease one of those which would be most likely to lead one
into a hospital. Still, the experience of physicians in private
practice substantiates the view of the rarity of gout in this country.
We are still ignorant of the exact changes in the bodily condition
which lead to gout, but may say in a general way that in this disease
certain products, derived from our food and from the wear and tear of
tissues, are not properly used up or eliminated, and are retained in
the body. One of these products is known as sodium biurate, and is
deposited in the joints, giving rise to the inflammation and changes
to be described. Gout occurs chiefly in men past forty. The tendency
to the disease is usually inherited. Overeating, together with
insufficient exercise and indulgence in alcohol, are conducive to its
development in susceptible persons. Injuries, violent emotion, and
exposure to cold are also thought to favor attacks.
The heavier beers and ales of England, together with their stronger
wines, as port, Madeira, sherries, and champagne, are more prone to
induce gout than the lighter beers drunk in the United States and
Germany. Distilled liquors, as brandy and whisky, are not so likely to
occasion gout. "Poor man's gout" may arise in individuals who lead the
most temperate lives, if they have a strong inherited tendency to the
disease, or when digestion and assimilative disorders are present, as
well as in the case of the poor who drink much beer and live in bad
surroundings, and have improper and insufficient food. Workers in
lead, as typesetters and house painters, are more liable to gout than
others.
=Symptoms.=--There is often a set of preliminary symptoms varying in
different persons, and giving warning of an approaching attack of
gout, such as neuralgic pains, dyspepsia, irritability, and mental
depression, with restless nights. An acute attack generally begins in
the early morning with sudden, sharp, excruciating pain in the larger
joint of one of the big toes, more often the right, which becomes
rapidly dark red, mottled, swollen, hot, tense, shiny, and exceedingly
sensitive to touch. There is commonly some fever; a temperature of
102 deg. to 103 deg. F. may exist. The pain subsides in most cases to a
considerable degree during the day, only to return for several nights,
the whole period of suffering lasting from four to eight days.
Occasionally the pain may be present without the redness, swelling,
etc., or _vice versa_.
Other joints may be involved, particularly the joint of the big toe of
the other foot. Complete recovery ensues, as a rule, after the first
attack, and the patient may thereafter feel exceptionally well. A
return of the disease is rather to be expected. Several attacks within
the year are not uncommon, or they may appear at much longer
intervals.
Occasionally the gout seems to "strike in." In this case it suddenly
leaves the foot and attacks the heart, causing the patient severe pain
in that region and great distress in breathing; or the abdomen becomes
the seat of violent pain, and vomiting, diarrhea, collapse and death
rarely result. In the later history of such patients, the acute
attacks may cease and various joints become chronically diseased, so
that the case assumes the appearance of a chronic form of rheumatism.
The early history of attacks of sharp pain in the great toe and the
appearance of hard deposits (chalk stones) in the knuckles and the
ears are characteristic of gout.
The greatest variety of other disorders are common in those who have
suffered from gout, or in those who have inherited the tendency.
"Goutiness" is sometimes used to describe such a condition. In this
there may never be any attacks of pain or inflammation affecting the
joints, but eczema and other skin diseases; tonsilitis, neuralgia,
indigestion and biliousness, lumbago and other muscular pains, sick
headache, bronchitis, disease of heart and kidneys, with a tendency to
apoplexy, dark-colored urine, stone in the bladder, and a hot, itching
sensation in the palms of the hands and soles of the feet, all give
evidence of the gouty constitution.
=Treatment.=--One of the most popular remedies is colchicum--a
powerful drug and one which should only be taken under the direction
of a physician. A cathartic at the beginning is useful; for instance,
two compound cathartic pills or five grains of calomel. It is well to
give five grains of lithium citrate dissolved in a glass of hot water
every three hours.
Laville's antigout liquid, imported by Fougera of New York, taken
according to directions, may suffice during the absence of a
physician. The inflamed toe should be raised on a chair or pillow, and
hot cloths may be applied to it. The general treatment, between the
attacks, consists in the avoidance of all forms of alcohol, the use of
a diet rich in vegetables, except peas, beans, and oatmeal, with meats
sparingly and but once daily. Sweets must be reduced to the minimum,
but cereals and breadstuffs are generally allowable, except hot bread.
All fried articles of food, all smoked or salted meats, smoked or
salted fish, pastry, griddle cakes, gravies, spices and seasoning,
except red pepper and salt, and all indigestibles are strictly
forbidden, including Welsh rarebit, etc. Fruit may be generally eaten,
but not strawberries nor bananas. Large quantities of pure water
should be taken between meals--at least three pints daily. Mineral
waters offer no particular advantage.
Part III
SEXUAL HYGIENE
BY
KENELM WINSLOW
CHAPTER I
=Health and Purity=
_Duties of Parents--Abuse of the Sexual Function--False
Teachings--Criminal Neglect--Secure the Child's Confidence--The Best
Corrections--Marriage Relations._